This article was published in Scientific American’s former blog network and reflects the views of the author, not necessarily those of Scientific American
Last week, a reader sent me a note: “I wish I could understand what it [addiction] feels like.” For you, dear reader, in the best way I know how to explain:
It’s hard to confess that I have a problem with sleep, but I do. I’m a narcoleptic. Some days I feel like an alcoholic -- unable to think of anything else but the craving. Sleep and I have a tumultuous relationship. I’m constantly exhausted and wanting more, more, and will never turn down a nap. On the other side of the coin, or pillow, I despise it. The current medical answer for me? Downing a combination of stimulants and anti-depressants, carefully enabling me to be awake and alert while only minimally zombie-like. The short answer is there is no answer.
Does the need-hate relationship sound familiar? The same is true for addiction. (To note: narcolepsy and addiction are not identical disorders, but I'm using the similarities to describe the feelings of addiction as best I know how.)
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Until now, I’ve made it a policy to tell only the closest people in my life, though this would likely benefit all of my acquaintances (i.e., if my eyes glaze over, it’s not you!). I do this mostly to avoid the bug-eyed looks and discomfort, or the question, “Do you fall asleep standing up?” (Answer: Yes, I have. No, I do not do so often.)
Hiding It: Shame and The Emotional Cycle
Most addicts harbor an urge to hide what feels like a terrible secret, myself included, though it’s just biology.
Worse than hidden mental battles are those that scoff. Various relatives have fallen into this category and have tried to shame me awake over the years: “If you loved me, you’d want to spend time with me while you’re visiting; you wouldn’t want to sleep.”
This ignites screams and fire in my head. Emotional blackmail doesn’t work on a neurological disorder any more than it works tell someone with a heart condition that, if he loved you, he could walk up a flight of stairs without resting. (To be fair to families and friends everywhere, it does take time to understand and discover mental disorder implications.)
The irony: when relatives play the emotional hand to encourage me to stay awake, my stress level spikes, which triggers my need to sleep. Addicts feel an overwhelming need to use in stressful situations, and then they feel irrevocably guilty, since really they don’t want to use the stuff in the first place. Guess what? I would love to be awake! Addicts would dearly love to lose their compulsion to use.
Daily Life
Like an addict, I spend my days trying not to think about it, trying to avoid situations that set me off. Situations like being near a bed, or the dreaded 1-3 pm block during the day, or just thinking about sleep might be unique to narcoleptics, but other compulsions are not. For instance, emotional situations either good or bad (i.e., family turmoil or a great new job) send addicts spiraling. At such emotional cues, for me, it’s as if the universe’s force momentarily manifests to drag my eyelids closed.
As you might guess, the constant urge to sleep (or use) leads to interesting psychological encounters and relationship problems over the years, and at times I've questioned myself and my sanity. Whether it’s sleep or cocaine, the feeling is that there’s something badly wrong with you, when you go on a drug binge around holidays or fall into a coma-like slumber after a fight.
My psychiatric conversations can be summarized neatly like this:
Psychiatrist: A lot of people that are depressed feel the urge to sleep. Do you feel depressed, or sad?
Me: No, I’m not depressed. I just need to sleep.
Psychiatrist: That might mean you’re depressed. It’s perfectly OK to feel depressed.
Me: I know it’s OK. But I don’t feel depressed. I’m pretty happy in life.
Psychiatrist: I think you’re denying the fact that you’re depressed.
“Circular,” “tiresome,” and “discouraging” are mild terms to award the frustration I’ve felt. Unfortunately, many a therapist isn’t trained to counsel and treat addiction or similar disorders. Diagnoses are hard and take years, especially when there isn’t a cure-all solution.
Really, there could be any number of things wrong. Many addicts begin therapy for what are called co-occurring disorders, like addiction and depression. Addiction sometimes bleeds into other problems, or trades one form for another, opiate abuse for an eating disorder. Sometimes medication makes you feel more unhinged than before or like another person entirely. You start to lose sight of yourself and who you are. Is it “you” when you use illicit drugs all the time? No. Is it “you” when you feel like a robot on treatment medication? It takes time, patience and personal exploration to find the right balance. There’s no quick fix.
Work Balances
Addiction can take tolls on your career, and actually frame the shape of it, in less than obvious ways. It’s more than missing work or punching the time clock while under substances’ effects: it’s a problem with the industry and work itself. I’ve known pharmacologists who handle pills they abuse all day, or restaurant servers who ferry customers alcohol. Now of course, there are ways to get around these things (having someone else physically handle the prescription drugs, asking someone else to serve spirits), but it’s something that rests perpetually on the brain.
For a long time, I was intent on going to medical school and finally, and after a long personal game of tug of war, I chose not to go. The major reason? I didn’t think I could stay awake during the infamous ‘round-the-clock shifts of medical school. I was scared and didn’t want to ask for special treatment, knowing the internal politics of hospitals. Long term, I didn’t think I could handle the lengths of shifts or the uneven schedules of shifts without rest. I still think about trying it, going back to study medicine. In my heart, I know it would never work, at least not in the way I would want it to. Addiction can actually change lives and careers; this disorder has changed mine.
Day-to-Day Management Tactics
It isn’t all bad, and I live a happy, full life. But it should be said how aware we have to be. That’s the word, Aware. I lump myself in with addicts here. What do I have but a sleep addiction? (Actually, addiction and narcolepsy are closely related genetic disorders, which I’ll get into in a later post.) But that’s what it feels like. I have to plan my days through a different veil than most people, and have an Out plan in place. I’m going to a party? I’ll get there early so that I can leave if I feel tired, without seeming rude.
Some days and events coalesce into Situation Roulette. Sometimes I might be able to stay up until 2 a.m. without any more of a problem than the next guy. Sometimes an addict might be able to walk near the beer aisle safely. The cravings' timing varies and is malleable, which makes the disorder harder to understand. At times, after five minutes of being the living equivalent of the Walking Dead, I can fight through it.
Addicts all have trigger cues, or settings where they're more likely to use. Sometimes alcoholics need to leave a party when champagne appears. I’ve had panic attacks when I felt too far away from a place to sleep, once at a crowded, noisy rock concert thousands of miles from home.
What It All Means
Addiction is confusing, inconsistent and inconvenient, just as much so to addicts as to family and friends.
A friend once asked what reaction I’d like from people, or how he could help. Giving love and understanding helps. Trying to understand what I’m going through helps, because sometimes I don’t know how to express how it feels. Like describing an emotion, sometimes it’s hard to form in words, especially if your audience can’t fathom feeling the same way. The point is, though, to try.
I’ve nearly ruined relationships by my inability to explain my disorder, by hiding it and by just not knowing. I didn’t know then what I know now. Being explanatory, honest and open to questions converges as the pinnacle of success for most things -- this is no different.
I think I can speak for most addicts in a note to family and friends:
We do love you, and we’re sorry we put you through this hard journey of ours. We don’t mean to, and we’re trying to figure out how to work on it. The trouble is, no one really knows how. But don’t write us off yet. For everything over the years, Thank You.