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Lyndsay Albert, PharmD Candidate 2017
Ohio Northern University Raabe College of Pharmacy

Lindsey Peters, PharmD
Visiting Professor of Pharmacy Practice
Ohio Northern University Raabe College of Pharmacy

The 1995 film “The Basketball Diaries” is set in the slums of Manhattan where a high school basketball player, Jim Carroll (DiCaprio), and his friends ultimately take a sharp nosedive into the tragic world of drug addiction. It is a stomach-wrenching glimpse into the lives of those addicted to heroin and other drugs. Not only does this movie show in graphic detail the disturbing bodily effects heroin has, but it also depicts the drug’s overall destruction of Jim’s livelihood. Warning: This is not a movie for innocent eyes!

Jim and his friends snuck out of school every “once-in-a-while” to get high. They terrorized the neighborhood by cliff-jumping into the Harlem River and dumping pretzels on the local prostitutes. Jim’s friend Neutron even commented saying: “She’s a dope-head. See what that stuff does to you.” The turning point in Jim’s drug abuse came when Neutron invited him over to spend the night with two girls. The promise of sex with an older girl was all the motivation Jim needed. Having done drugs before, cocaine did not seem like that big of a leap. After one sniff, the flood gates opened. When that was not enough, Jim raided the medicine cabinet for pharmaceuticals to send him back to the pleasurable oasis of that incredible high.

The death of a close teammate battling leukemia caused Jim and his friends to do the unthinkable: resort to heroin. Jim was told, “If you’re going to sniff it, you might as well pop it; if you’re going to pop it, might as well mainline it.” Despite his fear of needles, Jim gave in. He referred to heroin as “a long heatwave through his body. Any ache or sadness or guilty feeling was completely flushed out.” As most people know, a common adverse reaction from opiate use is nausea and vomiting. The next morning, Jim found himself in the bathroom, facing the bottom of the bowl. That didn’t stop him.  As Jim wrote in his diary, he explained that heroin started off as a “Saturday night thing to make you feel cool, like a gangster or a rock star.” He continued, describing it as something that “felt so good, you start doing it on Tuesday. And then Thursday. Then, it’s got you. Every wise punk on the block says it won’t happen to them, but it does. The voice is always there in your head…Just one more time, then I’ll stop. But you can’t.” This shows the extremely addictive properties heroin has. Just one time and Jim was hooked. People think drug addiction will never happen to them, that they will be immune from the deadly grasp of abuse and addition. All too often their assumptions are proven wrong.

Jim found himself needing the drug. He would do anything in order to obtain that coveted next fix. Eventually, he was kicked off the basketball team, kicked out of school, and then kicked out of his own home. Jim fell so far into desperation attempting to get money to supply his habit that he resorted to prostituting himself in a public bathroom. He became the person he and his friends originally mocked and pitied. Although this may seem extreme, there are many who have gone down this path due to severe drug addiction.  

Jim’s body became a sickly shell of what it used to be and he was barely able to function. His face was sunken, pale, and ashened. At one point after shooting up, he sat on a staircase, body slumped, colorless lips, and vomit covering his chin. The prostitute walked by, lifted his head and sarcastically commented, “You look good, Jim” only to allow his head to fall back to where it was. This portrayal reminded me of a recent patient experience. At the clinic, there were a few heroin addicts coming in for treatment; I will never forget how one specific woman looked.  She appeared lost in space, as if she was just going through the motions of life but unable to feel emotion, like a zombie. Under her eyes were large dark circles that went halfway down her cheeks. It looked like she had not slept in months. She was rail thin.  Undernourishment commonly accompanies drug abuse. The next meal takes a backseat to the compulsion of finding drugs for the next high.

Jim overdosed and passed out in the snow in the middle of winter. Reggie, a man with whom Jim earlier played neighborhood basketball with, found Jim nearly frozen to death. Reggie forced Jim to dump his habit cold turkey, driving him into withdrawal. It was an excruciating scene of guttural screams of pain and dysphoria. Sweat poured down Jim’s face as he slowly lost control of his body. He crawled to Reggie, begging him to get him some drugs to stop the pain. After a few days, Reggie left for work and left Jim alone. Jim’s anxiety grew and he ransacked Reggie’s apartment to find money. Running out of options, Jim returned home to his mother for money. She shut her son out, refusing to enable his addiction.As Jim wailed and pleaded for money in the hallway of the apartment building, his mom called the police.

The DSM-5 diagnostic criteria for substance use disorders requires impaired control over substance use, social impairment, risky use of the substance, and pharmacological criteria. Jim showed impaired control through his consistent and time-consuming effort to obtain the drug, through his intense craving for the substance and through his unsuccessful effort to cut down on drug use. Jim’s social life was impaired as evidenced by his termination from the basketball team, expulsion from school, and removal from his own home. Jim showed risky use of the substance nearly every time he used the drug. He constantly put himself in situations where substance use was physically dangerous. He was dependent on the drugs to live his daily life and constantly needing more. Reflecting on Jim’s story, it is clear that he met the diagnostic criteria for a substance use disorder.

Jim spent six months in prison for assault, robbery, resisting arrest, and possession of narcotics. He “sweated out a horrible cure and stayed clean the whole stretch even though it was easier to get good junk in prison than on the street.” After his release, he finally had the strength to deny drugs. Jim became an accomplished poet, telling his story of drug addiction and its consuming power. Although many people try to overcome substance abuse disorders, addiction is a relapsing disease and seldom do people kick the habit the first time around. It is commendable that Jim was able to quit cold turkey while in prison, despite the presence of available drugs around him. Most addicts need supplemental programs such as narcotics anonymous or even a medication assisted treatment program in order to begin living the sober life. The way that the lives of addicts are depicted in this movie is accurate. “The Basketball Diaries” definitely provides a gruesome reality of this disease instead of the glorified and glamorous depiction some Hollywood movies portray drug use to be. Jim Carroll lived in New York City and passed away in September 2009. He will be remembered as an acclaimed poet, musician, novelist, and performer but most importantly – a survivor.

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