The Addiction Casebook

The first sentence in the book’s preface really sums up the problem with addiction, and that problem is the stigma. Even impotence and erectile dysfunction aren’t anywhere near as shameful, attested by the fact that Senator Bob Dole was a spokesman for Viagra. But drug addiction, now that’s something nobody wants to admit. Perhaps it makes the addict look like a failure? Is it because it makes the patient look weak? Or is it because addictions are preventable, unlike cancer, acne, or tuberculosis?

The Addiction Casebook reads much like a guide for educators. It has tables and rubrics that can be filled in to assess the problem. We have issues like the amount of alcohol, the frequency of use, the time and place it is consumed. These factors are listed in order, then used in the assessment of the addict. As the title says, this book has case histories of addicts and their paths to addiction, many of which don’t involve the actual drugs or alcohol themselves. One of the cases involves a 34 year old alcoholic whose addiction cost her a job, relationship, ability to pay bills etc. Through regular sessions with a psychologist, she was found to have had chronic anxiety from her early years. The alcohol had been a way to help her cope with it, along with other stressful things like bills, rent, and deadlines.

A second interesting case involves not alcohol, pills, or cocaine, but nitrous oxide. The addict was a 20 year old with ADHD, a history of school and family troubles, and a hostile attitude towards his parents. Was his addiction to inhaling nitrous oxide canisters  a way of “dulling the pain” and gaining instant relief, or was he paranoid about the other medications he’d been using, like Aderal? Just because the gas was legally bought does not mean it was harmless. On the contrary, he’d had difficulty graduating high school, failed at college, and the massive number of cans cost $80 a week. It seems that as it was in the previous case, the underlying problem involved a preexisting disorder.

The Addiction Casebook goes on to discuss things like tobacco use, hallucinogens, and crystal meth abuse in the gay community in New York City. As with earlier cases, there are always underlying factors, be they anxiety, paranoia, feelings of inadequacy, or the shame of being a gay man in a conservative all-male environment.

I remember hearing something about addiction from the great Rabbi and Psychiatrist Abraham Twersky, that resonates with this book. He admits seeing in himself the traits of an addict. “I’m a procrastinator,” he says, “I often crave instant relief.” It is that dread of responsibility that can lead to addiction, not only drugs or alcohol, but video games and gambling. Supposedly healthy activities like mountain biking and watching movies can be addictive too.

One drink doesn’t make you an addict. Playing video games doesn’t make you an addict either. But when these things get in the way of work, nutrition, and your life, then you need to wonder who’s in control, you or the activity?