Life as an Extreme Sport

The Daily [05-08-06] – Dependency vs. Addiction

If this looks familiar to some of the longer-time readers, well… it was a busy week. And besides, the original was pretty good in and of itself.

Dependency vs. Addiction
Publish Date: 2006-05-08

I meant this column to be about the idea of informed consent. It’s a subject both House and Grey’s Anatomy have covered in their last couple episodes; something I would call a coincidence if they hadn’t been doing this back and forth of show themes for two seasons now.

But one evening I managed to find myself on the Television Without Pity Web site, in theory rereading the details of those pertinent episodes of Grey’s and House, when I decided I wanted to read recaps from earlier episodes.

That decision led me back to a first-season episode of House titled “Detox.” The theoretical point of this episode was a teenager with bleeding of unknown origin, but the actual point was to examine the vicodin use of the main character, Greg House.

For the few of you who’ve managed to miss this show, the character likes to discover novel ways to take vicodin.

In his defense, he’s missing a good part of one of his thigh muscles and has severe nerve damage from various complications of a blood clot and surgery years before.

House is accused of being a vicodin addict, and is challenged to go a week without taking any. He accepts the challenge, and during the course of the show appears to go through withdrawal, going so far as to break his hand to force his body to pay attention to different pain.

The result? Everyone crows that House is a drug addict.

I don’t agree.

Addiction is a biological and psychological condition that compels a person to satisfy their need for a particular stimulus and keep satisfying it, no matter what the cost.

Dependence is a physical state that occurs when the lack of a drug causes the body to react.

Physical dependence indicates that the body has grown so adapted to having the drug present that sudden removal of it will lead to withdrawal reactions. This can happen with almost any drug.

House is in constant, chronic pain. The physical dependency on vicodin is one that allows the character to maintain a normal lifestyle.

To use analogy to illustrate the point, imagine that a normal, healthy person is akin to a full glass of water. Someone who is in chronic pain is only half a glass of water without pain medications.

Add in a bunch of ice cubes, and the person in chronic pain is brought back up to the normal and functional level of everyone else.

In the case of the addict, toss a few ice cubes in a full glass of water, and watch everything spill everywhere in a mess. That’s addiction.

The chronic pain person needs those ice cubes of vicodin on a daily basis to provide what the body needs to function, but it’s not a situation where they would actively seek out, need, or desire any more than necessary to achieve that state of near-normalcy.

Regular use of some medications is necessary for some people to live a normal life. A diabetic is not addicted to insulin, nor is someone taking medication to control high blood pressure addicted to it.

They are, however, dependent upon it, as a person in chronic pain is dependent upon their drugs to function normally.

Perhaps that’s the thing one needs to consider when weighing notions of addiction or dependency — the person who is addicted does not have improved functionality with their addiction, while the dependent person does.

The writers of House have been irresponsible in how they’ve portrayed the character of House’s dependency, and this causes a lot of grief for actual living and breathing people with chronic pain.

There is a stigma associated with needing pain medicine every few hours. This stigma, shame and fear prevents many doctors from properly treating pain, and prevents many people from seeking out the relief they need.

Faith Healing and the Body

Tonight’s episode of House dealt with the idea of faith healing, something that comes up a lot these days in medical journals. What is the power of prayer? Does faith healing work? Can miracles happen?

I realize it’s a symptom of my interdisciplinary training, and perhaps of being under Phillip’s thumb in particular, but I think a more interesting question is why miracles can’t happen? After all, a miracle is just that which we don’t understand. As has been often remarked, our technically is magic to those who don’t understand how it works, as is often our medicine. The typical example is a cell phone in the rain forest, although I’d argue there’s an awful lot of technology and medicine that might as well be magic for our understanding – there is simply the belief, the faith that it will work, because someone is being told it will work.

How is that so different than hearing a faith healer tell you the same?

Of course, we of the rational, medical type say we have medicine, we can take the time to understand how technology works. But we can’t fully understand how the body works; we keep finding new things, miracles keep being rationalized and understood, filed away into things to learn and knowledge to distill.

If we have learned one thing, it’s that the body is an amazing thing. Who’s to say that the power of the placebo effect, the mind, isn’t enough to help some people? We know, scientifically, medically, that positive thinking does positively affect our health, including to help us recover from illness. Who knows?

We don’t, so it gets filed away as faith healing fakery and fraud. But in ten years, perhaps it will have a Latin name and a textbook. That’s the way knowledge goes, a part of life for both miracle and medicine.

Veronica the Vampire Slayer

Over at Beliefnet, the religion and pop culture blog is comparing Buffy the Vampire Slayer to Veronica Mars, with the latter show not yet living up to the former. She has some interesting things to say, but per the norm, fans go a bit weird in the comments and defend Veronica Mars as though the show will be killed based on this single article. I mostly find it to be an odd case of coincidental timing, since I was just talking about the show and why it no longer holds my attention with both Sandra and Michael. Sort of summing it up is what I said in the comments in the Idol Chatter thread:

I should confess that I only started watching Buffy when it was for a class, and then I got hooked and ran through 5 seasons in 3 months – so story arcs and progress was much more evident than it may have been in a “time of viewing” situation.

That said, I’ve tried VM. Several friends were very hooked last year, and persuaded me to watch. And I did, and I really enjoyed some of the interactions between characters – especially Logan and Veronica.

This year, though, failed to hold my attention. Yes, it’s a modern attempt at noir, a genre I love. They did it very well last year,… but what it’s missing is what Buffy had in spades, although BtVS lost it in the last two years of the show.

Buffy was a teenager, and so were all the other characters. Sure, they were fighting supernatural beings and had powers and such…but at the core of everything, they were teenagers, and they acted like it. Teenage crushes, first loves, awkwardness, pimples, cramps, bad hair days.

VM has adults running around a high school setting. The only time I’ve truly enjoyed the show ahs been in the interactions between Veronica and Logan, because those feel like interactions between teenagers. The rest of it, I just don’t buy – Veronica is a early 20s girl in a high school, as are the rest of the characters. Very rarely, they slip into being teens, and then the show grabs my attention, because then it feels like it’s supposed to.

That said, I think that, provided VM gets renewed for another year or two, it gives the show much more potential than BtVS had, because the background they hang the stories on will be able to grow into the characters they’ve developed – they will become adults, and the cognitative dissonance that exists currently will disappear, and create what I think will become a very compelling show. The point at which BtVS began to fade – college and life beyond, areas Joss just isn’t good at writing – should be where VM finally finds its feet.

Addiction, Dependency and Vicodin

Tonight, NBC is debuting its new show, The Book of Daniel. Normally, I don’t catch when new shows come on, but there has been a bit of kefuffle about this particular show because of its themes: the American Family Association has decided to protest the show because, among other things, the daughter is busted for doing drugs, a son is gay, and the main character, an Episcopalian priest, is addicted to Vicodin. That addiction may or may not be the reason Jesus is quite literally his co-pilot; he sees and talks to Jesus, who is an active character on the show. Now, personally, this sounds right up my alley, and I’m sorry that I can’t see the two hour premiere tonight. But, it’s not terribly surprising – if the AFA dislikes it, chances are I’ll love it; they’re a fabulous barometer for things, so far as that goes.

But what actually has my attention about this is comments that I’ve seen from several sources: friends commenting to me, in other people’s journals, and critics who’ve been reviewing the new show. Everyone is commenting that this is another in (what some people fear will be) a new trend of Vicodin-addicted characters, and they then immediately cite Hugh Laurie’s brilliantly portrayed Greg House, who eats Vicodin like candy.

Now not being a television reviewer, I can’t comment about The Book of Daniel; I’ve not seen the show, after all. But I was a regular devotee of House when I could be home on Tuesday nights, and I have every intent of watching it again this quarter. And I can tell you, pretty damn clearly, House is not a Vicodin addict. “But wait, Kelly” you say. “What about that episode where he was dared to go off the Vicodin, and he went through withdrawal? That proves he’s an addict!”

Does it? Let’s play a small game. This game is called “what happens when you drink several lattes a day for a year, and then suddenly cut that latte out without warning, and consume no other caffeine.” What happens to you? Do you get a headache? Do you start sweating? Are you nauseated? Do you generally feel miserable? Of course – and when talking about this, people say they’re going through caffeine-withdrawal because they were addicted to it.

This is technically, medically, incorrect. Your body is physically dependent upon the caffeine, but you aren’t showing drug-craving, drug-seeking behaviour because you don’t have the caffeine. Addiction is a biological and psychological condition that compels a person to satisfy their need for a particular stimulus and to keep satisfying it, no matter what the cost. Dependence is a physical state that occurs when the lack of a drug causes the body to react. Physical dependence is solely a physical state indicating that the body has grown so adapted to having the drug present that sudden removal of it will lead to withdrawal reactions, and this can happen with almost any drug.

The character of Greg House is in constant, chronic pain. The physical dependency on Vicodin is one that allows the character to maintain a normal lifestyle. To use analogy to illustrate the point, imagine that a normal, healthy person is akin to a full glass of water. Someone who is in chronic pain is only half a glass of water without their pain medications. Add in a bunch of ice cubes, though, and the person in chronic pain is brought back up to the level of normal and functional everyone else is. (And in the case of the addict, toss a few ice cubes in a full glass of water, and watch everything spill everywhere in a mess – that’s addiction.) The chronic pain person needs those ice cubes of Vicodin on a daily basis to provide what the body needs to function, but it’s not a situation where they would actively seek out, need, or desire any more than is necessary to achieve that state of near-normalcy.

The writers of the show House have been irresponsible in how they’ve portrayed the character of House’s dependency. They have openly questioned – and suggested – that he’s an addict when he’s not. This causes a lot of grief for actual living and breathing people with chronic pain. There is a stigma to needing to take Vicodin every few hours, or oxycodone, or any other opioid. This stigma, shame, and fear prevents many doctors from properly treating pain, and prevents many people from seeking out the relief they need. It’s impossible to say, without seeing, how The Book of Daniel will handle the character’s need for Vicodin, and whether it is an addiction or a dependency, but hopefully they are very clear on which it is, and do a better job than House has at distinguishing between the two states.

That House made the decision to feature a character living not with but in spite of chronic pain is something that drew me to the show. After all, I have a chronic pain condition. I eat Vicodin like candy, and often take two or three other opioids on top of it to control my pain. I’m also an honors student, I work 20-30 hours a week, I teach, and have an active social life. I’m about as far from a junkie as it gets – but if I skip that dose of whatever is up at the hour, I will break out into a sweat. I will start to get a headache, my heart will race, my nose will run.

Regular use of some medications is necessary for some people to live a normal life. A diabetic is not addicted to insulin, nor is someone taking medication to control their high blood pressure addicted to it. They are, however, dependent upon it, as a person in chronic pain is dependent upon their drugs to function normally. And perhaps that’s the thing you need to consider when weighing whether it is an addiction or a dependency – the person who is addicted does not have improved functionality with their addiction, while the dependent person does.

While I wouldn’t say this is a sore subject for me, I would say that it is a personal one, and one that I hope people will keep in perspective when they are cracking their jokes about pill-popping doctors and addicted ministers. There are people out there, people you know, people like me, who have invisible disabilities and dependencies. And while you make your cracks about Vicodin popping addicts, I make a mental note that I should make sure to not take my pain medication when you’re watching. I already deal with the stigma of disabitliy, I don’t need the stigma of addiction to go with it.

Stargate Atlantis: Conversion

“I know you have a high threshhold of pain, but this is…
…gone.”
“What?”
“Gone.”

Heh. Dr. Beckett gets a lot of the good lines on Atlantis. Geeks abound! Geeks abound!

Don’t feel like doing a writeup of this, but I am surprised by how much I really liked this episode. I was expecting it to be relatively trite and irritating. Instead, I was pleasantly surprised by an intense and character driven episode. The horror aspects were well done, and I really liked how Rodney reacted to everything. It was obvious how much he cared, and how impotent he felt in the face of something that could only be solved by something outside his field. Also, the interplay between Weir and Sheppard was incredibly thick with emotion; it was nice to see the two play so strongly off one another.

I really, really liked this episode. Might just be the best of the season.