Addiction spares no one because of age, gender, race, privilege or social status. In a pair of interviews in Glamour magazine (September 2013) and the Today show, Christina Huffington, the 24-year-old daughter of the editor-in-chief of The Huffington Post and prominent spokesperson, Arianna Huffington, told the all-too-familiar story of the progression of the disease of addiction until she was living on the knife's edge of life.
Addiction is a disease. Addiction is not recreational drug use or risky behaviors (like adolescent binge drinking or buying drugs on the street). It is characterized by alcohol and/or drug abuse (compulsive use despite clear harm to relationships, work and physical health) and dependence (where the body experiences withdrawal when blood levels of a substance drop).
Addiction is the leading cause of preventable death in the U.S., which is why, in addition to its being blind to who you are, it is the equal opportunity threat to life. Of the approximately 2.5 million deaths in 2009 in the U.S., nearly 600,000 deaths were attributable to tobacco, alcohol or other drugs. The costs of addiction to government, (not to mention families, businesses and communities, exceed $468 billion annually. Yet, and this may be even more difficult to believe, only one in 10 people with addiction report receiving any treatment -- at all.
For Christina Huffington, her road to addiction began at age 12, with surreptitious use of alcohol. By the time she began boarding at an eastern prep school, she was drinking compulsively and showing, in her words, binge eating -- another compulsive behavior that led to admission to a eating disorder program and return to LA and being closer to home. Then, at age 16, came that moment that people with addiction so frequently describe: that experience of using a substance and feeling like they had never before, a feeling that seemed to demand repeating, and repeating, and repeating.
Cocaine became her "drug of choice," an expression in the addiction community that portrays the one drug that an addict prefers more than any other. She denied having a problem (another feature of the disease early on) and stopped after she was caught at home. But she did not stop being an addict, she stopped using -- for the moment. She worked hard at school, getting into Yale, and was clean for three years until she took the next snort. It was if not a moment had passed; she was again as compulsive, and secretive, a user as she had been. That feature of going from zero to 60 right away is also characteristic of the disease of addiction. Everything else gives way to using. She developed tolerance (where increasing doses are needed to get the same high) and a host of physical problems from her daily drug abuse. She got scared and told her mother. That is the first step in recovery: admitting you have a problem.
The next step was rehab, the beginning of a journey in recovery where it is not the drug a person faces but who they are, and what it is about them they use the drug to bear or run from. Rehab also begins a process of turning to others for support, and not only to stay sober -- though that is essential. Many people in recovery, though not all, follow the 12-step approach familiar to many from AA, NA (Narcotics Anonymous), and Alanon. Rehab begins a process of learning to live a drug-free life, one where love, work and purpose serve as the natural highs we all need. For sure, the first time in rehab is not the one that works for many people. It can take a number of tries at being clean and sober, at living a life of recovery, before the process takes hold. Experienced clinicians know not to give up hope even though it can be very hard to predict when recovery will really kick in; people with addiction, and their families, need to know this as well to stay the course, to not abandon hope, to persist and be there when a person wants to try again.
What we don't want to see or admit, we do not confront. Within a family and within our culture, tackling addiction starts with detecting it. Simple screening tests for alcohol, drugs and tobacco exist and can be made standard practice throughout medical care (and in educational and counseling settings). SBIRT -- Screening, Brief Intervention and Referral for Treatment -- is a recognized, proven and even reimbursed medical procedure that awaits general use despite the consequences we suffer from not using it.
There are many paths for people to take to addiction recovery. No one size fits all. For some, 12-step programs are life saving. Others benefit from medications that aid in remaining drug free (called medication assisted treatment, or MAT) coupled with psychotherapy. We all, not just addicts, need to surround ourselves with people who want to support our wellbeing, and assiduously avoid people who want to exploit and otherwise take advantage of us.
Addiction is America's most neglected disease. Bravo to Christina Huffington and her family for speaking out, for baring their struggle, and for offering hope to so many others.
Dr. Sederer's new book for families who have a member with a mental illness, The Family Guide to Mental Health Care, published by WW Norton, is now available, as is his even newer book (with Jay Neugeboren and Michael Friedman), The Diagnostic Manual of Mishegas.
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The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.
For more by Lloyd I. Sederer, M.D., click here.
For more on addiction and recovery, click here.