Editor’s note: Dr. Itai Danovitch is the director of Addiction Psychiatry Clinical Services; associate director of the Addiction Psychiatry Fellowship, and assistant professor of psychiatry and behavioral neurosciences at Cedars-Sinai Medical Center in Los Angeles.
(CNN) — Whether or not Amy Winehouse succumbed to the addiction she so vividly sang about, some will draw a cautionary tale from her untimely death.
Is there a lesson in her passing? Did rehab fail her, or did she fail to come back to rehab? For now, few details are known and these questions will have to remain unanswered.
We still don’t know whether drugs caused her death. But what is certain, however, is that during her brief life, Amy Winehouse gave expression to a turbulent and troubling relationship with addiction. She gave interviews about previous experiences attending rehab and sang a song about not wanting to return.
With her simultaneously commanding and pleading tone, she emblematized the contradictory nature of addiction: The outward appearance of success, and the internal tumult and despair; the alluring mastery of an art, and the low self-worth beneath it; the pressure to enter treatment, and the internal drive for personal autonomy at any cost.
These contradictions are familiar to anybody who has struggled with addiction or has lived in close proximity to it. Addiction appears to result from a voluntary act. One drink, one pill, one line. And yet no matter the wreckage, no matter the addict’s brilliance, intelligence, or insight, there is no stopping the next round.
Recovering celeb addicts, reformed liars
Family, friends bid Winehouse farewell
No matter the wreckage, no matter the addict’s brilliance, intelligence, or insight, there is no stopping the next round
–Itai Danovitch
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Adding to the mystifying nature of addiction, often those people who appear most self-assured and independent are the ones who fall hardest.
Is it the quality of rebelliousness, a brilliant feature in its own right, that makes some addicts so hard to reach? Is it the constant drive toward novelty seeking, a trait often associated with success, that eventually leads to self destruction? Or does it have to do with the fleeting refuge that drugs provide from the turbulent offerings of reality?
Over the past two decades, researchers have painstakingly tried to resolve these questions. While addiction is far from being cured, a great deal has been learned.
First and foremost, addiction is a disease. It manifests through interactions between a person’s underlying biology, psychological makeup and environment.
Most people who use drugs do not go on to develop addiction, but for the sizeable minority who do, alcohol and drugs profoundly influence the motivational circuitry of their brain. As a result, unconscious factors constantly conspire to make future drug use more likely, no matter the consequences.
Addiction is chronic and relapsing. This notion of “chronicity” is vital for understanding why even after extended periods away from drugs the vulnerability to relapse continues. The long-term risk of relapse among people who often otherwise have striking capacities for self-discipline and discernment is one of the mystifying characteristics of the disease.
Consequently, effective treatment is founded not so much on any particular episode of care (though all episodes of care are important) as continuity of care. Recovery is not about rehab, but rather what happens after rehab. In this respect, addiction is very similar to many other medical illnesses with high relapse rates (including asthma, hypertension and diabetes), where success is measured by health outcomes over time.
Treatment works. A wide range of therapies and medical interventions are effective in helping people recover. Like all complex medical conditions, one size does not fit all, and the details of what works or doesn’t work have a lot to do with someone’s unique genetics, psychology and the supportiveness of his or her environment.
Addiction is often associated with depression, anxiety, trauma, eating disorders and other mental health problems, and often these issues need to be addressed for treatment to be successful. Additionally, people can be successful in treatment even if initially they were reluctant to enter it. This is why long-term health often requires creating a context that continually encourages recovery work.
Addiction is common, but treatment for addiction is tragically uncommon. In the United States, only 10% of people who need specialty addiction treatment actually receive it. These numbers are astounding given addiction’s personal and societal cost, over $600 billion annually, as well as the evidence that treatment actually works.
Obstacles to treatment include the absence of insurance coverage for addiction services, the inadequacy of addiction training among many medical providers and the perpetual ambivalence among so many people who suffer from addiction. As for the multitudes who never get help, they are left to suffer through the consequences of untreated addiction, which claims relationships, careers, health, happiness and sometimes lives.
The association between creativity, drug use and mental health has been a constant throughout the history of music. Amy Winehouse died at age 27, tragically joining a group of brilliant but disenchanted artists who passed away while contending with the complicated burden of their early success. We still don’t know the details as they pertain to Winehouse, but whatever refuge drugs offered was probably illusory.
The opinions in this commentary are solely those of Itai Danovitch.