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JACS: Jewish Alcoholics, Chemically Dependent Persons, and Significant Others

JACS LIBRARY - ARTICLES

ADDICTION IN OUR COMMUNITIES:
PRETENDING IT DOESN'T EXIST WON'T MAKE IT GO AWAY

by Dr. Benzion Twerski

I will start with the punch line. We have drug problems in our community. Once believed to be immune to addictions, Jews of all denominations and backgrounds are as vulnerable to alcohol and drug abuse as anyone else. It's time we took off our blinders and recognized this as reality. I apologize for any discomfort or shock this may cause you, and also for using a form of intervention that is normally not in my domain, shock therapy. But recognition of a problem is vital to its solution.

My rebbe, R' Chaim Bressler, shlita, once scorned the description of the Holocaust as the murder of six million Jews. He claimed we should view it as the murder of one Jew, and another Jew, and another Jew, etc. Every alcoholic or addicted person jeopardizes the well being of several others, particularly spouse, family, and others. I will, for present purposes, deviate from my scientific training and look away from statistical data. I suggest we adopt an approach that ignores percentages, and choose to see the addiction of one Jew, and another Jew, and another Jew, and another Jew etc.

Playing ostrich has not been easy. The few windows of exposure in the Jewish media are met with stiff opposition. When drawn into conversation with friends, neighbors, or others about my work, I am routinely admonished to refrain from "washing our dirty laundry in public". "Most of your business comes from non-Jewish or at least non-Orthodox clientele," I hear them say. Not so. Addiction wears every form of malbush. It is an equal opportunity disease and spares no race, creed, gender, or religious denomination.

ALCOHOL

Alcohol is a central feature of celebration and ceremony. Every bris, chupah, kiddush, and yahrtzeit involves the use of alcohol. We toast L'chaim, extending wishes of longevity, success, health and various best wishes over wine, beer, or liquor. Scholars have believed that the lower incidence of alcoholism in Jews was related to the ritualistic and religious significance accorded to alcohol. This belief was so pervasive that one of the experts in the field of alcoholism several decades ago noted wryly that he could cure alcoholism by converting his patients to Judaism!

But we have "kiddush clubs" in many shuls which are fertile ground for excessive drinking. Purim is viewed by many as a day with an automatic license for drunkenness. Some believe that Simchas Torah is properly celebrated when intoxicated. The use of alcohol as a substance to relax or unwind is increasing. Exposure to non-ritual use of alcohol is on the increase, not helped much by reports in the media on the alleged health benefits of regular, controlled drinking.

However, excessive use of alcohol results in intoxication. Toxicity is a condition induced by poison. Regular use of alcohol can impair many areas of function. It is rather unkind to the brain, liver, stomach, pancreas, and circulatory system. Judgment is impaired while under the influence, as well as both before and after drinking. Interactions with others and relationships are affected, and friendships, relationships, and marriages can deteriorate. All sorts of emotional dysfunction are common, including guilt, shame, depression, irrational fears, anxiety, and anger. In addition to all this, alcoholism is a progressive disease. The drinking pattern may begin as infrequent but -almost unnoticed- it can increase steadily.

MARIJUANA

Over the last 30 years, marijuana has been developed by growers to increase its strength, and it is now almost 30 times more concentrated than when it was first introduced to the drug users of America. As far as carcinogens in the smoke, a single joint as equal to a pack and a half of tobacco cigarettes. Marijuana is highly toxic, affecting reaction time for 6-8 hours, it has a highly negative impact on the capacity to concentrate and learn, and it is addictive. It destroys motivation, impairs emotion and perception, and is damaging to many body systems. This is also a gateway drug, and often leads to use of other drugs.

Many of the cases of marijuana use that lead to calls for help involve adolescents. A majority of these young people exhibit other signs of dysfunction, and here is where increased attention on the part of both parents and educators is critical. Much of the marijuana use occurs socially, in the context of groups or cliques. Parents act responsibly when they take note (and some control) of who their children's friends are. While some of this could conceivably happen during school hours, it usually occurs at night, on weekends, and at extracurricular group activities. To allow them to go out without supervision is risky. Adolescents are inquisitive, curious, and often frustrated. One can no longer assume that a teenager's group of peers have never encountered marijuana, and I sadly include our yeshivas in this assumption.

COCAINE

Cocaine is a derivative of the coca leaf, grown in several South American countries. It is usually processed in South America, producing a paste or powder which is exported. In the U.S. it is processed further, usually "cut" or diluted to a lesser concentration. It is sold to drug users as a white powder which is inhaled, mixed with water and injected, or cooked and vapor-inhaled (free based). It is also mixed with baking soda and baked into small chunks which are smoked (crack).

Cocaine is a fast-acting stimulant, increasing heart rate and blood pressure, affecting the brain and nervous system, and producing an intense feeling of euphoria. The effects are brief, so the user is apt to take more to prolong the euphoric experience. It is so powerful that the cocaine user quickly develops strong cravings for more. Cocaine users describe their addiction as overpowering, replacing all other drives and needs. The escalation of cocaine addiction is also rapid. The risk of overdose is high, and the dangers of dying from cocaine use are real and immediate. The number of cocaine overdose deaths is high, through the media report only celebrities who die of overdose.

Cocaine users often drink alcohol to temper the high as well as prolong it. The combination of cocaine and alcohol is highly toxic and more lethal. When they are used together, the body produces a metabolite that has been shown to last longer and is implicated in more deaths than cocaine alone. When you hear about someone dying of a heart attack who was neither elderly nor had known heart disease, there is a good chance that cocaine was involved.

Among the mental effects of cocaine is paranoia. Most users develop a great fear that someone is watching them. They will double-lock doors, shut windows and shades, and perform all sorts of hiding and protecting rituals. As uncomfortable as this might be, the craving to repeat this is intense. This irrationality is common to all other addictions.

HEROIN

Heroin is a derivative of opium, a form of poppy. It grows in warm climates, including the Middle East, Mexico, and South and Central America. Opium was smoked hundreds of years ago, and it was found to have pain-relieving properties. Heroin was developed as a pain-medication and found its way to the streets as an inject-able drug, popular in the 1960s. It is no longer available by prescription, but it has been replaced by many other opiate medications (including Morphine, Percodan, Percocet, Demerol, Codeine, Hycodan, and many others). It is highly habit forming, and the addiction involves tolerance, cravings, and withdrawal. The user experiences a sedative euphoria, and quickly develops the need for more heroin to achieve the same experience. For example, whereas a 2 or 3 bag-a-day heroin habit is enough to warrant detoxification in the hospital, 10 bag-a-day habits are not uncommon. Not long ago, I saw a Jewish patient who claimed his addiction stemmed from pain medication he was given after a back injury. When doctors stopped prescribing the increased doses of other opiates, he took to the streets and began using heroin. His habit reached about 35 bags a day. To describe the disability of this condition, he was unable to work, had no income, spent at least 350 dollars a day (at wholesale price), and was unable to partake of any aspect of social life.

PILLS AND PRESCRIPTION DRUGS

Pills are also commonly abused substances, and are drugs with much the same dangers and risks, as the illegal ones mentioned above. The minor tranquilizers, such as Valium, Xanax, and Ativan, are potentially addictive. The legality of the pills and the fact that they are dispensed by a doctor and pharmacist does not insure protection from addiction. Current regulation in New York State requires these be dispensed on a triplicate prescription form, a copy of which is kept on record in Albany. This prevents some of the overprescribing that allowed addictions to develop and continue. As Jews, we are generally willing to get fast-acting help from a doctor, and more than willing to take medicines for discomforts. While these drugs are often useful in the short term, prolonged use carries addiction as a major risk. One pharmacy in a Jewish neighborhood reported up to 80% of all tranquilizer prescriptions as beyond clinical effectiveness, and were probably still prescribed to maintain an addiction. There are several classes of tranquilizers used for anxiety and sleep which fit this category. There are pills sold illegally on the street that may carry the additional risk of being produced without quality control. Who knows what they contain?

HALLUCINOGENS AND INHALANTS

There is another category of abuse that is just as lethal, and which includes hallucinogens such as LSD, mescaline, PCP, mushrooms, and inhalants. Adolescents may experiment with inhaling vapors of glue, gasoline, and spray cans. These substances are not only not benign, but many carry the distinction of being instantaneously fatal. Some cause brain damage the very first time they are used, and do not need repeated use to induce such effects. The ads in the papers depicting the frying egg as symbolic of the brain on drugs are quite accurate.

THE IMPORTANCE OF EDUCATION

We should all make it our business to recognize the signs of addiction and to refer the problem to professionals for evaluation and treatment. When it comes to children, learn to identify the signs of drug use and drug-related behavior.

For too long we've played ostrich, as assuming that drugs do not affect our own. Since it is thought to be not relevant, teaching our students about the types of drugs and their dangers is considered taboo. Much as chazal dictated that fathers teach their children to swim in order to be prepared for the eventuality of a water accident, so, too, must we prepare our children to resist the forces in society that extol the use of drugs. There are pushers everywhere. I was contacted at least three times in the past year about Jewish dealers who preyed on yeshiva students to sell their wares. I consider this a capital matter and suggested that the report be given to authorities for criminal investigation.

Our society condones the use of chemicals to feel better quickly. Convenience is the name of the game. We develop automatic gadgetry and disposable everything to make life easier. But where does one turn when feeling emotionally or spiritually deprived? The messages of self-sufficiency and the all inclusiveness of Torah do not always result in our finding practical answers to the nebulous questions. With substances available that change the way we feel, the invitation is too explicit. These influences surround us everywhere. We all go to doctors. We all shop in stores that sell over-the-counter medications. We all know the effects of a little alcohol. It is a smaller step than it seems to experiment with another chemical, legal or otherwise.

Exposure to secular friends, broadcast media, and popular literature are not required to encounter drugs these days. Even the ideal of living a totally sheltered life within the walls of the bais hamedrash does not protect individuals from the danger of drugs. In concert with the instruction found in Pirkei Avos, " Know what to answer the apikores," I suggest we "Know what to respond to the worldly influences."

ADDICTION IN OUR COMMUNITIES: PRETENDING IT DOESN'T EXIST WON'T MAKE IT GO AWAY