addiction secretsI’ve shared a small amount of information about my own addiction to opioids. My addiction started in the early 1990s after I took codeine for a lingering cough from a respiratory infection. As an aside, codeine is converted to morphine by the liver, a metabolic process that varies in efficiency from one individual to another.

Some people obtain little pain relief from codeine because of the lack of conversion to morphine.  Unfortunately, some doctors interpret a patient saying ‘codeine doesn’t seem to work to me’ as evidence that the patient is an addict seeking strong narcotics.  I’m sure that in some cases, a request for non-codeine narcotics is a sign of drug-seeking.  But some people have a legitimate beef with taking codeine—a medication that in their cases has minimal pain-relieving activity.

I knew fairly soon during my use of cough medicine that I had become addicted, but I tried my best to push thoughts of addiction from my mind and instead get on with life. The realization of the depth of my problem became harder and harder to avoid as my tolerance increased. It is one thing to self-medicate a cough with a half-teaspoon of cough syrup; but something else to gulp down cough medicine from the bottle!

Even as the evidence mounted, I told myself that I had things under control. My mind was in the condition I’ve described in earlier posts, bouncing between two realities. In one, I was a popular and successful doctor dealing with too much stress through no fault of my own. In the other, I was a liar, hiding secrets that I feared would bring enormous shame to myself and to my family. I have never read the classic novel Dr. Jekyll and Mr. Hyde, but the reference certainly came to mind.

Shortly before my addiction became public, people close to me confronted me with evidence of my problem.  I reacted the way that my current patients do; I disclosed only part of the story, minimizing the extent of the problem and assuring her that things were under control. The half-admission is silly when I look back on it now; why would I think it is less frightening to hear that one is else is addicted to two bottles of cough medicine per day, as opposed to four?!

The term for this type of partial disclosure is ‘minimization,’ and the behavior is very common. Physicians learn about minimization when as new doctors they are taught to multiply a patient’s reported daily alcohol consumption by a factor of two—or more.

I thought about the tendency to minimize a few days ago, as I talked with a new patient whose urine drug test didn’t match the history that he provided.  He initially denied taking any substances for the past ten days.  But as I pointed out the breakdown products of benzos, opioids, and stimulants in his urine, he admitted to using a list of substances that grew during our discussion like a snowball rolling downhill.

I thought about how he traveled to see me, taken time away from work for the appointment, and spent money to sit across from me. Why would a person in that position keep secrets? There are no consequences to being honest about drug use in this setting; it should be easy to ask for help. But then I put myself in his shoes, and remembered my own behavior—frantically running from appointment to appointment, only to sugar-coat what was happening. There is a consequence to being honest that I had forgotten; once the truth is verbalized, it becomes impossible to pretend that everything is OK.

People in AA are familiar with the phrase ‘secrets keep us sick.’  Perhaps the most dangerous secrets are the ones that we keep from ourselves; especially secrets about problems that grow larger and larger — until recognized and addressed by the full measure of our insight.