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February 6, 2014

Why Philip Seymour Hoffman's death is so scary

BOSTON — I cried when I heard about Philip Seymour Hoffman. The news scared me: He got sober when he was 22 and didn't drink or use drugs for the next 23 years. During that time, he won an Academy Award, was nominated for three more, and was widely cited as the most talented actor of his generation. He also became a father to three children. Then, one day in 2012, he began popping prescription pain pills. And now he's dead.

The root causes of addiction, like those of many multifactorial diseases, are frustratingly elusive, a nebulous mixture of genetics, exposure and environment. Addiction runs in families, but plenty of addicts come from families with no history of the disease. Availability plays a role, too - but having access to crack doesn't make someone a crack addict. The science about recovery is also hazy: Alcoholics Anonymous, the most widely used form of treatment in the country, has no set structure or methodology, which makes it tough to evaluate its effectiveness. (There's also the fact that its core principle - that members never publicly acknowledge their presence in the program - makes broad longitudinal studies difficult, to say the least.) In-patient treatment centers, like the one Hoffman checked himself into last May, have been accused of obfuscating their success rates.

If anything, the science on relapses is even more slippery. (We do know that relapse rates for drug and alcohol addiction are comparable to people's inability to control other chronic illnesses, such as type 2 diabetes, asthma, and hypertension.) The challenges are as basic as agreeing on a definition for long-term sobriety. In a graphic titled "Extended Abstinence is Predictive of Sustained Recovery," the National Institute of Drug Abuse says, "After 5 years - if you are sober, you will probably stay that way." I unconsciously added a "forever" to the end of that sentence - but the study that chart is based on ran for eight years, a bar Hoffman cleared easily: http://bit.ly/1iqtYoL

My first attempt at recovery came in 1991, when I was 19 years old. Almost exactly two years later, I decided to have a drink. Two years after that, I was addicted to heroin. 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.

 In August 2011, after a dozen years in New York, I moved back to Boston, the city in which I was raised and attended college. I was 39 years old and married; my wife and I had a 1 1/2-year-old boy and another child on the way. I'd written three books, won some awards, and was about to start teaching at MIT. If I'd been asked to provide a CliffsNotes version of my life, those are the details I would have included.

Being back in Boston was a visceral reminder that there's an important part of my past that isn't on the bio page of my website: From 1995 to 1997, the last time I'd lived in the area, I'd been an IV drug addict. Living here again made me acknowledge that past every day: The drive to my son's preschool took me within blocks of the apartment that I'd lived in during those years; my route from his school to my office went past the free acupuncture clinic where I'd sought relief from withdrawal pangs. One afternoon, I looked up and realized I was in front of the emergency room I'd been taken to after overdosing on a batch of dope laced with PCP. I did a double take and looked to my wife, but, of course, that wasn't a memory we shared. We met in 2004, when I'd been sober for more than six years.

One truism of addiction science is that long-term abuse rewires your brain and changes its chemistry, which is why triggers (or "associated stimuli," in scientific parlance) are major risk factors for relapse. But these changes can be reversed over time. Walking past the apartment where my dealer used to live didn't make me want to score; it made me feel as if I was in a phantasmagoria of two crosshatched worlds - but I was the only person who could see both realities. None of my colleagues at MIT, no one in the science writing community I lean on for professional advice and support, none of the people who've worked on my books has ever seen me slip into that other world.

That was a disquieting realization. I worry about the day that I stop acknowledging both of those realities. Most adults with jobs and mortgages and spouses and kids can have a glass of wine after work. For me, a glass of wine is a gateway to my past - and that past provides a pretty robust pool of evidence that there's not much separation between my having a drink and my ending up alone in an apartment with a needle in my arm.

A lot has happened in my family over the past 2 1/2 years. Our daughter was born. We bought a house. My yearlong job morphed into something more permanent. My route to work no longer winds through the spectral landmarks of my addiction. Days can go by without my thinking about how close I came to being a statistic - but then my eye will catch on the two inch-long scars marking the veins in the crook of my elbow or I'll notice someone nodding out on the bus. Or maybe I'll talk to one of the small handful of close friends who have relapsed and are now fighting to regain a foothold in sobriety - or be reminded of a friend who relapsed and died. I was lucky the last time I ran that experiment. I don't want to do it again.

 It's impossible to know what led Hoffman to start using after so many years of sobriety. After he opened a portal to that vortex of chemical relief, however, it doesn't surprise me at all that he couldn't heave himself out in time to save his life.

 

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