Updated: Aug 30
It was April 2005 when I walked up to the car rental booth at Phoenix’s Sky Harbor International Airport and announced to the man behind the counter, “I’m high on cough syrup.” I had spent a year researching the history of the Narcotic Farm for a documentary with my partner JP Olsen and at that moment I felt like a test subject in the institution’s Addiction Research Center. I let loose a verbal flash flood: “I’m having trouble using my hands and things look streaky and my feet are kind of floating but that’s not what I meant to say. My name is Luke Walden. I’m really high on cough syrup.”
Addiction Research Center Inventory (ARCI)
I was close to reenacting an old story: in trying to calm a body-wracking cough, I had taken two gulps of an unfamiliar syrup called Delsym and accidently gotten high. And I kind of liked it. While my intoxication subsided by the next morning, I continued to enjoy the medicine’s apparent side effect of making tedious work (videotaping a sales conference) not just bearable but even pleasant for two full days. But suddenly on the third day I found myself bored to tears, exhausted and desperate. I considered taking more of the orange syrup and if there had been a fourth day I might have. A news segment on the tiny TV in my taxi back in New York made me glad I hadn’t. I learned that Delsym’s active ingredient Dextromethorphan (dxm) was the hot new drug of abuse among high school kids. It all seemed like a familiar story ripped from the annals of drug history.
Four years after finishing The Narcotic Farm, I find myself still hooked on the history of drugs. (Literally. I just spent two guilty hours compulsively reading old Points posts and watching YouTubers trip on dxm and salvia.) It puts me in a strange position. I am a generalist documentary filmmaker (and now mostly full time dad) who only got involved in the “Narco” project at JP’s invitation. So I am sometimes startled to find myself on stage in academic settings, being asked serious questions about what addiction is, what lessons we should take from Narco’s history, and what I learned from doing this project.
I tell audiences first that I learned to approach historical accounts and especially documentary films with a healthy dose of skepticism. Filmmaking is highly constrained by the need to engage and constantly maintain the viewer’s interest. This is usually interpreted to mean that “storytelling” takes precedence over all, that a good story follows an Aristotelian or “Hollywood” structure and is told in terms of one or two main characters’ emotional experiences. I call it the tyranny of narrative.
On the nod at the ARC
I also tell people that studying the history of Lexington has educated me surprisingly well to cope with having an addict in my own extended family. This unexpected benefit first became clear when I recognized that my mother-in-law was “on the nod” at Christmas dinner. Rather than being mystified to see a normally vivacious person slumped over the ham, my study of the old Addiction Research Center lab films allowed me to confidently identify opiate intoxication. Catherine had been prescribed OxyContin after shoulder surgery and had tried to taper her dose by cutting her time-release pills in half. It was an old familiar story of accidental overdose. I thought of myself floating through Sky Harbor.
My historical research equipped me to speak matter-of-factly despite Catherine’s history of defensiveness about her alcoholism. She agreed not to drive and to see a doctor about minimizing her use of narcotics. But her entanglement with opiates didn’t stop there. Some months later I took one look at Catherine lying sick in our guest bed with her legs stirring the sheets and recognized that she was kicking cold turkey, just like the test subjects in the A.R.C. films. She had run out of her prescription but thought she just had the flu.
After several months she got clean, but she believes that the opiates “softened her up” so that depression could trigger a shockingly severe relapse to alcohol after 10 years sober in Alcoholics Anonymous. My research helped me again. When she called with crazy excuses for failing to do what she promised I was emboldened by our interviews with retired former addicts and by our study of therapeutic communities such as Matrix House to confront her. I could say, “I know you are lying to me and I know that’s what addiction makes people do. If you can be honest with yourself and with me that you have been drinking, then we can discuss the actual situation and figure out how to work on this problem together.” Her years of work in AA and my ability to compassionately confront her opened a productive dialogue. Ongoing conversations didn’t solve the problem, however, and over the next few months things deteriorated. In one three-week period she was admitted to an ER and two detox centers and spent a day in jail.
At her lowest point Catherine took comfort from one of Lexington’s lasting legacies: the definition of addiction as a chronic relapsing brain disease. This model was proposed and debated by Harris Isbell, Abraham Wikler and others at the ARC in the 1950s and has since evolved and become entrenched as the public slogan of federally funded research on addiction. Points has entertained a lively discussion about what David Courtwright has recently called “the NIDA paradigm.” But one aspect of this idea not extensively explored in recent Points posts is how the disease concept affects people in recovery and their families.
Catherine has told me that thinking of addiction as a disease helped her to overcome deep shame so she could make the honest self-assessment necessary to get back on the path of recovery. Discussing addiction as a disease allowed me to frame it not as a problem with her as a person, which might make her feel attacked and me resentful (though inevitably there is a bit of both), but as an affliction. If she had cancer I would be compassionate even though her smoking might have brought it on. Similarly, thinking of addiction as a medical problem allowed me to set aside emotional reactions to her addictive behavior and act as compassionately as possible. Ironically, having completed outpatient rehab and with several months sober in N.A., Catherine now says she doesn’t think that addiction is a disease. That definition is no longer relevant for her and instead she thinks about recovery in terms of taking personal responsibility for her choices.
Promoting the disease model at Lexington. Photo by Arthur Rothstein, 1939.
It’s also ironic that in my own life the most useful lesson of Lexington’s forty year history is the original ideal upon which it was founded in 1935: that addicts should be treated with compassion, as “sick” people needing help. Defining addiction as a disease can be useful. It elicits compassionate behavior (and policy decisions and funding) from those who do not suffer from it. But I remain curious about how addicts themselves experience the effects of the disease definition. Do they feel liberated from shame and stigma? Or burdened with a defective brain? Does defining addiction as chronic and relapsing facilitate recovery or precipitate relapse? How would I feel about it had I gone back to the Delsym again and again and taken a journey as hard as Catherine’s? And do these pragmatic, treatment-oriented considerations even matter for addiction researchers or historians? As an accidental drug historian I find that they matter to me.
— Luke Walden