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Are We Killing Drug Addicts Like Amy Winehouse?

Statements by Winehouse's parents and a new study on addiction reveal how common misconceptions about addicts' ability to get clean can be deadly.

On Monday, Amy Winehouse's parents released a statement disclosing the surprising results of the 27-year-old soul singer's autopsy. The media has widely speculated on her cause of death, with her hit "Rehab" setting an eerie backdrop to what many expected to be a drug overdose. But according to the family, autopsy results indicate that there were no illegal drugs in Winehouse's system. And while the autopsy showed alcohol was present in her system, toxicology reports have not yet determined whether it played a role in Winehouse's death.  

The results offered much speculation as to the cause of Winehouse's death, with some commentators suggesting she may have died from an alcohol overdose or illegal drugs not mentioned in the report. Winehouse was an admitted heroin addict, and legal prescription opioids, like OxyContin, kill more people every year than their street equivalent, heroin. But what these analyses miss is much a larger issue: We may be judging our addicts to death. 

Winehouse's parents made two salient claims as to what killed their daughter, and they are highly reminiscent of a recent study that offers radically new definitions for, and explanations of, addiction and addictive behavior.  

A new report by the American Society of Addiction Medicine (ASAM) concluded that total abstinence is an unrealistic goal of effective treatment for some addicts -- a conclusion that some may find disheartening. This assertion was just one of many that refute dangerous, common misconceptions about addiction. According to the study, the inability to abstain is not a problem of free will that causes addiction, but a symptom of it. What's more, addiction is a chronic disease of fundamental brain circuitry, and its causes and maintenance have nothing to do with addicts' behaviors or emotional states. They, too, are simply symptoms of flawed brain functioning. But old misconceptions have dangerous implications. 

According to unnamed sources close to the Winehouse family, Amy's dad Mitch gave an emotional speech at Amy's funeral, where he identified alcohol withdrawal and Amy's "all or nothing" approach to use as possible causes of his daughter's death. Statements that Amy reportedly said she "had enough of drinking" and could not "stand the look on the family's faces anymore" are examples of how families affected by addiction may actually hurt their loved ones, even though their intentions stem from compassion. 

But calling relapse a failure and demanding full abstinence not only drives addicts to use; should addicts succumb to pressure and attempt to quit "cold turkey," they may actually die from the withdrawal. Prior to autopsy results, Winehouse's family members also speculated that "abstinence gave her body such a fright" she died.

By encouraging total abstinence and becoming angry with addicts who relapse, the most loving family and friends of addicts incorrectly hold addicts responsible for what ASAM labels a medical, biological loss of control. What's more, when addicts see relapse as a failure, they are more likely to believe they are incapable of "recovery." As Winehouse's dad suggested, they give up the fight and any interest in treatment, having submitted to the notion that they are not strong enough to be well. Treat relapse as a learning experience, however, and addicts are better able to identify triggers that may encourage their use and develop psychological mechanisms that help them avoid using.  

Alcohol withdrawal, like that from some other legal drugs, including Xanax, can in fact cause death. Because alcohol increases the release of neurotransmitters, during withdrawal, alcoholics experience under-stimulation of GABA receptors (which create calmness) and extreme nervous system excitability that can cause confusion, tremors, anxiety, seizures, and death from respiratory failure and cardiac arrhythmias. Delerium tremens, a severe form of alcohol withdrawal, once had a mortality rate as high as 35 percent. Modern treatment has reduced the rate to 5-15 percent. When Winehouse's parents suggested she may have died from the shock of withdrawal, their suggestion was backed by science.