The little voice in your head

8 12 2009

Last week, I finally listened to the little voice in my head. At the time, I was contemplating, “Should ride back down on the road, or should I ride down the trail.”

The trail would have been much more fun. There are roots, rocks, some really steep pitches, lots of fast curves, tricky corners and a series of hairpin turns right before the big drop that delivers you back to the road just above the highway. Usually, by that time my heart is pounding, my legs shaking and my arteries flush from the injection of adrenaline. Then it’s back to the office.

But just then I passed the sign on the road that says, “Are you prepared? If you get lost, does anyone know where you are going? This is not for nothing. Every year, in every season, people die on the North Shore mountains, because they get lost, it get’s dark and they fall of a cliff or succumb to hypothermia. So, just before I pointed the front tire of my new Trek Fuel mountain-bike down that gnarly path, I heard the little voice in my head.

The voice said, ” You know, that might not be such a good idea. It’s Friday at noon on December 4th; there is no one on the trail, nor will there be anytime soon; the trails are super-slick because it has been raining like crazy for the last month; no one knows where you are; you don’t have a cell phone;  and if you fall and need help, it will be dark and cold soon and basically, you’re toast!”

Usually, I would have argued with the voice. I would have said, “Oh, what do you know. It’s a beautiful day; you haven’t ridden this trail in months and you’ve got lots of time. Don’t be a wimp.”

But then I remembered all the near death experiences I have ever had. Three of them, three and a half if you include the time Simon Parker and I got lost in the dark on the back side of Bowen Island. Right before each of them, I had a similar exchange with the voice in my head. And… I remembered that after each of them I promised that I would be more diligent, more careful and I would not ignore the voice of caution.

So this time I listened.

I listened to that voice… no questions asked. I listened because I finally realized that if you get that little voice in your head telling you, “maybe this is not such a  good idea”, that you should bloody well listen, because it is not telling you, it’s not such a good idea, for nothing. It’s telling you, it’s not a good idea, because it is desperately trying to save your bacon. So, listen.

Most anthropologists are pretty clear in saying that humans are not completely rational beings. They point out that humans often act in ways that are contrary to their best interests, when we make emotional rather than rational decisions. Recent research suggests that, it’s not that we are not rational, but rather that we often act before any rational thought has had a chance to influence our behaviour. We are often flying down that proverbial trail and before we know it, we are ass-over-tea-kettle, looking right at the worst possible consequence that we could ever have anticipated, if only we had…anticipated. But we didn’t anticipate. We didn’t think it through. We acted without thinking, again.

Does this sound familiar?

To most of my patients with ADHD and addiction, this is the story of their life. Shoot first, ask questions later. Neuro-biologically, this can be explained as follows…

Normal people have about 4 milliseconds between impulse and action, giving them a brief but adequate window, during which the little voice in their head has just enough time to say, “Hmm, maybe that’s not such a good idea.” This is when normal people put on the brakes, look over the edge of cliff and say, “Phew, that was close.”

On the other hand, impulsive people have about 1 millisecond between impulse and action, which means, by the time their little voice has spoken, they are already at the bottom of the cliff, wheels up, engine billowing smoke, wondering, “What the heck just happened. Maybe I should have hit the brakes.”

For the record, Buddhist monks have about 8 milliseconds between impulse and action, during which they have enough time to have a national debate on whether or not to hit the brakes.

So, as you can see, being impulsive is quite the handicap. Take for example, the patient I saw the other day. Tough kid…  smoked dope at 11; doing lines of coke at 13, dropped out of school at 14; smoking crack and shooting heroin before his sixteenth birthday. So you might think he was stupid, or came from a bad family. That’s the current thinking. But he was an intelligent kid, raised by loving and intelligent parents. Unfortunately, he was also impulsive, a risk taker, a stimulus seeker who found school to be too boring. He was a skilled mountain-biker, dirt-biker, 4×4 truck driver, but what really turned him on was seeing the duffle bag full of $20 bills when he cashed in his first grow. 4000 marijuana plants make a lot of pot and at $2000 a pound, that’s a lot of green. Pretty soon he’s running two grow-ops and starting a third. Money is as addictive as the finest drug.

Long story short, our friend, we’ll call him Jake, is now up for 5 counts of possession with the intent to traffic. So he comes in today to have a little chat. He was diagnosed with ADHD as a child because he was hyperactive and could not focus in school. He was tried on medication, but it made him an introvert and he did not like it and so he stopped.

I explain to him that is a very common outcome, because the medicines in those days were too short-acting; few people knew how to use them and that his experience is caused not by the medicine, but by the medicine wearing off. He and his father both nod as if they understand, but I can see that they both wish there would be could be a way to make it all better.

I explain that right now there won’t be any medication; that we first need to finish our assessment and I remind his father of what he already knows. There will be no more bail-outs. It’s not that we don’t feel any empathy for Jake’s plight. It’s just that protecting Jake from the consequences of his actions is not doing him any favours. So he is  looking at 6 months in jail. He’s made his bed, now he has to sleep in it.

I tell Jake that I am happy to help him, but the first thing he needs to do is to make a commitment to stop using cocaine, because I can’t safely treat his ADHD until he is cocaine free for 4 months. There are a few things we can do in the meantime, so I am not blowing him off, but he has at least to give me his best effort. I say good bye and wish them both luck.

A few hours later, Jake’s dad calls back in a bit of a panic.

As we discussed, Jake’s dad made it clear that there would be no more hand-outs, bail-outs or redemptions. That Jake would have to stay in a shelter and get some kind of temporary job so that he could get back on top again. It so happens that Jake is a highly skilled carpenter who could easily earn $50,000 a year, legally, by applying the skills of his trade. Unfortunately, he sold all of his tools to buy drugs.

Jake, being the master manipulator that all drug addicts are, will have none of it. He wants Dad to take him back. If he doesn’t, Jake says he will commit a few B/Es to get the cash that he needs.

Jake’s dad wants to know what to do. I tell him my thoughts and he thanks me. He just needed to hear it from someone else.

So, do you think Jake will take the time to think through the consequences of his threatened actions? Do you think he will listen to the voice in his head? Do you think he can even hear the voice in his head?

Stay tuned...

Dr. Anthony Ocana

MSc, MD, CCFP, ABAM

Family Physician

Addiction Specialist

drocana@telus.net



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2 responses

7 11 2010
Val in Vancouver

My first thought is 6 mos! for 3 grow ops!! Very light sentence. I agree on the honest approach. I don’t know the pharma controls at all. I think he will keep going until he hits the Big NO! and 6 months with dad taking him to see you isn’t yet all the way.

14 11 2011
Dr. Anthony Ocana

Yet he remains in recovery more than 2 years later.

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