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In advance of the burgeoning national obsession with the trial of Dr. Conrad Murray, charged with the murder of Michael Jackson by overdose of an anesthetic that shouldn’t be used outside a hospital, I wanted– surprise, surprise– to weigh in.

It’s clear that Conrad Murray was uncomfortable with routinely putting Michael Jackson to sleep, if you believe that he would turn his head away when running the IV.

Here, for the record, is an entry from Wikipedia that seems to fit as a C.O.D. for the King of Pop:

Propofol infusion syndrome is a rare syndrome which affects patients undergoing long-term treatment with high doses of the anaesthetic and sedative drug propofol. It can lead to cardiac failure, rhabdomyolysis, metabolic acidosis and renal failure and is often fatal.[1][2][3] Hyperkalemia, hypertriglyceridemia, and hepatomegaly are also key features. It is associated with high doses and long-term use of propofol (>4 mg/kg/hr for more than 24 hours). It occurs more commonly in children, and critically ill patients receiving catecholamines and glucocorticoids are at high risk. Treatment is Supportive. Early recognition of the syndrome and discontinuation of the propofol infusion reduces morbidity and mortality.

But more importantly, there is an issue in all of this that commands everyone’s attention, or should. What is an addict, anyway, and was Jackson one?.  Confusion reigns, as it emerges that MJ had long relied on booze and drugs in their many forms and combinations.

I wager that every one in this country who drinks does so because he or she likes the effect of alcohol. We’ve legitimized it for centuries; we’ve bottled ethanol so that a forty-year old Bordeaux is an objet d’art, a holy relic..We’ve made it all respectable, no big deal. I wager that nearly everyone looks forward to the 5 o’clock bell and the opportunity to rendezvous at the local pub. Or, after a day of working hard outdoors or at the computer, to getting out a nice bottle of crisp white something. Everyone is aware of the dangers of drinking too much and some people do it anyway. Some people drink nothing on one night and a bottle of wine the next night.  And, yes, some people pass the point of no return, get hooked and drink themselves to death.

Regarding the Rx pain killer dependency epidemic in this country, not everyone tells their doctor that they like the opioid high.  Because then, of course, you wouldn’t be able to get them. Opioids produce euphoria and make everything o.k. for three or four hours until they wear off. If you don’t want to be stoked on Vicodin or Percocet or Lortab all day long, you monitor yourself and try to take it just for your pain. Or, if you are at risk, you err on the side of caution and if you need it for minor surgery or a slipped disc, you get off it fast. I’m suggesting that all of us who drink, take pills or ever have, until late in the game, when dependency slides into addiction, have many choices.

I therefore do not see Michael Jackson as a victim any more than I see myself as one, although it’s easy for me to blame the several years I took percocet on my surgeon for prescribing it.  I knew why I took it; it was for the high. I stopped taking it at my initiation and am now addressing a related issue with a far less scary medication for pain.

In an ideal world, every person with an unhappy childhood would get into therapy and short-circuit the need for escape and/or pain relief.  But we have millions in poverty, millions in dysfunction who don’t even know what normal is, or what a family is.  Where was it that the ten year old kid just shot his neo-nazi dad? Moreover, many of us have absolutely no intention of letting someone dig around in our psyches to find out that we were abused and worse.  Or we tried it, and it drove us crazier.  Many of us don’t believe it’s a good idea to set up camp in old wounds.  So, we do what we have to do to tamp down the pain and keep going.  Does that make us addicts?

I have to say, after spending half of my life dealing with the addiction vs. dependency, no choice over substances vs. control issues, that I do not believe we can generalize and say that everyone who takes or uses a drug “recreationally” or drinks too much sometimes is an addict.

To me, an addict is someone who has to have a substance 24-7 to function, to cope, to face life, and who makes very bad decisions–like driving drunk or stoned– in the process. An addict obsesses about his or her fix and doesn’t like running out of whatever it is.  An addict loses control and is ruled by the substance and not the other way around.

That all happened to me with alcohol, and I’ve now made the decision to not drink– not for any reason.  I’ve never wanted to have just one glass of anything: I drank to get high and crazy and cut loose, and four years ago in that state I fractured my right leg, so that I’m writing this in a wheelchair.  How and why?  Well, I had a beautiful horse I was afraid to ride as I had fallen the last time I rode, so I drank a bottle of champagne and a few glasses of wine, tacked up, forgot to check the cinch, got a leg up and had someone with me, even, when the saddle slipped as I was dismounting and my leg was trapped in the stirrup so that I had to tear myself free. I would never have risked another fall if I hadn’t been drinking; my courage came out of a bottle.

A good exercise is to journal about how many times in a day one thinks about one’s substance of choice. Is one obsessive, leading to the compulsion to use, as the addictionologists (I hate it that there is such a word– very close relatives of the proctologist), say?  What about your behavior?  Do you make a fool out of yourself or pick fights?  Then maybe whether you’re an addict or not is moot.  Maybe you just need to quit, to make a decision to stop.  Stopping alone early in the game can be done– by tapering off and replacing “using” time w/ other activities, and the aid if necessary of a supportive friend.

I’ve taken swipes at AA on this blog because I personally found AA to be a very disempowering organization that is more like a cult than not. AA contends that alcoholics have lost the power of choice in drink, are beyond human aide and must throw themselves into the arms of a Higher Power of their understanding.  I did AA for about eighteen years and got crazier, evangelized and evangelizing, programmed. But there are other ways to get support for alcohol and drug abstinence these days that don’t require “spiritual surrender”, which is a cover for putting yourself in the hands of other ill people on a power trip.

No one should tell anyone else that he or she is an addict. No one should generalize and put all people who have substance abuse tendencies but have some measure of control in the same box as the gutter drunk– who himself or herself, is still a human being worth helping, and who is on borrowed time.  Check out Ray Liotta’s performance as an end-stage alcoholic on ER about ten years ago, and things will be clearer.

Back to Michael Jackson. A tape was played during the first day of the trial today in which Jackson is clearly stoned. It turns out that he had a history of reliance upon sedative drugs, and probably wasn’t honest about that to Dr. Murray until Dr. Murray felt he couldn’t abandon Michael. Murray states that he was trying to taper Jackson off the stuff that killed him, although he’d just ordered four gallons of it. As someone just pointed out on tunnel-visioned Dr. Drew, there was an employer-employee relationship going on between Murray and Jackson, not a doctor-patient relationship, although I personally believe that we all need to be far more assertive with our providers, ask them more questions and hold them accountable when they are wrong.  We pay them, after all.

But Michael Jackson was a bright guy.  He knew damn well that he was on thin ice.  He knew himself well, and he had his priorities:  fame.  A comeback.  To rid himself of awful feelings that allegedly include having been physically abused by his father, by any means.  To get the most out of life by foreshortening it–a working definition of an addict’s m.o. in a nutshell.

Jackson doctor-shopped and struck oil with Dr. Murray.  Murray drank the MJ  kool-aid and loaded him up with propofol to get him to sleep.  Now, come on; what doctor does that?  How crazy is that.  He is therefore culpable.  He contributed to MJ’s demise.  But Jackson hired him in the first place, however much the family would like to portray him as a victim, and chose to kill himself.  I half-buy the defense theory that when Murray’s back was turned, Jackson swallowed more pills and actually drank the anesthetic, as it was found in his stomach.  Don’t think that Murray put it there.  Seemingly he did not himself that afternoon administer a lethal dose.

I would say that if you die from an o.d., with the exception of the tragic deaths of college kids who don’t realize somehow and sometimes what they’re doing to themselves, you were probably an addict, and you probably did yourself in all by your lonesome, and chose not to get help.  R.I.P. you who have so chosen: MJ, Anna Nicole, Heath Ledger, Marilyn, Morrison, Amy Winehouse, Joplin, Hendrix, everyone…my own mother.  And God help those of us who do our best to face life on life’s terms and be honest with ourselves–especially in being self-forgiving and self-merciful when we don’t do life perfectly, or even, by some rigid perspectives, live altogether “sober.”  Dr. Drew claims that alcoholics are incapable of honesty, to which I say bullshit.  Self-honesty is key to getting off stuff that’s bad for you and people bust themselves on their own denial every day.

The family and the prosecution in this case cast Michael as a victim; the whole crrew is in denial.  It turns out that ativan and other things combined with propofol make a lethal cocktail.  This will all be a tough call for a jury that may not be up to dealing with the forensics in the case.