"I want people to hear my voice and just forget their troubles for five minutes."
-- Amy Winehouse, age 12
Is addiction a "disease?" Depends on who you ask, it seems, but if you ask those with the most experience and training -- including doctors and scientists in the field -- the answer is yes. With the recent, tragic death of singer Amy Winehouse, though, the commentary came fast and furious about how much she and others were responsible for her struggles and demise. The best popular piece I've seen, however, came from a fellow actor, Russell Brand. His expertise comes from similar experience, and it clearly has given him insight and compassion.
Winehouse was not my favorite singer, but after she died, I dug out her second and breakthrough CD, "Back to Black," and gave it a spin. Hindsight may lend insight, but this time I was amazed that a then 22-year-old woman could write and sing with such pathos and force. Her words and voice were of a woman who had already lived much longer. She has now posthumously been compared to icons such as Billie Holiday, which I would agree to be premature, given that she only produced two albums in her lifetime. But what a presence -- and, again in retrospect, what pathos and pain in such a young voice.
She's joined the much-remarked "27 Club" -- musicians who died at that age, or close to it -- including Hendrix, Joplin, Morrison, Cobain, Parsons, Buckley, Drake and too many others, including many of the best (and Holiday herself, though she outlived that list). Would-be musical philosophers have speculated about the quasi-mystical dangers of that age, but I'd wager the clustering of overdoses and deaths in that late-20s zone has more to do with the natural history of addiction.
Many, if not most addicts start using young, in their teens, and it commonly takes years, a decade or more, for addiction to truly take hold and take over. And musicians, especially if successful, lead lives without the more conventional constraints of jobs and so forth that give incentives to moderate use. Couple that with longstanding media imagery that it is cool to be high, and the risks are often too daunting to overcome. And thus, struggle and tragedy, often romanticized unto death. "I wanna live fast, love hard, die young and leave a beautiful memory, " Willie Nelson and Faron Young wrote and sang before any of the rockers above took the message a bit too literally - and left some less-than-beautiful memories.
As for the "responsibility" issue, it's of course not all-or-nothing; anybody who's struggled with the problem, especially if that person has encountered "12-step" programs, know that willpower and commitment are essential and tested if one tries to overcome their addiction. Still, the stigma and judgmental factors are high in our culture, and over and again I have seen that most people do not really understand addiction until they see it firsthand in somebody they love -- or in themselves. We tend not to guilt-trip people with other chronic, progressive, relapsing conditions such as, say, diabetes, when they fail to perfectly adhere to ideal treatment guidelines. But again, addiction comes with stigmas and often negatively impacts others more than most diseases.
Much of the "professionalization" of modern, medical treatment of addiction can be traced to here in the Bay Area. The Haight Ashbury Free Medical Clinics were founded partly as a reaction to the stigmatization of addicts by "mainstream" medicine. Doctors at the Haight clinics, besides treating the addicted, realized they had to advocate for better standards and research in this field and eventually professional medical associations focused on addiction were formed. The University of California San Francisco and San Francisco Medical Society were integral to this nascent work, which was intentionally promulgated nationwide. The Haight Clinic even formed a "Rock Medicine" program to staff major concerts, which pioneered new approaches as well.
All that said and done, our national drug policy is in longtime dire need of improvement. There have been many authoritative calls for reform and improvement of our approaches to addiction (see one latest example below), but thus far progress has been limited, but many good people soldier on with science and compassion as their inspiration and tools, and their dedication is a continual source of inspiration.
It has taken decades to attain true legitimacy within medicine and beyond for the "disease concept" of addiction and advances in treatment -- but it has happened, and continues to. The American Medical Association has identified addiction as our biggest public health problem, when all the impacts and costs are factored in. The "tobacco wars" continue, and alcohol abuse remains rampant. Abuse of prescription medications is still increasing, with often tragic consequences. Illegal drugs are often a scourge, and our longstanding "drug war" has not helped much, objectively viewed. There are still huge unmet needs for treatment, more science-based policies, health insurance coverage and more. We are only starting to take more aggressive approaches to limiting marketing of addictive legal drugs, especially to young people.
If there's a "take home" message in this most recent celebrity death, it may be that we sometimes have to risk resistance and even ridicule by being assertive with those we care about when they might have a drug-related problem. Videos of Winehouse's final concert -- harrowing viewing which I don't recommend -- bring this home. I understand why her colleagues might have been hesitant to do so -- beyond their paychecks -- even the late, sweet former First Lady Betty Ford, a pioneer in this arena, recalled that she called her family "monsters" when they tried to intervene in her addictions. But she later realized their concern set her on a path that saved her life. If only everybody, famous or not, were so lucky.
A good NYT piece, "Who Succumbs to Addiction and Why?":
http://www.nytimes.com/2011/08/02/health/02abuse.html?_r=1&nl=health&emc=healthupdateema2
For authoritative definitions or addiction and a very good "Frequently Asked Questions" document, you can't do better than the California Society of Addiction Medicine:
http://www.csam-asam.org/resources.vp.html
An in-depth description of addiction, for clinicians but useful to anyone, is provided by the American Psychiatric Association:
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=431
Jimmy Carter's recent New York Times op-ed on the Global Commission's call to "Call off the Drug War", with a link to that report: http://www.nytimes.com/2011/06/17/opinion/17carter.html
The Marin-based Alcohol Justice works to protect the public, especially young people, from the alcohol industry's harmful marketing practices: http://www.alcoholjustice.org/
For a local resource, the reborn Haight-Ashbury Free Clinics and Walden House, well worth supporting:http://www.hafci.org
And finally, the one Winehouse clip I've seen that shows how talented and impassioned a singer she could be; just her and a guitar, and a heartbreaking, self-deprecating smile at the end:
http://www.youtube.com/watch?v=Q6JRttxTBC8