1,000 Days – A Case Study of Addiction

Jason is a 44-year-old man, occupationally/professionally successful in a selling occupation where he heads up a small team who have a huge annual sales turn-over. He has used drugs beyond marijuana and alcohol from 14 more of less continuously through to the present day. His long-standing preference is “ice”, injecting, and has been previously caught by his employer, twice. Jason has made solemn undertakings to his employer and his wife, attends Narcotics Anonymous (NA), and has an NA mentor and so on. His team know about his ‘ice’ use and monitor, and urine test him every two weeks. Jason tested positive for methamphetamine a third time and this produced a major crisis in the company about the fate of Jason. How do we think about Jason and what do we advise and do?

[“Ice” is Crystal methamphetamine, a stimulant, usually in small chunky clear ice like crystals or a white or brownish crystal-like powder with a strong smell and bitter taste. Ice speeds up the messages between the brain and the body. Smoked or injected the delay is 3 – 7 seconds; swallowed a 15 – 30 minutes delay; snorted a 3 – 5 minutes delay. “Ice” is stronger, more addictive with more harmful side effects than “speed” (methamphetamine powder). “Ice” can produce incredibly strong up-side feelings of intense pleasure, confidence, alertness, energy, sexual desire and drive. On the downside “ice” can produce enlarged pupils, dry mouth, elevated heart rate, rapid breathing, teeth grinding, excessive sweating, agitation, and reduced appetite. It can also produce an intense itch and scratching. Snorting can damage the nasal passage and cause nose bleeds. Injecting carries a risk in common with all injectables i.e. Hepatitis B and C, HIV and AIDS. The risk of an “ice” overdose is real and the symptoms include racing heartbeat, chest pain, breathing problems, convulsions, uncontrolled jerking, extreme agitation, confusion, clumsiness, the sudden onset of a severe headache, and losing consciousness and the ever-present risk of an overdose, a stroke, heart attack or death. It can take several days to come down from “ice” and the user may experience sleep disturbance, exhaustion, headaches, dizziness and blurred vision; feeling emotionally irritable and ‘down’; and possibly paranoia, hallucinations and confusion. Some people use alcohol, benzodiazepines or cannabis (i.e. depressants) to come down. Longer-term effects include all of the above plus extreme weight loss, dental problems, frequent respiratory and sinus infections, difficulty concentrating, breathlessness, muscle stiffness, anxiety, depression and heart and kidney problems. Dependence produces financial, work, social and relationship problems. Key relationships often fracture. “Ice psychosis” is produced from high doses and frequent use, characterised by paranoid delusions, hallucinations and bizarre, aggressive or violent behaviour, symptoms that usually disappear a few days after the person stops using. Dependence on “ice” is relatively quick compared to other drugs and rapidly becomes integral to that person’s daily life. It is not an abstraction. Often a person dependent on “ice” will be unable to get through their ordinary daily obligations and responsibilities in terms of work, study, family and socialising. Regular “ice” use often negatively impacts on the user’s ability to feel enjoyment in ordinary everyday activities. A person may experience rapid mood fluctuations, get stressed easily, anxious and depressed as a longer-term consequence to “ice” use. The effects of “ice” are experienced from weeks to months after ceasing. Cocktails of “ice” and other drugs can be unpredictable and dangerous. This includes “ice” with over-the-counter and prescribed medication. “Ice” with speed or ecstasy puts the heart and other parts of the body under an enormous strain and can be a precursor to a stroke whilst “ice” with alcohol, marijuana or benzodiazepines stresses the body by creating the conditions for an unintended overdose e.g. the contradictory stimulant and depressant effects of “ice” and benzodiazepines. Withdrawal is challenging because the body has to function without it. Most withdrawal symptoms settle down after a week and disappear after a month. These can include craving “ice”, increased appetite, confusion, irritability, various aches and pains, exhaustion, sleep disturbance, nightmares, anxiety, depression and paranoia. 2% of Australians use methamphetamines, half prefer “ice” and “ice” users have doubled since 2013.]

What I will do is step you through the process of working therapeutically with Jason in the context of his employer and his family. Jason is a valued employee and this was a crisis from the employer’s point of view. The employer contacted me and I agreed to see Jason immediately. The employer had previous spoken to me somewhat discursively about Jason and the actions they had taken in dealing with his previous indiscretions in this regard. This time was different. The CEO was deeply disappointed in Jason and felt betrayed and wanted to know how to approach this and whether the situation was redeemable. The Chair simply wanted to sack Jason. When Jason’s wife found out she simply wanted to divorce him, immediately. Jason’s staff who had supported him through thick and thin and believed in him were dark with disappointment and devastated. They were all young, in their twenties. I saw Jason late that day and obtained some general information about him and his family and his life, his use of substances and alcohol and in particular his long term use of “ice”. This was not therapy. This was not a formal first interview. This was a look-see for Jason and a look-see for me as the practitioner simply to see if we could dance this therapeutic dance together. I made the call on Jason and told him that no therapy would commence with me until he was clean for a month minimum. Jason had already seen a raft of practitioners over many years so was seasoned in the byways of the clinical-therapeutic process. The advice he had been given over the years was somewhat sketchy and his account inherently as unreliable as Jason. Secrecy and deception is an endemic feature of all forms of conventional addiction from poker machines to alcohol to “ice”. Unconventional addictions are those legal and medically prescribed addictions, smoking and street addictions. Alcohol starts out as unconventional and slips across in the conventional as an addiction somewhere in the course of degeneration. So I approached Jason as a conventional addict, unreliable, secretive, avoidant, perhaps a liar, certainly deceptive and right now Jason wanted something and he could smell the authority that resided in me to deliver what he wanted. Jason needed to dig himself out of the hole he was currently in with his wife and with his employer and I figured that Jason would say and perhaps do almost anything to recover his situation. No agreement for therapy surprised Jason but he recovered his equanimity very quickly. After all Jason is a highly intelligent street-smart man, physically big, big mouth, preoccupied with himself, lacking humility, a lover of status, a man who clearly loved to be loved and adored and admired. It became clear that Jason had been touting himself and his addiction and his remarkable recovery around the Christian-addictions traps and other places that put a premium on this “I saved myself – next step Jesus” recovered addict story when all the while he had continued to inject “ice”, but only occasionally of course. He had been deceiving his NA mentor! Injecting is a seriously premeditated act. Injecting requires considerable organization, forethought and the cooperation of others, the dealer, the person with the gear for injecting, unless of course he had retained that gear in secret hiding place just in case he wanted to use again. Either way, secrecy and deception are the order of the day. Injecting is an elaborate, orchestrated process. Injecting is not done instantly, on a whim, opportunistically like it is with an alcoholic passing by a pub or a bottle shop. Addicts gather into one place, in a person, l some of the finest qualities that make us human, in particular our incredible abstract and analogic cognition and our ability to adapt instantly to circumstances, to adjust, accommodate and manipulate. Stunning. I wasn’t playing Jason. I was clear and straight. I would not commence any therapy with him until he was straight and I would not advocate for him with his employer until he was straight and he and I had actually engaged fully in the therapeutic process and I wouldn’t engage therapeutically unless his entire social and family and work context were all available to me. This I made clear to Jason and I told him I could make one telephone call and probably have him in drug rehabilitation facility in some remote place in outback Australia within 48 hours and that would come at a price and he needed to decide how much he wanted this. Addicts are geniuses at manipulating responsibility and authority, the key political parameters in any treatment process. Simply, if the person with the authority does not have the corresponding responsibility in his hands that the clinical-therapeutic process will probably fail. Equally, if the person with the responsibility is possessed of the corresponding authority then that the clinical-therapeutic process will probably fail. Responsibility and authority must be appropriately focussed and particularised and balanced for the therapeutic process to have half a chance of succeeding. My first move in this matter was to make the call on the politics of the clinical-therapeutic process consistent with my authority and responsibility, not over-reaching either. We spoke discursively about addictions and it became clear that Jason was hedging his bets with me and I understood that and advised him (genuinely) that it may be unwise to proceed into therapy with me given how tough and accountable our programme is and that there were much softer approaches to this matter of an “ice” addiction than our programme. Jason wanted to know about our programme and I gave him a few sketchy details such as the fact that we would hold him accountable for one thousand days because that is how long it takes to turn a mature life around and his was certainly a mature life and at forty-one time was running thin on him and the pressure must be overwhelming for him to sort this out. I spoke to him about secrecy and deception and how this was probably even more tightly ‘wired’ into his head and his heart and his gut and his entire neurobiological system than Crystal Methamphetamine and how this incredibly fine honed skill of secrecy and deception was probably the glue that bound this addiction to him and him to the addiction in a beautifully symbiotic and perfectly symmetrical relationship and why on earth would he want to call a halt to something so perfect. Perfection is compelling and worth being addicted for! Perhaps! And such secrecy and deception were hard wired into his interactions with people, his wife, his children , his dealer, his mother, his boss and his colleagues and mentor who had believed in him and backed him and protected him and who he had now disappointed. To proceed with what I was suggesting, rehabilitation in the outback, I needed complete support and agreement from everyone around him in order for us to proceed, not with therapy, but to get him into this remote facility. And of significance is that this remote facility in the far north of Western Australia is run by people who I don’t warm to and who don’t like me all that much and whose model is very ordinary and excessively pompous, lacking appropriate humility, but so be it they have done a fine job before with another young female client, so I persist. In my view the model for any form of so called treatment is simply to organize and constrain the clinical-therapeutic and other activity of the practitioners and shape it into something vaguely beneficial for the client. My view with Jason is that the real work will begin on the ground in earnest when he returns from the Kimberley’s, that’s if he goes, and of course he does because he needs to for the purposes of this story, and he does so in reality after consulting his very taken aback wife when she realised her errant husband was now about to shoot through to a cattle station in the East Kimberley’s for at least one-month.