Addiction is often compared to diabetes. I got dealt a pair of medical aces.
Two months after I passed out in the middle of a comedy show, in the midst of a decade-long streak of sleeping at parties, I fell into a diabetic coma. It started with a weekend-long period of throwing up in late October 2014.
Unexpected vomiting is a symptom of ketoacidosis, a fancy word for hella high blood sugar that occurs when your blood is so acidic, your organs can’t function. Being a type I diabetic since age 12, I should have had my chronic illness at the forefront of my mind. If I had, the constant vomiting would have prompted me to test my blood sugar to see if it was abnormal.
But by that point, I was short on blood sugar test strips because I’d spent the last few years selling them. That’s right—I sold them to a random Craigslist guy to make extra cash to support my 25-hour-a-day weed habit. So no strips meant I tested my blood sugar infrequently. Plus, I was too high for the thought to enter my mind.
Thus, I endured the vomiting thinking I had food poisoning. I’ll just get high and sleep it off, I remember telling myself. What I thought would be a half-day nap turned into a month of me unconscious, while my family and friends went through a hell of hospitals and uncertainty. Word even spread that I had died.
That’s a lot to unpack, so let’s not yet. Right now, I want to focus on a theme that recurs in survival stories like mine: the “rock bottom” phenomenon.
All rock bottoms are not created equal
The coma was unquestionably my bottom. What is questionable is why it took ketoacidosis for me to tend to my bad habits and self-destructive behavior. Is such a rock bottom necessary for someone to effect change in their life? How can anyone create meaningful change that lasts?
I worry about the way the expression makes it seem as if there is some objective standard for what counts as “hitting rock bottom.” Must it always involve the loss of family? Of everything? Of self-respect? Of the respect of other people? There’s no one answer.
Furthermore, I worry that people assume that hitting this rock bottom is the only way that people will ever attempt to make significant changes. There’s a belief that hitting this bottom will necessarily prompt a change. This way of thinking may perversely and ironically keep a person from seeking help earlier, when the problem may not be as serious.
Dr. O’Connor goes on to suggest replacing “rock bottom” with the concept of a “misery threshold,” as developed by William James in his The Varieties of Religious Experience. A person’s misery threshold is the point beyond which they will not allow their physical, emotional or psychological pain to continue, and crossing the misery threshold can prompt an individual to begin the process of making serious changes in their life.
The misery threshold concept unshackles addicts as well as their families and treatment professionals from the tyranny of an objective standard that creates a barrier to entering recovery, in favor of focusing on the individual addict’s experiences and desire for change. As Dr. Akikur Mohammad, a board-certified psychiatrist and doctor in addiction medicine, writes in his book The Anatomy of Addiction:
There is no medical science that supports the idea that addiction can be treated only once you’ve blacked out on Skid Row, driven a car into a tree, ended up in a hospital or jail cell, or any other calamities associated with hitting rock bottom. That’s tantamount to saying a diabetic can be treated effectively only once he or she goes into insulin shock. It’s always better with any chronic disease?—?be it asthma, heart disease, bipolar diseases, or substance addiction?—?to get help early.
Another way of saying this is an old aphorism in recovery: “Your bottom is where you stop digging.”
I’m annoyed to see how often treatment for addiction is compared to diabetes, but I guess I’m just one of the lucky bastards who got dealt a pair of medical aces. In my case, I stopped digging in both areas at a pretty low point, but even near-death almost didn’t stop my internal engine’s bent toward self-destruction.
What comes after rock bottom
I woke up from the coma (spoiler alert: I’m alive!) not knowing what had happened to me and thinking I was in rehab. The fact that my brain immediately assumed “rehab” suggested to me that I had a problem with alcohol. In the Cincinnati hospital to which I’d been transferred, I promised my parents I was done with drinking for good. We could all go home, I insisted. They responded as gently as they could to my naiveté, saying they were happy to hear I was committed to my health but that I wouldn’t be leaving the hospital just yet.
At the time, my commitment to quit drinking must have seemed like nothing more than a flight of fancy cooked up in a heavily-medicated fever dream. And yet the decision stuck. I have not had a drink since waking up.
But upon my return to Chicago, where I lived, I took up my weed habit anew. It was a three-week return to my old life of doing nothing more than getting high and performing in or seeing comedy shows. By the end of it, I was smoking nearly as constantly as ever, and I began to feel distant from the trauma that held the potential to make me change everything.
If you had told me in the midst of all my pre-coma misery that an event would occur that’d shake up my entire life like a snow globe, allowing me to reevaluate my orientation toward the world and everything I had in it, I would have said, “Bring it on.” You might have replied, “Ummm, dude, are you sure? It’s not going to be good”—but even now, I have to acknowledge that surviving the coma was the best worst thing ever to happen to me.
Yet, after all I’d been through, there I was, feeling as stuck as ever.
Honoring the epiphany
After realizing that the coma might as well have never happened for all the good it was doing me, I decided to get completely sober. That meant no booze and no weed. If nothing else, I felt compelled to honor my coma for the epiphany I wanted it to be. I couldn’t trip into an epiphany. I had to work for it.
It was the start of a long and ongoing journey of focusing on my physical, mental and spiritual health that has laid the foundation for many wonderful changes in my life.
The thing is, change doesn’t just happen, and it certainly doesn’t happen magically or overnight. In a different blog post about the human capacity for change, psychologist Linda Sapadin writes plainly about some of the keys to creating change that sticks:
You acknowledge the need for self-discipline, perseverance and hard work. You know why you want to change. You know who you want to be. You know that your actions need to adhere to your beliefs. You know it makes no sense claiming you want to change but then doing nothing about it. You’re tired of disappointing yourself. You’re fed up with feeling frustrated. You welcome change. You’re ready to go. You get off your butt.
“Rock bottom” may not be a helpful yardstick in the general treatment of addiction. Bottoms happen, but each individual must define their own. Once it’s acknowledged, escape from that dark place is possible. But the key is to stop digging. We have to claw up and out, inch by inch.
My bottom was more than the coma. It also encompassed the desperation I felt when faced with the possibility of returning to my old, weed-addled, anxiety-and-depression-ridden life of misery and disappointment. Awareness of that desperation was an important first step, but that awareness alone wasn’t enough to create the lasting change I hope I’m building now. That required commitment. Real change is gradual, even when it begins with catastrophe.