The Myth of Normal 173

Eastside, a neighborhood notorious as North America’s most concentrated area of drug use. Within its few square blocks dwell thousands of people living lives of desperate dependence on substances of all kinds, inhaling or ingesting or injecting alcohol, opiates, nicotine, cannabis, cocaine, crystal meth, glue, rubbing alcohol. Even visitors from New York or Detroit or Bristol are routinely shocked by what they see there. “If the success of a doctor is measured by how long his patients live,” I would often say, “then I’m a failure, because many of my patients die young.” They died from complications of HIV, or from hepatitis C, or infections of their heart valves, brains, spines, bloodstreams. They fell victim to suicide, overdose, or violence, or to vehicles that struck them while they stumbled in a drugged-out haze onto busy streets. Unlike “high-bottom” addicts such as Bruce, now rehabilitated and back on the job, my patients had lost everything—their health, looks, teeth; their families, work, homes. Some had squandered lives of middle-class comfort, and a handful had gone, surprisingly, from riches to rags. All along, they knew full well they were facing the ultimate forfeit: their lives. And still, having struck bottoms lower than most of us could conceive of, they persisted in their habits, as I depicted in my 2009 book on addiction, In the Realm of Hungry Ghosts. Prevailing views about addiction have progressed somewhat in the past decade, in the direction of more compassion, science, and sense. For all that, deceptive and dangerous myths about addiction’s provenance and its very nature still reign in many circles, from medical treatment to criminal justice and policy. Even the well-meaning world of rehabilitation and recovery has its blind spots. Given the evident shortcomings and even ruinous harm wrought by our standard approaches, many voices are finally calling for a fresh view. As a prelude to considering this, let’s deal directly with the two leading misconceptions: that addiction is either the product of “bad choices” or else a “disease.” Both fail to explain this unrelenting societal plague, just as they hobble our efforts toward remedying it. The bad choices view should by now barely warrant mention, given the scientific advances in understanding, except that it still has a vise grip on