What was he thinking?
That's a question people ask when someone such as Philip Seymour Hoffman -- a man with a family, with talent, with riches -- commits a seemingly senseless act of self-destruction.
The question usually is laced with judgment, disdain, and incredulity.
It is impossible to know the exact thoughts in another person's mind. Most of us find unfathomable the notion of piercing the body to inject a potentially fatal, uncontrolled substance. A few who have been in that position -- Russell Brand and Mackenzie Phillips, for example -- give us insights with their testimonials.
We will never know what went through Hoffman's mind in his last hours. But based on research about the effects of addictive drugs on the brain, we know a great deal about how decisions happen when a person is addicted.
The most important thing to understand is that a brain addicted to heroin makes decisions differently than a non-addicted brain. It's as if the neurons in the addicted brain are all sending the same message at once: Get the drug. Now. Get the drug. Now. Get the drug. Now! This becomes the most important priority to that person in that moment. These powerful signals drown out any other messages that a non-addicted brain may hear, such as: I have children, I have a future, people love me.
Get the drug. Now. This drives the addicted brain. This is what drives the person's behavior.
Humans have been abusing drugs -- or, more accurately, drugs have been abusing people -- for centuries. The vast majority of adults in the U.S. have, at some point in their life, found ways to feel a little different. Consider the last time you had a glass of wine or a jolt of caffeine. The differences can be in the type of drug, how addictive it becomes, how often you use it, your genetic makeup, and, most importantly, to what extent -- and toward what harm -- the substance alters your decision making and behavior.
Because of the many places opiates can work in the brain, they are particularly menacing. Addiction to heroin and other opiates is one of the most powerful and deadly addictions we know.
In the face of this science, some then conclude that the situation is hopeless.
They are wrong.
Terrific advances in treatment have been achieved, but this progress must race ahead of the wave of opiate addiction that is crossing the country. In 2012, more than 4.5 million Americans aged 12 or older had used heroin at least once in their lives. I'm still stunned by that number. Why is this happening? A common precursor to heroin use is the abuse of prescription painkillers, which is now the main cause of overdose death, outnumbering deaths from all other drugs combined.
But as incredible as the problem has become, there are many solutions to apply. Here are some of the advances we know that need to be used in full force against the heroin epidemic:
Evidence-based treatment. As with any disease, not all treatments are alike. And one size doesn't fit all. As David Sheff writes, it's time to stop blaming the patient when treatment doesn't work, and instead be sure that we're using proven clinical practices that match the patient's condition.
FDA-approved medications. Stigma, stigma, stigma. Unlike treatment for other chronic, relapsing conditions, we have yet to fully embrace the science-based solutions for addiction. And, unlike addiction for most other drugs of abuse, we are fortunate that research has provided us with multiple FDA-approved medications to help treat opiate addiction, including buprenorphine, naltrexone, and methadone. In conjunction with clinical therapies, these medications can prevent overdose, support recovery, and save lives.
Naloxone training for all first responders. In cases of opiate overdose, naloxone can prevent death by quickly reversing the effects of the drug. Police and all emergency responders should be equipped with it and trained to use it. It's a proven life saver.
Overdose prevention at critical moments. The risk for overdose is extremely elevated after a period of abstinence, such as during a period of inpatient treatment or incarceration. The body has a reduced tolerance for the drug and is highly susceptible to overdose and death. In these cases, tight case management is critical, including quick access to naloxone if overdose occurs.
Good Samaritan laws in all 50 states. Varying from state to state, these laws grant immunity from criminal charges for drug possession if a person witnesses a drug overdose and calls for medical assistance. Only 17 states, including Illinois, currently have such laws on the books.
Tighter prescription controls. As Dr. Roland Reeves writes in Addiction Professional, doctors are part of the problem when they over-prescribe medications without understanding the realities and consequences of addiction. In too many cases, the problem of heroin abuse originates in a common medicine cabinet or with a doctor's prescription.
Diversion to treatment. When someone with a substance use disorder is arrested, depending on the nature of the alleged offense, there are often better responses than to hold a person behind bars. As I've written before, our jails and prisons are filled with offenders with a drug problem. Understanding addiction as a health issue is a first step.
The heroin epidemic is dangerous, startling, and tragic. But it is far from hopeless. The solutions are in front of us, and research continues to provide more answers every day. We must be as focused and driven as the addicted brain: Implement the solutions. Now.
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.
Timothy P. Condon, PhD, is chief science advisor to the Center for Health and Justice at TASC, a national public policy group focused on strategies and solutions at the intersection of criminal justice and public health. Dr. Condon has served as the science policy advisor to the director of the White House Office of National Drug Control Policy (ONDCP) and as deputy director of the National Institute on Drug Abuse (NIDA).
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