Wednesday, November 11th, 2009
A comment from a previous post suggested I watch a documentary titled “Cracked Not Broken” by independent film maker Paul Perrier. It was time well spent. In short, the film is about a woman named Lisa who is addicted to cocaine and works as a prostitute to support her habit. Much of the film is an interview with Lisa in a hotel room, where she honestly and openly talks about various aspects of her life on the edge – or as she calls it “the game.” I love how the film goes from black and white to color as she feels the effects of the cocaine she has just injected into her body (yes, there are some graphic scenes). It also shows that despite a number of treatment espisodes, Lisa continues to struggle with relapse hitting home how we understand addiction today – a chronic, relapsing brain disease.
What does Lisa need to successfully move forward in her life?
- Healthy intimate relationships. Cocaine and sex have become more important than relationships – more important than her daughter, her friends, her family. Ultimately, for her to heal, she needs deep emotional connections to those she loves and cares about. For her to have sustained, healthy emotionally-fulfilling relationships, will require that treatment and intervention place increased emphasis on helping her understand her emotional world in a safe way, and developmentally addressing her emotional deficits and constrictions .
- Trauma resolution. Just watching Lisa in the video you can sense the chaos and trauma in her life. The splitting off and not letting herself feel is classic trauma. I have blogged about trauma being the gift that keeps on giving (although it is hardly a gift), and for Lisa to move beyond her addiction will require significant trauma work. Again, this is where traditional drug treatment programs often fail clients. They may diagnose PTSD, but rarely have the resources, time, or expertise to address it sufficiently. For someone like Lisa, this work likely will require many months (or years), but usually never happens because of short treatment stays.
- Medication. Addiction is a brain disease, and as Eric Nestler (Professor and Chair of Neuroscience at Mt. Sinai) has so aptly put it – one that hijacks the brain with a force almost unheard of in our natural world. As a result, for Lisa to succeed, she will likely need some medication to help her with cravings, depression, anxiety, and other symptoms associated with her long use of cocaine as she slowly engages into a life without drugs and sex. The HBO series on addiction has an excellent segment on relapse from Anna Rose Childress where she explains why the brain is so vulnerable to relapse. Her example in the film is a guy who is addicted to cocaine and reminds me a lot of Lisa. Dr. Childress even talks about an experimental medication for cocaine abusers that dramatically reduces the brain activity associated with craving (baclofen). Lisa would also likely benefit from medications that reduce some of the hypersensitivities around her trauma, allowing the critical therapuetic work to progress more rapidly.
- Creativty. Actually, her willingness to be interviewed for the film, and share her story with others, taps into her creative side. She wants something “good to come from [her] addiction” and long-term success will necessitate that she continue to find ways to make meaning from her prior life experiences. Writing, singing, becoming a counselor, working with youth, helping other woman get off the street – these things become catalysts for turning shame into meaning.
As an afterword, there is a website dedicated to the film where Lisa had a blog – one that ended on 10/20/08 with her having been through treatment and acheiving over a year of abstinence. She said she is going back to school to become a social worker. Since the blog entry, I can find no updates on how she is doing. My hope is that she has connected with a long-term solution that leads her permanently away from addiction. Godspeed Lisa.