I have been working in the field of addiction for over twenty years and I continue to be mystified by many of the misconceptions surrounding this most common disorder. Addiction is a deadly disease. It is a brain disease that alters the brain’s fundamental motivational drives such that thoughts, judgment and volition become severely distorted and actually serve the abnormal motivational priority of getting and using more drugs. Untreated severe addiction is more likely to kill a patient suffering with the condition than most cancers. Treated Breast Cancers, Prostate Cancer, most Lymphomas, and the vast majority of skin cancers, have a better prognosis than a treated addict. And yet addiction is the only disease I have to convince a patient that they have and more importantly convince the patient that without treatment his or her life is in danger. Getting families to understand this is often even more difficult. For those of us that are parents, every instinct we have is often precisely anathema to the interventions we should be taking when our children become addicted.
I was at dinner with my own children some months ago and we were discussing addiction and I explained to them that as a result of my experience treating addicts, I wanted them to know that I would go to any lengths to combat this disease should one of them ever fall victim. I reminded them that I spend my days trying to resurrect lives that have been devastated by this disease, devastation that might have been avoided had someone been sufficiently clear to have gone to the mat for this patient when they were younger and earlier in their disease. Family members have to be willing to go to any lengths and unfortunately this often means bringing about circumstances that restrict that individual’s freedom. As the parent of an addict you must be prepared to bring consequences to bear. I am talking about painful interventions that save lives.
I am not naïve about the treatment of addiction and I know well that some times any and all interventions are in vain. There are those professional who would argue that abstinence based interventions are unrealistic for severe addicts and physicians should pursue replacement or so called harm reduction therapies. But when I was asked as a father, if I were in Michael Lohan’s position, what would I do to help my daughter, I am clear that I would go to any lengths to get her to and retain her in treatment. Bringing legal consequences to bear is often the only alternative. It would kill me but I would do it. Perhaps I surrendered my equanimity to a flight of journalistic excess by even suggesting that he plant drugs. But if I was in his position and I knew she was addicted (which I personally do not) and all else had failed, I suspect I would contemplate even this as a last resort.
Let me be clear I am not suggesting this as a routine intervention but we frequently enlist law enforcement when we have exhausted other measures. To those of you who reacted in outrage when I made this suggestion, I will remind you that millions of you watched the first season of Sober House when as difficult as it was for her, the house manager, Jennifer Gimenez, summoned police to contain Steven Adler. We then advocated for long-term treatment as an alternative to imprisonment; an enlightened judge granted this, and today as a result Steven is sober and thriving. Were it not for this intervention, as miserable as it was for Steven, I believe he would have or soon succumbed to his addiction.
I have participated in similar interventions many many times and it saves lives. Judges will grant treatment and this can be a very effective means to keep patients engaged in extended care. In my experience the outcomes can be quite good. I do not know Lindsay Lohan but I sincerely wish her the best. She has had excellent treatment in the past at outstanding treatment programs. I hope one day she returns to her recovery as I believe she will one day thrive, provided that this disease does not first bring some horrible consequences down upon her. As a father my heart goes out to Michael Lohan who deeply appreciates the dangers of this condition and (if she is in fact active in her disease) lives every day in the shadow of his daughter’s potential demise.
Drew Pinsky, M.D.
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