The cocaine addict is neither rational nor in control. Credit: Getty

I have never seriously asked myself why I went insane when I was young. It didn’t occur to me to ask because I thought it was fate, and who questions fate? I didn’t like to remember what happened to me; or, perhaps, what I did to myself. Those are the two potential narratives for the addict, and they are at poles: victim or persecutor. Which am I? I don’t ask but the tension is always with me. I carry the trauma, which I usually call shame; I carry it in anger and in the fat on my body.
I stopped drinking because I knew I would die, and I wasn’t ready. I went to AA, clinging on to a willingness, if not a pleasure, to live, and recited the dogma. Jonathan Franzen said his friend David Foster Wallace, who killed himself, was so terrified of what he had seen of his id while using, it decimated his trust in his lovability. I understand this perfectly. I know I became a writer to form myself, but I wonder if I invented the person writing these words to disguise the monster that is my true self. I am 20 years sober, and this is my settled state. Fear.
Some addicts think critically about their condition: or they can try. Carl Erik Fisher, a child of alcoholics, is a psychiatrist and he was, during his training, addicted — a phrase that has no settled meaning — to alcohol and pharmaceuticals. He was, “greedily grasping after a new identity for myself”. Fisher used, denied, hallucinated, and collapsed. He believes that denial, a crucial and hitherto mysterious element of addiction, allows the addict to lie more effectively to others, and this makes perfect sense to me. He was tasered by the police in his flat in New York City, “dangerously near the peak of my heart”. He recovered, in the sense that I have: he stopped using. Instead, he wrote The Urge.
It’s a seeking, of course: an attempt to make sense of his life. It is a search for reason because he lost his, and it is as diffuse as his using was simple: just give me more of it. The Urge contains history, memoir, science, miscellanea, literature and polemic. There is a mountain of information out there about drug use — if only we could process it meaningfully — and Fisher read it all, amid his sullen, yet hopeful, quest to return to psychiatry.
It asserts the primacy of the psychiatrist over the primacy of the addict. It is Fisher’s internal conversation with footnotes, and the reader is the listener and, in my case, the patient. Addiction need not, he says — primarily, I suspect, to himself — be a mystery filled with fear.
I found using drugs a return to early childhood state because the feelings I remember are those of childhood: wild freedom; wild hunger; wild sensibility; wild terror. They are life, magnified, and life runs out. Drug use is both a metaphor and a paradigm of the human tension that exists in our consciousness: between the ego and the id (if you are a doctor) and between the sacred and the profane (if you are a priest). It is a truism that they expand our consciousness. For the addict who cannot stop taking them, it expands too much. Then — I speak for me — it dramatically contracts, and that is when I went insane.
But the terror itself moves from the internal life of the addict to society itself. Almost no one here is rational or in control. Most people do not become like Fisher and I, because drugs, he writes, drugs “are not ‘addictive’ in themselves”. They are not the draught of a demon king, then; they need a social hinterland to flourish, which we summon glibly and continually. “Pray for her,” my friend was told when he rang 999 to say I had collapsed with alcoholism, as if medicine had nothing to offer me because I was peculiarly cursed. Yet there is no definitive personality type for a drug addict and no evidence that addiction is genetically determined. Of those who become addicted — those who continue to use long after it is pleasurable and, as AA says, “unto the gates of death” — most get better.
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