The Dumbest Article You'll See About Addiction
The Dumbest Article You'll See About Addiction
In an article of stunning ignorance published on Slate last week, writer Cristina Nehring claims that alcoholism, addiction and antidepressant use are not only equivalent—but that psychiatric drug use may be killing off people who once would have died drunk. Oh, and we “pill poppers” who take psych meds are also smug, antisocial killjoys.
Attacking a column I wrote for The Fix about how antidepressants helped me overcome cocaine and heroin addiction, Nehring calls my work:
"…an all-too-hackneyed contemporary coming-of-age story: the rueful user of nonprescription drugs (e.g., alcohol) who becomes a pious user of prescription drugs (i.e., Zoloft and others).'My only regret about taking [these] medications,' [Szalavitz] proudly concludes her piece, 'is not having done so sooner—in fact, I wonder if I might have skipped addiction entirely had these drugs been available in my teens.' What she does not admit, however obvious it may seem, is that she has simply swapped one addiction for another addiction, at least equally powerful."
This is, to put it bluntly, utter bollocks. When I was in my early 20s, I was injecting cocaine and heroin up to 40 times a day. (Alcohol was not my drug of choice—it isn't even mentioned in my article.) I had dropped out of Columbia University, was unemployed and weighed about 80 pounds. Both of my arms were pierced with tracks and if someone hadn’t educated me about using clean needles, I almost certainly would have become infected with HIV. I spent my time either scoring drugs or shooting them, often alone or with other equally devastated people. I was neither productive nor happy.
Today, after 20 years of antidepressant use, I am not, as Nehring claims, “isolate[d]…in the bathroom studying the fine print on a prescription label, or throwing back capsules with toothpaste water before repairing to a lonely night of video streaming.” Instead, I'm writing daily for Time online and twice a month for The Fix, and am the author or co-author of six books, one of which helped lead to congressional hearings on abusive treatment for teenagers. I have a life partner and enjoy a convivial social life. And I’ve never spent a single night video streaming, lonely or otherwise.
Can anyone honestly argue I was better off with illegal injection drug use compared to prescription Prozac pills?
Nehring, who has written a book and many articles about love and romance, is clearly out of her element when she turns her attention to addiction. She misunderstands the most basic facts about this disorder—or, worse, may be misrepresenting its very nature in order to be “provocative” (her piece is titled “In Defense of Drunks”).
Let me set the record straight. The problem of addiction is not defined by taking a substance to function (as I do with my meds), elsewise we’d all be water and air addicts. Instead, addiction is compulsive engagement with a substance or activity despite negative consequences.
If heroin and cocaine had consistently done for me what antidepressants now do, I’d still take them. However, after initially providing some joy and escape, they sucked me into a world of misery and ever-worsening isolation. My story doesn’t make me feel superior to people who are still using, as Nehring implies; it means I can empathize with them and want them to experience more happiness and less harm, in whatever way works for them. I favor, for example, the use of heroin maintenance for those who can benefit from it.
Equating alcoholism with social drinking, heroin addiction and Prozac use makes about as much sense as equating alligators with tennis shoes, passion fruit and Magic Markers.
But in contrast to the utter wreck my life became during my IV drug addictions, the worst side effect I get from Prozac is probably dry mouth. And given that I sometimes forget to take my antidepressants—a problem I never had, I will note, with cocaine or heroin—my use of antidepressants can hardly be defined as obsessive or compulsive.
Nehring provides no data to support her claim that “the dangers of prescription drugs are in danger of seriously lapping the dangers of good old wine and beer.” She cites Michael Jackson’s death from “anti-anxiety medications” as a case illustrating the problem—but in fact, Jackson died not from any type of legitimate prescription but from an overdose of an anesthetic that is never prescribed outside of an operating room. Here, her argument is not just anecdotal, but completely erroneous.
And even if you were to accept the bizarre premise that shooting or snorting Oxycontin, misusing Valium and taking Prozac as prescribed are all equally well described as “addiction,” and evidence of a “prescription drug problem,” alcohol still kills 100,000 people annually, compared to nearly 40,000 for all prescription drug overdoses. Besides, equating alcoholism with social drinking, heroin addiction, Prozac and other types of prescription drug use makes about as much sense as equating alligators with tennis shoes, passion fruit, the Internet and Magic Markers.
The irony is that if Nehring had read, rather than cherry-picked, my work, she would have seen that I have nothing against drinking, drug use or pleasure. I frequently write about harm reduction and moderation approaches to addictions. I favor regulation, not prohibition. I am not “pious” about my antidepressant use and condemnatory of recreational drinking or drug use. I don’t care if people get high or drunk—I know they always have and always will. But I do care if they are harmed by it or harm others around them—and I think we can do a lot better at mitigating these risks.
Unfortunately, articles like Nehring’s only add to the damage, by promoting unscientific myths about both addiction and antidepressants in order to “prove” the point of her piece, which appears to be that life was better (more creative, social, romantic, etc.) when alcoholism, rather than sobriety, was “in fashion.”
But that was never really the case. Alcoholism and addiction are not recreational use, daily use or even needing the substance to function. Antidepressants aren’t addictive: If they were, we’d see Prozac heists and the stuff would have street value.
And even using an addictive drug daily isn’t the same as being an addict. People on pain medications or in methadone, Suboxone or even heroin maintenance aren’t the same as active addicts; they have a different relationship to the drug.
Rather than chasing it and obsessing, they take it regularly; rather than the ups and downs of addiction, they have a steady state; rather than drugs making life worse, they make it better. In this state of regular dosing, they are not high or crashing, simply normal. If treatment is successful, the drug is no more a focus in these lives than insulin is for diabetics. Addictions make life miserable; therapeutic drugs make it better.
Of course, I understand the chemical romance and the camaraderie of the barroom. I can see why Nehring might imagine that therapeutic drug use (or a clear mind) might seem bland and deadening. The excitement of the night and the pleasures of social drinking and recreational drug use—even the odd binge—are real. I also recognize the appeal, for the many editors and writers who enjoy knocking back a few, of a piece decrying knee-jerk health-nannying.
But addiction is something else entirely. It destroys joy and erodes human connection just as surely as Puritanism can. The early deaths of Sylvia Plath, Amy Winehouse, Jimi Hendrix, Janis Joplin, Kurt Cobain and, yes, Nehring's beloved Dylan Thomas (whose death was alcohol-related, even if not an actual overdose), show how much addiction and other mental illnesses can cost the arts: While it’s possible to argue that drug use and some degree of madness enhance creativity, there’s no evidence that active addiction and crippling mental illness do so.
Therapeutic drug use, by contrast, restores—if it doesn’t, it’s not working. And if Nehring can’t see the difference between my current “Prozac addiction” and the hell that was my early 20s on heroin and cocaine, if she can't distinguish between self-destructive self-medication and effective therapy, I don’t think it's me who is being “arrogant” or demonstrating “smug complacency.”
Maia Szalavitz is a columnist at The Fix. She is also a health reporter at Time magazine online, and co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010), and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006).