Here is the full transcript of Scott McFadden’s talk titled “Addiction: A Story of Stigma, A Story of Hope” at TEDxColoradoSprings conference.
Listen to the audio version here:
TRANSCRIPT:
Understanding Substance Use
As I was trying to understand my own long journey of substance use, I came to realize that its roots took shape long before I even picked up a drug. I remember I was 13 years old, ran away from home with my friend Michael. Excuse me, we didn’t go far, stayed around the neighborhood, but managed to stay out a couple weeks, sleeping in people’s basements, in an abandoned car, and one night in a park. Finally got tired, cold, and hungry enough and went on back home.
And when I got home, I wasn’t whipped, I wasn’t beaten, like my friend Michael. I was actually hugged. My mom held me and cried and asked me not to do that again. And I got to tell you, for me, this was miraculous. There were no hugs in our home. No expressions of affection or caring. I hadn’t heard the words, “I love you,” and I didn’t hear them then, but I knew that’s what she was trying to say, even though she didn’t have the emotional vocabulary to express that.
Seeking Attention
But to my young adolescent mind, there was another message coming through there. What I heard was, “Oh, so this is how I get love. I need to act out, run away, get attention.” So I started running away more, playing sick to get out of school, getting invites at school. Then at 15, I found this whole new exciting way to get that attention.
I was introduced to meth by some high school friends. We injected it, and I immediately fell in love. It felt so incredibly good. So good, in fact, that I thought, “Well, I am just going to have fun for the summer.” I’m going to do this all summer. When the summer’s over, I’ll get back in school, maybe just do this on weekends. Didn’t quite turn out that way. So by the time I was 16, I had tried every drug imaginable, except maybe birth control pills.
The Spiral Downwards
And I was so overwhelmed by the drugs I was doing, I had to drop out. I couldn’t keep up in school. Another year, and by then I was fully addicted to heroin and headed off to prison. You know, and let me interject here.
You know, something happens when a person starts off on that road of drug use. The sort of training begins by society at large, where first you’re wrapped in all these labels: Junkie, loser, liar, thief, manipulator. And everyone around you reinforces these labels.
Everything you see on TV, from the drug busts on the nightly news, to the dramatic movies that glorify drug use, and things like Breaking Bad. And your family, your friends, law enforcement, teachers, they all sort of reinforce those labels. Because that’s the way we’ve come to see addiction. For more than 100 years, we have looked at it as a crime.
Incarceration and Labels
And the only treatment a person could expect was incarceration. So at 17, I was with someone that had stolen a purse for $3. Excuse me. I hid a syringe in my pocket. So I ended up with a year in prison for those combined charges. And, as luck would have it, not just any prison. I walked into Mansfield Reformatory in Ohio. It’s one of the two worst prisons in the state.
In fact, it was built just after the Civil War. It boasts the biggest cell block in the world. My cell block was six floors high and 50 cells long. In fact, you may have seen it on Shawshank Redemption. They film a lot of movies there because it’s kind of an eerie, castle-looking place. Turned out to be the worst year of my life.
So I decided while I was there, “Okay, if this is what drugs do, I am through. I will not use again as long as I live.” Because I figured, like many people do, that this is just a matter of willpower and I can grit my teeth and be stronger than this thing. So I got paroled after that year. And it took me just a few hours to get a needle in my arm. And my first thoughts were, “What am I, stupid or crazy?”
The Battle for Recovery
I was so confused by my own behavior. So I knew I very sincerely wanted this recovery thing. Yet my feet were walking right to the drug. And then the labels kicked in. I guess I am just a junkie and a loser. I guess they are right. See, the labels were doing what labels do. Becoming self-fulfilling prophecy. I was becoming the label.
But in a very real sense, the truth is, I was really still that kid just running away, looking for love. And I don’t think that’s much different than most of the people that are caught up in this very powerful, very confusing disease. It may look like they don’t care.
But the truth is, they have just lost control and can’t figure out how to get out of it. And in their heart of hearts, they wish they could just be held and this could all be over with. According to the National Institute on Drug Abuse, we are losing another person every 11 minutes to this opioid crisis. Even though we have some very effective medications and treatments available, only 10% of the people that actually need the help are reaching out to get it.
The Stigma of Addiction
And the greatest obstacles preventing them from doing so are the labels, the shame, and the stigma. The stigma. The word we hear a lot these days in the realm of mental health and addictions.
But I know I, for one, didn’t really fully comprehend the full import of that word until I went and looked it up.
You know, the actual definition is that it is a mark of disgrace. Disgrace is a pretty powerful word. And when you’re marked in disgrace, like the scarlet letter, that’s saying you’re no longer welcome in our community. You’re no longer part of our group. You’re no longer part of our family.
When they used to use that word, when they started using that word back in the 1590s in England, a stigma was an actual mark that was tattooed into a person to let people know that they were a criminal or a traitor or an adulterer, and sometimes for mental health issues. And then they started branding it into a person with a hot iron so that they would be shamed for the rest of their life. Fortunately, we don’t brand people these days.
The Criminalization of Addiction
At least not with a hot iron. Today we use a criminal record. A person may be arrested for drug possession, prescription forgery, basically for the getting and using of more drugs to satisfy the cravings of the disease. Still treating the disease like a crime rather than a medical problem.
So the question arises, why do we stigmatize this particular disease? We treat it differently than any other disease. And part of the reason — according to the American Association of Addiction Medicine, this is a chronic brain disease, so that’s where we have to look. The part of the confusion lies in the dopamine reward system.
Dopamine is a neurotransmitter, it’s sort of a chemical messenger in your brain. But in a practical sense, dopamine is that feel-good chemical that kicks in to motivate us to repeat certain behaviors that are important for our survival and success. So when you have a really great meal, ice-cold water on a blazing hot day, maybe you got a promotion at work and the boss tells you how awesome you are. “We are so lucky to have you.” That feeling there is dopamine, and your brain is telling you whatever you just did is important. Continue that behavior.
Now, the levels of dopamine are all important in understanding this dynamic. Dr. Corey Waller has done a real good job of outlining those levels. So on just a normal day, having enough dopamine in your system to motivate you to get out of bed, get to work, and take care of your business. That’s about 50 nanograms per centiliter, right?
Then you have those days where you might be depressed, you might be sick, you’re not going to even make it to work. It’s dropped to about 40 nanograms there. Then we all have those really great days, right? A perfect day. It’s like 77 degrees and sunny out. Might be hiking the Rockies or laying on a beach somewhere. Won a little lottery. You won some TED tickets. Whatever your perfect day is, that shoots your dopamine level up to about 100.
The Impact of Substance Use on the Brain
Your system isn’t made to get beyond that. Now go back to that day I did that first shot of meth. That caused my dopamine level to surge to 1,100 nanograms. You can imagine how incredible that feels. Heroin and other opioids, high hundreds. Eight, nine hundreds.
So the brain at that point has been tricked and hijacked. It believes that because the nucleus accumbens and ventral tegmental area has been flooded with dopamine, it believes that this is important behavior and motivates you to continue that behavior.
And then other parts of the brain kick in. Particularly important is your frontal cortex. This is the administrator. This has to do with rational thought, impulse control, judging good from bad. So that’s knocked out of service, along with your reward system. So there goes your willpower and your good decision-making. When I got out of prison there at 18 and relapsed right away, I continued to use for decades. Until about 18, 20 years ago.
A Turn for the Better
By then I was homeless, sleeping on someone’s kitchen floor in the inner city of Cincinnati with my girlfriend. At the time, I was on the 10 most wanted list in Cincinnati for prescription forgery and parole violation. I had already served time in three different states at that point, twice for the federal government.
I had Hepatitis C. Not surprisingly, I was contemplating suicide. Not a lot of hope at that point. Obviously, my attempt failed. I was re-arrested. But when I got out this time, something different happened. I was introduced at that point to what they now call medication-assisted treatment. Methadone first, very briefly. It wasn’t quite working out for me. Then there was a new medication at the time called Suboxone, buprenorphine. So I start this medication. I’ve got to tell you, for me, this was such a drastic change.
Literally from one day to the next. One day I was the most hardcore, out-of-control person with an addiction. The next day I was sane, I was stable. I was motivated. And I was amazed. Within a couple weeks, I had a little job. Telemarketing. Now that in itself was a big thing. That was a turning point.
The bigger thing was that it introduced me to a whole new circle of people where I was able to start making human connections. Because that’s the gist of recovery. That allowed me to start overcoming the unbearable aloneness that an addict feels. The isolation. It was brought on by the labels and the shame and the stigma. And especially important to note is that I went into that job label-free. Not sharing who I was until people got to know me.
Breaking New Ground
And then I started experiencing new labels. Suddenly I was the hard worker, the good salesman. I was the skydiving guy. I was the vegetarian. Because for some odd reason, I quit eating meat before I even quit drugs. “It’s okay to shoot heroin, but heaven forbid you give them your red meat, right?” An addict’s thinking. So this is good news, right?
We have some medications and treatments that can help us turn this thing around, save some lives. The problem is that the stigma extends to the medication. And people hear things like, “Oh, that’s just another crutch. You don’t want to do that.”
That’s just another addiction. And you know if you start that, you’re not really in recovery. So it’s severely underused, and we keep losing people when treatments are available. Look, if the greatest obstacles preventing us from saving lives are the labels, the shame, and the stigma, then we need to work together in turning this thing around, alleviating all those.
First of all, by challenging the labels and the words that we use. And pledging not to use words like junkie, crackhead, loser. More appropriate and more sensitive is using person-first language. A person with a substance use disorder. Not even drug abuser. There is no positive connotation for the word abuser.
Secondly, calling out stigma wherever we see it, for mental health and addiction. And most importantly, talking to one another and sharing our stories. No matter what your connection to this issue, it is not a reason for shame.
Stigma and shame can only live in the dark. They grow in secrecy. Bring it out into the light of day. Talk about it. And I think you’ll be surprised how often someone will turn to you and say, “Thank God you said something. Me too.”
And if you’re a person in recovery and you haven’t done so already, maybe it’s time to rethink some of that anonymity. Come out of the shadows and shout to the world that we are overcomers. We are victors. Recover out loud. You have hope to share. Share it. It could save lives. This is my story. Tell me your story.