What if Rehab Doesn’t Work?

Photo by Vinicius “amnx” Amano on Unsplash

If you knew nothing else about her, you knew she was an addict. A self-proclaimed train wreck whose talent was too often overshadowed by a tabloid-fueled persona that turned her public life into a frustrating spectacle. Amy Winehouse‘s addiction had become a pop culture punch line.

According to media accounts, I was in good company having learned of her death from friends’ social media posts. My shock was two-fold: that Winehouse was actually dead at the young age of 27 and how insensitive and downright mean some of the reactions were. Many played off her own lyrics, saying she should have said “yes” to rehab-poking fun at her hit song: “They tried to make me go to rehab but I said no, no, no.”

Part of what made Winehouse’s death so surprising was that it was so unsurprising. In a July 24 article for the Washington Post, Chris Richards wrote,” The Internet’s fixation with her misdeeds actually captured us at our most revolting.” He went on to describe a website that for years hosted a contest offering a free iPod to whomever correctly guessed the day she would die. The day after Winehouse did die, the site read: “Amy Winehouse has passed away…Winner will be announced later.” Why was it okay to make her a joke when it was so clear that she was in a dangerous battle with addiction? How do we learn the lesson that “the joke” is what kills some people who do not achieve and maintain sobriety, even after many times through treatment?

Of course the story of Winehouse’s struggles with addiction is complicated by her role as a performer. On the surface, she appeared to be an iconoclast, adopting the aesthetics of a 1960s R&B singer with a sense of what seemed like irony. Her unwinding beehive and disheveled vintage dresses made her look like a prom date climbing out of the backseat. And yet there was the talent, the song lyrics that revealed a sharp self-awareness. Her melodies were often chipper, tidy little ditties, but that chipper exterior belied the heft of reality in the lyrics of songs such as “You Know I’m No Good”: “I cheated myself / Like I knew I would / I told you I was trouble, / Yeah, you know that I’m no good.” While we may never know what killed Amy Winehouse, it is clear she struggled, and sadly, probably meant it when she wrote those lines.

What went wrong for her? How could someone with such a well-expressed sense of self-awareness (she won 5 Grammys) express her thoughts, feelings and fears, yet not be able to overcome the addiction that was a frequent topic in her work?

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Of course many people, famous and not, share Winehouse’s long-term battle with addiction, which begs the question: why do some people successfully recover while others do not? Heidi Kammer Hodge, M.S.W. an addiction counselor and professor at St. Mary’s University, explained addiction has been historically viewed as a “moral, behavioral disease, but it really is a brain disease. It’s not just a simple choice to keep using. The alcohol and drug use alters the way the brain works.” According to Kammer Hodge, this misunderstanding has led to a persistent stigma surrounding addiction.

Bringing it into a personal perspective makes all the difference in removing the stigma of addiction.People understand what it means to have a chronic disease like diabetes or a heart-condition — illnesses that cannot be permanently cured, but must be managed over the long term. But when it comes to addiction, there is a higher level of shame and blame, and a tendency (for both user and observer?) to look at the situation as hopeless. As Kammer Hodge explained, there is also some lingering disagreement within the treatment community about viewing addiction as a brain disease, although medical science continues to support this idea.

Just this year [2011], the American Society of Addiction Medicine (ASAM), issued a new definition of addiction stating, “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual who pathologically pursues reward and/or relief by substance use and other behaviors.” (Asam.org) In other words, it is not simply a matter of will power. Kammer Hodge cited this misperception as a common obstacle to maintaining sobriety, saying, “People who are addicted often know they have a problem. They have that insight, but don’t accept what that really means. They think, if I can just get some space on this; if I can just be sober for 6 months I can get things together.”

Clients entering Recovery Resource Center (now Avivo), have an average of six or more past treatment interventions. When asked why it takes so many peole so many times in treatment to succeed, Kammer Hodge points to some common themes such as other mental health issues (80 percent of Avivo’s clients have co-occurring disorders), homelessness (90 percent enter treatment from being homeless), criminal histories (70 percent have past criminal histories), limited education, unemployment, a history of trauma and abuse, along with experiencing oppression and racism (80 percent are people of color). Unless all of these challenges can be addressed, maintaining sobriety is much less likely.

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Kammer Hodge also explained that multiple treatments can be a part of the process of recovery. “People being treated for heart disease or diabetes often need several treatments to be healthy.” Taking the analogy further, she illustrated the impact of the stigma surrounding addiction. “A diabetic might slip and have a piece of chocolate pie, go into a diabetic coma and end up in the hospital. While people might judge them somewhat, it still isn’t on the same level as it can be with an addicted person. People still believe [the diabetes patient] will get better again, where there might not be the same level of hope with the addicted person.” ASAM’s new definition of addiction even points to the likelihood of relapse stating, “Like other chronic diseases, addiction often involves cycles of relapse and remission.”

When asked about people who don’t make it, who die still battle addiction, Kammer Hodge said, “People can lose perspective and get so caught up in their addiction that they don’t see a way out They can lose all sense of hope. Maybe they don’t make an active choice to die, but they put themselves in harm’s way.”

An insufficient support network or remaining in an environment conducive to using can also be stumbling blocks. As Kammer Hodge explained, “Understnading addiction as a brain disease means learning that whatever age you start using, your brain starts to change so  you need to use just to feel normal again, just to function. It’s like learning to ride a bike one-way-[the addicted person] learns to do things while they are using. Once they stop, they have to learn a new way to ride a bike. It’s that hard.”

Despite the sad end of Winehouse’s high profile story, Kammer Hodge offered an optimistic outlook. “Don’t give up on people who are addicted. We always have to offer hope. When we see a person who is addicted, we need to remember their children are in school with ours. They live in our community, go to our church, shop at our grocery store. Bringing it into a personal perspective makes all the difference in removing the stigma of addiction. I want to get the message out that people do recover.

Jessica Orange is a freelance writer in the Twin Cities.

This article first appeared in the September/October 2011 issue of The Phoenix Spirit.

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