In 2018, as a young physician who was quite unfamiliar with the world of drugs, I began to delve more and more into the issue of drug use and harm reduction, realizing that it was a critical need that was not being addressed. I prepared a table of dangerous drug interactions, set up first-aid courses for party-goers, wrote countless articles on the subject, and realized I had stepped into a realm truly pivotal for saving lives and averting severe medical crises.
I do not specialize in treating addiction as a doctor but rather try to make information accessible about drug use and its dangers, yet in my recent years of dealing with the topic, Addicts and their families seek my assistance in finding the necessary help when confronted with situations of addiction that demand treatment.
Sadly, the number of people turning to me has increased over time, especially in the last two years. This also uncovers the profound shortfall in the current treatment options available for addressing this issue.
I see it every day and everywhere - friends, work colleagues, leading figures, and everyone who doesn't fit into the pattern that we so easily assign to addicts. In the late night hours, just before the onset of war, I was inspired to write this article following an encounter with another family desperately seeking help. This experience made it clear to me that I could no longer keep silent. I felt compelled to share the realities of this pressing issue, realities that are not just mine but also belong to the world we all live in.
Currently, this reality is only worsening the situation. In an era where numerous individuals resort to substances as a coping mechanism for anxiety, depression, diminishing self and familial assurance, and the instability of daily life amidst the conflict in Gaza, the prevalence of addiction across diverse demographics is bound to escalate further post-war. This is particularly true for those who have endured the front-line battles, as they face the daunting challenge of reintegrating and functioning in everyday life once the conflict has ceased.
They are around us all day. They are the lawyers who represent us in court, the doctors who treat us in the clinic or hospital, the pilots who fly us to our summer vacation in Ibiza, successful high-tech CEOs, and engineers who decide whether the building we moved into is safe enough to live in. Perhaps no less important - they are our best friends, our beloved children, and those whom our family is most proud to tell about what they are doing and how successful they are, and they indeed are.
But behind these successful lives, and perhaps partly because of them, things start to happen - Instances of repeated delays, an increasing number of sick days, showing up at work with fatigue and bloodshot eyes, sudden outbursts of anger towards superiors which were previously unheard of, and occasional minor car accidents. These are accompanied by unusual shifts in behavior, ranging from an exaggerated display of joy and excitement over trivial matters to an apparent disinterest in even the most significant issues that would normally demand attention.
Trying to understand the signs
Sometimes we ask ourselves - what's going on with them? Why are they suddenly sending angry letters to the whole world about things they used to brush off easily, why do they start to clash with colleagues without restraint, Why have they unexpectedly started to skip the family meals they used to cherish?.
We also start to ask why they have lost weight recently, how come they forget to put on some perfume at least because wow, the smell isn't great, and then suddenly we also look at a picture from two years ago and ask - how can it be that they seem to have aged a decade? But despite all this, we suddenly remember the talented people, the efficient ones, those who always control the situation, those we turn to for advice on what to do with our career or with our money in the stock market.
Thus, we begin to weave a different narrative in our minds - "He's just going through a minor rough patch, it'll resolve itself," "That's just his way, he's always been like this," "It's just a part of aging, caring less about things," "Honestly, if I were in his shoes, dealing with that kind of job stress, I'd be overwhelmed too."
And them? They're excellent at hiding, especially because they don't feel they're hiding anything, after all, there's no problem. After all, just three years ago, they started with a little sniff of coke at a friend's house, or on evenings of good cheer after a crazy workday, or with some "Doctor" (MMC) they were given to try, and they felt that it was so light, it made them feel good but without any "down" the next day at work - how wonderful! But gradually, the occasional indulgence turns into a more frequent habit, shifting from "just once in a while" to an unpredictable pattern of "yes one day, no the next, maybe the day after." Before long, Telegram evolves into a regular tool for transactions, closely intertwined with their credit card use.
The first to notice might be the close friends, some of whom actually manage to control their use, and they start to throw words every now and then like "Maybe we'll relax today?", "Let's just go to a movie or maybe have a quiet pizza night at home". But that's it, a pizza night at home without “lines” on the table next to it,is no longer an interesting evening, In the end, what are they really seeking? Simply a respite from the hectic day spent with kids, wrapping up work, and navigating the complexities of our Western lifestyles. So if the friends decide on a quiet evening, maybe it's time to find some new friends?
And their luck, or maybe their biggest curse, is the "reserves" - the fact that they are so smart and functional, the fact that at any given moment, even if last night was terrible, they will still know how to stand in front of an audience, give a crazy show in a lecture, Excel impressively during a presentation to investors. Over an extended period, they lead a dual life – one part playing the role of a family person and professional, and the other consumed by the shadowy world of nighttime and substance use.
And then? Then we understand too late, that it's no longer them, but the dopamine, serotonin, norepinephrine, and all those neurotransmitters that make us who we are on a daily basis, and also change us when we mercilessly play with them consistently through such and other substances. And who would have believed that he, he? would become addicted to crystal meth?! That she would become addicted to MMC? But in the end, our denial, and especially theirs, only leads to one way in which even in the most extreme moments, a step from death, they still might not see that there is a problem.
Adopting a harm reduction approach
The addicts of 2023 were born into a world where the enforcement (or lack thereof) of drugs is no longer something that scares them, and led us as caregivers to increasingly adopt a harm reduction approach - understanding that saying “It’s forbidden” won't save them from the next visit to the emergency room, or worse. The most advisable approach is to avoid drugs entirely, yet for those inclined to use, it's crucial to understand fundamental guidelines that could be lifesaving.
Yet in the long run, perhaps this is also one of the reasons why the number of users of psychoactive and other substances is consistently rising. This situation resembles playing Russian roulette - some individuals might manage their usage meticulously for years, restricting it to specific occasions and times (like once a month or solely at parties). In contrast, others may gradually increase their use without realizing it until they've crossed a critical threshold. The factors behind this variance could be psychological, physiological, and possibly even genetic.
Regrettably, globally and particularly in Israel, there's a significant lack of preparedness to address addiction as the chronic disease it is, akin to cancer, diabetes, and other serious illnesses. Addiction in the Western world extends beyond substance abuse to behaviors that disrupt routine and provide a thrill, like gambling or compulsive online shopping. Current treatment centers struggle to adequately differentiate the detox needs of individuals from diverse social backgrounds, leading many new addicts to feel alienated and out of place. Moreover, while addictions may present similarly, each specific drug and its associated addiction is unique and requires a tailored understanding for effective detoxification and managing future expectations.
A 2022 report from the Israeli Center for Addiction (ICA) revealed that one in seven Israelis suffers from some form of addiction. Notably, 90% of these individuals do not seek treatment or support. The report further highlighted that in the past five years, an additional half million Israelis have become part of the addiction cycle, marking a 25% increase since 2018. Similarly, in the United States, the 2022 National Survey on Drug Use and Health (NSDUH) found that over 48 million Americans, or more than one in six, are grappling with substance use disorder. However, only a quarter of them are receiving treatment. The survey also noted a significant rise, with 2.5 million more people facing addiction issues from 2021 to 2022.
In the last year, The Health Ministry transferred the responsibility for addictions to the Health maintenance organizations. I hope that this move, while also having even before an extreme manpower crisis in mental health professions, especially in light of the war, will succeed in finding original ways to provide appropriate solutions to this issue and will know how to train new professionals in the field, who will have the knowledge and the ability to accept, treat and understand also "the addicts of the 2024"
The author is the chairman of the Israeli LGBTQ+ Medical Society and director for LGBTQ+ health services at Clalit and Tel Aviv Medical Center.