A grittily illuminating look at addiction

As editor Douglas Gosse points out, no topic is more unifying, capable of scaling and all social and economic barriers, than addiction. This collection is composed to expose and enlighten that.

The personal accounts are divided into sections of, first, addiction to drinking or smoking or ingesting drugs like cocaine or opioids; second, to drowning in a digital pool of, for example, gambling or porn; and third, wrestling with eating or body disorders.

It opens with that most accessible of vices, cigarettes. “Back then, smoking was considered a habit,” Jennifer Barnett relates about public health awareness in the 1970s, in “My Life is Going Up in Smoke.”

Employers often placed an ashtray beside your typewriter. Her mother smoked – the doctors told her it was fine, even during pregnancies. Her grandmother smoked – the doctors actually advised her to, to mitigate stress. “Smoking has a unique place among addictions.” It’s hard to quit, because it’s still somewhat acceptable.

As is drinking, as Michael Parsons addresses in his letter beginning, “Dear alcohol, We can no longer be friends, ever.”

And then there are the behaviours that are more broadly associated with addiction. As Stephen Miller writes in “A Choice,” he and his partner “lied, cheated, short-changed, and betrayed whomever necessary, up to and including each other … At the time it seemed pretty exciting … romantic, almost. We made quite a team … In the life of an addict, success is measured by your ability to stay high. Me and Joy were very successful addicts.”

In the middle section, Kaila Mcanulty explores sex addiction from a diagnostic and therapeutic perspective, and David Frenkel its legal ramifications (for example what can determine a parent’s access to children if the marriage ended because of extramarital encounters or entanglements).

Of course, the internet offers a new universe for such cravings – in fact it creates whole new compulsions. As Ian Young chronicles his virtual addiction: “At my absolute worst, I played video games sixty-four of seventy-two hours, the rest was spent passed out on my bed beside my computer, or directly on the keyboard. Video games gave me a community of like-minded individuals who didn’t care for the things I was mocked for in my real life.”

Addiction also seeps from the food we need to put in our bodies, and into our very bodies. One woman eats until she weighs almost 600 pounds; Hazel Mills’ tracing of the beginning and end of this condition, embedded in two conversations with her parents, decades apart, is insightful and very moving. Margaret Scott, whose mother has been told by a doctor that her daughter eats too much, goes to university and meets a fellow student who consumes only clear tea and six crackers a day. She weighs eighty-five pounds but would like to lose five more. Scott dodges that lethal cycle but still became “obsessed with food: clean food, non-gmo food, organic food, and fair-trade food. I still eat too much of it.”

A fixation on physical perfection is usually associated with girls and women, but body dysmorphia also affects boys and men.

Andrew Drechsler, in “Concave Man,” writes “I wasn’t just skinny. I was extremely skinny … I never seemed to ‘fill out’.” His chest is sunken, an object of mockery to family and fellow students. In locker rooms he tries to be invisible. He never goes to the beach. At the same time he is successful in his career. “With a promotion at work came a compulsory physical exam. I didn’t normally see a doctor as I was still in my twenties and otherwise healthy. I asked the doctor about my chest and the possibility of corrective surgery. He could not have been more rude and insulting.”

There are patients addicted to medicines their doctors prescribed them. And doctors who become addicts themselves. Physicians have unique risk factors, explains Derek Puddester, with their student culture of binge drinking and caffeine; access to all kinds of drugs, including product samples; and the stigma against seeking help for their own mental health problems.

The book closes with an assessment of contemporary treatment theories and options, and a review of service providers.

My one critical note would the title. “About Face” seems to imply a simple 180-degree change in attitude, and there’s more then that in grappling with such dependencies; it also suggests something superficial, which is also far from the case.

But the work inside is gripping, grittily illuminating, heartfelt, and occasionally very funny.