Does Calling Heroin Addiction a Brain Disease Help Avoid Tragedies Like Philip Seymour Hoffman's Death?

WikipediaWikipediaIn a recent Time essay, David Sheff says Philip Seymour Hoffman was not responsible for the decisions that led to his death because he suffered from "a brain disease that's often progressive"—i.e., drug addiction:

It wasn't Hoffman's fault that he relapsed. It was the fault of a disease that often includes relapse as a symptom and the fault of the ineffective treatment he received.

You might surmise that there is a connection between viewing addiction as a brain disease and coming up with an effective treatment for it. But you would be wrong. The dominant model for addiction treatment in the United States is the 12-step approach promoted by Alcoholics Anonymous, which describes addiction as a disease yet advocates what amounts to a spiritual cure—one that does not seem to work better than any other approach, possibly including no treatment at all.

Sheff, author of Clean: Overcoming Addiction and Ending America's Greatest Tragedy, suggests some alternatives. "Traditionally," he writes, "the only choices offered to addicts were 12-step programs, but proven treatments now include cognitive behavioral therapy, motivational interviewing and psychopharmacology." But the effectiveness of cognitive behavioral therapy and motivational interviewing hardly depends on viewing addiction as a brain disease rather than a hard-to-break habit. And although "psychopharmacology" sounds  more like a medical treatment, here is what Sheff has in mind:

We don't know if Hoffman was, upon discharge from treatment, prescribed medications like Suboxone, which prevents opiate relapse, but it's unlikely, because most treatment programs eschew them. If he had been (and if he took them as prescribed), it's almost certain that he'd be alive today. Another medication that may have saved his life is naloxone, a drug that reverses an overdose. All opiate addicts, as well as police and other first responders, should have access to this drug. 

Suboxone contains buprenorphine, an opioid used, like methadone, in "maintenance treatment," which substitutes one narcotic for another. (Although Sheff speculates that lack of proper medication may explain Hoffman's apparent overdose, the New York Daily News reports that buprenorphine was found in the apartment where he died.) There may well be advantages to substituting an orally ingested pharmaceutical-quality opioid for a snorted or injected black-market opiate. But that does not mean addiction is a brain disease, or that a heroin addict must accept that view to benefit from the substitution. It is even less plausible to suggest that naloxone will work to reverse a heroin overdose only if you adopt Sheff's view of addiction, although he is certainly right that naloxone should be more widely available.

Might there be disadvantages to viewing addiction as a brain disease? Stanton Peele, a psychologist who has been writing about addiction for nearly four decades, suggests that the "learned helplessness" inculcated by the disease model makes tragic outcomes like Hoffman's death more rather than less likely. An addict who believes complete abstinence from heroin is the only acceptable option because he is physiologically incapable of exercising control over his drug consumption may be ill-prepared for a relapse. Having adopted an all-or-nothing view, he may be disinclined to take precautions such as moderating his intake, asking friends to look in on him, having naloxone on hand in case of an overdose, and avoiding other depressants (which are involved in the vast majority of so-called heroin overdoses). In other words, the lack of responsibility that Sheff urges can have deadly consequences.

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  • Certified Public Asskicker||

    Jesus Christ, another PSH post.

  • SIV||

    The "H" stands for HEROIN.

  • Certified Public Asskicker||

    Oh, that's a twist, I didn't know he was using heroin.

    Is that how he died? I mean, he is dead, right?

  • Rich||

    And a piece of all of us died with him.

  • Rich||

    That's what the "P" stands for.

  • BakedPenguin||

    Yup. Also, Lou Reed.

  • Certified Public Asskicker||

    Come back tomorrow for the post:

    Does Calling Heroin Addiction a Liver Disease Help Avoid Tragedies Like Lou Reed's Death?

  • Sevo||

    BakedPenguin|2.4.14 @ 5:51PM|#
    "Yup. Also, Lou Reed."

    And Franco! He's still dead.

  • Spawn of Nyarlathotep||

    Heroin? Damn, for the last few days I'd thought he was killed by a HERON. Those birds can be dangerous, right?

  • Pelosi's Rabbit||

    Heroin let him down one last time.

  • Rufus J. Firefly||

    One more than Mandela?

  • Paul.||

    "a brain disease that's often progressive"

    Insert appropriate joke here.

  • Sevo||

    I believe you already have.

  • Robert||

    And Progressive Insurance has inserted [an appropriate?] ad on the right.

  • GILMORE||

    "In a recent Time essay, David Sheff says Philip Seymour Hoffman was not responsible for the decisions that led to his death because he suffered from "a brain disease that's often progressive""

    Man, they REALLY don't like the whole "personal agency thing" AT ALL. At what point is a person EVER responsible for themselves? Fat? nope. Poor? capitalism's fault. Hooked on smack? you caught COBAIN'S SYNDROME. Never ever ever ever ever ever is anything ever an individual's responsibility. That's way too heavy, man. instead, lets make *everything* a disease. There is no 'bad'. Its just you caught that 'shitty person' bug.

  • Rich||

    At what point is a person EVER responsible for themselves?

    Let me answer that question by posing another. At what point is a village EVER responsible for itself?

  • Paul.||

    Man, they REALLY don't like the whole "personal agency thing" AT ALL. At what point is a person EVER responsible for themselves?

    Doesn't the government have some interest in stopping [fill in the blank]?

  • BakedPenguin||

    At what point is a person EVER responsible for themselves?

    When they hold disfavored political beliefs, they're not only responsible for themselves, but also for all the evil in the world!!1!!11!

  • ||

    They hate personal agency because it means that people are responsible for their own actions. At their heart, they hate this idea because to accept it means they are responsible for their own actions. Being responsible for your own actions terrifies the shit out of a lot of people, and especially certain kinds of people. Coincidentally, the people most terrified of personal responsibility tend to be leftists/progressives/whatever you want to call them.

    They love collectivism because it's a way of discharging personal responsibility. "We" do things. Not "I". That way everyone is responsible, and their terror is soothed, since the responsibility is collective.

    Now, I'm not sure why they are terrified by personal responsibility, because I can't understand it. But I have seen enough people literally almost losing their shit when confronted with their own actions and being asked to own them that I know that this terror exists.

  • sarcasmic||

    Now, I'm not sure why they are terrified by personal responsibility, because I can't understand it.

    Remember that we're talking about people who don't think. They emote. Everything is based upon feelings.

    Being responsible for your own actions means you might make mistakes, and that doesn't feel good.

    When everyone is responsible, no one is responsible. There are no personal mistakes. Bad feeling have been avoided.

    It always comes down to feelings.

  • Duke Trshmnstr of Stench||

    Now, I'm not sure why they are terrified by personal responsibility, because I can't understand it. But I have seen enough people literally almost losing their shit when confronted with their own actions and being asked to own them that I know that this terror exists.

    You probably don't understand because you've never felt chronically inadequate and helpless. These people do. They keep trying to find satisfaction in life, but end up all the more miserable and are helpless to resolve it. They did all the right things. They did alright in school, they went to college, they used condoms, they supported all the right causes, they felt the right way about all the right things, and they're still miserable. They aren't the special snowflake that they wanted to be, and they aren't making a difference in the world. They're just stuck in an average existence, wallowing in self-pity, counting down the days, months, years until their meaningless existence is snuffed out.

    Rather than reflecting on their own lives, or perhaps pursuing spirituality or the betterment of their sphere of influence, they turn bitter. When that bitterness weakens them enough, they hear a faint call from the wild, a quiet "It's not your fault". It's the call of the modern progressive, a movement founded in puritanism, but with over a century of honing and winnowing. These sad souls never had a chance. After all, would you rather blame yourself or others for your shortcomings?

  • ||

    After all, would you rather blame yourself or others for your shortcomings?

    That's really it, isn't it. It's the siren song of "other people's fault". If it's other people's fault, then that explains why they failed when they were so obviously destined to succeed.

  • Duke Trshmnstr of Stench||

    I think it's all traced back to the progressive stranglehold on education and childhood entertainment. They teach that you're a "special snowflake", that you're important, that you can "change the world", and that you're destined to succeed if you put your mind to it. It has infected the culture to the point that we don't even notice it anymore. The phrase "save the environment" is one of those subtle ones that introduces superhero thinking. I'm not reducing my impact on the environment. I'm not being more efficient with my waste. I'm saving mother gaia!

    When you're built up on those lies from infancy, you literally run into a crisis of character when you see that the real world is much larger and more complicated than you were told. How are you supposed to make the world a better place, achieve your goals, and make a difference when you're just one of 7 billion? I think that one's answer to that question depends on the age they confront it and how much they bought into the "you can change the world" line.

  • GILMORE||

    "They teach that you're a "special snowflake", that you're important, that you can "change the world", and that you're destined to succeed if you put your mind to it"

    I believe that's a fair summary of the article "why millennial (gen Y) yuppies are unhappy" =

    http://www.huffingtonpost.com/.....30620.html

  • Duke Trshmnstr of Stench||

    The comments are completely lacking self awareness... it's a bit hilarious.

  • montana mike||

    A common sense post on fluff po...gasp. As little as I visit that cesspool the comments are hilarious (the 8 or 10 I looked at.

    I'm nearing 60 and hope it goes down differently (I have a lot of nieces and nephews and most are productive and an asset to society). Reading those comments I fear for our future as a country.

    Bad shit could go down, internally or externally (I'd venture internally) and many of these kids will be too busy with their face in their smartphone to notice.

    The funny thing to me is their lack of awareness that the debt prior generations are leaving cause of many of the problems they face. They should rightly be pissed about that, yet the fluff poers seem to think the gravy train can go on forever and are seeming clueless sheep about that fact.

    On a positive note I know quite a few people in their 20's and 30's at my local pub that are sniffing out the bullshit. I always steer them to this site. They seem to realize neither team has their best interests in mind. This town is progtard heaven but some young people have seen it's epic fail on the ground. The city council seems to specialize in feel good things like an LBTQ ordinance with no enforcement mechanism when the state already has a Human Rights Law. But it's the right thing to do so we can have a circle jerk and pat each other on the back. I try to point this idiocy out (I of course support equal rights for anyone).

  • David Wall||

    Yes, liberal-progressives hate the idea of personal agency, but it goes further. They hate competent, happy, successful human beings--people with high levels of personal agency. But they know they need to induce guilt in these competent human beings so these competent souls will feel obligated to take care of their sorry asses. They hate the good for being good--they hate those who take responsibility for themselves, but yet they try their best to hide from themselves that they need these good, competent people for their own existence.

    That is the bottom line: they hate life and their own existence.

  • GILMORE||

    "Now, I'm not sure why they are terrified by personal responsibility, because I can't understand it."

    Eric Hoffer =

    " “There is apparently some connection between dissatisfaction with oneself and a proneness to credulity. The urge to escape our real self is also an urge to escape the rational and the obvious. The refusal to see ourselves as we are develops a distaste for facts and cold logic. There is no hope for the frustrated in the actual and the possible. Salvation can come to them only from the miraculous, which seeps through a crack in the iron wall of inexorable reality. They ask to be deceived. What Stresemann said of the Germans is true of the frustrated in general: "They pray not only for their daily bread, but also for their daily illusion." The rule seems to be that those who find no difficulty deceiving themselves are easily deceived by others. They are easily persuaded and led.”

  • Fist of Etiquette||

    Hoffman found a cure.

  • Jerms||

    The disease idea is a farce. Its just an excuse to help people rationalize all the shitty things they did while caught up in their addiction.

  • SIV||

    Some commenters this AM seemed convinced heroin addiction is a "genetic disease". That is even more ridiculous than calling it a "brain disease".

  • Rich||

    It's a *metabolic* disease.

  • Paul.||

    It's a societal disease. The beatings will continue until the disease is cured.

  • Jerms||

    I think some people with certain genetics are more prone to have problems with addiction, but I dont think that makes it a disease. In AA meetings, you always hear alcoholism compared to cancer. Way to turn yourself into a victim.

  • Paul.||

    I caught the alcoholism.

  • Spawn of Nyarlathotep||

    I've heard you can get it from a toilet seat.

  • Rufus J. Firefly||

    I thought by sitting on a tractor.

  • playa manhattan||

    It's going around these days.

  • ||

    I think some people with certain genetics are more prone to have problems with addiction, but I dont think that makes it a disease.

    Unless I missed something that's what some people in the AM links said and SIV is just mischaracterizing them.

  • SIV||

    You missed something.Heroin addiction is not a disease, much less an inheritable one.

  • ||

    But they were saying that there genetic factors that make someone more prone to addiction. Which is completely different.

  • Heroic Mulatto||

  • Rich||

    Is peanut allergy a disease?

  • R C Dean||

    Wow, there's a heroin addiction germ? Who knew?

  • SIV||

    No, but some are claiming there is a heroin addiction gene. Reportedly one of the Google-founders' exes will even test you for it.

  • R C Dean||

    Here's the more or less formal definition of "disease"

    an impairment of the normal state of the living animal or plant body or one of its parts that interrupts or modifies the performance of the vital functions, is typically manifested by distinguishing signs and symptoms, and is a response to environmental factors (as malnutrition, industrial hazards, or climate), to specific infective agents (as worms, bacteria, or viruses), to inherent defects of the organism (as genetic anomalies), or to combinations of these factors

    Note that, whatever quibbles you have about "normal state" or "modifies the performance of vital functions", you can't get around the need for environmental factors, infective agents, or inherent/genetic defects.

    I don't see how anyone can hang a behavioral issue like heroin use or addiction on any of those.

  • Bo Cara Esq.||

    Here is what I found from Merriam for 'disease'

    "a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms "

    I can certainly see how some addictions could fall under that.

  • Robert||

    The squirrels got to Jacob! Both posts say 5:14, so they must've acted quickly. Is anyone safe!??

  • Archduke von Pantsfan||

    We want Heroine Vending Machines in HIGHSCHOOLS!

  • sarcasmic||

    How the fuck will trial lawyers make a buck if people are held responsible for themselves?

    There must always be someone or something else to blame!

  • DWC||

    Blah, Blah, fucking Blah.

  • Tanya||

    I have NF2, a disease that has given me 9 brain tumours so far. THAT is a brain disease. Heroin addiction is the result of a series of bad decisions, that you can basically 'un-decide' your way out of. I wish it were so easy for me.

    Go fuck yourself, David Sheff.

  • Heroic Mulatto||

    Wow. I wish you the best.

  • Alice Bowie||

    And How's your kid doing?

    I hope all is well !!!

  • Alice Bowie||

    I wish you the best Tanya.

    But there are people that get injured, get prescribed an opiate, and then become addicted to heroin. These are not people that just started or tried DOPE.

  • Tanya||

    Fair enough. But that doesn't change the fact that they can, still, simply 'un-decide' their addiction. I get that it would be difficult to do, but it's still down to a change in behaviour.

    I wish.

    Thanks for the well wishes. To be fair, I'm doing real well. Most with my disease are in very rough shape, tho. I got lucky.

  • Spoonman.||

    Okay, but to not die they have to not take heroin.

    You can't tell somebody with a "real" disease, "Just don't grow brain tumors!"

  • Alice Bowie||

    I'm hearing the same thing over and over again.

    People start taking Oxy or another opiate based pill and end up using heroin as it is much cheaper.

    It's happening to my nephew. I had to cut him off. I know what happens to people once they start shooting dope. There's nothing anyone can really do but to avoid them.

  • LibertarianX||

    Of course it was his mistake and he is responsible for his own death. Every time someone uses heroin addiction or death is a possible conclusion. He knew this, and decided the pleasure was worth the possible bad results. No sympathy for people who take their chances and lose.

  • Slag||

    Psychologists say it's disease when it is time to profit off of treatment or a celebrity has a problem but take no active stance against non-celebrity users being sent to rape factories. Most psychologists are opportunist cowards and gov certified drug dealers.

  • ||

    Do we really need three Phillip Seymore Hoffman heroin abuse threads a day?

    You guys are outgunning ObamaCare and the CBO here.

  • SIV||

    3? I think you missed a few.

  • Eggs Benedict Cumberbund||

    Industrial disease.

  • Harvard||

    Reason seems to be absolutely vexed by the death of this shit bird.

    Reason is a Libertarian publication.

    Most Libertarians belong to the Church of Evolution.

    Therefore: Most Reason readers believe nature culled Hoffman from the herd.

  • Sevo||

    "Therefore: Most Reason readers believe nature culled Hoffman from the herd."

    I'll go for that and add: Who gives a shit?
    Guy who made a living pretending to be someone else kicks off! Film at 11 unless everyone turns off the tube!

  • GILMORE||

    Hello Mary 2.0

  • Redmanfms||

    Harvard isn't anything like Mary.

    This is the Lou Reed episode repeated, and plenty of people were bitching about the idiocy of having multiple posts/articles about the same thing about that event per day for weeks on end then.

    Hell, that became an H+R meme.

  • JD3||

    On an average year, approximately 105 people overdose per day (last year's numbers)...that comes out to more than 38,000 people dying from drug overdoses.
    Hoffman knew that Heroin was dangerous. He played with fire and got burned. It happens to the best and worst of us.
    Ain't no fucking disease.
    Ain't no liberal/conservative/Hollywood/New York/BFE shit either.
    It's a human being making a personal decision to ingest/snort/shoot/smoke and that's that. It's as simple as that.
    There's nothing to uncover here.
    Some dude decided to stick a needle in his arm...and he fucking died.
    He happened to be an actor. He showed emotions on camera and people enjoyed his performances so that somehow makes his overdose a more tragic case.
    Put the shit in perspective.
    PSH had a case of the fuckarounds and paid the ultimate price.
    Nobody forced him.
    Well maybe the Scientology shitheads or the Illuminati did.
    I don't know. I wasn't there.
    Who was?
    A hooker?
    Terry Bradshaw?
    That big black dude from the Old Spice commercials?

  • UCrawford||

    My own two cents on Hoffman...

    I tend towards the "addiction is a mental disorder" camp. I have a sister-in-law with two brothers who have/had alcohol and drug issues...one has quit, the other is struggling to do so. Her father was a heavy drinker until he died. I've known many alcoholics in my life, many of whom had parents with alcohol and drug issues. I'm not a psychologist or physician, so I have no idea if it's inherited or learned behavior or a symptom of other problems, but there seems to be a connection (correlational or causal, I don't know). And although the key to dealing with addiction is to stop engaging in the addictive behavior, the path to that is not really as simple as just telling an addict to quit.

    In Hoffman's case, the guy died with a lot of drugs in his apartment and his neighbors said he'd had a drug problem for awhile. He had a long-term relationship end (after a stint in rehab). He'd become reclusive and started avoiding interviews he'd normally do. I suspect that in his case, he wasn't doing drugs because he was bored and wanted to have fun and be irresponsible...and I somehow doubt that enlightening him about personal agency would really have changed much. For some reason he felt compelled to hole up in an apartment and shoot a lot of drugs until he died. I don't his thought process is something that can be fixed by what would work for most of us, because most of us would never be driven to do what he did.

  • UCrawford||

    Caveat: I am not saying this to call for continuing drug prohibition or because I think 12 step programs work or because I think people are all victims. I just think addiction is a compulsion that people have...like OCD or overeating. It's not a disease, per se, but it's something that they do have and aren't always able to control. And that it varies in severity with the individual. In Hoffman's case, it appears his compulsion was pretty severe. And maybe in his case there wasn't a cure for him...maybe nothing would have helped him.

    Last note, a few commenters have indicated that Hoffman was some kind of scumbag by virtue of being a drug user. Personally, I don't find that to be accurate. From all accounts, he was well-liked and respected by the people who knew him and worked with him, and he was a talented artist and seemed to be a decent enough person. He was just a talented artist with a drug problem that killed him. It happens...doesn't mean he was automatically a horrible person.

  • Harvard||

    [I tend towards the "addiction is a mental disorder" camp.]

    I competed in SCCA racing for some years. I recall a fellow racer, engineer for Bendix and a smart guy. He once opined "how intelligent can a chap be when his hobby can kill him?". Even at that level catastrophic injury and death was not unheard of.

    We were mentally ill than?

  • UCrawford||

    I'd say that competitive sports are a different kind of hobby from shooting smack. I played sports (rugby, primarily) because of the camaraderie, the competition and the physical challenge. I suspect that you and your friend did the same. I doubt any of those were motivators in Hoffman's case.

  • Harvard||

    My evidently concealed point was, we all make choices based on any number of factors, reasonable chance of harm being one of them.

    And don't give me the addiction horseshit. Unless you have experienced g forces exerted in anger you have no idea how addictive racing is. It is a lot like narcotics, limited solely by your pocketbook.

  • UCrawford||

    Yeah...you completely missed the point.

    The guy didn't shoot smack just because he thought it was a good laugh. He said it was a problem for him and he was trying to not use it (as evidenced by the presence of buprenorphine and his stint in rehab).

    It's got nothing to do with your hobby of racing or me playing rugby.

  • Archie Bunker||

    Seems to me that a lot of posters are quite dismissive of the "addiction is a disease" idea. Granted, as far as I know, there haven't been any studies that substantiate that idea, but that doesn't necessarily make it false. At the very least, some people may be more genetically predisposed to addiction than others. It's important not to off-handedly dismiss an idea simply because it doesn't conform to one's world-view, especially in matters of biology and physiology where we have to let science do the talking. If the science on the matter changes, so should the views of the rational.

  • UCrawford||

    I agree.

  • ~Knarf Yenrab~||

    Addiction is a disorder, not a disease. It's the conflation of psychology (which would say that heroin addiction is a maladaptive and harmful human behavior) and psychiatry (which employs a disease model for everything from alcoholism to Parkinson's) that creates the illusion that every human problem is somehow rooted in physiology and that "we" are helplessly along for the ride.

    The disease model of behavioral problems asserts that only a particular brain state that the physicians call "healthy" permits individuals to choose and be capable of free will, personal responsibility, and agency. If a "diseased" brain isn't capable of choosing freely because of a particular arrangement of its atoms and organs (which is 99.9% the same as a "healthy" brain), why would a slightly different arrangement allow "free will" to blink into existence? Mind is either an epiphenomenon or it's not, addiction notwithstanding.

    Taking it to the justice system, it's ridiculous that a judge might take a criminal's background into consideration during sentencing without also taking into consideration the judge's own background. These "product of his environment" rulings--either in court or in media--have as much to do with racism and classism as anything else, as elites have a strong tendency to want to view themselves as atomic, self-made individuals of free will while flattering their egos with "sympathetic" views of the criminal of low intellect who just can't help himself.

    /rant

  • Archie Bunker||

    I agree, and like I said, we have to go with what the science has shown for the time being. That being said, the brain's physiology is something that is still under study and new ground is being broken all the time. If it turns out that addiction is a brain disease (and I would have to see multiple studies corroborating this) I would adjust my views accordingly. Anything else would be analogous to religious delusion.

  • RishJoMo||

    Sammy DeSoSo is not going to liek that at all man.

    www.Anon-Works.tk

  • Paul Pot||

    Prohibition failed to save him as it has failed so many.
    Old Chinese men would smoke opium without any problems.
    It was the economics of the drug war that forced the concentrates on the world.
    End the drug war and let people have the safer, natural originals.

  • IT||

    Legalize all this shit and people will still die from it. Don't paint an idiotic drug nirvana. It doesn't exist.

    That said, I say legalize it all and people will be held responsible for their decisions.

    Abuse it? Have a fucked up life. Use it and kill people accidentally (car wreck, train wreck)? Be prosecuted for it.

    Your 'halcyon' opium days in 19th century never existed. Opium use was stupid then, it's stupid now. But if that is the way you roll ...

  • UCrawford||

    Ummm...and you base the statement that they had no problems as a result of smoking opium on what evidence?

    While I'm not for prohibition, I think you'd have to be delusional to claim that there are no downsides to using opiates.

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