Before the Devil Knows You're Hooked
Drug overdoses spark debates on addiction that belie its complexity.
Posted Mar 04, 2014
Even over a month later, the image of actor Phillip Seymour Hoffman lying in his bathroom, extinct, with a heroin needle sticking out of his arm, feels raw and unbearable. It is persistently shocking that someone who understood so much about what it means to be alive could stop living so suddenly, so soon. Many clever reviewers have subsequently lionized the Oscar-winner’s brilliant body of work (1) but, almost inevitably, the occasional commentator has used Hoffman’s tragic exit to once again debate issues of tone and policy:
- Is an addict is “to blame” when his addiction proves fatal?
- Does labeling addiction a disease and “medicalizing” it make it easier or harder to fight than criminalization?
- What does “personal responsibility” mean for addicts whose minds have been commandeered by a drug (2)?
- On one website two fellows even exchanged flames over whether or not Hoffman was a “good” person or a “bad” one (3).
This debate seems particularly inappropriate applied to Hoffman because one of his greatest skills was to portray flawed men who know they are flawed. It seems wrong to cast him as either a helpless addict overwhelmed by an invincible disease for which he bore no responsibility, or—as did The New York Post’s Andrea Peyser—a responsibility shirker who sacrificed the well-being of family and colleagues for a fleeting thrill (4). Such caricatures obliterate the self-portrait compounded of desire, frustration, self-awareness, and self-betrayal that he spent his life developing.
Hoffman, who became—or discovered that he already was—an alcoholic and a drug addict while in his twenties, was over twenty years clean—until about a year before his death. He seemed to be able to manage the stresses that, in a 2011 NPR interview with Terry Gross (4), he described as inextricable parts of his profession. But sometime last year, according to The New York Post, he relapsed, ingesting prescription opiates, and his various dependencies returned full force. (5a) (5b)
A stint in rehab in 2013 didn’t stick. The New York newspapers recorded his fall in sordid detail (6). He was still attending AA meetings when, in early February, a security camera at his local ATM showed him buying; and then he was dead.
Although many blamers claim that anyone who ever uses illegal drugs recreationally—even once—is “asking for” trouble, this is not, strictly speaking, true. While statistically, persistent use of hard drugs will shorten your life and, often, your mental acuity and personal relationships, only around 10% of first users are likely to develop a full-blown addiction like Hoffman’s. So, in practice, the “consequences” that a first time user is supposedly accepting aren’t clear until it’s too late:
A risk isn’t a certainty. People who slip quickly into addiction don’t know--at first—that they are among the minority of users who will hit a hidden patch of black ice and skid into oncoming.
Then there are others. Keith Richards, according to his autobiography, was an addict by choice as well as proclivity. He broke his dependency, he claims, only when the police were closing in and threatening to destroy his band. In other words, he was the kind of addict upon whom legal disincentives eventually worked (7).
Everything we know about Hoffman suggests that he was a different sort of substance abuser: those who prove hyper-vulnerable to chronic addiction. These are people who neurological research reveals are wired differently from everyone else. What they have isn’t a disease like cancer or rabies, but it is a neurological flaw, a proclivity towards addiction, a hidden patch of dark ice (8).
The attempt to apply uniform policies to all addictions is the fiasco it is because different addicts—and potential addicts—are hurt and helped differently by identical approaches.
For example, when drugs are illegal and socially unacceptable conformists will be deterred from trying them, while rebels will be enticed by these same prohibitions. Similarly, the publicly unforgiving attitude towards all addicts that some blamers recommend—while “deglamorizing” drug use for those with more rigid moral frameworks—has a paradoxical effect on live-and-let-live types who, hearing creative and sensitive people excoriated, are likely to identify more with the tortured addict than with the angry scourge.
Similarly, Peyser’s claim that calling addiction a disease encourages addicts to surrender to it rather than resist, is most likely true for some people. A recent article on obesity in The New York Times presented research showing that a group of overweight subjects, encouraged to think of their excess poundage as a medical condition, tended—statistically—to choose more fattening foods than a group allowed to feel shame and responsibility for their condition. A medical diagnosis can, but doesn’t always, send an unintended message (9).
The conservative strategy of shaming and blaming, on the other hand, once internalized by the addict, may as easily drive him back towards a desperate search for relief from self-hatred. As the old joke goes:
“I drink to forget.”
“That I’m an alcoholic.”
So, while for some, “you can beat this; just do it,” will work; for others—for whom it doesn’t—“This is bigger than you are, and you need help,” may be the best path to sobriety.
In most chronic addictions, the “off” switch for substance abuse is stuck in the “on” position in the addict’s brain, and it is beyond the reach of his conscious control to flip it. The addict orders himself to stop, but his drug-tweaked brain circuitry blocks the message or robs it of importance. Long after using becomes odious rather than pleasurable, the addict’s reward circuitry can’t learn to adjust to the new information.
For a mind wired to use, deliberation can only do so much. Try sucking in your stomach all day and…well, good luck. We survive by putting most of life on automatic. We aren’t designed to remember to break an ingrained habit 24 hours a day. To stop using for any length of time, an addict has to fool his mind into somehow either replacing or bypassing the entire switch or swapping out the damaging addiction for “healthy” ones. There is no one way to do this, and many addicts try several approaches before they find one that works for them.
But there are key points in an addict’s life when he has some active role in deciding his fate. Taking the prescription opiates—America’s new gateway drug to heroin abuse—that allegedly sent Hoffman back to the needle last year after over two decades clean, can be justifiably described as a stupid mistake, an unnecessary capitulation to a set of inner demons that he certainly knew well enough to shun (10).
It would be wrong, certainly, to say that his addiction “made him” relapse. At the same time, addiction does impair the addict’s mental circuitry in ways that give relapsse a boost. It’s easy to imagine all sorts of perfectly reasonable and utterly convincing lies Hoffman’s addicted brain could have whispered to him, from promises to unlock him creatively and put him back in touch with a younger, more vital self, to reassurances that now he was well-established and mature enough to handle it. Everyone’s addictions have personalized scripts, but they all amount to the same thing: the fleeting and often fatal delusion that this next high won’t steal your freedom.
All in all: Because addicts vary in so many ways apart from their addictions, the impulse to either blame or exonerate them without intimate knowledge or qualification of their individual circumstances, other psychological problems and innate predispositions indicates a deeper addiction: an insatiable craving for absolute certainty that is arguably more dangerous than any drug.
Whatever addictions Philip Seymour Hoffman suffered, an addiction to certainty was not among them. Not only was Hoffman capable of appreciating complexity, ambiguity and irony, but he was sbrilliant at it. He showed us that being fascinating but flawed, while it doesn’t necessarily make us likeable, or consistently good to ourselves or to those we love, should never be condemned without mercy, because in the end it is what makes us human.
I am embarrassed to use his death as an occasion to discuss this misguided debate between people who want to punish fellow citizens who fail to maintain something resembling personal autonomy and people who hope that those of us who have been overwhelmed by intoxicants can help each other wrestle our habits to the mat. I can see why they annoy the hell out of each other, but I hope they won't mistake that visceral irritation for evidence-based thought or sagacious social policy. Addiction is an agile foe and can only be subdued by supple strategies.
(1) Here are several well-turned appreciations of Hoffman’s career and work:
Lee Siegel for New Yorker Magazine’s “Page Turner” blog column http://www.newyorker.com/online/blogs/culture/2014/02/philip-seymour-hoffmans-beautiful-helplessness.html
Anthony Lane, film critic for The New Yorker http://www.newyorker.com/arts/critics/atlarge/2014/02/17/140217crat_atlarge_lane
David Edelstein, at New York Magazine’s Vulture http://www.vulture.com/2014/02/edelstein-on-philip-seymour-hoffman-1967-2014.html
and see also on Vulture, writer and director of Almost Famous, Cameron Crowe’s account of what Hoffman as an actor brought to his role as rock critic Lester Bangs in that film. http://www.vulture.com/2014/02/cameron-crowes-account-of-pshs-uncool-scene.html
(2) Fox news’ resident psychiatrist, Dr. Keith Ablow http://www.foxnews.com/opinion/2014/02/06/drug-dealers-didnt-kill-philip-seymour-hoffman-hoffman-did/
(4) Andrea Peyser “It’s Not a Disease” http://nypost.com/2014/02/09/philip-seymour-hoffman-cast-as-a-victim-of-disease/
(5) http://www.npr.org/2014/02/03/270954011/philip-seymour-hoffman-on-acting... "So, you're not there to be in therapy; you're there to take, you know, what you know and the experiences and behavior and emotional life of yourself and others and try to make something artful out of it. But the carrying of that around and the focusing of that can be, it can be tough."
(5a) New York Post, Page Six asserts “Hoffman spent about 10 days in rehab in early 2013 after relapsing on prescriptions drugs and then heroin.”http://pagesix.com/2014/02/11/private-diaries-reveal-hoffmans-demons/
(7) Additionally, Richards claims that he learned over time that after you get high, taking more drugs won’t get you higher, something he pointed out, addicts, particularly relapsing ones, ignore at their peril. http://www.psychologytoday.com/blog/dream/201102/the-devils-playthings
(8) It wasn’t just heroin that Hoffman fell in love with, it was alcohol and uppers, too: “all of it.” In a 2008 interview Hoffman suggested to Terry Gross that he was one of those pre-disposed to immoderation:
“It's not a great pleasure for me to have a couple of glasses of wine… Like, why aren't you having the whole bottle? ... That's much more pleasurable. So, to somebody who doesn't understand that, they just don't understand it.”
(9) In a 2011 interview with "60 Minutes," he discussed his past struggles with drug and alcohol addiction. "Anything I could get my hands on, I liked it all," he said. http://www.cnn.com/2014/02/02/showbiz/philip-seymour-hoffman-obit/
(10) "They get it in their mind that they can go back to using just once or just a little. Or maybe they think that they can use another substance other than their substance of choice and be fine, but they can't," he said. "It just takes one moment of weakness to lead them down a path of destruction."
Dr. Joseph Shrand, a Harvard professor and the medical director of CASTLE, a teen addiction treatment center in Brockton, Mass. "It requires lifelong vigilance to stay clean."