Sometimes the greatest facts can be transmitted by fictional stories.
My bookshelves at home are groaning under the weight of all sorts of written material about addiction. I have textbooks, journals, and SAMHSA publications about addiction and treatment. I also have numerous autobiographical memoirs written by people with addiction issues, which seems to be a whole new exploding genre, with more books coming out each month. I’ve read The End of My Addiction; More, Now, Again: A Memoir of Addiction; Pill Head; Rolling Away; Drinking: A Love Story; Dry: A Memoir; Beautiful Boy: A Father’s Journey Through His Son’s Addiction; Tweak; Leaving Jersey Dirty; Broken: My Story of Addiction and Redemption; Lit: A Memoir; Parched: A Memoir; Hit Hard; The Adderall Diaries; Junky; and probably many others that don’t come to mind at present.
But I can’t think of any fiction I’ve read about addiction, probably because I tend towards non-fiction in my reading life. So this new book I recently read was unusual for me, and I enjoyed it. I also found many truths contained within the fictional story.
In this novel, All Fall Down,” the protagonist, Allison, narrates the arc of addiction from occasional pain pill use to compulsive and uncontrolled use, and then through the bad consequences that follow. The book gives a fresh and accurate account of the protagonist’s stay in an inpatient rehab, and ends by describing her life in early recovery.
I am particularly impressed by the way the author describes the thoughts of Allison, the protagonist. The author has great insight into the mind of someone in active addiction. Allison lies to herself about how many she takes, about the reasons she takes the pills, and that she functions better with the pills than without. I found the author’s description of Allison’s thought process and self-deception to be accurate and believable. I hear the same self-deceptions in my work. Allison tells herself she deserves a few extra pain pills because she’s under emotional stress dealing with a difficult family situation. She tells herself everyone uses something to get through the day. She resolves again and again to cut back on her pill use, and then has moments of clarity when she realizes she’s using more than ever.
When Allison has these moments of clarity, the author accurately describes her confusion and self- blame. Allison realizes she’s doing things that are against her personal beliefs, resolves to stop, and yet can’t. The author truthfully describes the self-reproach and shame an addict feels when she can’t control her drug use.
Eventually, she admits she needs help, but still has to be forced into treatment by her family.
Buprenorphine makes a brief appearance, and I’m not too happy about how it was portrayed. In desperation because her pill stash was gone, Allison goes to an urgent care to get a prescription for pain pills, so a made-up reason. She surprises herself by being honest to the doctor about how much oxycodone she’s using. Even more surprising, the doctor is knowledgeable about opioid addiction and prescribes Suboxone. But in the book, the doctor doesn’t set her up in an addiction treatment program. Then Allison goes into precipitated opioid withdrawal after she takes the Suboxone, and has to go to the hospital. The hospital talks to her family and Allison is eventually admitted to an abstinence-only treatment center called Meadowcrest.
Meadowcrest gets harsh treatment from the author, but the details are amusingly accurate. Allison is dismayed that most of the treatment center staff have few counseling credentials, other than being past graduates of the treatment center themselves. She also illustrates the petty meanness some people are capable of when given power over other people. She describes Michelle, an overweight recovering addict who delights in thwarting Allison’s plans to use the phone or go to her daughter’s birthday party. She describes how some of the treatment center staff talk down to patients they are supposed to be helping, by calling them selfish and lazy.
This author does such a great job of describing all of the facets of early addiction and treatment that I can’t help but think she must either have personal experience or has a close friend or family member who went through opioid addiction and recovery.
I appreciate the honesty of the Allison character. She thinks the slogans of 12-step recovery are dumb and trite, and that she’s different from all the other patients because she never injected opioids or was homeless. She feels out of place around patients who have obviously gone much farther down in their addiction. She resents the twelve step program and finds some of the steps to be shaming. She has a difficult time with the idea of a higher power.
Then gradually, as Allison slowly starts bonding with other patients, she acknowledges she has the same feelings as they do, underneath the addiction circumstances. She comes to see that when she was stopped from driving by a teacher at her daughter’s school when she was impaired, that was her bottom. For other people, stealing or prostitution constituted the low of their addiction, but the feelings of shame and self-reproach were the same.
Allison starts to focus on her similarities to other addicts, rather than her differences. She starts to feel empathy for other addicts and wants to help them recover. Her own healing begins.
By the end of the book, Allison is going to 12-step meetings and she feels connected to the other people there. She sees that the slogans do have value, even though she finds them trite. She still struggles with any concept of a Higher Power, and is honest about that. She often doesn’t want to go to meetings but still goes, if only to see how the other addicts are doing. She develops a focus outside of herself, and begins to do things that are helpful for her and her recovery. Her marriage may be over, but she’s able to tolerate not knowing what will happen, allowing things to play out on their own.
This book will resonate with all people who have addiction, but especially with the relatively well-to-do opioid addicts who didn’t experience the low-bottom consequences of jails and institutions. I think the author accurately described the inner experience of the opioid addict. She certainly illustrated the failings of the Meadowcrests of the world while still showing how they can help people.
After I read the book and wrote this blog entry, I went to Amazon and read the book’s reviews. The people who liked it and gave the book five stars seemed to be either life-long fans of the author, Jennifer Weiner, or to have had some previous encounter with addiction. The readers who didn’t like it, and gave it one star, said the book was boring and depressing, or that it wasn’t like the author’s other books and they were disappointed. A few of the one-star readers said they were in recovery themselves, or worked in a treatment center, and they didn’t feel the book gave a realistic portrayal of addiction.
It’s always fascinating to me how two people can read the same book and come away with such opposite views.
I recommend this book for people with opioid addiction, in recovery or out, and for those who love them. It’s a great book for anyone who has been puzzled by the weird behavior of the addicts in the world.
I’d like to see more addiction fiction like this…