Substance Abuse and Addiction

Think back to the last time you heard a Really Loud Noise.

Was the Really Loud Noise a truck backfiring? How far is the nearest road? Could a sound have traveled that distance? Is it the Fourth of July? New Year's Eve? Could the Really Loud Noise have been a fire cracker? Was the Really Loud Noise a gun shot? Where are the children? Are they indoors? Are the children safe?

All these thoughts--trucks, holidays, fireworks, guns, children--went through your head in a split second. But split that split second into many parts and here's what happened way before all those thoughts sprinted through your awareness: your body reacted. Before you had started to analyze what the Really Loud Noise was or whether or not the Really Loud Noise actually represented danger, you were startled; your heart rate went up; your senses were heightened, you started to breath faster.

Sixteen year-old Paula is unhappy at her rehabilitation facility in California.

She was happier last year before ending up in treatment. She was happy when she was running away from home, getting into cars with strange adult men, staying away for days at a time, binge drinking, and using IV drugs.

Paula has been making some slow progress in treatment. OK, let's be honest: she's barely making any progress at all. She doesn't "get it," that drugs were destroying her life, that her future outside of treatment was time limited, that the issue was not "if" but "when" something truly terrible happened. (By this high standard of truly terrible, her STD doesn't even make the list.)

"I've changed, Mom. I'm not going to smoke pot any more or play video games either. I just need some money until I can get a job." Tommy pauses as if for dramatic effect then plays the card that has always worked in the past: "I can't believe you don't trust me."

How should Tommy's Mom respond?

Should she explain that trust is a bucket that gets emptied all at once, but is filled up one drop at a time?

Should she articulate that Tommy has failed to achieve his purpose repeatedly and that unless he gets treatment no further communication will be forthcoming except of course that she will stay on the phone just this one last time to say the same things that she's said six bazillion times before and that maybe just maybe this time will be the time that her cogent pleas connect and Tommy agrees to treatment?

(Nah, that can't be the right answer. The correct choice is never a run-on sentence.)

"It's all your fault, Mom. You are the reason I don't have any friends. All of the other kids drive nice cars, but you gave me this lousy car to drive. The other kids make fun of me. If you would just leave me alone, everything would be OK."

"But, Honey, if I leave you alone, you don't even get up and go to school never mind do your homework. You just stay in your room playing that video game until one in the morning."

"See, there you go again. Always badgering me. Don't you see how this is all your fault?"

"No, I don't see how it's all my fault at all. Your father and I work hard to provide for you and your brothers."

"There you go again. Always comparing me to my brothers who are so perfect. Why can't you get good grades like your brothers? Why can't you help out around the house like your brothers? It's always the same thing. Why can't you just leave me alone?"

"We try to leave you alone but you keep getting suspended from school and arrested."

I've never asked Dennis and Joanie for money. But I could if I had to. If I couldn't make a mortgage payment, I'd ask them for a couple thousand to tide me over and they'd say, "You're sure you don't need more?" That's how close we are. That's the kind of people they are.

So when Joanie was griping at me this morning about how I just "don't get it" when it comes to video games and what a zealot I am and how I'm living in the dark ages and do I want to go back to prohibition, I realized that I must not have expressed myself well in our previous conversations and in this forum. Joanie is my good friend: I know she reads my blog. If she doesn't understand my position, it's me. Clearly, I need to be more clear. (Obviously, I need to be more obvious?)

Here's an expression that I hear frequently. You may have even said the following words yourself recently. "That's the stupidest thing I've ever heard." Yeah? Bring it. You think you've got Stupid? Compared to what's been going on with me this week, you haven't ever even met Stupid. Stupid doesn't know where you live.

Top this: Some months ago, I glanced out my window and happened to observe a young man wearing short pants and a gray shirt getting into my car. Certain that I had proffered no such invitation to any person wearing a shirt of any color, I scampered outside and engaged the crew cut gentleman in conversation.

"What do you think you're doing?" I began.

"Yeah, man, it's ok. I'm leaving. It's ok," he replied.

One of my running buddies, Ron, is snarky, curmudgeonly, sarcastic, and grumpy. On a good day. Ron has a bitter view of the world and agrees with Snoopy, Charles Schultz's philosopher beagle, who said, "I love humanity; it's the people I can't stand." Ron looks for the darker motivations of a person's actions and can always be counted on to explain a seemingly altruistic act as one of selfishness or self deception.

But these qualities aren't the only reasons we're so fond of him.

Because Ron also has a wonderfully analytical brain and "gets it," sometimes after only a decade or two of intense thinking about an issue. For example, after our five-mile plod down to Matheson Hammock yesterday, I asked Ron what he had learned from our morning run.

"What do you mean 'learned'?" he asked guardedly.

"Well, you've run 16 marathons..." I began.

"Actually, 17," Ron corrected.

The other evening, my older son sliced open the side of his finger. We took a pleasant drive over to the Emergency Room at ten o'clock and by five the next morning, he was sewn up as good as new. The doctor was thoughtful and competent--it turned out our kids had gone to school together--and, as we were leaving, he handed me a prescription which I dutifully filled after dropping my son at home.

Ellery's protestations that I wake him up and take him to school in an hour notwithstanding, I let him sleep off the effects of the anesthesia. When he awoke at the crack of noon, I asked him how he was feeling. He acknowledged that his finger hurt pretty badly, that he was in fairly severe discomfort. Even though I had 20 Oxycodone in my pocket, I gave my son an Advil. When he woke up again at four that afternoon, I asked him again how bad the pain was. "I can handle it," he said.

Javier's and Alejandro's parents could have been in the same Lamaze class. Born days apart but in the same hospital in 1987, the lives of the children had followed almost identical courses: learning differences and attentional issues that turned into trouble in school, evaluations that turned up no psychopathology, just the high verbal IQ and low processing speed frequently associated with kids who have trouble getting their homework done. Both Javier's and Alejandro's middle class parents hired wonderful, supportive, creative tutors not just to remediate or get the children "up to grade level," but to make the curriculum meaningful and get the children turned on to the joy of learning.

In short, their parents did everything right, but the children turned out horribly wrong.

Saw an old acquaintance this morning. My buddies and I were doing our usual 6:00 am run down to Matheson Hammock, chatting about nothing, telling the same jokes we've been regaling one another with for the past several decades. After running around the lagoon--the "pee pool" for those of us who grew up in Miami--we stopped at the water fountain and to watch the sun come up as we have pretty much every Monday morning since the invention of yeast.