“Fine, Doctor Harvard, but you’re dumber than you look"

Levi Yitzhak had a significant substance abuse problem that was getting in the way of any meaningful forward movement. While both his mashgiach and Aunt Frumy, his legal guardian, had taken a stand by encouraging him to continue treatment, we hadn’t yet had one sober meeting. I’d promised him a Danish if he’d show up sober for our third visit. Part III

Levi Yitzhak wasn’t my first patient to show up intoxicated during our initial encounter, but here he was, sitting across from me in our third attempt at a meeting, bleary-eyed as could be, bright and early at 9 a.m.

“So, you high today, tzaddik?” I asked honestly. It was getting a bit difficult to tell.

“I wish. Maybe if I had gotten high last night, I could have slept more than zero minutes,” he quipped.

“Levi Yitzhak, I appreciate your efforts. The first day of sobriety is the hardest one,” I told him. “Now here’s your Danish.”

“Who said I was sober?” he said as he snatched the Danish out of my hand. “I had to take a few Tylenol PMs with some extra Benadryl to get to bed.”

Levi Yitzhak took a swig from a giant bottle of Coca Cola on the desk. “You know, Doctor Freedman, I think this marijuana addiction thing is a little bit out of proportion. Marijuana is not a drug. Crack is a drug. You ever—”

“I get it, tzaddik,” I cut him off. “Marijuana isn’t crack cocaine. But it’s obviously not a piece of cake to quit either or you wouldn’t have had to pound beers and throw back sleeping pills in order to get through a marijuana-free evening.”

Levi Yitzhak just folded his hands and sulked. He obviously wasn’t in the mood for a lecture on clean living.

“Levi Yitzhak, during my training as a resident physician, a sizable majority of the psychiatric patients who graced the emergency rooms during the overnight shifts were high on one thing or another. I’d gotten used to the unofficial protocol of waiting for drunken patients to sober up and eat their complimentary turkey sandwich before starting the interview. I’d also gotten used to dealing with agitated men and women who’d been abusing a host of addictive substances — we’d bring in security and let the nurses administer as many sedative shots as necessary to keep people from getting hurt. I got to know plenty frequent flyers over the course of my overnight calls at Boston’s emergency rooms, and I learned a good rule: “ If you’d had multiple encounters with an intoxicated patient, the guy had a problem.”

“So what’s that got to do with me?” he asked.

“It means that you’ve been to my office three times: once high, once drunk, and now bleary-eyed from Benadryl. You got a problem, tzaddik.”

“Fine, Doctor Harvard, but you’re dumber than you look. For real, you think I have a marijuana addiction? Marijuana isn’t addictive. It’s just a plant, a vegetable.”

“You’re the one who said it’s impossible to sleep now that you’ve stopped smoking for a night,” I countered. “Insomnia and anxiety are cardinal symptoms of marijuana withdrawal for heavy users. I bet your stomach feels uneasy too.”

“How’d you know?” he said, looking a bit nauseous. “Actually, I do probably have a mild case of diarrhea, if you really wanna know.”

“Of course you do, tzaddik. It’s all part of marijuana withdrawal. Your body has gotten used to it, which is why it used to be a couple drags and you were high as a kite, and now you just keep puffing away in order to get that same goofy feeling.”

Levi Yitzchak sat deep in thought for a moment before acknowledging he’d been bested. “Fine, Doc. Let’s agree that it’s addictive. Now, what do we do about it to help me sleep and get back to normal and get the stuff out of my system, assuming I’m gonna give it a try?”

“Well, let’s just try to make it through the first week,” I suggested. “I know it’s gonna be hard to sleep, so I’ll give you a non-addictive antianxiety medication to help you sleep and to settle your stomach.”

“For real, Doc?! I got to take a medication to get me off a plant? Besides, I hate chemicals!”

Levi Yitzchak clearly had to think it over. Getting clean would mean putting down the very thing that’s been giving him that illusory sense of comfort, and it would mean having to finally confront the pain and trauma of neglect and abandonment he’d experienced at the beginning of his life, after his mom was diagnosed with bipolar disorder and his dad made a quick exit. While Uncle Boruch and Aunt Frumy lovingly raised him as one of their own from age five, trading in his drug of choice for finally facing his demons was a step I wasn’t sure he wanted to take.

While abuse and neglect can negatively impact anyone at any age, it leaves its biggest mark on children. They rely on their parents for love and protection, and not having that creates a foundation of toxic stress in their brains, making the trauma of abandonment much deeper and harder to change than trauma experienced later on. And that trauma can create an insatiable yearning for relief or fulfillment, since their sense of emptiness is overwhelming and constant. Substance abuse, with its feel-good sense of comfort and release, becomes an easy form of relief. I wasn’t sure Levi Yitzhak was up to letting that go.

He confirmed my suspicion, but I appreciated his honesty. “Dr. Freedman,” Levi Yitzhak said, looking down at his hands, “I’m scared. Scared to look at myself and figure out who I really am. I’m not sure I’m ready…”

“Will you ever be?” I asked gently.

“I hope so,” he said as he stood up and walked toward the door. “I gotta tell you, I appreciate your honest approach. That’s why I’ll be back when I’m ready. Or maybe I just want another free Danish.”

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

Dear readers,

I’ll be taking a short break to work on some new projects. Wishing you all a happy, a healthy, and a sober summer!

Yaakov Freedman MD

Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman, whose new book Off the Couch has just been released in collaboration with Menucha Publishers, can be found learning Torah in the Old City or hiking the hills outside of Jerusalem. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com

(Originally featured in Mishpacha, Issue 857)