‘Dying of a Heroin Overdose Does Not Make You a Scumbag’ by A. Thomas McLellan, Ph.D.

Unknown-6Great article in the Huffington Post by one of the leading addiction treatment researchers involving the loss of one of my favourite actors.

‘In the wake of the tragic death of Philip Seymour Hoffman, I am shocked by the vast range of opinions and emotions that have been voiced in the public discourse. Media outlets of all shapes and forms are weighing in on his death – and specifically, the foolish, self-destructive choices he made associated with his addiction.

The explosion of speculation and moralizing surrounding this death brings to light how conflicted our feelings, as a society, are about this disease. And the science is clear on this point.

Addiction is a disease – and like so many other diseases – its onset is caused by an inextricable cluster of biological, behavioral and environmental factors. But for some reason, this disease still inspires a socially acceptable prejudice that is simply not appropriate and certainly is not right.

Last week I was speaking with a prominent and well-educated journalist who was doing a report on substance abuse. He was interviewing me as an expert in the field – having spent my career researching addiction and working to advance policies and practices to support improved care.

But in addition to my professional experience, and like so many of us out there, my experience is personal as well. In 2008, I lost my youngest son to an overdose.

And yet, despite knowing my professional and personal background, this seemingly intelligent reporter made the following statement to me in casual conversation: “What a weak piece of sh** that Philip Seymour Hoffman was, eh?” Even as I sit here several days later, I am dumbstruck by the callousness, the audacity, and most of all, the ignorance of this comment.

Overdosing on heroin doesn’t make you a scumbag. Having a drink after 20 years of sobriety doesn’t make you weak. Having an addiction is not a moral choice. In fact, I think it is accurate to say that having an addiction is not a choice at all.

Sure, it is a completely voluntary act the first time anyone picks up a drink, smokes a cigarette or uses another drug. And that remains true for at least several more voluntary choices to drink and/or use.

But then something happens in the brains of about 10 percent of those who use – we don’t yet know exactly all that happens in those brains but for sure there is triggering of genetic expression, and likely induction of immunologic reactions. We know that those biological changes have primary effects in the brain especially in the areas responsible for governing judgment, inhibition, motivation and learning.

We do not yet know why some drugs produce these effects in some people; how much or often one has to use to bring about these changes, or how long these brain changes last. And we do not yet know which of those who drink or use for the first time will go on to become addicted.

But we do know two things for sure. Nobody – nobody – has their first drink in order to become an addict. And we know for sure that the brains of those who become addicted are very different from the brains they started out with.

I wonder how the media or the public would have reacted if Mr. Hoffman had passed away as a result of another disease that he had been struggling against for 23 years? Say cancer?

I think the young actor’s triumph over cancer likely would have been celebrated throughout his career as an example of his personal strength – a story of a talented individual bravely overcoming the odds. Perhaps he would have been “the face of” recovery from his particular form of cancer. Giving hope to fellow sufferers, raising awareness and needed research funds to find a cure.

What, then, would have been our response if the cancer had come back, and ultimately he lost his valiant struggle? My guess is we would have had compassion – we would have celebrated his struggle and remembered him for his courage – and we would have been right to do so.

But Mr. Hoffman reportedly died from the disease of addiction. An acquired, progressive, relapsing disease that he managed to beat back for 23 years of his life. And it was likely a day-to-day fight.

Science has shown that drug addiction actually produces lasting changes to the brain’s structure, particularly in those areas responsible for inhibiting actions and moderating motivational urges.

For example, we know that environmental cues associated with alcohol and drugs (like alcohol commercials on TV) can trigger brain changes associated with substance use. These environmental events (people, places and things associated with substance use) have been shown to evoke strong cravings even in sterile laboratory settings; and even among those who have remained steadfastly abstinent for years.

In other words, commonplace situations – like being offered wine at a dinner party –can literally cause the recovering addict’s brain to work against his effort to maintain sobriety.

Cast in this light, maintaining recovery from addiction sounds like a pretty heroic effort to me.

So why haven’t we celebrated that part of Philip Seymour Hoffman’s story? Why are there no national campaigns celebrating the many day-to-day battles that recovering individuals fight to stay clean and sober? And why – if this disease overtakes you and you lose the fight – do people who should know better sneer and suggest that the victim was a “weak piece of sh**”?

We don’t talk about other diseases like we talk about addiction. But we used to. I am old enough to remember that before science helped us understand other stigmatized diseases like cancers, tuberculosis, polio, depression and HIV – those who suffered from those illnesses, and their families, were also ashamed, alone and angry. But science and medicine changed public understanding for these still terrible diseases.

Those who suffer from these diseases also fight relapse and they do it valiantly – but at least they no longer have public approbation and scorn to add to their struggles. And they have large, well-funded public associations properly championing new and better treatments for them. For each of these diseases science has changed the way they were perceived and managed; and with those changes came public understanding and ultimately public support.

The science is equally strong in the case of addictions and it is time that media and public perceptions about addiction catch up with the science about this disease. Until that happens, too many talented and extraordinary people will struggle in silence and die in the shadows of shame.’

Comments

  1. Maria Blanshard says:

    I myself work with Addicts in Recovery in Blackpool, tbere is no funding available for this project, as for the same reasons. Mentioned above, the stigma around this disease is still very apparhent. I agree with this article as im inspired every day with these guys in their determination, and desire and their struggles throughout life. These oeople deserve this Recovery. As do many others.

  2. Hi David,

    That all sounds a bit 12step and AA to me, calling the addiction a disease, but I agree that making the choices to use leads to being diseased by the addiction.

    Once I was addicted to heroin and chose to stop using. A massive influence and tool that I used to help me stop was the WiredIn to Recovery community. One of my favorite diversionary activities was to compose poetry.

    Many of my poems were solely stored on the WiredIn website under my blogs and in comments – as I did actually write some articles in response to others posts in the form of prose.

    It would be greatly appreciated if you could forward my work to me as it was often a barrier in times of heightened risk situations to my returning to use, as you are no doubt aware single use by a former heroin addict all too often results in overdose.

    Many of the poems have specific content to use as a tool, be it avoid alcohol, reminiscence of my own personal near fatal overdose, bring back the feeling of withdrawal, there is even one that pits the recovery based motivational part of the brain, in battle against the areas of the brain responsible for encouraging drug use that never actually cease to exist, they really lay dormant until some trigger long forgotten rekindles them into action.

    As such risks have become apparent in my life and linked to my many forms of relapse, I was not just addicted to heroin, my substance addiction has taken many paths, including alcohol, one action I have taken to reduce triggers is to even remove the television from my house, as you point out those TV commercials are all too powerful, yet can even be subliminal within programs for me to risk exposure of them.

    Having tried many times to access the WiredIn site I reach the access authorisation point… http://www.wiredin.org.uk

    This would make it seem like the site is still live? If so could you please access and forward my work to me? Most poems are digitally signed ‘MMM@DGUGU’ in any case of my requiring to prove ownership of the original material. All posts and comments are under the username ‘marcymarcymarc’.

    I hope you can be of some help David.

    Please watch this short video about Recovery in Wales…
    https://www.youtube.com/watch?v=Qm_kCQXrQJU

    Thank you for your time.

    Happy St David’s Day!
    MMM@DGUGU

    • David Clark says:

      Thanks for this Mark and Happy St David’s Day to you. I’ll email you this weekend about your blogs, just running around at moment. Good to hear from you. My best, David

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