On the evening of June 16, 2013, before a screaming packed house witnessing the NBA finals in Miami, Florida, Ray Allen, standing in the right corner, after a clutch offensive rebound by Chris Bosh, received a pass. The rebound followed a missed shot by LeBron James with 10 seconds left in the game, leaving the heat behind by three. The San Antonio Spurs defender rushed at Allen, leaping and flailing his arms. Allen rose into the air, his gaze fixed on the rim, and at the apex of his leap released the ball. When the ball left his fingers, there were three seconds left.

As all astute basketball fans know, the shot caught nothing but net, tying the game and the Heat battled on to win both that contest and the NBA championship. At that time and later, Allen was one of the most respected players in the league. Though not one of the best three-point shooters on a percentage basis, he seemed to know when it mattered most to take and make the big shot. It is of note that in the playoff game just described, LeBron James took the first crucial shot and it clanged off the back of the basket. When Bosh got the rebound, he did not toss the ball back to Lebron, certainly one of the best players in history, for another try. Rather, without hesitation, the ball went to Allen. And that choice made all the difference.

The film shows that after making the critical shot Allen allowed himself just one brief moment of satisfaction, then rushed to cover his man on defense. Allen didn’t drink or smoke or eat tasty but unhealthy food and was known for taking hundreds of practice shots every day. He was known for running constantly (which, in games, exhausted his defenders, contributing to a tiny opening for the late shot), and for caring for his body like the fine instrument it is. He was still one of the fittest players in the game when he retired, nearing age 40.

What does all this basketball drama have to do with opioid dependence and recovery? We’ll see.

Allen, for all his achievements, is a remarkably modest and well-grounded man. During and after his years at UCONN and in the NBA he scrupulously studied nutrition and now runs a natural foods restaurant in Miami. As on the basketball court, he is a very formidable presence in the restaurant. He understands the science behind why eating 100% natural foods is good for you, and he can explain it. Though he has said that he would love to eat a cheeseburger or a thick steak, he never allows himself such indulgences. He is so strict with himself, he says, because he wants to be around for his children and grandchildren, and to be able to move and run, perhaps not quite as fast as he does now, at age 80.

He has also said that when he goes around to talk to youth groups these days, he is struck by young people’s interest in the latest sneakers, in the car he drives, in the size of the house he and his friends may live in. He strives right away to help the young people understand that all those things, if you want them, will eventually come “if you put in the work.” But only if you put in the work – the hundreds, the thousands of shots, and the long hard runs, every day without fail.

Maybe you work at a hamburger joint and you show up on time and prepare the fries perfectly month after month and one day the CEO of the corporation walks in and notices your effort and offers you a job at corporate headquarters. Some years thereafter you end up president of a huge multinational business. All because, Allen says, you put in the work of preparing the fries perfectly, every time. That’s Ray Allen’s Philosophy 101.

Of course, you don’t prepare the fries perfectly because you expect it to lead inevitably to wealth and fame as a Wall Street executive. You do it because you understand that completing tasks, whatever they are, as well as you can, will bring a variety of rewards, most importantly the personal pride that comes with becoming known, and knowing yourself, as someone who does the job reliably, without drama or outsize expectations. Ray Allen understands that in the end it doesn’t matter if you are an NBA star or an ace prep cook in a fast food restaurant. What matters is devotion to your purpose.

Ray Allen is aware as well that there is an aspect of fulfillment of purpose, a stage in the process, that typically involves struggle. If one employs the metaphor of a journey to define the process of fulfillment of purpose, then the period of struggle usually occurs after the excitement of the beginning of the journey has diminished and, assuming that to some degree you fulfill your purpose, well before the relief and congratulations of the end have been awarded.

It is in the middle that most journeys fall flat or are abandoned. One has covered some distance and is fatigued but has no idea how long the journey will endure or even if it has a clearly defined destination. What if you started down the wrong path, and each step you take will have to be undone as you return once again to the beginning? Should you turn back now, while you imagine you might still have the energy to make it back to the starting point? In the middle, the purpose of the journey is less clear. It is easy to believe that the journey may just be a foolish waste of precious time, and all the others, back there at the beginning or out on some other, more correct path, are laughing and joking about you, at the very moment when you are most doggedly struggling to continue.

This is the “crisis of autonomy,” when, if one is to obtain fulfillment, one must slog on, putting one foot in front of the other even though one understands that there is a clear risk of loss, of failure. One understands that there are no guarantees in the purposeful journey, and there is no one who can provide unfailing support so that the journey is easy and effortless and always successful. In other words, one is alone. One learns that here is a reason why “alone,” when taken apart, says “al(l) one.”

It is at that moment, when one is lonely and most subject to despair, that the poison apple is invariably offered, if only by oneself. One realizes that she or he can surrender the effort and experience that great if brief rush of relief that comes when the struggle, even though it has resulted in failure, is over. One knows too that, in time, the disappointment will arrive, followed by the self-recrimination and regret. But right now, after giving up, after doing whatever one can to avoid suffering and sacrifice, a flood of comforting neurochemicals will bath the brain and will not ask questions about the future.

Though using opioids probably never crossed his mind, Ray Allen certainly knew this – he knew that the central part of the journey is the struggle, and he felt it, and he knew it most clearly after leaving a (then) relatively obscure college basketball program and seeking to make his way in the big leagues. He knew this as he put up shot after shot after shot and ran mile after mile after mile, and deprived himself of all transitory pleasures so that when his moment came in the sixth game of the championship, he would receive the ball and would not hesitate to do what he could.
He knew, without doubt, that there are no short cuts to bliss.

Using opioids, which long established medical opinion has demonstrated are not even particularly effective in relieving long-term pain, is often an effort to find “a softer easier way,” as Dr. Bob discussed in the Big Book of Alcoholics Anonymous. Opioids, sometimes, are an easier way to avoid struggle and enjoy the gratification of reward without the effort of clarifying a purpose and enduring the pain of the journey.

The truth is, it would be great to be able to reap the rewards of hard work without putting in the hard work, to avoid the travails of transient pain, to be able to do more, achieve more, be more, without effort or suffering. There is nothing wrong with wanting to avoid unhappiness and take a short cut to success. There is a problem, of course, with believing that one can actually achieve the rewards of work without putting in the work, and believing that one can live a fulfilling and challenging life without pain.

Some would suggest that in recent years there has been an encroaching belief that struggle, discomfort and suffering are not only unfortunate but also wrong. It is difficult to achieve a goal, any goal, to fulfill one’s purpose, any purpose, whether it is establishing a stable relationship or creating adequate housing for the poor. And, as with any difficult goal, there are many times when all our efforts are fruitless and we are left with only disappointment and failure. And physically, at some point and in various ways our bodies will break down and inevitably we will experience that great transition called death.

It is only one’s beliefs that determine how suffering and failure and death are understood, how they are interpreted. Indeed, the fabric of our lives are a great blank canvas onto which we project our beliefs, our assumptions and even our desires. Failure can be a necessary trial run from which one learns and prepares for future success, or it can be a hopeless flailing about that drains one’s energy to no worthwhile end. Suffering can be a valued investment in improving the lives of others or it can be a diabolical way that a malevolent fate tortures its vulnerable subjects. Over the course of our lives most of us eventually understand that, to a great extent, we determine which it will be.

Over the long history of opioid dependency we have seen its use increase and decrease, largely in conjunction with changes in beliefs about suffering, about pain and sacrifice. Somehow, great masses of humanity got along without opioids for decades and even centuries, only to see them re-emerge encased in a new or at least rewoven belief system, and then once again there was a new explosion of opioid use and abuse.

As many would say, the most recent resurgence of opioid use and abuse was precipitated by the “rediscovery” of opioid compounds that allowed pharmaceutical companies to assert that, however implausibly, the newly created compounds could be prescribed continually and in all cases without creating tolerance and drug dependency – without creating a “drug addict.” That assertion was based on the most flimsy of research (I am old enough to remember when tobacco producers touted equally reliable studies asserting that cigarettes were good for you), and medical doctors who had been extensively trained in microbiology and neuroanatomy should have been able to see through the tainted research, but a perfect storm of physician greed and incompetence and corporate pressure led to the current situation in which many tens of thousands have died and enough opioids are legally prescribed to addict every adult in America.

This tsunami of opioids made billions of dollars for prescribers and corporate America, and was supported by the designation of pain as “the fifth vital sign,” thus ensuring that every physician would complete a notoriously unreliable pain assessment and then prescribe, sometimes to a completely unsuspecting patient, enough dependency creating substances to ensure that the patient would have a drug problem they would, at the very best, need to struggle to address for the remainder of their lives.

Underlying this exercise in greed and incompetence was a sometimes insincere concern for the suffering of others, which suddenly seemed very important now that it had become very profitable. But in the course of the assertion by figures of authority that pain and suffering were both unnecessary and wrong (and, let’s face it, in some circumstances medical doctors prescribed opioids out of fear that they would be sued if they did not), the message got out there that such was the case, and patients began approaching their doctors with an attitude that clearly communicated that whatever their discomfort, the doctor had better do something about it, and fast. And the fastest if not the most effective way to do something about it was with opioids. And then, where do you draw the line? If suffering is the subjective self-assessment of pain and discomfort, how reliable is that assessment? What suffering is worthwhile and what pain is a fire that simply must be extinguished? And is it within a medical doctor’s competence to make that assessment?

Doctors are not coaches, and most patients are not hard-working NBA players, and so doctors, as our opioid crisis developed, were unwilling to say to patients that they were just going to have to deal with their pain. They were unwilling to say, like a good parent, “It may be hard, but you will find a way – and I don’t want to make you a drug addict.”

So, it is unclear how much a media-inspired belief that medical treatment has advanced to such a degree that suffering and disappointment are no longer necessary has contributed to our opioid epidemic; but it is safe to say that it played a role, probably a big role. The truth is that there is no clear barrier, and there likely never will be a clear barrier, between an acceptable and necessary level of purpose-driven discomfort and relentless random agony that any compassionate person wants to relieve. Doctors want the authority and power appropriate to their level of expertise, but they are not experts at the objectification, the perfect quantification, of internal human experience. And when they blunder in there and assume an unknowable level or prescience, as they have in the opioid epidemic, an unholy mess is created, and an unknown number of future Ray Allen’s will remain forever on the sidelines.