Filmmakers Take On Addiction

When I was 21, one of my closest friends began taking heroin 'recreationally.' He loved the way it made him feel - it counteracted the stress of everyday life - and he firmly believed that he was smart, self-aware and disciplined enough to do it just now and then. "It's just a media myth" that you can't take drugs and not get hooked, he told me one afternoon as we had lunch in an East Village café.

Over the next five years, I watched him, helplessly, as he deteriorated in front of my eyes. Friends planned interventions that failed; we talked to him endlessly about his problem. Still, when he died from an overdose, it came at a time I least expected it. He had been clean for four months, had moved out of Manhattan, and was living Upstate in his parent's house. The person I used to know was coming back to me. All of his friends, we all felt like he had dodged a bullet.

And then one night when he and a girlfriend he had met in Narcotics Anonymous came to the City for "one last party," he overdosed. And that was it, just like that. He had injected the same amount he did when he was the height of his addiction and it was just too strong for his new clean body. He was dead at age 26 because he thought he could control his addiction.

If he had known at the start that he couldn't, would it have saved his life? Would he have stayed away and stayed clean?

I don't know, but I wish I cold live through that lunch conversation again and tell him what I know now. I wish I could show him the hard photographic evidence - the brain scans of users - that I myself have seen. I wish I could have showed him my film. Because the evidence is incontrovertible: being self-aware and disciplined and all that is irrelevant. Drug addiction is a disease - like heart disease or cancer or diabetes. Yes, drug addiction starts with a behavior - the addict decides to start taking the drug. But these other diseases have behavioral elements as well; smoking and a high fat diet can cause cancer or heart disease. They are all diseases nonetheless. Drug addiction is a disease of the brain, plain and simple. Nothing can combat that other than a medical and chemical counterattack.

I learned this through Dr. Nora Volkow, the director of the National Institute on Drug Abuse, who has done remarkable brain imaging studies that show the way in which drug use alters the brain's pleasure pathways in ways that make staying off drugs a question that goes beyond desire or willpower. Drug use activates the same receptors in the brain as behaviors linked to survival, like eating or having sex. Drugs cause a surge in a brain chemical called dopamine, which causes a pleasurable feeling. The brain remembers this feeling and wants it again and again. The problem is, drugs activate this dopamine system in such an extreme fashion, that other natural reinforcers, like food, sex, hugging your children, or what have you, no longer have meaning. The only thing that causes pleasure now is that drug. For the addict, now, obtaining and taking these drugs becomes a matter of survival.

In the segment of HBO's Addiction Project that I directed, a young man named John who had been taking drugs for over a decade submitted himself to a brain imaging study. He went into a PET scan that was meant to measure brain changes in dopamine receptors resulting from addiction to different substances. The PET images showed a remarkably altered dopamine uptake system, which supports John's notion that he had to take drugs just to "feel normal." Taking drugs wasn't even making him feel high anymore, it was just getting him to a place where he felt he could survive. All other natural stimulants, like love, food, or sex, no longer would even register on the system.

When someone asks an addict, then, why can't they just STOP?, the answer is because addiction is a disease that requires treatment. They cant stop taking drugs anymore than someone can just stop having heart disease. The good news is that the brain's dopamine system can be restored over time - life can return to normal - if someone stays clean for a long period. But to stop taking drugs, an addict needs treatment, which often involves taking a medication, just as with any other disease. And it is not your fault if you relapse, its not a failure of character, it just means you need more treatment. Relapse is, sadly, just part of the disease. It's the part of the disease that killed my friend.

So would my friend have lived if he had seen my film, or any one of the great segments from this amazing series that my brilliant mentor-extraordinaire Sheila Nevins conceived for HBO? I don't know. But I do know this: nobody who sees this series will be able to say they didn't know what drugs could really do to them. And nobody who sees this will feel as helpless as I did, back then in my 20s, because they will know there is a cure - there are drugs to take to help the addict stay clean. And the longer you stay clean, the more your brain will recover, and the more your life will be "normal" again.