Andy Warhol Was a Hoarder (26 page)

A
LCOHOL AND DRUGS HAVE LONG HAD
a double-edged reputation—good at certain times, bad at others. Over the centuries, alcohol has been regarded as medicinal panacea and religious offering as well as ceremonial drink and social lubricant. In the 1800s and early 1900s, medicinal compounds now deemed dangerous were welcomed as miracle cures. In an infamous 1884 essay, “Über Coca,” Sigmund Freud rhapsodized about the merits of cocaine, which he used himself, recommended to friends, and prescribed to patients for depression and sexual impotence. Around the turn of the century, cocaine syrups and lozenges were marketed to treat a variety of ills, including headaches and seasickness. Bayer cough suppressants contained heroin. Mothers gave five-day-old babies a spoonful of medicine spiked with alcohol and opium to calm them down. And Mrs. Winslow's Soothing Syrup, which contained morphine, was sold as a tonic for teething.

Today, our perception of alcohol and drugs has changed dramatically with the knowledge that these substances can be highly addictive and fatal. The CDC estimates that the harmful effects of alcohol are responsible for about 88,000 deaths and 2.5 million collective years of “potential life lost”—lives cut short when Americans die prematurely from excessive drinking. Prescription drug addiction, meanwhile, has become an urgent concern among
public health officials as Americans swallow too many pills to dull their physical and emotional pain, or crush and snort the medicines to get a quick high. Overdoses of opiate painkillers like Vicodin and OxyContin, the most commonly abused category of prescription drugs, now kill more than 40 people a day in the United States—more than heroin and cocaine combined. The problem has increased most dramatically among women. Between 1999 and 2010, the death rate from painkiller overdoses among women quadrupled (it rose two and half times among men); a staggering 48,000 women died, most of them unintentionally.

All told, 40 million Americans aged 12 and over struggle with addiction. That beats the number of people battling heart disease, cancer, or diabetes. Yet the public's conception of the illness is rooted in bias rather than science. It has been more than 250 years since addiction was first described as a disease, not a moral failing, says Dr. Samuel Ball, president of the National Center on Addiction and Substance Abuse at Columbia University (CASAColumbia). But because the initial act of drinking or using drugs requires a conscious decision, and because addiction directly affects a person's behavior and judgment, it continues to be viewed as willful and dishonorable. Even today, people struggling with alcohol and drug dependence are dismissed as drunks, lushes, druggies, and crackheads. They are seen as weak, manipulative, self-absorbed, and lacking willpower. And they appear to make bad choices over and over again with no regard for the lives of their loved ones.

Researchers are busy trying to shift this common misconception to an understanding that they believe is more in line with modern science: addiction as a chronic brain disease. Evidence for this dates back to the early 1990s when scientists began to harness the power of brain-scanning technology to unravel addiction at its roots. What they found is that some people are biologically primed
to become dependent on alcohol and drugs, and, at the same time, these substances can alter the brain. At a most basic level, alcohol and drugs act on the same part of the brain that modulates many of our desires. This “reward system,” as it has come to be known, works by flooding the brain with neurotransmitters, including brain chemicals related to pleasure, such as dopamine. This serves a critical survival purpose: ensuring that humans desire food and sex so that we stay alive and procreate. The problem, however, is that this same circuitry can become overloaded with substances that cause harm—multiple glasses of wine, a handful of painkillers, an injection of heroin.

The brain's reward network is paired with circuitry that controls our behavior, and together they provide an elegant “stop” and “go” system. “Go” responds to cues (the sight of a vodka tonic) and anticipated rewards (relaxes me, liquefies my problems). “Stop” is responsible for processing the consequences of indulging (too much is bad for me). Scientists are now learning more about the exceedingly delicate balance between “stop” and “go,” and they have discovered that it varies across individuals, says Anna Rose Childress, director of the Brain-Behavioral Vulnerabilities Laboratory at the University of Pennsylvania's Center for Studies of Addiction. Some people are better at controlling their urges than others, possibly because they were born with well-regulated reward and behavioral-control systems, allowing them to distinguish what they want from what's actually good for them. Others, however, start out with unstable circuitry from birth, weakening their ability to “stop” when they should. In either case, positive childhood experiences can enhance the balance of this system, while stressful experiences, including poverty, violence, and abuse, can undermine it. “We are at the mercy of our biology and our environment,” says Childress.

Viewed this way, addiction is not a choice but a matter of how our brains work at a most fundamental level. Biological and environmental risks also help explain why many people fail to stay sober. Relapse is the great nemesis for people struggling with addiction; it is exceedingly common (rates range from 30 to 70 percent for alcohol and as high as 85 percent for opiates) and is tremendously difficult to overcome. That's because alcohol and drugs, like food, become ingrained in the brain as a powerful and pleasurable memory, which is triggered by cues—a favorite bar, a pill bottle. These cues are so potent, Childress has discovered, that they can register in the brain sight unseen. In a landmark study, Childress and her colleagues showed a series of drug-related images, including crack pipes, to a group of patients addicted to cocaine. The pictures were visible for just 33 milliseconds, far too fast for the patient to consciously see them, and yet the images stimulated activity in the brain's reward system. In patients struggling with addiction, Childress explains, the “go” system was engaged long before “stop” could say, “Wait a minute! What about the consequences here?”

Alcohol and drugs are especially alluring to people suffering physical or mental anguish, both of which plagued Betty Ford. In some cases, the best way to prevent substance abuse or manage addiction is to properly identify and treat commonly co-occurring mental health conditions like depression, anxiety, bipolar disorder, and schizophrenia as early as possible—before they fester untreated and people self-medicate. Once addiction sets in, many people find their way to Alcoholics Anonymous, the long-running support group founded in 1935 by an Akron, Ohio, surgeon and a New York stockbroker, both of whom struggled with alcoholism. The program, rooted in faith and abstinence, views alcoholism as “a progressive illness that can never be cured.” Members, who attend meetings all over the world, must attempt
to follow 12 steps, which include admitting to being “powerless” over alcohol and seeking a spiritual awakening. Opinions about AA and other groups like it, including Narcotics Anonymous, are complex and mixed. Some people claim that AA has saved their lives through fellowship; others drop out, often because they are uncomfortable with the religious undertones or unable to commit.

Methadone has been used for decades to reduce cravings and suppress withdrawal in people addicted to opioids, such as heroin and prescription painkillers. Other treatments reduce highs, cravings, and symptoms of withdrawal. The use of medications to treat addiction remains controversial, however, because many providers in the field insist that recovery should be a “drug-free” process, despite scientific evidence that medicines can help. Childress is most excited about therapies that might one day interfere with the biological mechanics of the reward system itself, stopping the urges dead in their tracks. Her research has shown that a common muscle relaxant called baclofen clamps down on the “go” system in patients addicted to cocaine, preventing the brain from reacting to cues, both visible and unseen. The ideal treatment would work on the “stop” system as well, strengthening a patient's ability to resist the pull of a drink or a drug altogether. “It would be great to have both going at the same time,” says Childress.

Today, the best approach to treatment is often a combination of medication, therapy, and support groups, says CASAColumbia's Dr. Samuel Ball. Given the complexity of the illness, however, there is no easy fix. It can be challenging for clinicians to tease out addiction from symptoms of other mental illnesses and to know which condition to treat first. Many people struggling with addiction never even have a chance at recovery: Only about 10 percent receive treatment at all, in part because mainstream doctors are still not adequately trained to identify the problem or
they overlook its impact. And then there are the most stubborn barriers to care: shame, secrecy, stigma. “The denial piece of this disease is so powerful,” says Ball.

Relapse is most wrenching of all. Watching a child, sibling, parent, or spouse become sober and then regress leaves family members feeling raw and helpless. Addiction, as everyone in the field will tell you, is a family illness. George McGovern, former senator and 1972 Democratic presidential nominee, described this eloquently in a memoir about his daughter, Terry, who battled both depression and alcoholism. During the last four years of her life, Terry was admitted to a detox center in Madison, Wisconsin, 68 times, McGovern writes in
Terry: My Daughter's Life-and-Death Struggle With Alcoholism
. Even a treatment program at the esteemed National Institutes of Health couldn't save her. Just after she was released, Terry told her father that she needed to pick up a prescription at the local drugstore; three hours later, a bartender called to say she had collapsed after having too many drinks. On December 13, 1994, Terry, who had tried repeatedly to heal herself, was found in an alley behind a Madison print shop. The 45-year-old mother of two girls had frozen to death in a bank of snow. Terry's death left her grieving father haunted by questions: “What could I have done differently? What if I had been a more concerned and actively involved parent when she was a little girl, or a fragile adolescent?” Most fundamental of all was this: “How did a beautiful, endearing, quick-witted, compassionate and perceptive little girl grow up to become an alcoholic powerless to control or save her life?”

M
RS.
F
ORD
'
S EARLY DAYS IN REHAB
were not easy. For starters, she didn't like the idea of rooming with three other women at the
naval hospital; she was a former first lady, after all. Didn't she deserve her own room? “I had a bit of the celebrity hang-up,” she wrote in her memoir. At 60, she was also older than the other clients, she was reluctant to talk about her personal problems during group therapy, and she wasn't interested in exercising. Above all, Betty Ford initially refused to accept that she had a problem with alcohol. “I could
not
say I was an alcoholic,” she recalled. “I didn't relate to any of the drunk stories I heard.” Denial, frustration, anger, crying, mood swings—she experienced every bit of it.

Over the course of four weeks of treatment, however, Mrs. Ford began to bond with fellow patients and share stories over coffee breaks and card games. It was the denial of a fellow patient, who said her drinking hadn't caused her family any trouble, that jolted Betty Ford to finally admit that she had a drinking problem. “Suddenly I was on my feet, and I said, ‘I'm Betty, and I'm an alcoholic, and I
know
my drinking has hurt my family,' ” she recalled. “Because I thought, by God, if she isn't gutsy enough to say it, I will. It surprised me to hear myself and yet it was a relief.” By the time she finished treatment, Mrs. Ford later recalled, “I was beginning to be happy again.”

In 1982, four years after successfully completing rehab, Mrs. Ford co-founded the Betty Ford Center (now a part of the Hazelden Betty Ford Foundation) in Rancho Mirage, California, with a friend, former ambassador Leonard Firestone. She was especially interested in making rehab more accessible and targeted to women, whose addiction problems often stem from trauma associated with men. From the start, men and women have been separated for most of their treatment at the center, which is rooted in the principles of AA—a powerlessness over alcohol and a spiritual approach to support and fellowship. Since the center opened, patient demographics have changed significantly, says Betsy
Farver-Smith, vice president of philanthropy. “It used to be that you were a garden-variety alcoholic and you drank excessively,” she says. Today, patients span generations, and they are dependent on a combination of substances. Older patients, often cognitively impaired, arrive at the center addicted to multiple prescription medications; younger ones, many of them teenagers, raid their parents' medicine cabinets to get high.