PART 1: As the fictional characters and real-life fans and actors of TV show, “Glee” prepare to say their good-byes to fictional high school football star “Finn Hudson” this coming week, they’re saying real-life final farewells to the beloved actor who played him, Cory Monteith. Just as the new fall season was getting off the ground, the official coroner’s report was released, declaring Cory’s death of last July “accidental” and reaffirming that the cause was a deadly combination of alcohol and opioids. (Opioids are natural opiates, such as heroin, which are drugs derived from the opium poppy, and also their synthetic and semisynthetic relatives, including many prescription painkillers.)
The toxicology analysis for the report revealed a “moderate level of intoxication” and the presence of morphine, codeine, and “an unambiguous metabolite of heroin.” (Several empty champagne bottles, a used hypodermic needle, and a spoon with drug residue were found at the scene of his death.) Both alcohol and heroin depress the central nervous system – in combination, they can cause sedation and death. Regular drug users build up a tolerance to their effects, but if they quit for a while and then resume use at previous levels, it can be deadly. The report went on to say, “Mr. Monteith had a history of illicit drug use with intermittent periods of rehabilitation and abstinence from drugs. The periods of abstinence ranged from years to months in duration.”
Why on earth, some people ask, would a young person with so much promise, good fortune, and adored by so many jeopardize it all? How could he do this when he had been to several prominent rehabs, one of them earlier this year? (According to People Magazine, sources confirmed that Cory had “spent time at both California’s Betty Ford Center and Crossroads Centre on the Caribbean Island of Antigua.”)
Things like this happen because, when someone has a serious addiction, the compulsion to use drugs and/or alcohol becomes more powerful than anything else, which is hard for many to understand. Certain factors place people at risk for developing an addiction including having a genetic predisposition (not reported publicly for Cory), and use of drugs and alcohol at an early age – Cory is reported to have started using drugs in early adolescence and he once told Parade magazine, that he used “anything and everything, as much as possible." You’re also at risk for addiction if you live, work, or go to school in places where alcohol and drug use is common – certainly, the world of fame and fortune makes the conditions “right” for out-of-control substance use for many young people. Having a history of childhood trauma, including physical or sexual abuse and serious neglect, boost addiction risk, too.
We also now know that changes can occur in the brains of people with addiction, some of which may be lasting. Alcohol and drugs produce their pleasurable, euphoric effects by directly or indirectly targeting the brain’s reward system, flooding it with a chemical messenger called dopamine and motivating use again and again. With repeated use, dopamine’s impact on the reward system in the brain can become abnormally lowered, so that even heavier and more frequent use results in less pleasure or “high.” Other brain systems such as the stress response system then become overactive and result in unpleasant feelings such as anxiety and “the blahs.” As addiction worsens, people are driven to keep using more to relieve these unpleasant feelings than to seek pleasure. That is, they use drugs and alcohol to feel “normal” or “not sick” more than to get high.
Addictive use eventually leads to profound changes in the brain and its memory systems so that reminders of drug or alcohol use, such as seeing drug paraphernalia or a wine bottle can trigger cravings, even after many years of not using. In short, chronic heavy drug and alcohol use can alter the brain’s structure and function, resulting in changes that last long after someone stops using and may explain why a return to drug or alcohol use can occur after prolonged periods of abstinence. For some substances, such as opioids and crystal meth, this “pull” back to using again is more profound than for others.
While people ask questions like, “Why would he do this?” and “Why didn’t rehab work?”, few ask “What kind of treatment did Cory receive – or not receive?” The celeb magazines and various blogs on the topic talk about difficult post-rehab transitions, insufficiencies of just 30 days of rehab, and the fact that rehab is only the beginning of recovery. While all are valid, few have asked, “Could it be that rehab failed Cory?”
The good news is that we have numerous sound, science-based approaches for helping people like Cory Monteith. The bad news is that many addiction treatment facilities use them infrequently, inappropriately, or not at all. Part 2 will address some of these approaches as well as where and how they may have fallen short for Cory.