Blog | Thursday, July 25, 2013

Addiction and substance abuse can strike anyone

Over the course of a year, I have an alternating pattern of caffeinated coffee ingestion. As readers should know, I will not swallow Starbucks 'Joe' as I do not think that I have sufficient stomach acid and other bodily defenses to successful prevail against this corrosive elixir. Of course, everything has a benefit if one is resourceful enough to discover it. For instance, I have found their coffee to be quite useful as a paint remover or shark repellent.

The best coffee in Cleveland is found at Dunkin' Donuts. Perhaps, one of the reasons their java is so smooth is that my order of coffee with cream is mixed at a 1 to 1 ratio. Cream at Dunkin' Donuts is no half and half concoction; it's the real thing.

As I write this, there is an environmentally unfriendly Styrofoam cup beside me. I'll down this coffee every day for weeks reaching a point where if I skip a day, I will enjoy the pleasure of an ice-pick, throbbing headache at 4 p.m. It's a pounder that stays with me for 3 hours, until it fades allowing my neurons to regain some level of function. At this point, I am aware that I have developed a physical addition to the stimulant, and need to resume daily use if I am to avoid the afternoon cranial crusher.

I now face a choice. Resume the daily caffeine or break it off and tolerate the withdrawal phase until I am successfully detoxified.

In general, I opt for the latter and survive on decaf for several weeks until I convince myself that a single caffeinated morning brew can't hurt me. And so, resumes the cycle.

While this is a real addiction with real withdrawal, it is a mere wraith of the addictions that I confront as a physician. While the tobacco habit is most common, there's an abundance of alcohol abuse in my practice, which I am sure is substantially underestimated. I surmise that most of the alcoholics in my practice are unknown to me. I see a fair amount of pain medication addiction, which was initiated for short term pain control, but over time has morphed into a new disease.

It's a sad reality to recognize how difficult it is for alcoholics and other addicts to recover successfully, even when they strive to do so. Booze and cigarettes over time become tentacles that wrap around their victims, squeezing tightly, such that most addicts don't have the strength or the will to remove them. It is humbling to appreciate the power that these substances exert over the users. These are folks who simply cannot throw these chains aside, despite suffering profound personal and professional losses and serious medical consequences. And, no one can do this work for them, as I have witnessed time and time again.

There is no comparison of these tragic and recalcitrant conditions to a coffee fling, which poses a small challenge to the afflicted individual, as I know. While some addicts manage to slay the dragon, most will serve as prey to the beast.

I've got a few more swigs of Dunkin' Donuts left this morning. Addicted? Of course not. I can stop anytime I want. Maybe tomorrow, or the next day ...
This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.