Addiction, face-to-face, part two: Tricks and triggers

By Amanda Knox
I accelerated into the mostly empty parking lot and veered a wide arch into a spot. I pulled up the parking break at the same time that I unclipped my seat belt. Chris already had the passenger side door open. We were on a last-minute mission to buy temporary black hair dye for my Jessica Jones costume, before heading to a haunted house with my family, and we were running a little late. We bounded toward the entrance to Walgreens when, suddenly, I jerked to a halt. Chris swept by me, but paused after a few steps, looking back. “What’s up?” he asked.
I stared through the passenger side window into the other lone vehicle in the parking lot. Inside, a man—tall, lean, white, 30s, with short, dark hair, wearing jeans and a plain, long-sleeve T-shirt—was slumped in the reclined driver’s seat, apparently passed out. His right arm lay stretched out in his lap, and his left hand curled limply around a needle sticking into the cubital fossa of his outstretched right arm. I stared. “Look!” I said to Chris. “He’s…Should we do something?”
We weighed our options. We could rap on his window…and say what? Hey man, don’t do drugs. They’re bad for you. That wouldn’t work. We could call the police. But what would they do? Further cripple him by shunting him through the justice system? Send him to jail? I knew better. Jails and prisons are not well-equipped to treat mental illness and drug addiction. It would probably only make this guy’s life worse, entrench him deeper. Chris and I exchanged pained looks. We realized there wasn’t really anything good we could do.
When we came back out of Wallgreens, I strode close to the vehicle to check back in. The man was awake now, and busy re-sticking himself with the needle. He looked up and met my eyes as I passed. I looked quickly away, as if I had accidentally walked in on him undressing. “At least he’s conscious,” I muttered to Chris as we buckled up. I was quiet as we pulled out. Then, “It’s like when I got my motorcycle,” I said. “I never really noticed motorcycles on the road until I got one. And I never really noticed addicts in plain sight until I talked to Justin.”
When I had met my cousin Justin at the cafe, he explained to me that he had never intended to use pain killers recreationally. It all started when he shattered his wrist and was prescribed Vicodin to manage the pain as he healed. He shared his prescription with a friend who had a bad toothache and couldn’t afford medical insurance. But by doing so, Justin’s prescription ran out sooner than it should have, so he asked for another, and another. Finally, his doctor told him he’d been red-flagged.
But Justin still felt that he needed help to manage his pain. “I’ve since found out a lot about the chemistry of the body,” he said. “The more you take, the more it screws your body chemistry up. The addiction had started to kick in and I didn’t even know it.”
“But how does that work?” I asked. “Didn’t you get a refill to cover the period of time it would take to heal enough that you weren’t feeling as much pain anymore?”
“Yes,” Justin admitted. Then he explained: despite the fact that he had healed and should have been feeling better, the Vicodin had altered the chemistry of his brain so that it exaggerated his minor pains, and made him feel like he was in more pain than he really was. It wasn’t about getting high. “I felt the need. I was told, Hey, I have pain. Let's use it for pain management. I considered the euphoria a bonus to feeling no pain. It's like, I feel no pain, and I'm also in a great mood. I'm motivated. So it was kind of like a win-win. I didn't understand at that time what it was doing to my body and what it was doing to my mind.”
I took a moment to let that disturbing idea settle. I’m a pharmacophobe myself. I avoid taking any kind of medication unless it’s absolutely necessary. As a kid, I once spent several weeks playing soccer on a broken foot, limping and cringing and crying, but refusing to see a doctor. Later, when all four of my wisdom teeth were surgically yanked out at once, I couldn’t manage even a single dose of the pain medication Oxycodone. It made me feel nauseated and sick, and I ended up vomiting it up. I preferred the pain. But I’m not usual in that regard.
“So…I’m curious, because I never realized that it's like your mind is playing tricks on you to make you feel like you were in pain when you weren't. So…I wonder, is it like hunger or thirst?”
“That’s what's called a trigger,” Justin explained. “Pain is one of mine, because that's what I associated it with for so long. Another trigger for me is the sound of pills being shaken in a prescription bottle.”
“That starts the craving?”
“Yeah. Because every time I heard it, I had it. So my mind and my body are like, Sweet. We have this coming. So that's the thirsty thing you're thinking of. It makes you feel what the pill makes you feel. I get that minor euphoria. So it's like, Ooh! I'm going to get that and it's going to feel like this, but better. Actually, just thinking about it, I'm feeling it right now.”
I felt a jolt to my heart. Like I had just accidentally run over a squirrel. Like I had just accidentally triggered my cousin into craving drugs. “Just thinking about it…” I muttered stupidly.
Justin continued, nonplussed, “Yeah, because I was thinking about the pill bottle shaking. It made me think of the noise, and I started to feel real relaxed and like I was going to take something in. That's how powerful the triggers are. I've heard of that happening. But that's the first time I've actually experienced it.” 
What I had learned about tricks and triggers lingered with me after we parted for the day. Never having heard the origin stories, I tended to associate drug addiction with immature, irresponsible choices, and even, criminal behavior. But whatever Justin’s actions as an addict, the way he described it, he at least became an addict while using his medication the way it was intended to be used, under the supervision of a doctor. So early in the process, it seemed like the only difference between Justin and anyone else—me, say—was a factor that couldn’t be a known until it was too late: predisposition. My pharmacophobia and near-allergic reaction to opioids made me predisposed in the opposite direction, but my doctors didn’t know that when they wrote my prescriptions. They also didn’t know that Justin was predisposed to addiction until he became addicted. Suddenly, I felt lucky. What were the chances?
To be continued…

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