ADDICTS PARALYSED BY SHAME AND GUILT

AIDS 'A Real Disease'; Addiction, On The Other Hand, Is Not, Aug. 17

As a doctor who practises family medicine in Vancouver's Downtown
Eastside, I wish to dispel the misleading assumptions in Margret
Kopala's column.

Anyone who argues addiction is a choice, not a disease, hasn't
witnessed my patients. Let me call one of them Shirley, who is so
overtaken -- driven -- by crack cocaine and crystal meth, which
lights up her limbic system like a sky full of fireworks, that her
hunger centre's emergency light flickers like a tiny firefly by
comparison. Unable to sense her own hunger, she forgets to eat and
soon she is no more than a skeleton with baggy skin.

Given a mirror, Shirley is horrified to see her skinniness, and shame
fills her as she wonders if her "chosen" path of self-destructiveness
will kill her. I've seen this same shame in smokers and overeaters
when I weigh them or ask about their habit.

Shame, like guilt, has only minimal benefits to motivate change;
mostly the emotion paralyses the individual, who wallows in
self-disgust, perhaps further imbibing in so-called "vice" to escape
their pain temporarily.

Inside my office, I am always trying to find ways to overcome the
impact of my patients' shame. If only they could face their situation
without the extra deflation of spirit -- without the extra
self-judgment that they are worthless individuals -- then they could
perhaps feel hopeful that they could change their situation.

At the moment, while scientists map the receptor changes occurring in
addicts' brains, Theodore Dalrymple is arguing that addicts are
"responsible for the negative results of [their] chosen behaviour."
The danger inherent in this argument might best be appreciated by
extrapolation.

Consider for a moment diseases such as diabetes, chronic obstructive
lung disease, hypertension and heart disease, all linked with
lifestyle choices, namely overconsumption, underactivity, and
smoking. Today, no one argues that these individuals are "responsible
for the negative results of [their] chosen behaviour." Although
Canadian society absorbs these patients' health care costs without
condemning the individual for their choices, there may come a day
when society will decide to offer treatment only to those patients
who can prove they are active, non-smoking, under-eaters.

Let me consider the issue in terms of costs to society, without
touching on the moral costs, only the financial. There is no question
addiction costs society in terms of property crime and spread of
infection -- HIV, Hepatitis C, syphilis, etc. However, if society
decides to simply incarcerate addicts, then there will be little
gained, as the funds will be redirected to a new set of industries --
the police force, the legal system and the jails.