Are We Killing Drug Addicts Like Amy Winehouse?
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.
Adding insight to death by withdrawal is the ASAM report, which defines addiction as a "primary, chronic disease of brain reward, motivation, memory and related circuitry." Basically, addiction hijacks the brain's reward system, resulting in the addict's fundamentally impaired ability to experience pleasure without his or her addictive substance. The high of drugs is a reward much more powerful than what humans are evolutionarily equipped to handle, and because our brain's reward system "bookmarks" things crucial to survival, like food, sex and friendship, normal pleasure becomes impossible without using an addictive substance. What's more, according to addiction specialist Dr. Mark Publicker, it "happens at the expense of what would otherwise promote survival," which explains addicts' high susceptibility to early death by sickness or suicide.
The revolutionary study suggests that, as Winehouse's death evinces, our attitudes toward addiction are dangerously misconceived. Sadly, many of our treatment programs do not deal with addiction as a chronic, uncontrollable disease. Alcoholics Anonymous strongly advocates abstinence. And while the first step of Alcoholics Anonymous encourages addicts to recognize their powerlessness over the disease, the "one day at a time" mantra pushes members to completely abstain from alcohol. Then, when addicts fail to do so, AA attributes the relapse to failure to adhere to other AA guidelines, like advancing to Step Five, where addicts "Admit to God, to ourselves, and to another human being the exact nature of our wrongs."
According to the ASAM study, addiction is not the result of any emotional disorder, but a biological disease in and of itself. If we do not change our behavior and treatment programs to address addiction as a disease of the brain, as opposed to a problem with willpower, we will continue to watch as addicts die victims of needless shame and suffering.