Why Celebrities Get Poor Addiction Care
The sordid death of Matthew Perry has been all over the headlines recently. The more we learn about what transpired, the worse it gets. The doctors he was illegally purchasing ketamine from were disrespectful, mercenary drug dealers who, thankfully, will never practice medicine again. Mr. Perry’s live-in celebrity assistant – who, obviously, has no medical training - blindly and recklessly followed instructions to inject Mr. Perry with ever higher dosages of ketamine. Mr. Perry has a history of severe addiction and shouldn’t, under any circumstances, have been calling the shots about dosage and frequency of injections of this powerful, psychoactive drug. This is particularly true for an unregulated dissociative anesthetic such as ketamine which, under different circumstances, can be quite safe and helpful for treatment resistant depression. All of this culminated in Mr. Perry being found dead, submerged alone in his hot tub.
Could this death have been avoided? Do celebrities have a difficult time getting reasonably adequate treatment for addiction? Is their care even more chaotic and patchwork than the care the rest of us receive?
Matthew Perry was not alone in his struggles. About forty million Americans have a substance use disorder, about half of whom are in recovery. This can be a deadly disease for anyone. The proof of this is that we lose about a hundred thousand or so people every year to drug overdoses. Yet, from Prince, to Tom Petty, to Michael K. Williams, it seems that celebrities have some unique challenges to treating their addictions. In many ways, they can be particularly vulnerable.
To someone who follows the news, it certainly seems as if celebrities are disproportionally affected by fatal consequences of their addictions. We are bombarded on social media with lurid stories about their demise. It seems that celebrities are dropping like flies. Is this true? This phenomenon is quite possibly attributable to selection bias. It may only seem like celebs are especially impacted because they are famous, and the grisly details of their lonely overdoses enter into the public discourse and end up on our radar and computer screens. When you look at anyone who dies from an overdose – famous or not, there is always a tragic sequence of errors and ill-fated decisions that result in loss of life. We just don’t hear about them unless we know the family. These lonely deaths rarely make it into the news.
Doctors certainly have unique and formidable challenges to getting the help that they need as detailed in my memoir ‘Free Refills’. Are there similar aspects of fame and celebrity status that provide barriers to treatment? I suspect that celebrities are surrounded by too many people (fans, assistants, doctors) who simply won’t say no.
What does it take to overcome an addiction?
This is a complicated topic! Having been through this -- I am now 16 years in recovery from my opioid addiction and have treated countless people with addiction, I feel the most essential features are:
One needs a great deal of humility to assess what went wrong with one’s life, and to fearlessly address how one can get emotional needs met in a healthier manner. When addicted, I used to just obliterate all of my resentments and uncomfortable feelings with drugs, and it was a critical component of my recovery to learn healthier ways to relate to tolerate distress. (Being a celebrity doesn’t always engender humility.)
Effective, comprehensive, up to date medical treatment for addiction. This is necessary but not sufficient to recover. It is sorely lacking for doctors, who tend to get boatloads of punishment and substandard treatment. Medical treatment with methadone and buprenorphine (Suboxone) is the standard of care for opioid addiction. It saves lives. (Celebrity rehabs seem to emphasize the wrong issues and are very thin with respect to the vitally needed medical treatments.)
Peer support is crucial. We don’t recover alone. Ideally, people have access to peer support that is better than cultlike groups such as AA or NA. (It is difficult for celebs to be just one person in the crowd, without attracting undue notice and attention.)
One also needs a hospitable social environment with includes adequate opportunities for housing and healthcare. (At least celebrities don’t have to worry about this!)
Why might all this be difficult for celebrities?
If one is recovering from any addiction, they are more likely to meet with success if their entire community is unified in helping them avoid making self-destructive or impulsive choices (which is what those of us with addictions tend to do). This is especially true in early recovery when it is profoundly difficult to not relapse if drugs are readily available. Every single one of your molecules wishes to consume them. Ideally, one’s family/community/social network are all on the same page with respect to helping prevent a relapse in any way they can. For example, my in-laws would ensure that, when I came to visit, there wasn’t any Vicodin or other narcotic in the medicine closet. At the time, it would have been almost automatic for me to open up that medicine closet, impulsively swallow some pills, and to reignite up the same brain pathways that we were all working so hard to extinguish.
Along these lines, it seems to be difficult for some celebrities create this type of united front against their access to drugs or alcohol. There will always be fans, sycophants, brown nosers, or assistants, who are under tremendous pressure to do whatever the celeb asks of them, to provide drugs if requested. According to a recent story in the NYT, titled, ‘I was a celebrity assistant. The power imbalance is real’.
Very few people have firsthand insight into the toxic dynamic that can develop while assisting a celebrity or understand the inherent power imbalance that can arise…an assistant to a celebrity can be expected to do whatever is asked, regardless of ethics or legality.
It can be almost impossible to say no, even if the choice is a highly destructive one, such as repeated high dosage ketamine injections, as we saw in the case of Matthew Perry. We have seen this time and again.
Another issue is the general cultural environment that celebrities find themselves immersed in. Celebrities party. There are drugs and alcohol galore. That is part of the culture and a big part of where the glamour comes from. It can make it more difficult to discern if one has a problem - because all of these behaviors are normative.
It should be noted that the most insane case of all, based on the bizarre and unorthodox medical care given, was that of Michael Jackson. His nutty, incompetent doctor had him hooked up to an I.V. for insomnia. The doctor turned on an intravenous anesthetic/sedative (propofol!) whenever Mr. Jackson wanted to go to sleep. He turned off the infusion when it was time to wake up. It is virtually impossible to describe how far this practice deviates from the basic standard of care, and duty not to harm, that patients should be able to expect from their doctors. This clown didn’t even know how to do CPR when Michael Jackson stopped breathing because of the anesthetic (he did it on the sofa instead of on the floor – it doesn’t work if you don’t do it on a hard surface).
Regular people simply don’t encounter scenarios like this. If that one particular incompetent, greedy doctor didn’t agree to provide this substandard care, the chances are, Michael Jackson could have found ten other doctors who couldn’t resist the money, fame, prestige, and excitement of being a doctor to the stars - even if you have to blur some lines here and there.
Other problems celebrities encounter
I am not a proponent of Rehab in general as a sensible, helpful, and cost-effective treatment for addiction as argued in a recent blog. Many of them are based on Alcoholics Anonymous 12-Step cultlike nonsense, which is only helpful to a fraction of participants. Most of the time they don’t believe in, allow, or prescribe the vital, lifesaving ‘Medications for Opioid Use Disorder’ or MOUD. It is tragic to witness families taking out mortgage after mortgage to pay for these senseless treatments that often do little good for anyone (except for the bottom line of the Rehab facilities).
Yet – if Rehab is what has been recommended for you, or it is what you think you need, at least go to an established, reputable facility that provides you with what you need to recover (such as MOUD). These snazzy, high-end celebrity rehabs seem to shift the focus onto all of the wrong things, such as massages, nice beach views, luxurious rooms, and comfortable amenities. This can’t do anything but distract from the hard work, the emotional pain, and the intensive soul-searching that is necessary (if not sufficient…) to enter into, and stay, in recovery. I am not a proponent, on the other extreme, of draconian, punitive facilities which can be counterproductive and inhumane, but to be distracted by the gourmet food or the high thread count linen sheets, is to distract from what is truly important.
According to the branding/advertising for the Cliffside Malibu luxury rehab, “Learn to love yourself again and live your best life”. Remember – people trying to recover are desperately attempting to rewire their brains so that they can, once again, focus on getting joy and sustenance (a.k.a. dopamine) from the simple things in life, such as a walk in the woods or a conversation with a friend.
Early recovery, unfortunately, can be a dark, lonely time. There’s no choice but to walk through the pain, and to use it to help forge healthier habits and safer, more meaningful ways of interacting with people.
All the fluff associated with these high-end facilities can only distract and undermine (and provide little bursts of dopamine, which the addicted brain is craving, in response to meaningless fluff).
What is a better way forward?
There are many commonalities to people suffering from addiction – the same disease attacks all of us in similar ways. At the same time, many of us have unique vulnerabilities which, ideally, would be factored in to our addiction treatment program. This is true across the spectrum, from relatively privileged physicians, attorneys, and celebrities all the way to the down and out and the unhoused (who, in addition to addiction treatment, need the basic human rights of healthcare and housing if they are going to succeed). Insight into what each person needs is critical, such as insight, in the case of celebrities, into one’s privileged position and the potential dangers that this can cause.
Accountability is critical. You simply can’t be in a position where you are the one deciding how much ketamine you should be taking if you not in stable recovery. Very few people recover without genuine humility. Without humility, it is difficult to take a truly clear-eyed inventory of what one’s strengths are, as well as what needs to change. The fame, attention, and fortune that go along with one’s celebrity status don’t do much for one’s ability to humbly confront one’s failings and mistakes. None of us recover alone. As we recover, we crave connection. Our emotional involvement with the drug needs to transition into genuine human connection. Many famous people complain about being “lonely in a crowd”. Above all, we need the courage to confront our demons and to forge a new, unknown path forward without our best friend…our drug of choice.