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Margaret Wente (Curtis Lantinga)

Margaret Wente

(Curtis Lantinga)

Margaret Wente

Philip Seymour Hoffman had a habit, not a disease Add to ...

Like everybody else, I was shocked when Philip Seymour Hoffman died. I adored him. “What a tragedy,” I told my husband.

“What an asshole,” he replied.

I knew I was supposed to feel sorry for him. He had struggled with his demons and lost. But the circumstances of his death were particularly degrading. He died in his underwear, surrounded by empty bags of heroin, a needle in his arm. A great talent had become a pathetic junkie.

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Then came the funeral. The picture of his sobbing kids was enough to break your heart. And all I could think was, how could he do that to them?

But that’s not the way we’re supposed to talk about addicts these days. We’re supposed to summon our compassion. We’re supposed to install vending machines for crack pipes. In our current therapeutic culture, the enlightened view is that addiction is not a character disorder. It is a chronic, relapsing brain disease – a problem of faulty wiring.

“It wasn’t Hoffman’s fault that he relapsed. It was the fault of a disease that often includes relapse as a symptom and the fault of the ineffective treatment he received,” addictions expert David Sheff wrote in Time. Most treatment programs are ineffective, he contends. If only they were better, fewer people would die.

“There is no cure for addiction, which is a chronic disease, the same as diabetes, asthma and heart disease,” Janina Kean, the head of Connecticut’s High Watch Recovery Center, told CBS News.

Addiction is the leading cause of preventable death today, Lloyd Sederer, a mental health expert, wrote in Psychology Today. Yet “only one in 10 people with any form of addiction report receiving any treatment – at all.” British comedian Russell Brand blamed drug laws and stigmatization. “Would he have OD’d if drugs were regulated, controlled and professionally administered?” he wrote in the Guardian, conveniently forgetting that the most lethal drug by far is alcohol.

Yet if addiction is a disease, it’s a peculiar one. Nobody gets Alzheimer’s because of something they’ve done. You don’t go to a support group and pledge to avoid heart disease. Therapy and counselling won’t help you kick your asthma habit. Changing your behaviour won’t get rid of pancreatic cancer.

The disease model of addiction implies that the victim is helpless. It denies the role of personal agency, which is probably the most important force of all when facing down your demons.

The disease model also assumes that addicts won’t get better unless they seek expert treatment. In fact, a pile of research shows that most addicts cure themselves. They do so when the price becomes too high – when they might lose a job, a marriage, their kids or the regard of people they respect. Most people who were addicted in their teens and 20s manage to clean up by their 30s. Unlike Mr. Hoffman, most don’t relapse.

Treatment programs are important, and we need more. But stigma has its uses, too. It helps to curb behaviours that are destructive to families and society. We’re happy to stigmatize littering, smoking and failure to recycle. And it works. We expect cigarette smokers to kick their disgusting, unhealthy, anti-social habit, and think less of them if they don’t. So why are we so forgiving when it comes to heroin, which, according to some experts is no more addictive than tobacco?

Mr. Hoffman’s death was no freak accident. He worked hard to kill himself. By the end, he was ingesting stunning quantities of drugs. Yet he was an unusually privileged addict, with resources, people who loved him and access to the best help money could buy. But he decided he needed the drugs more than he needed to save himself. And sometimes no intervention and no amount of tolerance and understanding can save someone like that.

Mr. Hoffman is no different from the brilliant alcoholic friend of ours who drank himself into a stupor and fell down the stairs one night and hit his head and died. His death wish was stronger than his life wish. What a stupid waste, we said. How selfish.

Addiction is built into the human condition. We crave self-soothing, all of us, and some of us succumb. I feel sorry for Mr. Hoffman, but I feel much sorrier for the ones he left behind. What a tragedy. What a stupid waste.

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