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Philosophy and pop culture

Philip Seymour Hoffman and the Russian Roulette of Relapse

Addiction is chronic, progressive, and fatal

I have co-authored this blog post with J.R. Lombardo (www.jrlombardo.com), a licensed social worker who specializes in addictions counseling. As fans of Philip Seymour Hoffman, we were saddened by the news of his overdose.

Recognizing that he had a problem, Mr. Hoffman quit using drugs and alcohol after college, but he resumed his habit several months ago. Heroin, Hoffman’s preferred drug, produces “an exaggerated sense of wellbeing,” and this is the lure. As heroin use persists, though, it becomes less about the high and more about staving off withdrawal symptoms, which start within 6-8 hours of the last use. Heroin withdrawal has been described as “the flu on steroids” and can result in death if not medically monitored. Heroin addicts call using “getting straight” because it has the immediate effect of minimizing or stopping withdrawal symptoms.

Unlike other Hollywood celebrities who make the news with their on-and-off battles with addiction, Hoffman had been clean and sober for 23 years before resuming drug use several months ago. One might think all that time free from addiction would mean that he would stand a better chance of beating it when he resumed his drug use. Not so. There is an expression in the world of recovery that addiction is “chronic, progressive, and fatal.”

When an addict like Hoffman stops using drugs his body can often heal from much of the damage. Unfortunately, though, no amount of time away from the substance is enough to erase the addiction. This is why people in 12-step programs refer to themselves as “recovering” alcoholics or “recovering” addicts. They recognize that, even though they are sober and abstinent, their addiction is alive and well. It is “doing pushups outside the meeting room,” as they say. The bottom line is that addiction can be treated but it cannot be cured. Hoffman likely knew that, but the subtle insanity of addiction led him back where he came from.

In the world of recovery there are “slips” and there are “relapses.” A slip is a one-time or small-scale occurrence with immediate return to sobriety, whereas a relapse is a full-scale return to the former way of life. There is no way of predicting whether using the drug again after a period of sobriety will amount to a small slip or result in a major relapse. So, several months ago, when Mr. Hoffman took heroin for the first time in 23 years he was, in effect, playing Russian roulette. And he lost. The slip was actually a relapse, and the relapse cost him his life.

What could he have done differently? It’s easy to play Monday morning quarterback. We do not know the details of Hoffman’s recovery, but we do know that he would have been welcomed back in the rooms of 12-step programs. It’s not okay to have a relapse, but if you have a relapse it’s okay to come back. There is no hierarchy in 12-step meetings. The person with 20 years of sobriety is no better than the person with 6 months. Movie star or maintenance man, any individual is treated equally. Although an individual might feel like a failure if they have a relapse after a long period of sobriety, they are always treated with dignity and often a round of applause and effusive hugs when they return. Coming back under those circumstances is literally like getting a second chance at life. The Russian roulette of relapse doesn’t have to end badly.

Copyright 2014 J.R. Lombardo and William Irwin

William Irwin, Ph.D., is a professor of philosophy at King’s College in Pennsylvania.

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