by Poorna Bell
Men are more likely to abuse drugs and alcohol than women. I wonder if this is due to an inability to articulate the need for help, coupled with short-term fixes to keep up appearances.
I spoke to Mr B, a well-vetted, anonymous contact who works with, for and around policy regarding mental health in the government. He said: ‘When things are difficult for men, they seek solace in behaviours that enable them to escape. Those behaviours are categorised as an addiction.
‘An addiction is where you get a buzz out of pursuing something that changes the chemistry in your brain, which makes you high or numb or makes you forget your problems. And if you have layers upon layers of things that trouble you, you will seek solace in escape. That escape becomes something you go back to in times of stress or times of “fuck it, it may be an addiction, but I enjoy it”. And what follows is shame and guilt, or “I don’t fit in”.
‘Then you get locked in this bubble of “you can’t deal with it, but you can’t confess to it”. Because you know if you confess to it, you will feel the shame of others, and the criticism and rejection of others, which you want to stop because you know that might lead you back to that addiction. So it’s a cycle.’
It may also go some way to explaining why more men kill themselves than women, as is the case in the UK. In his book Cry of Pain: Understanding Suicide and the Suicidal Mind, Prof. Williams says: ‘Alcohol and substance abuse present major risk factors for suicide . . . The prevalence of alcohol and drug abuse increases steadily from the age of fifteen until about forty-five, after which it declines.’ Interestingly, this is also roughly the main age demographic for male suicides in the UK – the biggest killer of men under forty-five.
He continues:
The number of years somebody who completes suicide has typically been abusing alcohol is between twenty and twenty-five.
This may be because, as the alcoholism progresses, it erodes those factors known to protect against suicide: first, it destroys social supports; second, it destroys intellectual function through brain damage . . . third, chronic alcoholism reduces personal control and increases helplessness. Studies show that alcohol and drug abuse are most lethal when they occur alongside depression.
This tells us that an addict’s journey is so much more complicated than we can imagine.
Like all addicts, Rob had long stopped having fun with drugs. And though the reasons why a person becomes an addict may be wide and varied, they are almost certainly taking drugs as a coping mechanism to deal with things that are too hard and too painful. And the longer the addiction goes on, the more that person becomes entrenched in drug use to cope with the shame of being an addict.
‘Most people want to get away from these drugs,’ Dr Shanahan told me, ‘and the question is: why do [these] people want to stay on them?’
He believes that harmonisation – the word used to describe methadone treatment – can work, and the danger is when you have a government that believes it cannot.
‘I think we are going to miss the people who simply cannot get off drugs and cannot stop using. There is no point pushing these people into abstinence on the basis that using methadone is simply parking them on it for life.
‘My view on that is, so what? If people are alive and safe and are given opportunities to get off it if they want to, I think it’s perfectly reasonable to offer that structure. And some people need it. The Dutch, Germans and Swiss have all found success with it.’
So why on earth does any government assume that wagging a finger and demanding absolute abstinence would work? Especially seeing as it never, ever has in the history of the world.
In fact, Hari’s theory – with which I partly agree – is that the way to tackle addiction is through human connection. Integration into society rather than penning them in a ‘them and us’ cage. Contrary to abstinence policies, evidence for the success of an integrated drugs strategy is overwhelming, showing how connecting with, rather than shunning, addicts can reduce deaths and crime.
The greatest travesty, however, is that when experts do advise the government or call for decriminalisation, they are fobbed off. In 2016, two of the major public health bodies in the UK – the Royal Society for Public Health and the Faculty of Public Health – called for the decriminalisation of drugs, saying the government’s policies had failed.7
The government denied this, and claimed that drug dependency had dropped. So this means that the machine with the power to change drugs policy is ignoring the advice of two huge, well-respected and knowledgeable bodies about a problem that affects thousands of people in the UK, not to mention the thousands of loved ones around them.
It isn’t just that the government – and this isn’t political because it is an attitude that has cut across the major national parties for decades – is not listening to the experts who know what they are talking about, but nor does it look to other countries who have successfully managed to implement decriminalisation.
‘Nearly fifteen years ago, Portugal had one of the worst drug problems in Europe, with 1 per cent of the population addicted to heroin,’ wrote Hari.
‘They had tried a drug war, and the problem just kept getting worse. So they decided to do something radically different. They resolved to decriminalise all drugs, and transfer all the money they used to spend on arresting and jailing drug addicts, and spend it instead on reconnecting them – to their own feelings, and to the wider society.’8
He has also written about Switzerland, which over ten years ago had a heroin epidemic similar to the one going on in the States at the moment. ‘Under a visionary president – Ruth Dreifuss – they decided to try an experiment. If you are a heroin addict, you are assigned to a clinic, and you are given your heroin there, for free, where you use it supervised by a doctor or nurse. You are given support to turn your life around, and find a job, and housing.
‘The result? Nobody has died of an overdose on legal heroin – literally nobody. Street crime fell significantly. The heroin epidemic ended. Most legal heroin users choose to reduce their dose and come off the program over time, because as they find work, and no longer feel stigmatised, they want to be present in their lives again.’
We use language to shame users, because we feel that they are persisting in their unhealthy lifestyle because they aren’t aware of the impact they are having on other people. That they don’t feel bad enough to stop.
How fucking laughable this is. How fucking sad that most of us, including myself, could think that this was the way to get results, rather than kindness and empathy.
Loneliness is such a huge driver of what compels someone to abuse drugs, yet instead of bothering to find this out, we and the powers that be decide that what they need is to be told clearly, in no uncertain terms, that until they fix themselves they are not allowed back into society.
Imagine the shame this causes a person. How can they ever hope to get the right kind of help, when everything is such a desperate race to wallpaper over the cracks so that they can rejoin the inner circle as quickly as possible?
For men, shame can be deadly. In Rob’s case, it was deadly. When I spoke to Jane, who used to run the male suicide prevention charity CALM, she said: ‘There is no give because there is no permission for give. Either you’re a proper man or you’re not.
‘So things like shame, embarrassment, guilt – failure to be a proper man is the ultimate disgrace for them. I often think what that must be like. Here you are, God’s chosen one. You’re supposed to do everything. Be responsible for everyone around you.’
Rob should have gone on methadone but what with him not being a child, I couldn’t force him to do it. His main reason for not wanting to go on it was because he felt it was shameful. The flipside to trying to redeem himself from feeling shameful was to try to fix it himself – something that continuously exasperated Prue and me.
This uncompromising sense of belief, the rigidity of ‘I can sort it out’, can be deadly. Prof. Williams refers to it as part of the
similarity between depression and addiction.
‘The difference between people who have an addiction and don’t get into trouble with it, and people who have addiction and do get into trouble is the fixity of the belief. Say it’s a gambling addiction. Some people would say, “I’m just doing it for fun”, other people would say, “I’ve got a system and that system will work despite all the evidence to the contrary. My system will get me out of trouble.” Even if – in the case of gambling – they are in huge debt. They don’t look at the actuality of the evidence.
‘Depression is very much like that in a way, in that you have a fixed belief that “I can’t do anything about this pain, and no one else can do anything about this pain ever”. And when you understand the fixity – the way in which that belief is so stuck in place – then it enables you to understand how desperate it all is.’
Rob was the product of a middle-class family, someone who had ticked the boxes he was expected to since birth – job, house, wife – who had then been faced with the fact that he had depression, which he had tried to self-medicate since the age of fifteen.
He had to accept that this had now turned him into an addict. He also had to accept the reality of what his behaviour had done to our marriage. And then he had to enter the system to get a heavily controlled drug, the process of which was more humiliating than calling up a drug dealer.
Of course, there are some people who abuse the system. Who save it up or sell it on. But there are also a lot of people who don’t and who need the stability that a methadone or Subutex replacement therapy provides. Contrary to what anti-drugs politicians say, methadone isn’t quite the easy drugs fix they assume it to be. You don’t simply pick it up like a box of macaroons and skip merrily home.
We looked into it. You have to notify the DVLA because it affects the conditions of your driving licence. In fact, the DVLA’s attitude to it is indicative of the unbelievably cackhanded attitude to methadone treatment generally, in that it categorises it as a ‘disability’.
You can get a permit to take your methadone script on holiday but it applies only to UK customs control. It states very clearly: ‘Clients should be aware that it has no legal status outside the UK.’ So no holidays abroad, unless you like being in foreign prisons.
And you may be thinking, Oh poor widdle babies can’t go on holiday, but we were trying our hardest to keep up appearances with our families. How could we explain – with relatives in New Zealand and India – that we couldn’t go on family holidays, ever, without telling them the truth?
You also have to go on an ‘Addicts Index’, presumably so doctors can monitor who is using what drug and when. You’re told it doesn’t affect your ability to get a job, but that’s putting a lot of trust in a system that doesn’t trust you.
When you pick up your script from a chemist, they may just say loudly in front of other customers, ‘Here’s your methadone.’ If you’re agitated that day – which could be because your bus was late or you had a shit day at work – they may make you take it in front of them, so they know you aren’t hoarding it. I mean, seriously, why not make people wear a sandwich board with ‘JUNKIE’ on the front of it before they go in, you know, in the hope that their shame might put someone off using?
The irony of how people can access controlled drugs safely in the UK and US is that every step ensures they are marked out as different, outside the norms of society, when it’s more than likely that an addict started using because they didn’t feel like they fitted into the society they were expected to serve and obey.
In support groups, you find out the cost addiction exacts on a life.
We are taught from a young age that the addict is unclean; a creature to be shunned, to be treated as a horror story, as an example to all good girls and boys so that they never, ever go down that path. And you, as the spouse, fight against making your own judgements every damn day. It takes all your will not to assume that your supposedly clean partner isn’t using that extra five minutes in the bathroom to get high. Or there genuinely was traffic when they went out to the supermarket and that’s why they were late.
I wasn’t just dealing with judgement from the government. I was dealing with the devastating loneliness that comes from not being able to tell people that your loved one is an addict. Because how could I expect them to react with anything less than disgust when that would have been my reaction, if life had been different?
So, there was grief for my old life, loneliness in my new life; and all the time, every minute of every day apart from when I lay in bed with Rob and we talked and held each other, my life was fake.
No part of my life was free from the cover-up, especially work. The day after I found out Rob was an addict, I called my boss and said my husband was sick, he’d be in and out of hospital and I’d need some flexibility in my working hours. I’m fairly sure they all assumed he had cancer. I didn’t correct them.
When you’re having a bad day and your stomach is in knots because you can’t get hold of your loved one on the phone, or they call you up and ask you to transfer some money because that payment didn’t arrive on time, or the GP apparently didn’t have time to do a drugs test that morning, you cannot tell people at work the truth. You can’t explain why your colleagues need to be kinder to you on a certain morning, or why you need to work from home occasionally to make sure you don’t find your husband swinging from his bedroom door. The silence around addiction gags you. It makes you live a double life that you didn’t want in the first place.
While I tried to keep my anger from Rob, I found it impossible at times to reconcile the man I loved with the candy floss of lies he had wrapped around us both. In the search for Rob’s absolution, I asked Dr Shanahan what he thought.
‘You have to ask yourself, what is the common denominator to all of these problems? And if it’s the drug use, then that’s the link. Because there won’t be any lying if it’s about other things not related to getting to the drug.’
I thought of when Rob had lied – the night-time walks with Daisy, the odd explanations about money, the insomnia.
‘They are not untruthful and dishonest people, they just want heroin,’ said Dr Shanahan. ‘And therefore you have to ask yourself, why are we not giving it to them? Why are we making it so difficult for these people and blocking them, rather than giving them a few months or years of stability so they can stop lying? Then they can actually build a life, so they can say, “I feel better, can I try at redemption now?” ’
While his words made me feel better, they also filled me with such sadness that this was not a path we took for Rob.
I have no doubt there are sections of society – big sections – that believe addicts are a waste of space. That if indeed they are killing themselves, either through an overdose or suicide, then it’s nature’s way of thinning out a segment of the population that can’t function as well as others.
But if you’re going down that route, then let’s remove the services that save lives from cancer. Let’s unplug the ventilators and stop putting stents into people’s hearts. Let’s remove therapists, doctors, nurses – anyone who tries to heal someone who is sick or isn’t able to get by without help from other people. Let’s see how many lives that affects, whether those human beings and their families will mind.
Addicts can lie, they can let us down in the most terrible of ways. They cause chaos unlike any other. Some of them steal. They break our hearts and our trust. But we don’t question the moral ethics of someone with a physical illness as a reason for whether they can have treatment.
We don’t ask if they were naughty or nice, before deciding if they are worth saving.
Remembrance can be abstract and literal at the same time. Abstract because a mere fragment can set off a deep grief pin-pointing to the sharp sensation of loss. Literal such as seeing a photo or coming across a pair of their socks.
Cemeteries are very literal places for remembrance.
Before Rob passed away, apart
from grandparents who had reached the natural end of their lives, no one close to me had died.
Looking back on it, I was lucky. I know people who have prematurely lost parents, nieces, nephews, best friends, and it shaped the rest of their lives.
When I was in New Zealand just after Rob died, we visited the cemetery to pick a plot. What I wasn’t prepared for was this huge expanse of greenery, the sense of calm.
We buried him in a plot in full view of the sun, and the edge dips into a valley of water where yachts bob in the distance.
Although I have talked to him constantly since he passed, whispered into the line where the sea meets the shore, talked out loud across moors, along rivers, by duck ponds, spoken into the megaphone of clouds funnelling above my head, this is the anchor and root of where he is.
I have longed for this place, yearned to sit beside him, but I am also terrified of what it may unplug emotionally. Will I start wailing and lose control?
The first time I visit the cemetery after he was buried nine months before, I take Prue with me. She gives me time alone to sit by him. And I cry. Not huge gulps, but I cry a little bit. I place my hand on the ground and try to reach out to his body lying far down below.
It seems wrong there is sunshine. That the grass has grown. That cicadas – the sound of summer in my ears – are humming while he will never speak again.
The importance of a grave, I realise in that moment, is it winches you back to reality when your mind tries to tell you this could not possibly have happened. That this man, whose hands once held your waist, whose lips kissed your own, who was the greatest love of your life, is now lying below your feet. Nature knows this to be true because grass has started to grow over him like a blanket.
