Surviving Addictive Substances: Replacing Shame with Science

By Margaret Bourne and Julia Nicholson

The science about dopamine and the survival center of the brain shows that anyone with a brain can get a substance use disorder. Therefore, this is nobody's fault. The science also suggests why treatment requires staying away from drugs and alcohol, keeping safe from people, places, and things that trigge

• Language: English
• Publisher: Margaret Bourne
• Release date: Dec 1, 2021
• ISBN: 9780578969794

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Copyright © 2021 by Margaret Bourne

Illustrations © 2021 by Julia Nicholson

All rights reserved. No part of this book may be reproduced or used in any manner without written permission of the copyright owner.

Book design by Maureen Forys, Happenstance Type-O-Rama

ISBN 978-0-578-96978-7 (paperback)

ISBN 978-0-578-96979-4 (ebook)

This book is for people suffering from substance use disorders and their families. This book in no way substitutes for medical treatment. I am not your doctor. Refer your medical questions to your own treatment team. It is a window into how I think about substance use disorders and how I understand the science. The brain is very complicated, and even brain scientists do not know most of what goes on inside it. It is possible that some of my information is incorrect since research is being done every day, even after this book is published. I have done my best to give you my understanding of how the brain works and how substance use disorders are best treated. Where you, your treatment team, and I differ in opinion or fact, I defer to you and your treatment team.

Introduction

When I was in my final year of medical school, a thirty-three-year-old man named Armand arrived in the emergency room, unresponsive. His skin, which should have been a light brown, was fluorescent yellow. He appeared nine months pregnant, his belly a big tight ball. I drew his blood, ordered radiology scans, and admitted him to the intensive care unit. I explained what I was doing along the way, but he did not move or open his eyes. When all tests pointed to a severely damaged liver, I read my textbooks and diagnosed Armand with alcoholic liver disease. I poured fluids and vitamins into his IV. If he had any healthy liver left, with time and care, his body could heal and he would live. However, if his entire liver was ruined from alcohol, Armand would die. There was nothing more to do but wait.

Every day, I visited Armand in the hospital, examined his body, ran more blood tests, and adjusted the IV fluids. At first, he seemed to be sleeping and his liver function did not budge. After a few days, though, he woke up. The whites of his eyes were even more fluorescent yellow than his skin. Confused and upset, he began frantically grabbing for things that weren’t there and calling me names of people I had never met. He did not appear to understand a word I said, looking frightened and angry at the same time. Nothing I did seemed to help. My supervising doctor explained that he was withdrawing from alcohol. We gave him a sedative while his body went through the process of detoxifying.

For two more weeks, I visited Armand. Some days he was agitated and confused. Other days he slept. Despite the way he looked, the liver tests I ordered each day were improving. He might just live. On his fifteenth day in the hospital, Armand sat up, ate some Jell-O, and asked me my name. I could see from his sweet smile and the return of normal color to his eyes and skin that his liver was finally working. I was thrilled. There is no greater feeling than playing a small role in saving a person’s life. This was the reason I was becoming a doctor: I wanted to help people.

Armand stayed in the hospital for exactly a month, eating more each day and gaining strength. I turned off the IV fluids and moved him from the intensive care unit to a regular medical room. He was weak from years of drinking, and his first wobbly steps around the ward were cause for celebration. Best of all, I was finally able to talk to him. I learned Armand lived close to the hospital, he had two cats, and he wanted to learn to fly a plane someday. During our talks, I explained that while he was getting better, he only had a tiny bit of healthy liver. It would continue to heal, but even one more night of drinking could kill him. He felt lucky to be alive and agreed to give up alcohol forever.

Armand was discharged from the hospital on my birthday. He climbed out of the metal bed for the last time and replaced his hospital gown with jeans and a T-shirt. He thanked me for helping him and promised I would be the first person he would let into the cockpit once he got his pilot’s license. He was done drinking for good. I hugged him and thanked him for surviving. This was the best birthday present I could remember.

That evening, a few classmates took me out to dinner to celebrate. I felt light as a feather as we walked to a nearby Italian restaurant. Everything in medical school was so new and exciting to us that we couldn’t wait to share what we were seeing and learning. How had we been so lucky to find a career that was both interesting