I recently read an article that said Philip Seymour Hoffman made a "choice" by relapsing on heroin -- the fateful choice that lead to his death and reportedly ending up on his bathroom floor with a needle in his arm. The article also went on to say that since he passed away, the treatment and recovery community has been feeding off his death and irresponsibly promoting addiction as a "disease" again. It also said that the recovery community is, yet again, shamelessly "selling" treatment to the masses by using the tragic death of a celebrity as a vehicle.
As an addiction therapist for the last 16 years, I would say that yes, every addict makes a choice to take a drink, to swallow prescription pills, to smoke marijuana and to put needles in their arms, etc. But why someone would continue making that choice despite the destructive consequences is the important question. Perhaps it's instead a consequence of many different reasons.
Addiction is not glamorous. No one starts out declaring they want to shoot heroin into their veins just for the hell of it. Or they want to become career tweakers, crackheads or drunks. But many start out small as a way to experiment because they learn somewhere along the way that some of these drugs can temporarily regulate a deeper issue of the brain. Research shows that some addicts have a genetic predisposition for addiction because their brains operate differently than others.
In short, addiction is principally a result of a brain imbalance in the person's biochemical configuration. This imbalance leaves individuals susceptible to seeking out substances to sustain normal mood and regulate distress states. The psychic pain and chronic discomfort the imbalance causes may be there long before the addict picks up a drug.
Another element might be that many addicts suffer from pre-existing conditions of the mind like depression, severe anxiety or bipolar disorder, just to name a few. Many addicts have what is known as a dual diagnosis, which is simply someone who suffers from an addiction and a co-occurring mental health condition that can cause severe impairment in their ability to function. So, the drive to self-medicate and seek that equilibrium is not always a choice but sometimes a necessity.
According to the Centers for Disease Control and Prevention report in 2013, Philip Seymour Hoffman is one of a hundred people who die of drug overdoses per day in the United States. In 2010, approximately 30,000 deaths were caused by unintentional drug overdoses. The CDC also reports that drug overdose deaths have been rising steadily since 1992, with a 102 percent surge from 1999 to 2010. They have become the leading cause of injury death in the U.S. And interestingly, the highest death rates reported were among people 45-49 years of age. Philip Seymour Hoffman was 46.
So let's come back to the "choice" argument. If Philip Seymour Hoffman made a "choice" to relapse, are we saying he's also rash and stupid? Are we saying that a man who has fame, success and the unquestionable respect of his peers would only throw all of that away if he was a fool? And are we also saying that he was self-centered and he chose drugs over his three children? Additionally, then the many thousands of Americans that die each year from drug overdoses are stupid too?
No one will ever know exactly why Mr. Hoffman relapsed, but what we do know is that he was sick with a very severe chronic illness that kills people. He may have relapsed because he felt like he had NO choice.
Remember, addiction can be defined as any compulsive behavior that has short-term benefits with long-term destruction. The short-term benefit is the key part here. It means addicts clearly seek something vital out of doing drugs, something that helps them balance the imbalance. Why else would they do it?
Another point to remember is that as of now, addiction is not curable. Meaning an addict will always be one step away from a relapse, not one step away from a choice. It's like putting "choice" in the same sentence as "willpower." If it was about willpower, then everyone who has ever been addicted to anything from illicit drugs, to sex, to compulsive shopping, to gambling is a weak person.
So, for the people out there who do not understand addiction from a clinical standpoint and for those who have never been addicted to anything and who do not suffer either mildly or severely from a mental disorder, please take a step back and reflect.
Relapse cannot be broken down so simply as a choice. Relapse is more of a consequence of many different elements in one's life.
It's a confluence of influence. There is no chicken and there is no egg.