Thoughts on Drugs and Addiction

In the aftermath of the passing of an actor

The news came out a couple days ago that Phillip Seymour Hoffman died of a drug overdose. It was as obvious as could be because of the needle left in his arm upon death and the bags of heroin in his room next to him. For people that have any connection to drugs or addiction-present, past or peripheral, this scene conjures up feelings. I have felt them in myself. A complex mishmash of shock, sadness, anger, loss and fear. Why all these feelings? I didn’t personally know this man, although I was drawn to him through his work. He was a brilliant actor who fully inhabited each character he played. I was outraged. At the finality of it; That he is really gone from this world, forever, because of an act so preventable. When I read posts from people saying RIP, I became angry, because RIP is what you say when people have passed that were suffering, or were innocent in their demise. Rest in Peace. My instant thought was that he was not the person to be feeling compassionate feelings towards. It was his family, his partner and 3 small children who should be thought of in this way. I have softened some in the past couple of days upon examining my reactions, but those feelings were real also.

So, once again, where does this vehemence in me come from? Well, personal experience of course. The fact that Phillip Seymour Hoffman claimed 23 years of recovery from addiction, clean time as it is called, abstinence from drugs and (I assume) alcohol. Then, according to reports, he began to use again, first with prescription pain medications prescribed by a doctor and then sliding into the use of street opiates-namely heroin. So, once again, why my outrage? I recognize that it comes partly from a place of fear. There is a feeling of a goose walking over my grave. The chills…How could this happen with a guy who had had 23 years of continuous abstinence?

First, let me introduce my own connection with addiction and drugs to help explain why I might have these reactions. I have been working with addicts for over 20 years professionally and almost 25 in a voluntary capacity. For my entire career at least 50% of my psychotherapy practice has been working with addicts and substance abusers. I have seen the struggle up close and personal and also have seen it in my family. Siblings that did not win in the fight of addiction and parents that didn’t think they had a problem because alcohol is legal. And yes, more than 25 years ago, I myself came to the turning point at which I left all drugs and alcohol behind. And, no, I have not looked back since that point. I have stayed abstinent, like Phillip Seymour Hoffman did up until the point he didn’t any longer. So when people question where I get my information, it has not come cheap and not from a book I read on the weekend required course in my graduate program.

Going back to using

After a long period of abstinence from substances, the reasons people use drugs again seem to follow a few patterns. For those folks who attend support groups (a 12 step group like Alcoholics Anonymous or Narcotics Anonymous or Smart Recovery or LifeRing) they may feel they don’t need to attend anymore and that they can handle life and their addiction on their own. This is a common misconception for many people. People think that once they have ceased taking in a substance for a considerable period of time that they will never try it again.

In the case of Mr. Hoffman, it has been noted that he may have suffered from depression. Untreated, depression can become unbearable and lead a person to want to use a substance to stop the darkness. As a matter of fact, it is well documented that many persons who become addicted to drugs are “self-medicating” or trying to treat their own symptoms of mental illness. The most common mental illness/self-medication situation is bi-polar disorder. An individual can attempt to deal with their own highs and lows for years with one illicit drug or another or alcohol as well. While in a manic state, a person may take methamphetamine to extend that state. It is not usually the case that this is a conscious act, but simply an awareness over years that the individual has developed about their own swings and how to deal with them. It is also true that on the depressive pole of bi-polar disorder an individual may use methamphetamine to prevent the incredibly deep dive into depression they might otherwise take. Alcohol is commonly used as well to try to compensate for the varying mood states and physical symptoms of bipolar. It has been noted that post traumatic stress disorder (now also known as post traumatic stress or PTS) is correlated with substance use and dependence at a rate of 50% or higher. In working with veterans and other people that have experinced extreme trauma, I have found this to be accurate. It is not surprising that an individual will want to quiet the noise, the hyper-vigilance or the nightmares by using alcohol or drugs. Individuals will also self-medicate with other anxiety disorders. Panic disorder, agoraphobia, and general anxiety disorder leave a person feeling constantly on edge and seeking something to take the edge off is very common. Alcoholism commonly co-occurs with these disorders. The person feels justified because of the intensity of what they deal with without the substance. Of course, all of these disorders can be treated with medication and psychotherapy and when an individual finally makes the step to get help from a professional, the landscape of their life can improve dramatically and they can stop self-medicating.

So considering heroin, why would heroin be a person’s “drug of choice” or the drug they reach for to self-medicate? In the research study I conducted some years ago on long term recovery from opiate addiction, I discovered that there is a correlation between trauma and the use of heroin. In one study of heroin addicted females 87% had been sexually abused as children. Physical and emotional abuse as well as witnessing violence as children was also common in adults addicted to heroin. If you think about it, heroin is an analgesic that cuts physical pain but also does a great job on emotional pain. Users report being able to forget about their reality if only for a short while. Coming from an abusive or violent household can lead an individual to seek escape and so, if the person is exposed to heroin, it can seem like the answer to harrowing memories and distrust of others. Of course, we know the cost is all to high for those that choose heroin as their answer.

Another common road to trouble for a former drug addict is alcohol. After a period of abstinence from all drugs and alcohol, the individual may feel that he is missing out. Others can drink, why can’t he? It’s legal for God’s sake! He may say, “I’m fully grown! I can handle a glass of wine or a beer. It is not the same as heroin (or cocaine or methamphetamine). I’ll be fine.” There are so many things wrong with this line of thinking that it is hard to know where to start. Alcohol, as we all know, lowers inhibitions and clouds judgement. Countless live studies have been done to measure the amount of drinks it takes for differing levels of judgement and physical control to decrease and finally dissapear. Once in a state of impaired judgement, an individual is much more likely to cross personal boundaries and engage in high risk behavior. These can include the boundary to stay abstinent from drugs. Once the individual crosses that line and ingests the illicit drug of abuse (it may not be their “drug of choice” at first) there is often a sense that it is futile to attempt to stay away from it now. “What’s the use, I’ve blown it, might as well keep using.” Now, it is not a case of the individual drinking a glass of wine or beer like everyone else. The barrier between them and using drugs (their former abstinent, recovery focused mind) has been permeated and is not as effective now. Until this person takes a definate step to consciously address this relapse into drug use they remain in a precarious position. This step could be reaching out to a treatment center, a therapist with knowledge of addiction or going to a support group.

The most common way I have heard for people with long term recovery from addiction to begin using again is through the use of pain medication originally prescribed by their physician for something. It is always a good idea to let your doctor know you are a recovering person and that you should not be on narcotic pain medicine if it can be avoided. Why? Because narcotic pain medications are opiate based drugs. If a person was once addicted to heroin (or even cocaine or methamphetamine) the use of drugs like percoset or oxycontin or even vicodin (very commonly prescribed) given for a valid reason can ignite a flame inside the recovering person that makes them forgetful of the dangers. They may increase the dose to feel it a little more fully than the prescribed dose. The possibility then exists for them to make the lethal mistake and choice to step beyond the prescription itself and look for their old illicit drugs. In a case where narcotics are essential for the healing and recovery process of a medical issue, an individual can prepare themselves for it by telling their support people (spouse, partner, sponsor, therapist) and even having someone hold their medication for them while they are on them.

So, once again, how could this happen? After a person has had a good life, a great life, full of loved ones and accomplishments and accolades? Because at the root of it all, the drugs solved a problem, salved a wound, blocked painful feelings…felt good. So the person gets caught in this vicious cycle again.

I have no knowledge of the trail Mr. Hoffman walked. From the news stories it is said his partner asked him to leave. He may have felt he had nothing to keep trying for. He may have been in the grips of depression and was self-medicating. Once the using starts again, there is no telling where it will end. It is never good. I have never met an addict that decided to stop using because he or she was just bored with it. By the very nature of addiction, it has you in its grips. That is not to say that recovery isn’t possible, people stop using drugs and alcohol every day. There are thousands of treatment centers that will help a person do just that. Staying stopped is the hard part.

There is also help out there to mitigate the effects of using, like drugs such as Naloxone, or Narcan it is called. This drug can bring a person out of an overdose and there is talk about availablity of this to the general public without a prescription. It would have possibly saved Mr. Hoffman’s life as it has many others, in a hospital emergency room. Having said that, he died alone and it takes another person to administer Naloxone so it may not have made a difference.

When I talk to people with addiction issues, I do not lead them to believe that they can ever use drugs safely. That is not what I believe. If they want to work with someone who will walk with them while they try to use drugs successfully, they will not choose to work with me as their addiction treatment specialist and psychologist. I am fine with that. I believe in abstinence from drugs like these because abstinence is assured of success (a person who uses alcohol alone is another kettle of fish and I will not address that topic here.) The trick is staying abstinent. And that takes a lot of work; constant work and willingness to ask for help. It is well worth the effort.

Mr. Hoffman gave a lot of us food for thought in his passing. The spotlight is on heroin addiction again and I am glad for that. It hasn’t gone away. As a matter of fact it seems to be on the rise in many cities and states.

What I see in my practice is that kids will start by taking prescription pills. They may get them at school, then they buy them off the street. But they are quite expensive. $40 per pill for an oxycontin. Heroin is much cheaper and much more lethal. Young kids are doing it in high school. How can you tell someone is on heroin? Their pupils are constricted, they may be having a tough time staying awake, they may scratch continuously. For some people, they may drop some weight but not much (in the case of methamphetamine, a user will drop considerable weight.) Its a good idea for parents to know the signs of drug use, and to be candid talking to their kids about it-don’t look the other way.

Every time a celebrity dies of drugs, it is another opportunity to speak about the seriousness of addiction. It is a tragedy and that celebrity becomes the symbol of the problem. This time it is Phillip Seymour Hoffman. I doubt this is what he wanted for his legacy. He is known for such brilliance in his roles. But perhaps this conversation will bring some positive light to this topic, and perhaps save a life because of it. Recovery from addiction is a lifelong process that needs to be protected above all else. That is the message I get from his death.