Tag Archives: Alcoholism

A Different Path to Fighting Addiction

When their son had to take a medical leave from college, Jack and Wendy knew they — and he — needed help with his binge drinking. Their son’s psychiatrist, along with a few friends, suggested Alcoholics Anonymous. He had a disease, and in order to stay alive, he’d have to attend A.A. meetings and abstain from alcohol for the rest of his life, they said.

But the couple, a Manhattan reporter and editor who asked to be identified only by their first names to protect their son’s privacy, resisted that approach. Instead, they turned to a group of psychologists who specialize in treating substance use and other compulsive behaviors at the Center for Motivation and Change.

The center, known as the C.M.C., operates out of two floors of a 19th-century building on 30th Street and Fifth Avenue. It is part of a growing wing of addiction treatment that rejects the A.A. model of strict abstinence as the sole form of recovery for alcohol and drug users.

Instead, it uses a suite of techniques that provide a hands-on, practical approach to solving emotional and behavioral problems, rather than having abusers forever swear off the substance — a particularly difficult step for young people to take.

And unlike programs like Al-Anon, A.A.’s offshoot for family members, the C.M.C.’s approach does not advocate interventions or disengaging from someone who is drinking or using drugs. “The traditional language often sets parents up to feel they have to make extreme choices: Either force them into rehab or detach until they hit rock bottom,” said Carrie Wilkens, a psychologist who helped found the C.M.C. 10 years ago. “Science tells us those formulas don’t work very well.”

When parents issue edicts, demanding an immediate end to all substance use, it often lodges the family in a harmful cycle, said Nicole Kosanke, a psychologist at the C.M.C. Tough love might look like an appropriate response, she said, but it often backfires by further damaging the frayed connections to the people to whom the child is closest.

The center’s approach includes motivational interviewing, a goal-oriented form of counseling; cognitive behavioral therapy, a short-term form of psychotherapy; and harm reduction, which seeks to limit the negative consequences of substance abuse. The psychologists also support the use of anti-craving medications like naltrexone, which block the brain’s ability to release endorphins and the high of using the substance.

A 2002 study conducted by researchers at the University of New Mexico and published in the journal Addiction showed that motivational interviewing, cognitive behavioral therapy and naltrexone, which are often used together, are far more effective in stopping or reducing drug and alcohol use than the faith-and-abstinence-based model of A.A. and other “TSF” — for 12-step facilitation — programs. Results of an updated study have not yet been released.

Researchers elsewhere have come up with similar findings. In 2006, the Cochrane Library, a health care research group, reviewed four decades of global alcohol treatment studies and concluded, “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems.” Despite that research, A.A.’s 12-step model is by far the dominant approach to addiction in America.

Jack and Wendy’s son, who is in his early 20s, began drinking to alleviate crippling anxiety and ease persistent depression. His drinking, while worrisome, was not an entrenched pattern, his parents believed. Some of Jack’s friends suggested that if their son did not attend A.A. of his own volition, the only thing Jack and Wendy could do was attend Al-Anon.

“The implication was that there was no other solution,” Jack said. “There was a great deal of sadness on their part, empathetic sadness, which in some ways was frightening in itself.”

“A lot of people credit A.A. with saving their lives,” he added. “It’s understandable that they can’t dissociate themselves from a program that worked for them. But it’s an all-or-nothing commitment for life. That really freaked me out.”

In A.A.’s literature, “alcoholism” is defined as “a progressive illness that can never be cured.” Members describe themselves as being “in recovery,” which translates to lifelong abstinence and adherence to the 12 steps mapped out in the Big Book, published four years after the organization was founded in 1935. First among them is the obligation for members to admit their “powerlessness” over alcohol. It also relies heavily on faith; God is mentioned in five of the 12 steps.

On a warm evening last month, about a dozen parents gathered to hear Dr. Kosanke describe the center’s program for families, which goes by the acronym Craft, for Community Reinforcement and Family Training. It rejects, she said, the use of three words: “addict,” “alcoholic” and “enabling,” a term often used to describe the acts of loved ones that help perpetuate unhealthy behaviors.

Instead of addict or alcoholic, she prefers the terms favored by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or the DSM-V, which says that patients suffer from “alcohol use disorder” or “substance abuse disorder,” terms that convey a spectrum of severity.

“Substance use takes on a lot of different shapes and sizes,” Dr. Kosanke said. “There are real downsides to labeling a child with a lifetime identity, when that truly may or may not turn out to be the case.”

And calling caring behavior enabling, she said, has a way of turning even acts of kindness into something negative. “Our field hasn’t done a good job of defining it in a narrow way that’s appropriate,” she said. “If you give your kid money knowing he will go buy pot, that’s enabling. If you take your kid to soccer practice, you’re encouraging healthy behavior. That’s not ‘enabling.’ ”

Part of the Craft approach has parents take care of themselves, too, said Lorraine McNeill-Popper, who volunteers for the parent hotline at the Partnership for Drug-Free Kids, a nonprofit group devoted to recovery for young people. “If you are sleep-deprived and stressed out, how can you think clearly?” she said.

Ms. McNeill-Popper has her own family history of drug abuse. Her twin brother died of an overdose, and she adopted his son, who later became a heavy marijuana user and ended up in rehab. “I tell parents, ‘It’s like when you’re on an airplane, and they tell you to put the oxygen mask over yourself first. That way you can help with the others.’ ”

The center’s approach is controversial in the recovery world. David Rotenberg, executive vice president of treatment at the nonprofit Caron Treatment Centers, a large drug and alcohol rehabilitation provider with branches in several states, cautioned against approaches that do not set abstinence as a goal.

“The majority of people who are chemically dependent would love to be able to drink and drug in a more moderate fashion,” Mr. Rotenberg said. “Most drug addicts and alcoholics would love to drink just a couple of drinks, and they try to do so, with poor results.”

The C.M.C. doctors say treatment for young people needs to be tailored for them, since teenagers and young adults are neurologically, psychologically, socially and legally different from adults, and have different treatment needs.

Dr. Wilkens founded the center with a fellow psychologist, Jeffrey Foote, in 2003. The two had worked together in larger hospital-based treatment centers where they struggled to introduce evidence-based treatments, she said. When it opened, the C.M.C. was one of the few centers in the nation that were not tethered to the 12-step model, she said.

“It was our strong belief that you can work with people at any stage of change, ranging from ‘I’m not even sure I have a substance problem’ all the way to ‘I just got out of rehab and want to go to A.A. meetings every day,’ ” Dr. Wilkens said. “We don’t have a judgment on how you address your substance use problem. Maybe A.A. is helpful to you and you find everything you need there. If it’s not, we genuinely believe there are many strategies for helping to resolve them.”

In fact, a majority of college binge drinkers do not go on to become alcohol dependent, said Stanton Peele, a Brooklyn psychologist who has studied substance use for decades and is a longtime critic of the A.A. model. While binge drinking and other drug use are risky, multiple studies show that most people “mature out” of such recklessness when they begin to have increased responsibilities.

A federally financed study of 43,000 randomly selected Americans, called the National Epidemiologic Survey on Alcohol and Related Conditions, or Nesarc, found that 75 percent of those who are heavy drinkers eventually regain control without rehab or A.A., Dr. Peele said. The survey, which was conducted in the early 2000s and was designed to be representative of the larger United States population, was aimed at helping researchers understand high-risk drinking patterns, design better-targeted treatment programs and monitor recovery. It found that over half of those who recover managed to cut back instead of abstaining, Dr. Peele said.

“Isn’t it more encouraging to know that most people are going to outgrow these habits than to think they’re going to have a disease for the rest their lives?” Dr. Peele asked. “The data show that the odds are in your favor.”

Dr. Wilkens is familiar with that pattern. She was a college binge drinker herself and also struggled with bulimia. Once she left her home state of Kansas for New York City, where she attended Hunter College, she felt culturally stimulated and intellectually challenged, she said, and the drinking and disordered eating disappeared.

“When you focus on building up the world around you, you find stimulation and rewards that are very different from using drugs and alcohol. You find other ways of soothing yourself, and things can get better,” she said.

That is precisely what L.S. learned five years ago. L.S., a Manhattan lawyer in his early 30s who asked to be identified only by his initials to protect his privacy, spent nearly a decade as an episodic binge drinker. He began drinking as a student at his large Midwestern university, where he played rugby and where many of his best friends belonged to fraternities. Alcohol, he said, flowed freely through both subcultures. L.S. said he thought his drinking — weeks of no drinking followed by serious binges of a few dozen drinks over several days — would end after college. Yet the behavior did not fade. The morning after his wedding, he awoke with a hangover that lasted a day and a half.

His father, who drinks socially, told him that people either were alcoholics or were not. But L.S. was unprepared to accept that label and began researching moderation on his own. He found a New York branch of Moderation Management, or M.M., a secular, peer-led support group that takes a cognitive behavioral approach.

In contrast to A.A., which stresses a drinker’s lack of power in the presence of alcohol, M.M. encourages personal responsibility for drinking. The group, founded in 1993, encourages members to start with an alcohol-free month, and then allows for the reintroduction of moderate amounts of alcohol. (Critics note that one of its founders, Audrey Kishline, was involved in a fatal accident while driving drunk. She left the group in January 2000 with the intention of joining A.A., and three months later, crashed head-on into another vehicle, killing the driver and his 12-year-old daughter.)

L.S. now attends hourlong meetings once a week at which he and about a dozen others discuss their goals for moderate drinking, as well as tips, challenges and progress on avoiding triggers. Since he began attending, L.S. limits himself to about five drinks a week, well below the 14 drinks M.M. advises as a safe limit for men.

L.S. is convinced that there is no single approach for all problem drinkers. “M.M. doesn’t profess to work for everybody. It has a scientifically based approach that works for some people,” he said.

The C.M.C. psychologists are blunt about the reasons many teenagers and young adults use drugs: When it comes to decreasing anxiety and relieving depression, substances tend to work for the short term. “Kids aren’t crazy for using them,” Dr. Wilkens said. “They have an effect that is reinforcing in some way. If you understand that, you can strategically work to support and reinforce other healthy, competing behaviors.”

That approach runs through the book she wrote with Dr. Foote and Dr. Kosanke, “Beyond Addiction: How Science and Kindness Can Help People Change.” It was published in February, just as the death of Philip Seymour Hoffman from a heroin overdose struck fear in the hearts of many parents whose children use drugs. It landed Dr. Wilkens on several talk shows and drew scores of calls to the center. (In addition to its New York office, the group has opened a residential treatment center in the Berkshires.)

Dr. Wilkens’s message struck a chord with Wendy. Her son had just left school, and the couple was exploring treatment options. Wired in the evenings with extreme anxiety, he drank excessively to get himself to sleep. Once in bed, he’d stay there till 5 p.m.

Before she read the book, Wendy said, she would stomp upstairs hourly to announce in an exasperated voice, “It’s 2 o’clock. You’ve got to get out of there.”

“I’d do that three or four more times and then be fuming,” she said. “I’d be fuming all day, at home doing my work and knowing he was upstairs sleeping off whatever he’d been drinking the night before.”

After learning the Craft approach, Wendy said, she stopped nagging, changing her negative, accusatory tone to a more pleasant one by asking open-ended questions.

Today, Wendy and Jack’s son is working with his psychiatrist and getting help for his depression and anxiety. He seems to be bingeing much less. When the family went out to dinner on a recent night, the parents each ordered a beer or a glass of wine and sipped slowly through dinner. “How will he learn moderation if he doesn’t see it modeled?” Wendy asked.

Ellie hopes her daughter, too, will be able to change her drinking patterns. Ellie is a New York editor, who asked that her last name be withheld to protect her family’s privacy. Her daughter, 23, has struggled with binge drinking since she was 16. While her daughter graduated from college and holds a responsible job, she still binges on weekends. “It’s so much a part of the culture, it’s everywhere,” Ellie said. “She says she’d have no social life if she stopped drinking.”

Ellie, who grew up in a home in which many relatives attended A.A., at first tried Al-Anon. “They talk about ‘disengaging,’ ” she said. “But it’s your child, and I’m not one of those people who can put her out on the street.”

While their daughter has resisted treatment so far, Ellie and her husband have begun seeing a therapist at the C.M.C. to better navigate their relationship.

“My child is much more than a label or a diagnosis,” she said. “She’s not a problem to be solved, but a child to be loved and guided toward a better life.”

Source:  The New York Times

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Addicted for life?

Breaking an addiction is often the hardest thing someone can do, and many never completely eliminate their attraction to the abused substance.

New research appears to support this premise by finding that even long-term abstinence from cocaine does not result in a complete normalization of brain circuitry. The brain just doesn’t appear to go back to what a “normal,” non-addicted brain looks like.

Research on drug addiction often involves chicken-and-egg questions surrounding the abuse of drugs. In particular, one of those questions is whether individuals who abuse psychostimulants like cocaine are more impulsive and show alterations in brain reward circuits as a consequence of using the drug, or whether such abnormalities existed prior to their drug use.

In the former case, one might expect brain alterations to normalize following prolonged drug abstinence.

In the new research, Krishna Patel and colleagues compared neural responses between three groups of people who were asked to complete a task that resembles bidding on eBay items.

The 3 groups consisted of 47 healthy controls, 42 currently drug-abusing cocaine users, and 35 former cocaine users who had been abstinent an average of 4 years. They also compared all three groups on their levels of impulsivity and reward responding. They found that active users showed abnormal activation in multiple brain regions involved with reward processing, and that the abstinent individuals who were previously cocaine-dependent manifested differences in a subset of those regions.

Both current and former cocaine users displayed similarly elevated impulsivity measures compared to healthy controls, which may indicate that these individuals had a pre-existing risk for addiction. Indeed, the degree of impulsivity correlated with several of the brain activation abnormalities.

These findings suggest that prolonged abstinence from cocaine may normalize only a subset of the brain abnormalities associated with active drug use.

“The knowledge that some neural changes associated with addiction persist despite long periods of abstinence is important because it supports clinical wisdom that recovery from addiction is a lifelong process,” says Dr. John Krystal, Editor of Biological Psychiatry. “Further, it is the start of a deeper question: How do these persisting changes develop and how can they be reversed?”

Researchers believe additional further studies will be needed to investigate such questions, including the continued attempt to determine the extent to which differences in former cocaine users reflect aspects of pre-existing features, exposure to cocaine, or recovery.

Source: Elsevier

Celebrity Addicts

Who dies, who survives, and why?

The toll of celebrity addiction — to street drugs, prescription drugs, alcohol or a mix — is long and mournful, and seems particularly heavy right now thanks to the deaths of Houston, 48, and Amy Winehouse, 27. And not just them: In recent years, Michael Jackson, Heath Ledger, and Anna Nicole Smith have succumbed to overdoses; going back further, the list includes John Belushi, Marilyn Monroe, Elvis Presley and Judy Garland.

Americans these days can’t escape the steady stream of news about celebrities and their controlled substances. Take Lindsay Lohan. After years of erratic behavior, multiple arrests and five stints in rehab, Lohan says she’s finally cleaned up her act. She promises to stay away from drugs and alcohol , and even completed her comeback gig hosting Saturday Night Live March 3 (the ratings were good but the reviews were mixed).

Recent weeks also brought news that Scottish actor Gerard Butler (300), 42, and comedian Artie Lange, 44 , both successfully completed rehab for addiction and are back working. But actress Demi Moore, 49, who was hospitalized after smoking something that gave her convulsions , sought “professional assistance” for her problem. And Australian actor Alex O’Loughlin, star of CBS’s Hawaii Five-0, has announced he would take time off to get “supervised treatment” for pain drugs prescribed after a recent shoulder injury. This sort of thing is not uncommon in Hollywood: Actress Tatum O’Neal, 48, who comes from a family of addicts and has long battled to overcome substance abuse, also is in “supervised treatment” to prevent a recurrence of addiction, to painkillers recently prescribed for back surgery. “She will always seek supervision when taking prescription medication that has addictive potential,” according to a statement issued by her manager, Angela Cheng Caplan. But it’s fair to ask: Is there a fatal attraction between celebs and controlled substances? Why do some survive and some die? How do you step away from addiction when the spotlight is always on? “It’s that caustic mix of sudden celebrity and being strung out and it being condoned by the people around you,” says Duff McKagan, 48, the original bass player for rock band Guns N’ Roses and a longtime drug and alcohol addict who had to nearly die from an exploding pancreas in 1994 at age 30 before he was motivated to get help. His mother weeping in her wheelchair over her youngest child, and his eventual discovery of the physical and spiritual strengths of martial arts also helped, he says.

Houston’s death brought up painful memories for daytime talk-show host Wendy Williams, who walked away from her secret cocaine addiction years ago because she wanted a better life, because it was breaking her parents’ hearts and because she knew that otherwise she was headed to an early grave. “Whitney and I, same age, and both plagued with the demon of substance abuse,” Williams said tearfully on her show shortly after Houston’s death. “It’s been almost 15 years since I smoked last from a crack pipe. It’s been almost 15 years since I waited on Jerome Avenue in the Bronx for my drugs.” Williams, 47, a former radio star whose three year-old talk show has been renewed for two more years and is syndicated in more than 150 markets, started dabbling in drugs when she was in college, but later fame and success didn’t prevent her escalating habit. She looks back on those years now with her signature mix of humor and sharp self-awareness. A middle-class girl with middle-class values, she says she could not have survived the “TMZ era” of salacious attention on celebrity addiction. “I never wanted to shame my family so I just stopped. It was a slow stop,” she says. “The unspoken disappointment of the people closest to me was tearing me apart. That girl who went through that, it made me the woman I am today, but I would have ended up dying. “And if I hadn’t died of dying, I would have died of embarrassment! I would have lost my job or been written up in the New York Post!

Addiction experts say it’s a misleading assumption that celebs are more prone to addictive behavior, because anyone can inherit that DNA. “Addiction does not discriminate, it cuts across all socioeconomic classes,” says Kevin Hill, addictions psychiatrist in charge of drug abuse treatment at Harvard Medical School’s McLean Hospital. “People use according to psycho-social stressers. Celebrities might have slightly different stressers, such as fame, but they use drugs like regular people — they just use better drugs.”

What actors, singers, athletes, even CEOs have that regular people might not have is more access to drugs, more time to indulge, more money to pay for it, and often a horde of enabling hangers-on who are financially dependent on them and thus more motivated to supply substances for them. It adds up to a situation hard to walk away from, McKagan says.

“Some can do (drugs) and move on and some do it and get stuck,” he says. “In the last year before ending up in the hospital, I had given up, I said I can’t stop this,” says McKagan, author of the memoir, It’s So Easy (And Other Lies). “I had to be scared to death.”

Winehouse’s demise in her London home last July was likely due to accidental alcohol poisoning, according to the coroner’s report. Her grieving parents are setting up a foundation in her memory to help people overcome addiction.

Houston was found submerged in a Beverly Hills Hotel bathtub, with bottles of prescription pills found in her room. Her family said she was taking anti-anxiety drugs, and she was seen drinking the night before.

Appearing on CNN last month, one of the Republican presidential candidates, Rick Santorum, said celebrities such as Houston are “the royalty of America” who set a bad example by their deaths by drug use.

“Ridiculous,” scoffs Hill. “He implies that she chose to suffer such a fate, when in fact she made multiple efforts to treat it. To say that someone makes a conscious decision to have her life go down the drain is preposterous.”

But one of Houston’s close friends, R&B legend Chaka Khan, a recovering drug addict herself, said on CNN that her best memories of Houston involve getting high with her and Houston’s ex-husband, Bobby Brown. “Talking crazy and having a really, really, really good laughing, and a really, really good time,” she said.

With the non-stop coverage of Houston’s death and also Michael Jackson’s drug overdose death in 2009, it’s easy to forget that there are more survival stories than tragedies among celebrity addicts.

Rocker/American Idol judge Steven Tyler, 63, who came close to dying from drug abuse, appeared with the other members of Aerosmith on 60 Minutes, talking about the ravages of addiction on bodies, band and relationships. But after 40 years, and lots of rehab, they’ve managed to make it into their 60s; they’re still rocking, about to tour the U.S., about to make another album.

Tyler told People he’s been transformed. “I’m on Idol now — the last thing I’d want the world to see is me slurring my words,” he says. “I don’t ever want to be a bad example again.”

Actress Kirstie Alley, 61, was “way into drugs” when she was Lohan’s age, she recently told Access Hollywood. “If you don’t die doing them, you just screw up your life sort of royally,” she said.

Actor Robert Downey Jr., 46, may be Exhibit A for the possibility of a successful celebrity comeback from addiction. Not so long ago, he was looking glum, wearing an orange jumpsuit and being sentenced to jail for drug-related offenses; now he’s out, he’s recovering and he’s a bigger star than ever with lead roles in the Iron Man and Sherlock Holmes movies.

Actress Mackenzie Phillips, 52, was so drug-addled (she was first exposed to drugs at age 11) that she spent hundreds of thousands of dollars on cocaine, lost jobs and lovers, used while pregnant with her son, watched as close relatives died from drug abuse, and was even reduced to a years-long incestuous relationship with her equally drug-addled father, iconic ’60s rock musician, John Philips, of The Mamas and the Papas.

She should be dead, she says, giving herself credit for battling back from the brink. True, most of her family cut her off because she spilled the creepy beans about her now dead father, but she feels she’s finally escaped her past. “At last I’m living the health and happiness that I always described but never experienced,” she wrote in her 2009 memoir, High on Arrival. “I’m living my life instead of watching it happen. I’m free.”

There’s nothing new about celebrity addiction. Billie Holiday, the great jazz singer who died in 1959, may have been one of the first major celebrities to go to her grave too early (she was only 44) because of the effects of alcoholism and drug addiction.

Nor is there anything new about addiction among non-celeb Americans. According to the government’s Substance Abuse and Mental Health Services Administration, 23.5 million people aged 12 or older needed treatment for a drug or alcohol problem in 2009, but only 2.6 million actually were treated at a specialty facility (aka rehab).

As for addiction deaths, those happen among ordinary people, too, but we just don’t hear about them because they’re not celebs.

What is new is that increasingly Americans — celebrity and regular folks — are getting hooked on prescription drugs, and ending up dead or close to it by accidentally taking too much or mixing them with alcohol. The number of overdose deaths from painkillers more than tripled from 1999 to 2006, to 13,800 deaths that year, according to Center for Disease Control statistics released in 2009.

Take rightwing radio king Rush Limbaugh, 61. Prescribed powerful painkillers after back surgery, he ended up hooked in 2003, got caught trying to acquire them illegally, was arrested and spent a month in rehab.

Prescription drug addiction has become “an epidemic” in recent years, says psychiatrist Marc Galanter, director of alcoholism and substance abuse treatment at NYU Langone Medical Center/Bellevue, and former president of addiction medicine and addiction psychiatry groups.

“There’s a whole new raft of (narcotic) drugs available that will compromise you and you don’t have to be a celebrity to afford them — middle-class people can afford them,” Galanter says. “Some people get them (initially) for medical procedures, and before they know it they’re addicted. And because it’s not ‘illegal,’ as it were, it’s easier to feel it’s OK.”

Why do people who are rich, famous, beautiful and talented feel the need for drugs and alcohol? Life coach and family advocate Lisa Nkonoki, who says she helped Ray Charles Jr. overcome his addictions, has offered her services to her longtime friend, Bobby Brown, father of Houston’s teen daughter, Bobbi Kristina, who as the child of addicts is at risk of stumbling down the same path. Nkonoki says that celebs, like anyone else, can become addicts because they don’t feel strong or good about themselves at some level.

“It’s an escape (from) the persona people want them to be instead of the person they truly are,” she says. Successfully stepping away from addiction, she says, comes only after accepting that it’s a disease. “No one wants to wear this badge, no one wants to go through this struggle. But when you get this disease, you have to deal with it, manage it, emerge from it and move on.”

The key factor in treating addictions, celebrity or otherwise, is recognizing that there’s usually an underlying mental-health issue, says Kathleen Bigsby, CEO of The Canyon at Peace Park, an expensive, exclusive and super private comprehensive treatment center in Malibu that has treated celebrities (no names, she says) for addiction and “co-occurring disorders.”

“Just addressing the addiction isn’t enough — there’s anxiety, depression, trauma,” Bigsby says. “Addicts need a new skill set to learn how to manage their stress.”

Actress/writer Carrie Fisher, 55, was addicted to drugs and drink (and food) almost from the time she became a star at 19 playing Princess Leia in Star Wars. Was it fame that made her a mess? Probably not, since she’s also bipolar and her wacky childhood as a Hollywood princess (daughter of Debbie Reynolds and singer Eddie Fisher) left her plagued by insecurity and despair. But fame didn’t help.

Fisher turned her difficulties into successful comic memoirs and stage shows, writing in her latest book, Shockaholic, that she tried everything to cure herself over the decades — therapy and retreats, overeating and fasting, 12-steps, meditation, re-birthing, walking over hot coals, jumping out of airplanes, climbing up mountains, floating down the Amazon, speaking in tongues…you get the picture. And yet, “I still did not feel — how shall I put this — mentally sound,” she writes. So she turned reluctantly, fearfully, to electroshock therapy, which to her surprise seems to have worked. True, it erased some of her memory but at least she’s still alive and recovering. And writing.

The problem for celeb addicts is they have to struggle and recover in public, in the glare of social media and the 24/7 celebrity-media industrial complex, Bigsby says. Nowadays even D-list celebs are in the spotlight, unlike in Billie Holiday’s era.

“There’s always been curiosity about celebrities, knowing about their personal lives and their experiences with pain and suffering,” says Bigsby. In the old days of Hollywood, they were protected. “Now we’re seeing even more about their struggles because we know more about them through social media. Now they’re out there texting and tweeting every thought, so there’s instantaneous exposure to everything.”

Meanwhile, tragic deaths can sometimes be educational, sometimes not, says addiction expert Galanter. “It alerts people to the danger but can also make it attractive, because if a celeb is doing it, people think maybe they can risk it, too,” he says. “Deaths might sober people up, but it depends on how sensible people are. I hope so.”