Boonen, Blow and Beyond

I'd rather have a picture of Boonen on the podium here

I'd rather have a picture of Boonen on the podium here

Ah Tom, you break our hearts. Your beauty at critical race moments is again dimmed by the haze of white blow. Your finish line finesse is again obscured by lines of powder on a mirror. And for this you trade your greatness?

This story hits me particularly hard. My days on a bicycle were borne as a release from enduring the trauma of life with a crack-addicted husband. The downward spiral manifested in loss of dignity, business and wife for him. Eventually the only measure to protect him from himself proved to be prison on drug-related criminal charges.

These consequences may affect the user for a lifetime. Yet cocaine’s short-term feel-good only lasts 5-30 minutes or about as long as that incredible rush toward the finish line in the final kilometers of a race. Because of the shortness of the high, cocaine is often abused in binges requiring increasingly high doses. A user can be highly functional abstaining for long periods between binges. Without treatment, eventually the cycle between binges shortens and addiction takes over.

It’s easy to understand why cocaine use would interest a bike racer accustomed to performance rewards. Blow stimulates dopamine, the brain chemical associated with pleasure and movement, in the brain’s reward circuit. The problem is that with repeated use, the brain’s reward system is altered. What was enjoyable before now yields little satisfaction.

Anyone who wins a lot knows exactly what this feels like. Winning is euphoric but there is a fall from its euphoria as well. Our lives must be based on a variety of rewarding stimuli, and a winner must remember that those rewards can be as simple as the smile from a loved one or an easy ride on a beautiful morning.

But what about beloved Boonen? I love the way he races – not just the sprint wins but his savvy and confidence in timing and positioning. The simplicity of his happiness when he succeeds is a joy to support.

Now he needs support of a different kind. He needs court-appointed behavioral intervention.

The system has worked in raising Tom’s awareness that he needs help by screening him for use. Raising awareness to the user that they need help is the first step of treatment. The next step is an objective 1 “non-judgmental motivational conversation” about its risks by a doctor. I think Tom has moved beyond an objective conversation by this point into the need for the next step – an effective treatment plan that requires specialty treatment for a period of time.

Boonen seems to have moved to an addictive state. His recent comments about its prevalence seem to indicate an obsessive awareness of its availability. I love coffee and can get it within miles of anywhere, but I don’t think about having it and how to get it. At this point, I think clinical treatment is necessary. With clinical treatment comes the necessity for several responses:

1. the user must be empowered to be active in recovery by choosing treatment which allows a continuance of lifestyles that support clean living. What does this mean in terms of racing involvement? A hard question for the right authorities to answer.

2. support services which provide for his care while undergoing treatment but which also hold Tom accountable for his attitude about use and his actions.

For this Tom must be monitored to evaluate the outcome and impacts of treatment. In general populations, accountability is sometimes linked to reimbursement of treatment as a result of a demonstrated abstinence from drug use. What is the thing dear to Tom that will act as a cost to hold him in check in order to demonstrate a long-term change of thinking and different pattern of behaving?

When drug use is linked with criminal behavior, the courts can provide a powerful incentive for rehabilitation. Court-appointed programs offer more extensive supervision under treatment. Whether the charge is dismissed and Tom gets to ride certain races is not as important an issue for me to tackle here as providing an effective requirement for treatment. The statistics for prevention using this method even when charges are dismissed are quite promising when in programs of relevant accountability lasting an appropriate time period – even up to two years.

Look in that mirror Tom and tell us what you really see. Do you see yourself or do you only see the white rows? Look there between the rows, I see Marco crying. Look again Tom, beyond the rows, we want to see only you, Tom Boonen!

 

1 What Works: Effective Public Health Responses to Drug Use, White House Drug Policy published March 2008 www.whitehousedrugpolicy.gov

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