Philip Seymour Hoffman's tragic death, apparently the result of a drug overdose, is a reminder that drug addiction crosses all socioeconomic barriers, the treatment system is lacking and addiction is a chronic brain disease. In one of his last impromptu interviews at the Sundance Film Festival, Philip Seymour Hoffman, unrecognized, was asked who he was and this is how he identified himself - "I'm a heroin addict."
After going to a rehabilitation facility and staying clean for over two decades, Philip Seymour Hoffman's relapse was the return of a stealth companion. His relapse ended in his passing, but death is not the inevitable outcome of relapse for every addicted person - the National Institute on Drug Abuse regards relapse as part of the recovery process, not a failure.
Millions of people addicted - a fraction can access treatment
While more than $51 billion dollars is spent in the United States for the "war on drugs", too many people who seek treatment face insurmountable obstacles -lack of funding, too few beds and insurance rigamarole. The U.S. Substance Abuse and Mental Health Services Administration (SAMSA) reported in its National Survey on Drug Use and Health that there were 23 million people who needed treatment in a specialized facility but only 2.6 million received it.
In New Jersey, heroin and prescription drug overdoses exploded in 2013. Hundreds died and the incidence of those who overdosed without fatality is not recorded. "What I think we are seeing is epidemic proportions," said Rebecca Alfaro, director of prevention and training on the Governor’s Council on Alcoholism and Drug Abuse. The spike in heroin addiction in New Jersey and Pennsylvania is often attributed to the increase of prescription painkillers.
When seeking treatment, the National Institute on Drug Abuse suggests that addicts consider five questions:
- is the treatment backed by scientific evidence?
- is treatment tailored to the needs of each person?
- does the program adapt to the person's changing needs?
- is the duration of treatment sufficient?
- does it incorporate 12 step or similar support in the program?
NIDA, which is dedicated to the science of drug abuse and addiction, makes the crucial point that relapse is likely - it is not a treatment failure. Drug addiction is a chronic disease like hypertension, diabetes and asthma - it can be managed.
Once in treatment, NIDA's Principles of Drug Addiction Treatment advises: "remaining in treatment for an adequate period of time is critical. The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment."
Barriers to Treatment in New Jersey and Pennsylvania
While hundreds die from drug overdose, those who seek treatment are often shut out. In New Jersey, in the most recent reporting year, 2009, 30,000 adults and 15,000 adolescents were turned away from treatment. Dan Meara of the National Council on Alcoholism and Drug Dependence commented that there is not enough funding and not enough beds - "a treatment shortfall" in New Jersey. Multiple obstacles include:
- Insurance companies which frustrate addicts who want treatment. Insurance companies may pay for 14 days of a 28 day program and families must spend thousands out-of-pocket or take their addicted family member out of treatment.
- The shortage of drug treatment facilities with enough beds can have devastating consequences. While attempting to get into treatment, one young woman was denied admission by one facility until she detoxed, but the detox providers were full and the insurance companies wouldn't pay for detox in the emergency room. Another young man was waiting to get into treatment but the outcome was a horror for his parents - they found him with a needle in his arm from a drug overdose.
- “In New Jersey, the only way to get help is if you commit a crime" said the parent of a young man in a drug court program. Mandated treatment may be the fastest way to enter treatment in New Jersey. Governor Christie signed legislation providing treatment for addicts convicted of non-violent crimes. However laudable the measure, providers have pointed out that this results in criminals who do not want treatment receiving services while non-criminal addicts remain on waiting lists.
- “The middle class is the one that gets squeezed,” said Frank Greenagel Jr., recovery counselor at Rutgers University and chairman of a state task force on heroin and opiate addiction. “They have insurance, but maybe insurance doesn’t cover it all.”
Pennsylvania has the 14th highest drug overdose mortality rate in the country. Out of a population of 12.8 million, over 800,000 Pennsylvanians have a drug and alcohol problem but state funding for treatment was significantly cut over the last few years - by $7-$10 million. Only 67,000 people were receiving treatment during the same reporting year (2010). Under these conditions, fewer people were getting treatment and more were going to jail.
"I've never had a problem with drugs. I've had problems with the police." - Keith Richards
Deb Beck, Executive Director of the Drug and Alcohol Service Providers of Pennsylvania (DASPOP), gave testimony to the legislature regarding budget cuts to human services this past May 2013. She pointed out that addiction is the common denominator in the majority of human services concerns, including homelessness, birth defects, children and youth cases, de-stabilization of families and the like. Drug addiction "drives most of the preventable spending in those categories of need".
"You don’t decide to be an addict. One morning you wake up sick and you’re an addict." - William Buroughs, author of Junkie
The Drug Policy Alliance is a national organization dedicated to reforming policies to bring about effective solutions, not escalate the "war". In addition to the paramount need to make treatment readily available, it makes several recommendations to prevent fatal overdoses, including the expansion of "Good Samaritan" laws.
Stigma and Isolation
Underscoring the dilemma of addicts who want to seek treatment and families dealing with an addicted family member is the sense of stigma and isolation. It detracts from recognizing and treating addiction as a chronic disease, notes Tom Mc Lellan, PhD, CEO of the Treatment Research Institute. Stigma has even been called a "lurking" variable in addiction treatment. Susanne Rohrer, Center for Substance Abuse Treatment, describes stigma as "a powerful, prejudicial, shame-based mark of disgrace and reproach that impedes treatment and recovery". Having the tools to overcome stigma is crucial for the person who is addicted and the family.
Good Samaritan laws
In May 2013, New Jersey Governor Christie signed N.J. Stat. § 2C:35-30, legislation providing Good Samaritan protection for anyone administering an opioid antidote to an overdose victim. Paramedics and ordinary citizens in New Jersey can use these opioid antidotes to aid overdose victims without fear of being sued. Governor Christie had initially vetoed the Good Samaritan bill but was impressed by Jon Bon Jovi's plea as it had affected his own child's life. Bon Jovi's daughter's life was saved by a Good Samaritan and now countless others will benefit.
New Jersey is among 14 states and the District of Columbia to enact such Good Samaritan laws. Pennsylvania is not among them.
Affordable Care Act: Medicaid Expansion
Drug treatment resources in New Jersey provided over 74,000 residents with treatment for drug or alcohol problems in 2011 but only 21 percent were funded by Medicaid. Because Medicaid in New Jersey covered only detox, not treatment, the rest were on their own. With Medicaid expansion under the Affordable Care and Patient Protection Act, thousands more residents will qualify and the number of patients seeking treatment will double.
CASAColumbia, affiliated with Columbia University, is encouraged by the potential for expanded drug addiction treatment, but cautions that this may vary from one state to the next.
Pennsylvania has not agreed to Medicaid expansion. Judge Michael Barrasse. Lackawanna County, told the state legislature in June: "This is the tool we have been waiting for a long period of time. He elaborated to say that "80 percent of crimes are related to drug or alcohol addictions and these types of offenders have a 45 percent recidivism rate, thereby adding to justice system costs." Deb Beck, on behalf of DASPOP, pointed out that there is a growing addiction treatment gap and that low-income wage earners are not eligible for traditional Medicaid. "This is something we should support, not penalize."
Philip Seymour Hoffman
Extended abstinence is the marker for a sustained recovery. Philip Seymour Hoffman was over 20 years in recovery and had a life full of accomplishment, family and friends. To those unfamiliar with addiction, his relapse may be more startling than his passing. To other addicts in recovery, his relapse is less remarkable. Seth Mnookin, the associate director of MIT's Graduate Program in Science Writing, is also a recovering drug addict. In Slate, his bold reflections on his own experience and reaction to Philip Seymour Hoffman's death sum it up -
"There’s a lot we don’t know about alcoholism and drug addiction, but one thing is clear: Regardless of how much time clean you have, relapsing is always as easy as moving your hand to your mouth."
The legacy of Philip Seymour Hoffman's tragic death may be greater respect for addiction and the addict in recovery. He wasn't "a heroin addict", as he described himself - he was a human being addicted to drugs, the same as other addicted people. Drug addiction changes the brain; recovery is extremely difficult.
No one would expect someone with diabetes to suddenly be "cured". Drug addiction is a complex, chronic disease that the general public may better understand through Philip Seymour Hoffman's death.