Georges Biard
The Los Angeles Times article on Philip Seymour Hoffman, titled "Philip Seymour Hoffman death: 50 heroin bags, used syringes found," describes a man who almost sounds like he was trying to die, or else who hadn't really learned in his 23 years of recovery how to manage himself. Among the revelations were these:
Hoffman "had about 50 bags of heroin and 20 used syringes on hand in his apartment before his death, law enforcement sources said Monday, according to several reports…A charred spoon used to heat the drug was also found, New York Daily News sources said, along with five prescription drugs for high blood pressure, ADHD and more. Buprenorphine, which helps opioid addicts stay clean, was reportedly on hand."
Hoffman had recently separated from the mother of his three children, costume designer Mimi O'Donnell.
Hoffman had gone off the wagon big time, his relapse following this course: "after slipping back into drug use, first with prescription meds and then snorting heroin…he was photographed appearing drunk on Thursday night in Atlanta, TMZ said, posting a shot of him at a bar." He was reported being seen making a large drug purchase.
And what are we to make of this?
Heroin Epidemic!
There has been an upsurge in reported heroin use in the National Survey on Drug Use and Health (NSDUH) leading USA Today (among many media outlets) to declare that Hoffman's death "is shining a spotlight on an epidemic of opiate addiction that has soared over the past decade…The number of regular heroin users soared from 239,000 in 2010 to 335,000 in 2012, the survey found."
But that's in a nation of roughly 300 million people, meaning that there are roughly one in 1,000 Americans who use heroin regularly (that's a tenth of one percent)—which means using as frequently as once a month! (USA Today has shuffled the NSDUH definition from "current," meaning use in the past month, to "regular.") Heroin users are too few to include in a line graph of illicit drug users in NSDUH. Of course, five million Americans are using pharmaceutical pain relievers off-label currently, or roughly two percent (20 times those using heroin).
The idea that people can even use heroin once in a month, or several times a month, or once or several times a year (often the figure cited is the more than 600,000 who used heroin at all in 2012) is stunning and incomprehensible to the American public and media. "What? Occasional use of narcotics—that's impossible—I don't care what those damned data tell us." What this actually tells us is that Hoffman was exceptional among heroin users in the scope of his use.
Which brings us to Chris Hayes interviewing Carl Hart on his evening MSNBC show. As smart and as savvy as Hayes is, his purpose is to alert and alarm us about the "heroin epidemic."
But Hart, experimental pharmacologist at Columbia University and author of High Price, is a bad go-to for drug scare stories. Leading off with statistics about growing heroin use and the governor of Vermont declaring a heroin emergency, Hayes wanted to highlight this "epidemic," declaring it the result of a government crackdown on Oxycontin, forcing people to use heroin instead. But he is barking up the wrong tree with Hart. Hart is all about how we overstress the effects of drugs, rather than dealing with social problems. Concerning the chief drugs he researches, Hart says: "Eighty to 90 percent of people who use crack and methamphetamine don't get addicted. And the small number who do become addicted are nothing like the popular caricatures."
Hart is good for the bad effects of the Oxy crackdown, but he just doesn't go along with the narrative that people are going wild on heroin. He begins by observing that "75 percent of drug overdoses are actually the result of combining narcotics with other sedative drugs or alcohol," and progresses to "it's not addicts who typically overdose since they have a good tolerance for the drug." His point is that we should educate people not to use more than one substance at a time. (See my recent writing on the subject.) But after citing social and pychological causes of drug misuse, Hart refuses to comment on Hoffman, because he doesn't like to speculate.
For that, we need a good disease narrator.
Cunning Disease!
The prototype for the "cunning disease that captured Hoffman" story line was published in The Atlantic, "Hoffman and the Terrible Heroin Deaths in the Shadows," by Jeff Deeney. Deeney is a recovering addict, but one who is aware of the need to provide help to street addicts through direct social and public health action, rather than thinking everything will be okay if we can just get enough addicts into 12-step meetings.
Nonetheless, Deeney can't resist relapsing into disease theory, recovering-addict bullshit:
There is a particularly chilling aspect to Hoffman's death that only another recovering addict can feel. He had 23 years clean, and then went back out. Just two weeks ago, I celebrated ten years off my own crippling drug habit. Sometimes I feel convinced that I'll never relapse and experience that kind of pain and insanity again. Recovery programs warn that this kind of thinking can be dangerous. The addicting substance is characterized as "cunning, baffling and powerful." It sounds like a cliché until someone with more than two decades clean, with a beautiful family and a career that is the envy of the world trades it in for a glassine envelope of dope and a set of works.
In other words since Hoffman relapsed, that proves heroin—or any addicting substance or activity, including marijuana, alcohol, food, sex, video games—is "cunning, baffling and powerful." Does Deeney teach (or plan to treach) his children that drugs, alcohol, food, sex, and gaming are "cunning, baffling and powerful" since some people become addicted to each? If so, he has a good chance of creating another generation of addicts for whom he can provide services.
Hoffman Was Taught Helplessness
Hoffman is not a good symbol for the efficacy of American treatment. He was famously abstinent after having entered rehab at 22. Then, supposedly abstinent for 23 years, he took some pain medications and went completely haywire, progressing to rampant heroin use. According to this model, a person who is addicted to heroin who simply samples a painkiller is doomed to all-out relapse by this "cunning, baffling and powerful disease."
But what are we to make of the stunning, continuing findings over the decades that most people recover from heroin and other drug addictions? Even a well-known figure associated with AA (but one who displays intellectual integrity) like William White can declare: after analyzing 415 scientific reports of recovery, from the mid-19th century to the present, that "Recovery is not an aberration achieved by a small and morally enlightened minority of addicted people. If there is a natural developmental momentum within the course of these problems, it is toward remission and recovery."
So Hoffman is an exception, one who tells us an important story. Let's turn to Charles Winick's 1962 classic, "Maturing Out of Narcotic Addiction," in which he found that two-thirds to three-quarters of known heroin addicts graduated off the Federal Bureau of Narcotics' rolls by their mid-thirties. Indeed, Winick surmises, we need a theory to account for the minority who fail to recover: "The difference between those who mature out of addiction and those who do not may also mirror the difference between addicts who struggle to abandon addiction and may develop some insight, and those who decide that they are 'hooked,' make no effort to abandon addiction, and give in to what they regard as inevitable."
Corralled by the disease theory in rehab in his early 20s, Philip Seymour Hoffman failed to allow himself to mature out, to develop a realistic assessment of his own strength relative to pharmaceuticals and other drugs. As a result he was left vulnerable, not to a cunning, baffling and powerful substance, or disease, but to an emptiness and learned powerlessness, or helplessness, in this area of his life, which so contrasted with his forcefulness and mastery in his acting career.
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