Prescribed Relapse

“I’m happy to tell you the surgery went quite well, so you’re going to be on the mend!  Obviously, you’re going to have some pain from this, so what I’ll just do is ruin your life, happiness, and relationships by giving you an opiate.  Sound good?  So… you’ll start off taking it according to these directions I’m jotting until, of course, your brain’s addictive wiring trumps your reason – haha, just like the old days! – and you find yourself helplessly abusing it.  Eventually, I’d like to see you transition to your drug of choice.  When you do that is up to you, but within a couple months, you should find yourself back in full-on relapse.  Okay?  Does that sound good?  I’ll just call it in now.”

If only doctors actually said this, we alcoholic-addicts might have a better chance of protecting our sobriety from the pain management substances that work fine for normies (i.e. non-addictive people).  The trouble is that, even today, the vast majority of doctors don’t get recovery.  They see before them a reasonable and sane person who, they assume, will self-administer a prescribed drug reasonably and sanely.

What they don’t get is that we’re different. Our brains are forever like a duplex we share with an insatiable lunatic who is temporarily napping.  Rap on its door with an opiate and – no matter how intently we self-manage the dosage – once that beast wakes up, all bets are off.  It’ll rage, it’ll bust shit up, it’ll burn the whole damn house down, motherfucker.  Because that beast has a hold on us more powerful than anything that well-meaning doctor can possibly imagine.

It’s more powerful than reason, than resolve, than all things human.  It’s run our lives before, and it’s psyched to do it again.

I remember the first time I raised my voice at a medical authority – my very kind dentist, a British woman – when I was about four years sober.  She’d just extracted one of my molars, and I’d just declined pain meds.  I remember the room we were in when she insisted, because it seemed to shrink and turn more yellow and seal off every doorway connecting me to AA.  I could feel the excitement rise in my chest: Meds!  Something GOOD!  There was hope!  Something really delightful perched just on the horizon!  Sure, I’d take ’em sensibly!  Of course!

…And I can’t say where it came from, but that small counter-voice, that love for the gift of sobriety and all the goodness it nurtured in my life – that sprang up in me, too.  They fought.  So by the time the words came out my mouth, sloppy from novocain, they were way too loud, too urgent, and too emotional.

“No!  I told you, I’m an alcoholic!”

“Yes, I know.  But this is a very safe drug – Vicodin.  You’ll be fine.”

“No, I won’t!  I’m sober and I want to stay that way!”

I remember the look of distaste on her face, that this normally calm and socially appropriate patient was going off on her.  She tried again, emphasizing the small dosage, but by that point tears spilled from my eyes and I had just one tremulous, throaty word for her: Ibuprofen.  Ibuprofen.  I’ll take ibuprofen…

And I did.  End of anecdote.

I’m not blaming doctors.  They’re rational; it’s we who make no sense!  That’s why the onus is on us to keep out of our lives what docs assure us is safe.   They don’t get the “curious mental blank spot.”  They haven’t heard the heart-rending shares of misery, helplessness, and loss sometimes dragging on for years – all triggered by a sensible prescription.   I have a huge number of friends in recovery.  And in contrast to the one alcoholic I know who successfully manages back pain with meds her partner doles out*, I know at least a dozen who have relapsed catastrophically – not counting those who have died.

I was messaging with one of them yesterday, my friend Rob.  He’s a wonderful guy traveling the country, working odd jobs, and struggling to stay off heroin for more than a few months at a time.  But failing.  He had a week.  Here’s what he messaged:

“Yah know, if I’d of known what I would become after a few Vicodin, I’d a shoved them up my doctor’s ass!!  I was never into opiates as a kid. But eight years into sobriety I hurt myself really really bad, and I guess I needed them. But in hindsight, if I had a choice between acute pain and becoming a heroin addict, I would have probably chose the pain. But whatever.  It’s done.  It’s over, right?” 

Maybe.  Maybe not.**

When we want to drink or use, only god can help us. But when someone else tells us it’s not a problem, we can use our brains.  Remember: the doctor is going to offer you something so legitimate, so routine, so neat!  The prospect of those little pills fucking up your life will seem so overly dramatic!  What I do is this: I picture a set of balance scales with two big pans.  On one side I put the prospect of perturbing my doctor, making a stink, sounding like an uncooperative bitch, no one getting it, and, quite likely, some physical pain.  On the other side I put every blessing I’ve won back sober, every person I love, every friend who needs me, my self-respect, my inner dignity, my body’s health, my spirit’s channel to god – and every beauty and joy of this life.

Then I bite my tongue to keep from saying, “Don’t you dare fuck with my sobriety!”  But it’s right there – that sense of defending what I love.

If your pain is such that you’ve absolutely got to take some meds, agree to a prescription of five pills.  Maybe eight.  Then call someone for each goddam pill you take and say, “It is 4:00, and I am taking a percocet now.”  Draw up a chart to keep exact track of what time you dosed, whom you called, and whom you’re calling next.  Stay in touch with your sponsor.  And as soon as you can, switch to ibuprofen and get the pills out of your house.  Do nothing alone because – remember – you’re not really alone: there’s that slumbering beast in the duplex, and you’re making a racket.

I recall the sadness I felt post-surgery many years ago, flushing the three remaining Vicodin I’d been given.  The magic was gone.  Now there was just me… and my stupid old life.  It took about five minutes for gratitude to return: the vial was empty, but my future was full.  I was sober.

*UPDATE: She relapsed after a year – knew where the pills were. After about a year of wallowing in opioid chaos, she’s clean again.

**UPDATE: Rob died of overdose less than a year later.