Drug use is not uncommon, addiction is less common. Following addiction, recovery is also quite common, with or without treatment – although we are convinced that the opposite is true.  At the same time, relapse is not uncommon, and can be handled functionally. What is dysfunctional is our temperance attitudes towards substances, their use, and their misuse. Our attitudes towards drugs are more lethal than the substances themselves. 

Philip Seymour Hoffman, age 46, died of an apparent heroin overdose Sunday morning in his New York apartment. In a "60 Minutes" interview he described going through rehab, age 22, and being "sober" – meaning no drinking or drug use – for 23 years. However, last year Hoffman entered rehab again. Futhermore, "Mr. Hoffman had admitted to a drug relapse at a Narcotics Anonymous meeting in December." So, Hoffman killed himself while attending NA and after being in rehab.

[March 1: Despite PSH's involvement in treatment/NA, he did not act consistent with a recognition of risk factors.]

Why did Hoffman join that large group of celebrities who died after recently having been in treatment? After all, many people have lived long lives while using opiates. Following are five reasons these deaths occur so often following rehab and while being in 12-step recovery. All of them stem from one basic fact: the one and only goal of American treatment and recovery is perpetual, lifelong abstinence. No treatment or NA time is devoted to the essential truth that most rehab grads and AA/NA members will use again, and to prepare them for this possibility.

1. Combining different drugs and alcohol. Rehab grads are not made aware that the worst usage pattern is to combine alcohol and other drugs, particularly depressants (such as narcotics, tranquilizers, and barbiturates). What is usually mistakenly called "overdose" is in fact the result of such lethal combinations, which depress the nervous system and cause the person's breathing to fail. This occurred in the case of "Glee" actor Corey Montieth.

2. Lower tolerance. If rehab grads haven't been using for some time (which is likely the case when they are fresh out of the rehab facility), their tolerance for their drug of choice has diminished--particularly in the case of narcotics. Rehab residents should be schooled in the basic facts of tolerance and alerted that, if they use, they should lower their accustomed dosage.

3. In for a dime, in for a dollar. Twelve-step programs teach people that any level of use of any drug or alcohol is the equivalent of a full bore relapse, so that addicts and alcoholics give up all efforts at self-restraint once they have consumed any amount of a substance. As a result, they often experience a complete relapse after a slip. The opposite approach is to train addicts in relapse prevention, which teaches methods for "getting off the runaway train" at any point, from exposure to a substance, to initial use, to excessive use – for all of which there are remedies or "off ramps."

Here is one respondent to my Psych Today blog on this topic:

One thing your article didn't stress enough is the idea of relapse shame. We are told in AA that to have one drink is as much of a relapse, failure, and loss of status as a week-long binge. And we are told that once we have the first drink we cannot stop. Is it surprising that a person who takes that first drink is quite likely to go on to consume a huge quantity of alcohol/drugs? If you are going to lose your "time" and have to "start over" and face shame in "the rooms" you might as well get your humiliation's worth, and they said you couldn't do any different anyway.

4. Failure to have safeguards in place. Since the only permissible stance post rehab is to vow never to use a substance again, graduates are not "allowed" (or alerted) to take safety precautions. For example, it is unwise for them to consume alone, as Amy Winehouse did. Embarrassed that she was violating her sobriety vow and that she was drinking at all (an autopsy revealed that Winehouse had consumed only alcohol before her death), she didn't ask her assistants to look in on her, so that they could potentially have saved her life when she became unconscious. (Hoffman was reportedly shooting alone -- generally only one person overdoses in a group, which of course undercuts the entire overdose narrative.)

5. Failure to have available an overdose kit. If you are going to use narcotics, you should have readily accessible an overdose kit, the main ingredient of which is naloxone (brand name, Narcan), a narcotic antagonist. Such kits are certainly not given to people leaving rehabs, since AA, NA, and 12-step programs refuse to recognize the possibility of controlling outcomes of use. Naloxone reverses the depression of the central nervous system and respiratory system that causes death, even when the "overdose" is the result of narcotics combined with other depressant drugs and alcohol. In many states, overdose kits are not even used by emergency workers.

As I said, all of these failures to prevent post-rehab deaths are due to the kind of unrealistic, perfectionist, just-say-no approach America takes to drugs, alcohol, and addiction – attitudes not restricted to Midwesterners. I watched Actors Studio host James Lipton describe how conservative he is in this area, so that he is totally unforgiving of drug use. Unfortunately, the insightful Mr. Lipton misses that Hoffman was equally unforgiving of his drug use, so that he wouldn't protect himself while, in fact, he took drugs. This protection is the essence of harm reduction.

It is ironic in the highest degree that people should be most ignorant of and resistant to taking the precautions necessary in order to live after having been in drug and alcohol "rehabilitation." After all is said and done, a person can recover at any point, so long as the person lives.

Stanton Peele's new book (with Ilse Thompson), is Recover! Stop Thinking Like an Addict and Reclaim Your Life with The PERFECT Program. Follow his guided self-cure program at lifeprocessprogram.com

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