Addiction, Dependency and Vicodin

Tonight, NBC is debuting its new show, The Book of Daniel. Normally, I don’t catch when new shows come on, but there has been a bit of kefuffle about this particular show because of its themes: the American Family Association has decided to protest the show because, among other things, the daughter is busted for doing drugs, a son is gay, and the main character, an Episcopalian priest, is addicted to Vicodin. That addiction may or may not be the reason Jesus is quite literally his co-pilot; he sees and talks to Jesus, who is an active character on the show. Now, personally, this sounds right up my alley, and I’m sorry that I can’t see the two hour premiere tonight. But, it’s not terribly surprising – if the AFA dislikes it, chances are I’ll love it; they’re a fabulous barometer for things, so far as that goes.

But what actually has my attention about this is comments that I’ve seen from several sources: friends commenting to me, in other people’s journals, and critics who’ve been reviewing the new show. Everyone is commenting that this is another in (what some people fear will be) a new trend of Vicodin-addicted characters, and they then immediately cite Hugh Laurie’s brilliantly portrayed Greg House, who eats Vicodin like candy.

Now not being a television reviewer, I can’t comment about The Book of Daniel; I’ve not seen the show, after all. But I was a regular devotee of House when I could be home on Tuesday nights, and I have every intent of watching it again this quarter. And I can tell you, pretty damn clearly, House is not a Vicodin addict. “But wait, Kelly” you say. “What about that episode where he was dared to go off the Vicodin, and he went through withdrawal? That proves he’s an addict!”

Does it? Let’s play a small game. This game is called “what happens when you drink several lattes a day for a year, and then suddenly cut that latte out without warning, and consume no other caffeine.” What happens to you? Do you get a headache? Do you start sweating? Are you nauseated? Do you generally feel miserable? Of course – and when talking about this, people say they’re going through caffeine-withdrawal because they were addicted to it.

This is technically, medically, incorrect. Your body is physically dependent upon the caffeine, but you aren’t showing drug-craving, drug-seeking behaviour because you don’t have the caffeine. Addiction is a biological and psychological condition that compels a person to satisfy their need for a particular stimulus and to keep satisfying it, no matter what the cost. Dependence is a physical state that occurs when the lack of a drug causes the body to react. Physical dependence is solely a physical state indicating that the body has grown so adapted to having the drug present that sudden removal of it will lead to withdrawal reactions, and this can happen with almost any drug.

The character of Greg House is in constant, chronic pain. The physical dependency on Vicodin is one that allows the character to maintain a normal lifestyle. To use analogy to illustrate the point, imagine that a normal, healthy person is akin to a full glass of water. Someone who is in chronic pain is only half a glass of water without their pain medications. Add in a bunch of ice cubes, though, and the person in chronic pain is brought back up to the level of normal and functional everyone else is. (And in the case of the addict, toss a few ice cubes in a full glass of water, and watch everything spill everywhere in a mess – that’s addiction.) The chronic pain person needs those ice cubes of Vicodin on a daily basis to provide what the body needs to function, but it’s not a situation where they would actively seek out, need, or desire any more than is necessary to achieve that state of near-normalcy.

The writers of the show House have been irresponsible in how they’ve portrayed the character of House’s dependency. They have openly questioned – and suggested – that he’s an addict when he’s not. This causes a lot of grief for actual living and breathing people with chronic pain. There is a stigma to needing to take Vicodin every few hours, or oxycodone, or any other opioid. This stigma, shame, and fear prevents many doctors from properly treating pain, and prevents many people from seeking out the relief they need. It’s impossible to say, without seeing, how The Book of Daniel will handle the character’s need for Vicodin, and whether it is an addiction or a dependency, but hopefully they are very clear on which it is, and do a better job than House has at distinguishing between the two states.

That House made the decision to feature a character living not with but in spite of chronic pain is something that drew me to the show. After all, I have a chronic pain condition. I eat Vicodin like candy, and often take two or three other opioids on top of it to control my pain. I’m also an honors student, I work 20-30 hours a week, I teach, and have an active social life. I’m about as far from a junkie as it gets – but if I skip that dose of whatever is up at the hour, I will break out into a sweat. I will start to get a headache, my heart will race, my nose will run.

Regular use of some medications is necessary for some people to live a normal life. A diabetic is not addicted to insulin, nor is someone taking medication to control their high blood pressure addicted to it. They are, however, dependent upon it, as a person in chronic pain is dependent upon their drugs to function normally. And perhaps that’s the thing you need to consider when weighing whether it is an addiction or a dependency – the person who is addicted does not have improved functionality with their addiction, while the dependent person does.

While I wouldn’t say this is a sore subject for me, I would say that it is a personal one, and one that I hope people will keep in perspective when they are cracking their jokes about pill-popping doctors and addicted ministers. There are people out there, people you know, people like me, who have invisible disabilities and dependencies. And while you make your cracks about Vicodin popping addicts, I make a mental note that I should make sure to not take my pain medication when you’re watching. I already deal with the stigma of disabitliy, I don’t need the stigma of addiction to go with it.