A Road Less Traveled

I kept buttoning and unbuttoning my black leather coat, responding to the alternating waves of heat and chill typical of narcotic withdrawal. It was a familiar sensation, but instead of being at home with the flu, I was sitting in a circle of fellow substance abusers sharing the misery and confusion of early sobriety.

We were a mixed bag of personalities, ages, ethnicities, income levels, and drugs of choice. There was a housewife who smoked pot daily, a young Filipino with a new baby and a methamphetamine habit, a 25-year-old blonde facing prison for her fifth DUI, an alcoholic ex-policeman showing signs of irreversible brain damage. And me: a middle-aged internist, mother, and narcotic addict.

I was the only doctor in that group, but I knew I wasn't unique. Nor was I treated with any particular deference. When my profession was discovered, a heroin user and recent prostitute sneered, “That's disgusting. You're supposed to help people. Anyway, you should know better.”

I thought she was probably right.

There is never a simple explanation why someone becomes an addict. Spiritual deficits, character defects, low self-esteem, grandiosity, depression, bipolar disorder, obsessive-compulsive disorder, poor impulse control, genetic predisposition, childhood neglect or abuse: All have been implicated. But none of these causes addiction, though they may be contributing factors. For some people, a drink or a drug appears to be the answer to psychic discomfort. And it works, but only short term. There was a sense of revelation after my first dose of Percocet, which was prescribed after a dental extraction. I felt like Dorothy arriving in Oz. The world was suddenly a wonderful place. The usual anxieties and insecurities of a third-year medical student just starting clinical rotations were gone. I was a better, more confident me.

But I used narcotics intermittently, relying …