Addiction is Accidental

By Katie MacBride 05/08/16

The general public doesn't understand that addiction is accidental. Choosing to use the substance isn't accidental, but crossing the line into addiction is.

Addiction Is Accidental
via Pixabay

The national conversation around the opioid epidemic in this country is often focused on prescription pain medication like OxyContin, Percocet, and fentanyl. The increased prescription of these highly addictive drugs results in addicted people who don’t adhere to our preconceived notion of who an "addict" is. Grandmothers, star athletes, devoutly religious folks who otherwise abstain from drugs and alcohol—these are not the type of people our society generally associates with the word “junkie.” These people are not to blame for their circumstances, some argue; it’s the doctors or the pharmaceutical companies or simply an accident—an unfortunate consequence of the addictive nature of these drugs.

What’s harder for the general public to swallow is the reality that all addiction is accidental. Even for a recovering alcoholic like myself, the notion of “accidentally” becoming addicted sounds strange. People in recovery will tell you—we knew what we were doing. We didn’t mistake a bottle of OxyContin for a bottle of Tylenol, mistakenly taking opioids instead of acetaminophen. We did not think Smirnoff was the brand of a bottled water company and attempt to rehydrate by chugging it down. We chose to use substances. Maybe some of us were looking to self-medicate a mental illness, or physical pain. Some of us were just trying to have a good time. Whatever the reason, it was deliberate. But there’s a sly difference here: substance use wasn’t the accident, becoming addicted was.

There is no word to describe the moment when someone crosses the line from using substances to becoming addicted. Most addicted people I know weren’t even aware the line had been crossed until it was well in the distance. But ask anyone who has ever been addicted to anything, recovering or otherwise, if they ever would have deliberately stepped across that line. The answer will always be no. Some may say they wanted to linger as close to the line as possible without actually crossing it and others will say that they never wanted to be anywhere near the line in the first place.

Why does any of this matter? Because for us to comprehensively treat addiction, we must understand that a) consciously or not, we still consider some people to be more deserving of treatment, care, and compassion than others, and b) that living with addiction is brutally, painfully similar for everyone.

The stigma associated with addiction is applied unevenly. Certain cases are likely to garner sympathy from the general public. When I interviewed Congressman Tim Ryan for The Fix last year, he mentioned just such a scenario. “What about the middle-aged guy who gets hurt at work and then is prescribed opiates to help with pain, and gets hooked on it?” he said. “He deserves treatment.” Ryan is absolutely right.

But the middle-aged guy who gets hurt at work is not fundamentally different than the person who becomes addicted to alcohol or illegal drugs. Both individuals thought they had found a solution to their pain, physical or mental, and that solution turned around and grabbed them by the throat. There are no “good” addicts or “bad” addicts, all addicts are simply...addicts.

With addiction killing people by the hundreds of thousands, we cannot afford to continue categorizing people as more or less sympathetic or deserving of treatment based on how they ended up addicted. We do not deny cancer patients treatment because they smoke, frequent tanning beds, or sunbathe without proper SPF coverage. We perform heart surgery on patients who need it, regardless of if they spent the last 20 years feasting on salads or cheeseburgers.

It’s easy to believe we’ve gotten past these judgements, but a careful look at the language we use to describe issues related to addiction proves otherwise. This is particularly evident in how the media describes overdoses. To be clear, not everyone who overdoses is an addict and not all addicts overdose. But how we talk about overdoses inevitably impacts how we talk about addiction.

Overdoses on prescribed pharmaceutical drugs are very often described in the media as “accidental” overdoses. Overdoses on street drugs, however, are almost always referred to simply as overdoses. Both are accidents, only one is described as such. In reality, the phrase, “accidental overdose” is redundant. All overdoses are accidental. A deliberate overdose is, unfortunately, a suicide attempt.

This is not simply semantics; recognizing the differences in the way we talk about addicted people is necessary to understanding the different ways we perceive, and ultimately treat them. In 2015, the New York Times interviewed a man whose daughter died from a heroin overdose at the age of 20. He talked about how the word “junkie” has changed for him. “‘When I was a kid, junkies were the worst,’ Doug Griffin, 63, Courtney’s father, recalled ... Noting that ‘junkies’ is a word he would never use now, he said that these days, ‘they’re working right next to you and you don’t even know it. They’re in my daughter’s bedroom—they are my daughter.’” Even the word "addict" has become controversial, with many people claiming it has negative connotations and calling for it not to be used anymore.

The words we use to describe addicts and overdoses matter. They contribute to our understanding of addiction and/or reinforce damaging fallacies about it. Viewing Prescription Addicts vs. Other Addicts as fundamentally different harms both of the illusory groups. People who become addicted through prescription medications may not realize the danger or the severity of the problem because they are technically under a doctor’s care. Those who became addicted through less legal or socially acceptable means are often viewed as less deserving of treatment because they are simply reaping what they sowed. In truth, we are all the same. We are all junkies. We are all victims. We are all simultaneously guilty and innocent. None of us walked willingly across that line into addiction and yet, here we all are.

No one chooses to be an addict. And until we stop imposing false moral standards on people who suffer from addiction, we will continue to see the problem spread. Sanctimony has no place in medicine and until we realize that, the numbers of those killed by addiction will continue to rise.

Editor's Note: For more analysis of how we understand "addiction" and how stigma surrounding opioid use hurts people who need help, please read today's feature by Zachary Siegel about the way the media has presented the details surrounding Prince's death.

Katie MacBride is a writer living in the San Francisco Bay Area. Her writing has appeared in The Bold Italic among other publications. You can read Katie’s work at her website; she occasionally tweets at @msmacb.

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