As Needed for Pain — recovery concepts

Dan Peres, former editor of Details magazine, recently released a memoir of his time as an opiate addict while heading a major publication. As Needed for Pain is a quick read with some interesting aspects.

Dan, who is a pretty clean cut individual, comes to opiates in a not uncommon way. He is prescribed Vicodin for a back injury. The trouble starts when the pain stops and Dan needs opiates to function. The book brings up an interesting question about opiates: How should these be prescribed in the setting of pain? Back in the early 2000s the theory was that if opiates are used for pain a patient cannot become addicted. Unfortunately this has been proved false on a massive scale. There are however many instances of patients using opiates for their pain and not becoming addicted. What separates the situations where people are at risk for addiction from those where they aren’t? Truthfully that has not been adequately answered and the use of opiates to treat pain is still not straightforward.

Dan honestly outlines his exact opiate regimen, which is staggering. He was using upwards of 60 Vicodin a day. For anyone reading that some immediate questions come to mind, like how the hell was he able to get that many pills? He does a good job of detailing what he did. He was a master at a practice known as Dr. shopping. Dan was in fact going to legitimate prescribers, not pill mills, but he was going to multiple physicians. This practice was the impetus for the electronic databases that were put in place to keep track of how many opiates a patient is prescribed. Dan did this in the 90s and early 2000s. Today acquiring this many prescriptions would be much more difficult.

Another question, one that was left unanswered, is how in the world is Dan not in liver failure? Vicodin is made of opiates and acetaminophen, Tylenol. Taking those doses for that long places your liver in serious jeopardy. This question remains unanswered.

An interesting aspect of Dan’s addiction is the sanctioning quality the white coat confers on the use of opiates. Dan drew a line at the use of what he viewed as heavier drugs, such as heroin, because he did not see himself as “that type” of addict. The fact that the drugs were prescribed by a doctor, even though he was not actually taking them as directed, provided him with justification for their use despite the strong evidence they were destroying his life. This sentiment comes up repeatedly in stories of those addicted to opiates, they often begin the journey with a prescription for pain. This highlights the fact that when prescribed, patients need strong warnings on the dangers of opiates. Perhaps even a copy of Dan’s book.

Dan describes in detail the progression from using opiates regularly for pain to the need for opiates to function. He rapidly requires the pills to keep him from going into withdrawal and to allow him to continue functioning at work. From his descriptions it appears no one around him knew he was an addict until he came forth with the information. This highlights the extent to which the body can develop a tolerance to opiates and in fact function at a level that can masquerade exactly what is going on. What Dan brings up here is heard time and time again in stories of addiction. Parents often say they had no idea their child was using.

The book also does a good job of describing the physical agony of withdrawal. Dan repeatedly touches on not only the crippling effects of withdrawal but how the fear of going into withdrawal is in itself crippling. A good percentage of his time appears to be living in fear of withdrawal and actively seeking drugs to prevent it.

Dan finally manages to escape the grips of addiction. When this happens highlights an important aspect of addiction recovery. Dan is able to recover when he in fact is ready to, not when the rest of his friends and family are ready for him to and well past the point that all signs point to the fact his life is falling apart. This moment is different for everyone. For Dan it was when his first child arrived.

The book is an entertaining quick read but not excellent. The time sequences jumped from childhood memories to more recent events repeatedly. This was somewhat disorienting although maybe done for effect to portray what his overall thought process was like while using. The childhood memories were boring, sorry Dan, and you find yourself jumping to the parts where he’s working at Details.

The most frustrating part of the book is that it lacks details on truly great stories. It's like everything is a little fuzzy. At one point Dan meets Mike Tyson but has to leave due to withdrawal symptoms. I found myself upset that his memory of the meeting and surroundings was not more vivid but instead occupied by his physical state. In another memory Dan is apologizing to Ben Affleck for misquoting him. Again the memory of Affleck and what happened is limited and what is recalled had more to do with Dan’s state. This brings up one of the most dangerous aspects of drug use that does not often get enough attention- great experiences are sacrificed due to a lack of full consciousness. It is impossible to fully participate in the world around when your every thought is clouded by addiction.