Oscar-winner Philip Seymour Hoffman had been clean 23 years before the demons came calling again. Last spring, the actor went back to rehab to try to beat a heroin addiction. He detoxified at a facility on the East Coast for 10 days, apparently long enough to get the physical craving out of his system. But clearly the mental war persisted. The 46-year-old died Sunday on a bathroom floor with a needle in his arm.
Addiction specialists say it's impossible to quantify how long substance abusers should stay in rehab, pointing out that every case is unique depending on the severity of the addiction. Experts say 50 per cent of substance abusers relapse – a shocking figure they explain exists because addicts often underestimate the mental challenge of staying clean. The Globe spoke to four Canadian addiction specialists about why recovery and abstinence is a lifelong commitment.
Dr. Harry Vedelago, chief of addiction medicine services at Homewood Health Centre in Guelph, Ont.
I was treated here at Homewood 14 years ago for an addiction to IV Dilaudid, a derivative of morphine that is 4.2 times more powerful than heroin. This place saved my life. I was lucky because I had a great support network once I left treatment. People have to understand substance abuse is not a weakness, not a moral issue.
Ten to 15 per cent of the population will have the disease addiction, which I think of as a hunger that exists in the absence of food. After residential treatment, you lose tolerance and the disease cycle doesn't end when you're clean. Sending someone out with no support after detoxification is ludicrous. You have to put in measures – have a plan – to ensure they don't get themselves into a situation where they can relapse, or worse, die. It's wrong to think alcoholics and drug addicts don't recover. They do. But we need a better support matrix in place, and to remove the stigma still attached to monitoring addicts and ensuring they follow a good recovery program.
Dr. Simone Arbour, research and program quality co-ordinator at Bellwood Health Services in Toronto
If someone like Hoffman had been struggling since he was 22 – when he first got sober – this is a long-term problem and a 10-day stint would not even begin to address the underlying issues. Most of the time, the addiction itself is a surface manifestation of something deeper, many times linked to trauma or a negative sense of self-worth. Addicts have to be given the coping skills to deal with life, on life's terms. We know that relapse rates are about 40 to 60 per cent. What predicts how well someone is going to do is whether or not they engage in a long-term continuum of care.
The initial rehab is just laying the foundation. It's not a choice to be an addict. What human would choose broken relationships, ill health or financial ruin? The real work for addicts begins when they return to the real world and have to learn mentally how to stop the irrational cycle of madness.
Dr. Tim Stockwell, director of the Centre for Addictions Research at the University of Victoria in British Columbia
Relapse is incredibly common, and for someone who has been using drugs in a dependent way for many years, almost any activity in your life will trigger a desire to use. When you're in a residential treatment facility you're not exposed to the stresses and strains of relationships, work and socializing. That's deliberate, to give people a break to come off. The coping takes place out there in the real world.
Particularly with a substance such as heroin, they've lost tolerance to the drug, so a relapse can be fatal. In overdose situations, people are usually scared to call for help because they don't want to get in trouble with the law. Progressive countries such as Australia have a policy in place where police don't chase ambulances to these calls. It erases the fear of arrest and saves lives.
Dr. Steven Melemis, a Toronto-based specialist in addiction medicine
In 10 days, a person's mind is just starting to clear up from the effects of their addiction, so they are not ready to learn how to cope. Many celebrities are in danger of getting short-term, "special" care because they say, "Listen, Doc. I've got a busy schedule. I need to be out of here." Which is the exact opposite of what they need. Hoffman had been recovered for 23 years before he relapsed, and he likely did so because he stopped making recovery the No. 1 priority in his life. Sometimes all it takes is a little stress to push them over the edge. Recovery is a lifestyle. It's a commitment and a concerted choice.
These interviews were condensed and edited.