Beautiful Boy Afterword—Hope for an Addicted Nation
Nic's book has helped me understand more about what happened to him and to our family. Often when he was using—his behavior unconscionable, his self-destructive course unfathomable and unstoppable—I felt, How could he do this to me? How could he do this to Karen? To Jasper and Daisy? Reading Tweak, I learned anew that he wasn't doing it to us. He was doing it to himself. We were innocent bystanders, collateral damage.
Sometimes I feel as if I'll drown. Relapse, loss, anguish, rage, death—the stories often devastate me. Every day and in every city I'm forced to face this chronic, progressive, and, when untreated, terminal illness. I define and redefine the words in order to fully grasp them. Chronic means that an addiction is constant, unceasing, unending, continual, unremitting, persistent, unrelieved, never-ending. All right. I get the point. Progressive means that it worsens over time. Unless the addicted are treated, they'll deteriorate before our eyes. Then they'll die. That's what they mean by terminal.
There's death everywhere. “Your family's story is my family's story,” people say. They tremble and their eyes well up. Over and over and over again.
“But we had a different conclusion. My beautiful boy didn't make it.”
“My beautiful girl died.”
“Your family's story is my family's story, but we had a different conclusion.”
So many children have died. So many people. Their parents and lovers and spouses and siblings and children come to see us. You can't imagine how many. As one tells her story, I look over at Nic. From across the room he smiles at me, his eyes clear. I'm flooded with gratitude that he's all right and with unbearable grief for this mother, whose child is gone. And guilt. Why did my son survive when so many others have been buried by their parents? Nic is so lucky to be alive. I'm so lucky to have my son. I look over at him, my beautiful child. Then I look into the other parents' eyes. I'll never forget them. I'll carry their agony and fury—fury at the disease of addiction and our disastrous system of mental health care, which failed them. I'll also carry their dignity and bravery.
The final leg of the tour brings us to the Bay Area. Nic and I have a free weekend, which he spends with us in Inverness. On a cool sunny Saturday, we pack the car with a picnic and wetsuits and surfboards and Charles Wallace, our new puppy. At the beach, Nic and Jasper don their black neoprene suits. Jas is almost as tall as Nic now. It's startling to see them together—how much Jasper has grown. It's almost inconceivable that he's a teenager starting high school, that Daisy's twelve, a seventh grader, or that next month Nic turns twenty-six. The two boys grab boards and run into the surf, where they paddle out into the peeling waves. Daisy and her friend build a fort into the side of a cliff. Charles Wallace repeatedly ransacks it.
Nic returns to Savannah, Georgia, where he's lived for the past two years. Three months later, he moves back to Los Angeles. The move worries me. Los Angeles is filled with ghosts for Nic. Ghosts can be triggers. I caution him but remind myself, It's his life.
We're having dinner at Nancy and Don's. It's late summer and the sky is orange and smoky from the spate of fires burning through California's forests. Other friends arrive, friends we haven't seen for a while. Around the redwood table, one of them asks about Nic.
Sometimes I tire of the convoluted, messy truth. It's so much easier to indulge myself by keeping it superficial, by offering a Zen snapshot: “Nic's great.” Karen and I had just visited him in LA. We saw a movie, visited museums, took a long walk with Nic and his hound dog, a stray he rescued. We laughed, listened, commiserated, made plans, compared notes, contemplated the future. It was a great couple of days. Nic seemed fine, but he acknowledged that it had been a difficult few months since he relapsed.
How did he relapse after two years? Was it two years? The word chronic plagues me these days. I wonder if the human mind can truly comprehend certain words. I struggled with death, but I fully grasp death now—the finality—through, and with, the people who have faced it. Chronic eludes me, though. I say forever and always and never-ending, and I understand them, but still I feel that the worst is over. It's not that I'm completely surprised by a relapse; I no longer deny the insidiousness of addiction. Another relapse is testament to the chronic part of it. As Nic would say, “This disease sucks.”
But a relapse strikes me with another wave of overwhelming sadness that Nic has this terrible illness, and many other familiar emotions resurface. I thought, Why must I keep learning and relearning the bleak lessons of addiction? How many times must I be traumatized? Clearly I'm still part of, contributor to, and victim of a culture of denial. When Nic relapsed, however, I knew it wasn't up to me. Nic would have to decide what, if anything, to do.
Other relapses quickly led to catastrophe, but Nic stopped this one. He recognized it for what it was and concluded that he needed help. Almost immediately he checked himself into a residential program. From there he enrolled in outpatient treatment that included therapy, twelve-step meetings, recovery support groups, and drug testing. He began working with a new psychiatrist who he says is remarkable, an expert in addiction and the disorders that often accompany it. The ability to recognize relapse and choose to get help is a sign of enormous progress. Am I grasping at straws? “As AA has long professed, recovery is about progress, not perfection,” Benoit Denizet-Lewis writes in America Anonymous. Nic has made significant progress, though it guarantees nothing.
I stop speaking and my friend looks up at me. “It sounds as if it's still so hard,” she says. Then she says that she read a book that might help me. “It's about exactly what you're going through—about how hard it is to be a parent,” she says. “You really ought to read it.” I can use all the help I can get, so I take out a pen and notebook to write down the title. She says, “It's called Beautiful Boy.”
So here's the point: I struggle. I know, and have repeatedly said, that it's an ongoing process, yet I can forget that ongoing means—well, it means ongoing. I've come a long way toward accepting that to live with addiction—one's own or a loved one's—involves living with uncertainty. It also requires enormous suffering. I'm coming to accept these truths after years of fighting them. The surprise is that the more I accept them, the less I suffer. But that's not all I feel. Early in the year, before it was published, Jasper read Beautiful Boy. Of course he knew the overarching story, but he had been too young to remember many of the details. In a report about the book for his English class, Jasper wrote that he had known the book would be hard to read, that much of it would be scary and sad, but he hadn't been prepared for something else. He didn't expect to laugh. "It was so great remembering all the things we did when I was little,” Jasper wrote. I understand how he felt. Somehow it's easier to recall the trauma than to hold on to the contradictions and complexities and yes, the joyful times. “There were horrible moments when Nic was using and on the streets,” Jasper continued. “There were happy moments such as when our family was together, or when Nic and Daisy and I played in the garden.” Both. Both, and every other moment, tell the story of our family.
Addiction is America's deep, dark secret too. Every story in those letters reflects millions more, from every corner of the country. A report by the National Institute on Drug Abuse concludes that, “every community is affected by drug abuse and addiction, as is every family.” Yet when they strike, most people are caught off guard. Given the enormity of the suffering, its astounding that we—the collective we—are doing almost everything wrong in our fight against addiction.
Most people know that President Nixon inherited the war in Vietnam, but few remember than in 1971 he initiated the war on drugs. Without question, it has been a failure, costing hundreds of billions of dollars, while the use of drugs, plus the resulting morbidity and death, has risen steadily. Testifying before the Senate Judiciary Subcommittee on Crime and Drugs in 2008, Leonard J. Paulozzi, M.D., MPH, an epidemiologist with the Centers for Disease Control and Prevention, summed: “The mortality rates from unintentional drug overdose have risen steadily since the early 1970s, and over the past ten years they have reached historic highs.” First-time users are younger, the drugs themselves are stronger, and there are many more types of drugs to abuse. Users can get their drug of choice whenever and wherever they want. Yet in spite of these facts, the federal government boasts that we're making progress. Statistics are manipulated, misused, and ignored to mask the fact that we're playing a zero-sum game, because addicts, unless treated, will find drugs.
It's hidden because most addiction-related deaths are officially ascribed to other causes: suicide, homicide, automobile and other accidents, heart attacks, hypertension, pulmonary disorder, strokes and other brain hemorrhages, hepatitis and other infections, HIV/AIDS, liver disease, respiratory disease, kidney disease, septicemia, and on and on. Health insurance companies—and Medicare and Medicaid—often refuse to pay (or pay at a lower rate) for treatment of illnesses or injuries caused by drugs or alcohol, so doctors tend to report a diagnosis that will ensure payment. Thirty-two states still enforce statutes—the Uniform Accident and Sickness Policy Provision Laws, enacted in 1947—that allow insurance companies to refuse to cover medical care in hospital emergency rooms if alcohol or drugs contributed to the patient's condition. Also, payment of life insurance may be denied if drug or alcohol abuse led to death, so doctors and medical examiners do grieving families the “favor” of citing a death's immediate cause—an accident or an ailment—rather than the underlying, primary one. And apart from these more practical reasons, addiction remains a secret because of the overwhelming shame associated with it. Last year, when the scion of a prominent Midwestern business family died suddenly, newspaper accounts cited the cause of death stated on the coroner's death certificate: injuries sustained in a motorcycle accident. The lethal dose of heroin in the young man's bloodstream was never mentioned.
We fail miserably when it comes to education about drug abuse and addiction. The week-long education sessions provided at school pale—in quality and quantity—in comparison to messages that promote use and abuse. We fail at prevention too because we're inept at diagnosing and treating the psychological and social problems that create fertile ground for addiction. “A presentation on the dangers of drug use will have little impact on the likelihood that a child who is experiencing depression, anxiety, learning disabilities, eating or conduct disorders, low self-esteem, or sexual or physical abuse or neglect, or who has no hope for the future, will self-medicate with drugs and alcohol,” writes Joseph A. Califano Jr., the former U.S. secretary of health, education and welfare, in the book High Society.
At the same time, addict watching has become America's favorite spectator sport. Last year Us magazine featured a photograph of Britney Spears on its cover, emblazoned with this gleeful headline: SICK! CNN ran a piece about “our favorite bad girls,” a list that included Spears, Amy Winehouse, and other celebrities with addiction problems. We'd leave these women alone if they had cancer, but victims of addiction are fair game. We revel in their misery and judge them for the irresponsible, humiliating, and appalling behavior their disease causes.
I think the gloating reflects something beyond the assumption that addicts deserve their fate because they're immoral, spoiled, and weak. We laugh because it's someone else's pain, while our own simmers below the surface. But then it boils up. “I thought we were immune.” I've heard it so many times. “I'd always thought, Not my son.” “Not my daughter.” Not my husband. Or wife. Or partner. Or brother or sister or mother or father. Addiction, the equal opportunity affliction, has struck again. And few of its victims—only one in ten—will get help.
Cancer hasn't been eradicated, of course, but the illness, once a death sentence, is now often treatable. According to Vincent DeVita, M.D., former director of the National Cancer Institute, the war on cancer “did everything it was supposed to do.” The incidence of cancer began dropping in 1990 and has continued to fall every year since then. Since 2004, the death rate from cancer has decreased at double the rate of the previous two decades.
I believe we need an all-out war on addiction modeled on the war on cancer. We could save millions of lives and billions of dollars now squandered on, and by, addiction. But we won't make a dent in this problem unless we decide to fight the right war.
Researchers have hundreds of promising ideas for medications, cognitive and behavioral therapies, and combination treatments that could improve the odds for addicts. I mention some of these in Beautiful Boy. At the moment, most are untested. A flood of money into the field will allow a far wider range of study and draw in new researchers who will intensively examine the mechanics of addiction and develop and test promising treatments.
And then there is the matter of insurance coverage. We can't imagine an insurance company paying for a week or month of treatment for a cancer patient, but then withholding any further coverage. As part of an effective war on addiction, insurance companies must be required to cover comprehensive addiction treatments, which are the most effective we have. Paying for the best treatment money can buy is expensive, but not doing so is more expensive. RAND Corporation's drug-policy center found that for every dollar spent on treatment for addiction, taxpayers save more than seven in other services, largely through reduced crime and medical fees and increased productivity. A visit to the emergency room, for instance, costs as much as a month in rehab.
In addition to lowering morbidity and mortality, the war on cancer changed the way we look at the disease and treat its sufferers. Cancer is no longer the “Big C,” a secret shame. Addiction, destigmatized, would come to be thought of as a terrible disease, best recognized and treated early. This might be the biggest breakthrough of all.
Can we cure addiction? Again, despite thirty-five years of aggressive research, many cases of cancer resist treatment. But we have made dramatic progress. And in the process we've relieved incalculable suffering, saved hundreds of millions of dollars, and saved millions of lives. A war on addiction would do the same—and more. By dramatically decreasing emergency room visits and prison populations, we'd eventually free up funds to treat other illnesses, improving health care across the board. We'd eliminate much homelessness and dramatically reduce violence, including child abuse, spousal abuse, and violent crime. We'd help families stay together and repair broken neighborhoods. We'd alleviate immeasurable suffering.