I know I’m late to the party—writing this article nearly 2-months after the January overdose death of Philip Seymour Hoffman. Despite my tardiness, the issue of accidental death by overdose remains topical. For good reason, as a nation we are experiencing an epidemic of drug overdoses—New York alone experienced a 84% increase in heroin-related deaths from 2010 to 2012. If you’ve paid any attention, you’ve undoubtedly witnessed the barrage of headlines and new stories on this subject. Coverage has been wall to wall, from NPR to the New York Times. For good reason too, accidental death stirs up so much emotion. Sadness is the first and most natural reaction to such loss. But I’ve read articles where anger was clearly being directed at the drug user. On the surface, I get it. The author of such an article is likely mad because death by overdose is so avoidable and such a waste. ‘Why couldn’t the addict just made another choice?’ Clearly it must be more complicated than that.
Since all of us likely know someone who suffers from an addiction of some kind, such accidents compel us to find someone or something to blame. That makes sense to me too. It’s natural for us to want to understand the reasons behind these tragedies. When blame is cast, it seems to fall on either the “disease” of addiction, or the poor “choice” of the addict.
When someone blames the disease, as did Huffington Post blogger Akikur Mohammad, MD did in his March 14th article, addiction is equated with cancer and diabetes, which have no known cure. I know I’m swimming against the stream of generally accepted medical consensus here, but the word disease, when applied to addiction, makes me wince a little. Is smoking a disease? I know smoking causes disease, but is it a disease itself? Also, if addiction were a disease, then addicts would have no free will. Nothing is forcing anyone to use drugs. Sure, ample evidence proves addiction causes brain changes that dysregulate both thoughts and emotions, which fixates an addict’s attention on obtaining and using drugs, which then makes it difficult for the addict to curb cravings. This is all true. And this is precisely why Dr. Mohammed also rightly makes the case for compassion rather than condemnation of addicts. But clearly, there’s a difference between an addiction and say, Alzheimer’s disease. Addicts can and do learn new attentional and emotional self-regulation skills. They can and do recover. Despite the best medicines modern science can provide, one cannot practice one’s way out of Alzheimer’s. We also often hear that addiction is “progressive.” Yes, sure. But my response to that argument is that addiction is progressive the same way practicing the piano is progressive. The more a person engages in any activity, the more one’s brain changes in response to the activity. Call it what you like: neuroplasticity, or training effect, or Karma. People get good at what they practice. For these reasons, I think it’s best to view addiction as a conditioned flow of contextually dependent triggers, thoughts, and sensations. If this flow remains unconscious, the addict cannot interrupt it, and it will continue indefinitely. If the flow of triggers, thoughts, and sensations is interrupted with skillful awareness, it can and will change. In that sense, addiction is more like a verb than a noun. Addicts wanting to recover must first learn how to mindfully monitor triggers, thoughts, and sensations before they engage in healthier behaviors. Healing any addiction requires one to consciously break out of an attentional fixation, and then wake up to a broader perspective from which a better choice can be made.
When a writer blames the user, he or she making a similar mistake, which is to say oversimplifying a complex flow of interdependent actions. This is what New York Post reporter, Andrea Peyser did in her Feb 9th article. Peyser is relentlessly damming, but on target when she takes on a complacent recovery industry, but then mistakenly blames Hoffman for his accidental overdose when she concludes her article with this sentence: “He made his choice.” In one sense she’s right—Hoffman engaged in a premeditated act. He made a string of fateful decisions that night, which culminated in his accidental death. And if this were a legal proceeding, Hoffman’s many “choices”—from calling his dealer, to going to and taking money out of the ATM, to cooking the drugs, and finally to injecting them into his arm—would convey responsibility onto him. But in another sense, Peyser and others who blame the addict are missing a vitally important nuance. First, even though he’d been sober for 23 years, he’d never really understood the causes of and remedies of his addiction. His “recovery education” up to that point failed him. Subsequently, once caught in a conditioned flow of triggers, thoughts and sensations (what others call the disease) Hoffman was ill equipped to skillfully work through the urges. Attentionally fixated as he was that night, access to the full range of choices was not available to him. I can relate with Peyser and her dislike of a recovery system that’s surely broken. But we lack compassion when we blame Hoffman for not knowing what he didn’t know. Without the understanding or the skill to get “meta” on himself, Hoffman did not have the ability objectively watch the flow of triggers, thoughts and sensations. Without the ability to be mindful, he was stuck in a cyclic addictive compulsion. Therefore, his “choice” to use was not so much a conscious one, but rather the only one available to him at the time. Addiction is complicated, where paradoxically, two seemingly contradictory conditions are true at the same time: 1) addicts are not forced to act out; and 2) once in the grip of a conditioned flow of triggers, thoughts and sensations, compulsive acting out is the only thing that occurs to an addict[1].
For the reasons stated above, blaming the disease, or the addict for lack of moral strength, is not appropriate. In Buddhist psychology, the primary reason people suffer is because of ignorance. Meaning people just don’t know how to help themselves. All of us want to be happy and avoid suffering. That’s what Hoffman was trying to do the night he died. The reason he was compelled to use drugs is because he had used them before. He was seeking relief in a way he had received relief in the past. We all do this. We repeat the past is because we are conditioned by it, and that conditioning influences us in the present. For this reason alone, the problem of addiction will not go away. We are only days or weeks away from the next talented but troubled person crossing the line and inadvertently killing him or herself with drugs. My hope is that this article can wake us up to a new mindfulness-based recovery paradigm—one that does not over simplify a complex set of interdependent conditions. There is a middle way between the extremes of blaming the disease or blaming the addict. If readers are interested in an evidence-based recovery programming (online courses, 13-month guided program, workshops and 1:1 Skype sessions) that employs mindfulness practice to work with triggers, thoughts, and sensations please visit www.skillfullyaware.com.
[1] Field M., Cox WM. Attentional bias in addictive behaviors: a review of its development, causes, and consequences. Drug alcohol depend (2008) 97:1—20. DOI: 10.1016/j.drugalcdep.2008.03.030
As Mate writes, ‘these are the hallmarks of addiction, all addictions.’ Mate goes on to explain that addiction involves the same brain circuits, whether the addiction is chemical or behavioral. Therefore, addictions do alter brain physiology.
Depression, anxiety, PTSD, ADD and or any number of other chronic stress-related conditions push an addict to seek relief in their drug of choice or in medicating behaviors. Interestingly, Mate points out that the same brain circuits that feel physical pain are also active during experiences of emotional pain. ‘When people speak of feeling emotional pain, they are being quite accurate.’ Mate states very strongly that ‘hurt’ is at the center of all addictive behaviors.
