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| DRUGS, BOOZE, AND FATAL MISTAKES CHAPTER 12 |
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If you don't now, never have, and never intend to use drugs or alcohol, you might want to skip this chapter. But if you do use drugs or alcohol or prescribed medications (especially sleeping pills, antidepressants or minor tranquilizers), then stay with me. The reason this chapter is important to you is that if you use any of the above chemicals (especially if you use drugs and drink alcohol together) and you are thinking about suicide, then you are walking on a very narrow ledge with your shoelaces untied. But first I want to ask you to do something: Don't read this chapter if you're high or loaded or stoned right now. I have a rule in my office and it goes like this: I only work with people who bring their whole brain to the appointment. It is difficult enough to come to understand ourselves and to learn new ways of getting on in this world without complicating the job by being high on chemicals. In my office you'd be paying for all of my attention, and I want all of yours. So, if you're under the influence right now, do yourself a favor and put this book down for now. Then pick it up later when your head is clear. (If you are taking a prescribed medication, okay. I will talk about prescribed medications in a bit later on.) Good. Now we have two complete brains in the same place. You already know that drugs and alcohol are both powerful and wonderful. Otherwise you probably wouldn't be using them. They can do for our moods what nothing else can. We can eat them, smoke them, drink them, sniff them up our nose, or shoot them in our veins, and the effect is nothing short of miraculous. And we can get this effect within seconds or minutes. With a sufficient dose of what we like, we can feel like gods. We can soar, we can laugh, we can send those blues on the run, we can be with people and feel like nothing can ever hurt us again. With a sufficient dose of what we like we can feel so good we ask ourselves, "Why should I ever feel bad?" I can guess what you're thinking. You're thinking, well, here it comes, the old drugs-are-bad, drugs-are-dangerous, booze-kills, etc., lecture. You're thinking I'm going to jump up on a soapbox and start preaching against the evils of substance abuse and how, if you would just wake up to the realities of these dangerous substances, you would stop using them this instant. Well, I'm going to disappoint you. I won't even pretend that I can talk you out of using drugs and alcohol in a book like this. If I thought I could, I would. But I hope I know better than that. I've been working in the substance abuse field for over 30 years now and if there was a quick cure for people who have found relief or escape though chemicals, I would have invented it a long time ago and registered the patent. Many, many years ago I realized that compared to drugs, alcohol, and sex, what a therapist has to offer is pretty thin soup. This is not to say that treatment for substance abuse doesn't work. It does. But at this moment in your life, I am more concerned about what might happen to you while two dangerous things are going on inside your body; the mixing of suicidal thoughts with alcohol and/ or drugs. So what I do want to talk to you about is drugs, booze, and fatal mistakes. Having assumed you are thinking about suicide and, further, having assumed you drink alcohol or use some kind of drug, I am going to guess that you don't do one without the other. Rather, I'm going to guess that when you are under the influence of the drug of your choice, you may think more about ending our life, not less. Or, after coming off a high, you may feel the idea of suicide, compared to the hangover or the downer that follows, has even more appeal. I'm making these guesses based on what clients have told me. "When I start to get drunk, Charles said, "I feel real good at first. I feel ten feet tall. I feel like all the problems in my life are small and far away. But then, as the night wears on and the booze wears off, I start to crash. And then I start thinking suicide again." George was sitting on a bed in hospital and I was talking to him about his suicide attempt. He had gotten drunk, gotten happy, gotten sad, and then gotten mad - mostly at himself for having gotten drunk again. "What went through your mind before you got the knife?" I asked him. "I thought. ..let's see. ...I guess I thought that, what the hell, things are never going to be better. I can't even stay sober." "Do you remember your last words to yourself?" I asked. George thought a moment. "I think they were, What the hell, he said. What the hell. What's the use. Nothing ever gets better, so why try. These are examples of the negative thoughts people often have when they are high or coming down. They are often the same thoughts that go through their heads before they make an attempt on their life. "Were you drunk when you got the knife?" "Sure was, said George. "Would you have stuck that blade into your wrist if you had been cold, stone sober?" George shuddered. "Hell, no! It would hurt too much!" Having known lots of people like George, I told him that as much as he might like to kill himself, I doubted very much if he could ever get it done sober. He agreed with me. He agreed that he would have to get good and drunk before he ever tried to kill himself. As he said, "I can't see how anyone can kill themselves unless they're drunk. It's just too painful. The solution to much suicidal thinking and fooling around with pills and knives and guns and reckless driving and vague plans to kill yourself can, in my opinion, be solved by simply getting straight and staying that way. I know that may sound simpleminded, but over the years I have met dozens of people whose thoughts about suicide only occur when they are intoxicated. It is as if thoughts of self- destruction do not enter their heads unless and until they are under the influence of some drug or other. (By the way, because alcohol and drugs are both drugs, I use the words alcohol and drugs interchangeably.) Because of what people like George have told me, I know how people can think when they are high. If they are in a good mood when they start to drug, that mood sometimes gets better. If they are in a bad mood when they start to drink, their mood often gets worse. If you use enough drugs or alcohol, it's sometimes hard to predict what kind of mood you may end up in - including a suicidal one. At least two other things happen to us when we get stoned. One, we begin to lose control over our thoughts and actions and, two, things do not frighten us the way they did only a short time before. Alcohol is a solvent and one of the things it can dissolve is fear. Even though this chemical courage only lasts as long as the alcohol is in our bloodstream, while it's there it works pretty well. As one shy young man who made a habit of putting down three or four beers before going to a dance told me, "Why do you think I use the stuff?!" If we could look our fears right in the face cold sober, many of us probably wouldn't need booze and drugs at all. But fear is fear and, since chemicals do work, you may have developed a dangerous habit of drinking or drugging to deal with what is frightening or painful in your life. When we've been thinking about our own death (the most frightening proposition of all), it isn't like a hit of some drug or another drink is not going to help. Because it will. That's the one sure thing about drugs and alcohol - they always work. But this is where the risk comes in. If you use a drug or alcohol to change your mood and your changed mood permits you to think more about suicide, then it follows that, while under the influence, you are more likely to do something you would otherwise fear doing - namely, trying to kill yourself. The research on this, by the way, is quite clear. People who drink and use drugs are at a higher risk of suicide than those who don't. Whether drug and alcohol use leads to suicide or simply permits suicidal people to carry out their plans doesn't really matter to me right now. I'll let the scientists sort that out. What matters to me is that you and I both understand that if you put yourself under the influence and start thinking about suicide, you've greatly increased the odds against your own survival. Here is another way to think about it. Cold sober, would you help someone high on drugs to take a fatal dose of heroin? Could you, in your right mind, hand an obviously depressed and drunken woman a razor blade with which to kill herself? Would you, with a clear head, let an angry and brokenhearted friend stoned on booze get into her car and drive home? Of course you wouldn't. You would say, "Hey, sober up! Don't do something crazy! Don't do something you'll regret." Assuming you, too, were not stoned, I'm guessing you would do everything within your power to stop an intoxicated friend or stranger who was talking suicide from doing it. Why? Because you and I both know that when they sober up or come down, they might not want to kill themselves. You don't have to be a doctor to know that people under the influence are not packing a full load of bricks. Not only are they two bricks shy of a full load, they don't even know where they left the wagon. If you don't even know where you left the wagon, how can you decide something as important as whether to live or die? If you wouldn't let some stranger who is high kill himself, why would you fool around with suicide under the same circumstances? Why wouldn't you give yourself the same chance to rethink things with a clear head? Fatal Mistakes The other thing I want to talk to you about in this chapter is fatal mistakes. Even sober and straight, we all make mistakes, including fatal ones. We can be distracted and make a left turn in front of a milk truck and that's the last mistake we will ever make. We can dive into a swimming pool on the wrong and shallow end, hit our head on the concrete, and that's that. We can climb up a tree to rescue a stranded kitty, fallout and end up in the next life - probably not liking cats very much. But these are fatal mistakes over which, because we're sober, we have some control. We might even have been thinking about suicide when we did these things, but it isn't like we set out to die by making some dumb mistake. Not at all. But now let's add booze or drugs and thoughts of suicide to the dangers of everyday living. Let's go up that tree after the kitty loaded on something. Let's crawl out on that skinny little limb bombed. Have we increased our odds of ending up in a fatal mistake? Or what about drinking too much and getting behind the wheel of a car? It should come as no surprise that when you have been thinking about killing yourself, drinking, or doing drugs, and get into a car that can do a hundred miles an hour, you're setting up a situation that is loaded for a fatal mistake. (And you're not doing any of us on the road with you any great favors either.) Then there are the fatal mistakes that arise out of simply mixing drugs and alcohol. Alcohol in combination with other drugs can be nothing short of deadly. Without going into a complicated explanation of cross-tolerance and drug-potentiation effects, what you need to know is that when you add drugs and alcohol together in your body, a new kind of math takes place. This version of new math can kill you, even though that may not be what you intended to do. The new math works like this: One ounce of alcohol added to one dose of a drug does not equal two ounces of effect. Far from it. One drug plus one drink might equal four or five or even six ounces of effect. In other words, alcohol can make a drug more powerful and vice versa. This goes for prescribed medications as well, and especially sleeping pills. One evening in 1974, a twenty-year-old girl drank several gin and tonics and took some pills. The new math took place in her body and she lapsed into a coma, a coma that lasted more than a decade. Her name was Karen Ann Quinlan. This combination of drugs and alcohol accounts for thousands of deaths worldwide each year, and it is not always clear that the person who died from the new math truly wanted to. Among names you would recognize are Judy Garland, Marilyn Monroe, and Elvis Presley. And for each of these famous names, there are thousands more who only earned a paragraph in the obituary column of their local newspaper.One of the things that happens when you mix drugs and alcohol, or simply start taking sedatives or tranquilizers is that, once the drug begins to take effect, you may begin to lose count of how many pills you have taken. Since short-term memory is affected while under the influence, you may simply lose track of how much of something you have ingested. I don't know about you, but when a doctor prescribes a medicine for me that is supposed to be taken three times a day, I have trouble remembering if and when I took it. If I have two or more medications to take, I have to write down, count out, or otherwise go to some extra effort just to follow these simple directions. If I were drinking alcohol while taking these pills, I could end up a whole lot sicker than I was when I started. The point I most want to make is that if you have been thinking about the forever decision, you at least ought to do it with a clear head. It is just too easy to slip down into the dumps, start a drinking or drugging episode, let your mind wander off into the seemingly simple solution of suicide, and, because you cannot weigh things out because you've put your brain on the shelf and your fears on the run, you can end up "accidentally" overdosing and dying - maybe quite by mistake. I know what you're up against with drugs and alcohol. I know what a wonderful tonic these are against bad feelings. I know they work faster than other solutions and that, in them, you can dissolve most anything - anger, depression, hurt, a broken heart, just about anything that is painful. And I know that once you are addicted, the job of getting off the stuff is not something you just up and do one morning before breakfast. But I also know you can get drug free. It takes some time, it takes some help, and it takes some strength and courage. But you can do it. In the meantime though, since you've been thinking about killing yourself, I want you to know that when you mix drugs or booze with depression and hopelessness and anger and disappointment and whatever else is troubling you, that you are engaging in the most dangerous gamble imaginable. While you may not be entirely sure you want to die, if you put this mixture into your body it is as if, like a coin, you are tossing your life into the air. It may come down heads, you win, or it may come down tails, you lose. I ask you: Is this the kind of high-stakes gamble you want to take? For my part, and if you were in my office with me, I would now tell you another of my rules: I don't work with suicidal people in therapy while they're using drugs or alcohol. The risk to you is just too great and it is not the sort of gamble I'm willing to take or be a party to. As my patient, if you couldn't stop using drugs or alcohol on your own or with the help of Alcoholics Anonymous or Narcotics Anonymous or some other treatment program (and I mean right now), then I would refer you to an inpatient program to help you stop using. This may sound hard-nosed, but if I have learned anything in more than 30 years of psychological practice it is that you and I need both our brains in full working order if we are to work together effectively. More importantly, because I have come to value you as a human being, I wouldn't want you to die by some mistake or miscalculation. Life, yours or mine, is just too dear to lose in the toss of a coin. |
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