Spin Dry: The failure of treatment and what can be done about it

Philip Seymour HoffmanBy now we’ve all heard about the tragic death of one of the leading actors of my generation, Philip Seymour Hoffman.

I say tragic in the sense of lamentable and piteous.  I also mean it in the sense of deplorable, because it shouldn’t have happened.  Mr. Hoffman, a man with some experience at getting and staying sober, checked himself into a treatment center about 7 months ago and left ten days later.  Now, I don’t have first hand knowledge of exactly what happened, but I have some experience of my own, recently even, dealing with treatment centers and I will tell you that I am not impressed.  Granted, I live in the Great Redneck Desert and one can’t rely on anything here to work the way one would expect in the rest of the world, but even discounting for that, there appear to be flaws in the way that recovery services are delivered in this country that I believe contributed to Hoffman’s death, as well as the death of fellow actor Cory Monteith, who died shortly after leaving a treatment center.

Before I go further I want to affirm my belief that treatment works.  Study after study backs that up, and those studies also point to which treatments work better than others.  I also want to point out that for the purposes of discussing treatment, I don’t find it useful to differentiate between opioid prescription medications which cause 15,000 deaths every year, and heroin, which causes far fewer deaths, but which is incredibly dangerous and has terrible ramifications to global security.  Besides, most new heroin users are people, like Hoffman, who started on prescription drugs and moved to heroin; an unintended consequence of making prescription opioids safer. Combined, the total number of overdoses in the U.S. totalled nearly 40,000 in 2010.

I also want to emphasize that the reason treatment is necessary is that addiction is a chronic, progressive disorder (or disease in the parlance of many from a 12-step recovery background).  Those who experience a relapse into active addiction are not weak or immoral, they very likely understand the benefits of recovery, and yet experience some moment when what they have been doing is suddenly insufficient to keep active addiction away.  My own writing here can attest to my love for and commitment to sobriety.  In Mr. Hoffman’s case, in a 2006 interview he credited sobriety for his whole career and even his life.

“I have so much empathy for these young actors that are 19 and all of a sudden they’re beautiful and famous and rich.  I’m like, ‘Oh my God. I’d be dead.’ You know what I mean? I’d be 19, beautiful, famous and rich. That would be it. I think back at that time. I think if I had the money, that kind of money and stuff. So, yeah [I would have died].”

If you’ve been following my blog lately you know that I recently left an outpatient treatment program long before I was supposed to because I felt like the treatment I was getting was totally pointless and prevented me from doing other things that I felt were more important.  Hoffman left his treatment center after only 10 days.  One can only speculate on what that means, but in my case, I left because I didn’t feel like what I was getting from treatment was useful; it didn’t add anything to what had previously been long(ish)-term recovery.

The fact that substance use disorder is real should by now be beyond dispute.  There is less volition in the process of picking up a drink or a drug than even those with the disease even imagine.  This will fly in the face of the law-and-order crowd or those whose worldview hinges on the concept of free will, but the facts as demonstrated through the best available scientific techniques tells us another story.  A hijacked brain is still a hijacked brain, no matter how healthy the brain may tell its owner that it is.  And this is where the story of treatment for the hijacked brain becomes critical.

Despite containing other, really useful information about addiction that needs to become more understood by the public, todays news reports on Hoffman’s death are focusing on the fact that Hoffman died despite having had returned to rehab last March. This places the blame for his death squarely on the disease and on Hoffman himself.  This is an error and treatment providers and the Federal government should have their feet held to the fire for spinning the tale this way because it fails to acknowledge a basic fact: treatment services in this country are low quality and under-provided because of rules that don’t mandate training and licensure or provide a mechanism for the kind of long-term follow-up that is empirically proven to save lives.

I can’t say that Hoffman didn’t, but I know I haven’t received a follow-up call from my outpatient provider.  No-one there has reached out to me to ask about how I’m doing or to mention that they had identified some needs that remained unaddressed in treatment and to suggest that we sit down and talk about them.  I have even had the experience of having a clinical director of a state licensed treatment facility tell me flatly that I’d never get sober unless I held my cigarettes in a more manly way.

We don’t permit other chronic diseases to be treated this way in America.  My brother had non-Hodgkins lymphoma and he had major, full work-up follow-up visits for years after he went into remission.  I was diagnosed with diabetes mellitus and I never go more than six months without hearing from my endocrinologist for a follow-up visit complete with blood work and more education when it has been required. But for some reason we allow the providers of addiction treatment to ignore evidence based protocols and to throw their patients, who cannot, because of the very nature of their disease, be relied upon to always make perfect decisions regarding their care.

There are rare exceptions.  There are some fantastic places in America to get treatment.  People like Hoffman could certainly afford them.  I cannot.  For 2 years before my relapse I dreamed of going, I ached to go to spend some time at Hazelden’s Renewal Center, a facility my late sponsor credited with keeping his own recovery alive in difficult times. There are other, similar programs available to those that can afford them, but most of us end up relying on some kind of public funding or on the provider that our insurance will pay for, and what our insurance will pay for is something far short of the mark that the good people at NIDA know works.

There is no way that one can view Hoffman’s 10 day stay at a detox and subsequent death as anything other than a failure of the treatment system.  Nor can we view Cory Monteith’s release from treatment and his overdose death a short time after as anything but a failure of the treatment system.  Hoffman and Monteith cannot be held culpable for picking up as they had very little if any choice in the matter.  The health care system charged with providing them with support and healing failed them when they could not stay abstinent on their own.

How treatment is provided and paid for, including types of treatment provided, quality of care, provision of care and reimbursement require an overhaul from top to bottom.  Until they are, we will continue losing 100 people every day to overdose, and countless others who will suffer and die slowly and unnecessarily.  We must demand better.  We owe it to those whose lives hang in the balance.

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  1. I think I’ve said before that addiction confuses me. Substance use disorder – I like the sound of that better than some things I’ve heard. It sounds like yet another failure on the part of the health care community. Not complete failure, I think, but gaps and holes and pockets of pitiful failure. Of course mental health care in this country is really messed up.

    Thanks for sharing your thoughts. You’ve got my brain thinking this afternoon, and that’s a good thing.

    Take care, Chris. I hope you are doing well.

    Reply

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