An apparent heroin overdose is a reminder of why we need to move toward evidence-based treatments for addiction
Like so many of us, I’m brokenhearted about the death of the remarkably talented actor Philip Seymour Hoffman. When I heard about it and learned the apparent cause — initial reports said it was a heroin overdose — my reaction wasn’t only sadness. I was enraged.
My rage about Hoffman’s death — and the more than 100 opiate deaths that occur every day — comes from the fact that it was preventable.
Hoffman was open about his addiction, which is rare in a culture that blames the afflicted and judges them as weak and selfish, bent on getting high no matter the toll it takes on those who love them — and on themselves. In interviews, Hoffman discussed his addiction in college that led, soon thereafter, to rehab. He said he remained sober over the decades since then, until last May, when a relapse led to another stint in treatment. Though addiction is a disease — a brain disease that’s often progressive — addicts who relapse are often blamed. They didn’t try hard enough to stay sober.
But it wasn’t Hoffman’s fault that he relapsed. It was the fault of a disease that often includes relapse as a symptom and the fault of the ineffective treatment he received.
After writing about addiction in a pair of books, I frequently hear from addicts and their family members about serial relapses followed by treatments followed by more relapses. It’s not uncommon for addicts to go through a dozen treatment programs.
A parent whose son died two weeks ago wrote to say, “I did everything I could, but I failed him.” “Everything” included eight residential programs and four outpatient programs. It’s not this father’s fault. The tragic fact is that with addiction, like many other illnesses, sometimes you can do everything right and people die.
But with addicts, most treatment centers don’t do everything right. In an article I wrote for TIME.com about the mental-health provisions in the Affordable Care Act, I noted that 90% of those who enter addiction-treatment programs in the U.S. don’t receive evidence-based treatment.
We don’t know what treatments Hoffman received, but it’s unlikely that it was state-of-the-art care rooted in the fact that addiction is a brain disease. He should have received a range of treatments that have been proved to be effective. Traditionally, the only choices offered to addicts were 12-step programs, but now proven treatments include cognitive-behavioral therapy, motivational interviewing and psychopharmacology. Indeed, medications are particularly effective in treating opiate addictions. Richard Rawson, associate director of the UCLA Integrated Substance Abuse Programs, says, “Failure to encourage patients to use these medications is unconscionable. It’s comparable to conducting coronary bypass surgery and failing to prescribe aspirin, lipid and blood-pressure medications as part of a discharge plan.”
We don’t know if Hoffman was, upon discharge from treatment, prescribed medications like Suboxone, which prevents opiate relapse, but it’s unlikely, because most treatment programs eschew them. If he had been (and if he took them as prescribed), it’s almost certain that he’d be alive today. Another medication that may have saved his life is naloxone, a drug that reverses an overdose. All opiate addicts, as well as police and other first responders, should have access to the drug. Also, addicts’ discharge plans should include follow-up treatment, including for co-occurring disorders, such as depression, anxiety disorder and others that often accompany addiction.
Proper addiction treatment works in many cases, but the most tragic fact of Hoffman’s and others’ addictions is that they could have been prevented in the first place. Addiction is caused by a combination of genetic, environmental and psychological factors. For now, genes aren’t fixable, but it’s possible to protect people from becoming addicted by improving their environments and addressing their psychological stresses. Risk factors such as mental illness; learning disabilities; ADHD; trauma; poverty; and growing up in dysfunctional families, where there’s violence and abuse and in neighborhoods defined by drugs and violence, can be mitigated and replaced by protective factors including counseling, social programs, therapy, education and a range of other interventions. If they are, drug use can often be averted or nipped in the bud.
Minutes after Hoffman’s death was announced, on Twitter I was asked if I feel despair because of another overdose death. I do, but I also have reason to be hopeful that this catastrophe may lessen or even end.
These days, most heroin addictions are preceded by addictions to prescription opiates like Oxycontin and Vicodin. These drugs can be hard to get and expensive compared with a cheaper opiate: heroin. If we can prevent prescription-medicine misuse, we can prevent many instances of heroin addiction.
If pain-medication abuse is effectively curtailed, so will the sharp rise in heroin addiction. If the treatment system adopts evidence-based practices, heroin addicts like Hoffman can be saved.