Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: Philip Seymour Hoffman

The Treatment that Might Have Saved Phil Hoffman.

Cross-posted with AfterParty Chat.

Philip-Seymour-Hoffman

Late last week it was suggested that a cultural stigma against maintenance medications such as methadone and Suboxone helped kill Philip Seymour Hoffman.

This doesn’t make much sense to me given the fact that, shortly after he died, it was reported that buprenorphine was found in Hoffman’s Bethune Street apartment. Buprenorphine is a long-acting opioid the FDA approved in 2002 for opioid detox and maintenance. It’s used mostly for maintenance: it’s the New Methadone, but it’s much easier to get, because while methadone is approved for addiction-treatment only in a clinic setting, buprenorphine can be dispensed in a doctor’s office. Refills can be called in or faxed to pharmacies.

So how did Hoffman get his bupe? Either he was being prescribed buprenorphine for his opioid habit, i.e. he was “on maintenance”—as so many opioid addicts are: buprenorphine maintenance is a booming business in this country. Or else, as many heroin users do, he obtained his buprenorphine on the street.

Poor heroin users often cop street “bupe” to tide them over between fixes. But Hoffman was far from poor. So it’s speculation, of course, but I think it’s more likely he got his buprenorphine from a doctor. That’s what doctors do these days with opioid addicts: When we get honest about our addictions inside the exam room (and because Hoffman had spent 23 years sober and abstinent via 12-step fellowships, it may be fair to say he had practice in being rigorously honest) the doctors’ fear kicks in and they boot us into Suboxone clinics, where we’re prescribed upwards of 16mg of this very strongly-binding, fat-soluble drug that stays in our bodies for days before it’s excreted. In painkilling power it’s weaker than morphine or oxycodone, but in binding power—in its ability to stick to the body’s opiate receptors—it’s the second-strongest out there.

The strongest is fentanyl, the drug that’s been cut into heroin and has killed nearly two dozen in my region alone.

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Some publications are wont to report that opioid addicts—like Hoffman, like me—wreck our brains’ opioid receptors forever through drug-use. (This proves they don’t understand how the body’s painkilling system works: a great portion of the body’s opioid receptors actually reside in the gut. Which is why we get that lovely warm feeling throughout our bellies when we use painkillers or shoot heroin.) But there’s at least as much scientific and anecdotal support for the idea of neuroplasticity in recovery—the fact (it’s not just an idea anymore, it’s a fact) that the central nervous system is far more adaptable than we ever before believed and is evolved to use this resilience to recover from major traumas and illnesses, including addiction—especially if we help it by taking care of our bodies in basic ways, with exercise, good nutrition, and relaxation.

So the “old-school” idea is not 12-step programs, as these pieces suggest. “Old-school” is what I was taught as a kid: that once you lose brain cells, you never get them back, that our nervous systems cannot heal.

Still, these publications are putting the idea out there—and it is not a fact, it is just an idea—that if “most opioid addicts” don’t take maintenance medications forever to “correct” the “permanent damage” we’ve done through drug-use, we’re doomed to relapse.

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Philip Seymour Hoffman just four or five years before he got sober, in his 1985 high-school senior-year portrait.

Philip Seymour Hoffman just four or five years before he got sober, in his 1985 high-school senior-year portrait.

The clearest example that this isn’t the solution exists in our states’ physician health programs (PHPs)—systems of recovery designed to help addicted and alcoholic physicians keep their licenses to practice. These programs vary from state to state but generally provide five years of continuous care and oversight. Success rates for PHPs are extraordinarily high—upwards of 80 percent of physicians finish five years of treatment and are able to keep practicing.

These programs ought to be considered models for our citizenry. But they remain off the radar because they’re rigorous, expensive and intensive—five years, as opposed to a 28-day rehab, or even a ten-day or three-day detox.

Also, studies of PHPs show that linking recovery to one’s work is one of the strongest incentives you can give an addict to take responsibility for healing. Addiction thrives in situations of un- and under-employment not because the poor are somehow more susceptible to addiction, but because the people affected don’t have enough, or any, productive work.

It’s sometimes said that PHPs are effective for “highly motivated” addicts. Which leads me to my last point. I find it astonishingly patronizing that some are suggesting that public prejudice against maintenance killed Hoffman. Hoffman was an extraordinarily intelligent, articulate, “highly motivated” man and consummate professional whose work, he said, required him to be extremely introspective and emotionally present. I find it hard to believe he would be so easily swayed by public opinion about his choices.

I can more easily see him protecting his ability to work.

To act with the depth of feeling and nuance that he managed required full use of his entire internal emotional range. And opioid medications—including buprenorphine—necessarily dull one’s range of feeling.

I think it’s more reasonable to suggest that Hoffman tried bupe and found that, while taking it, he couldn’t access his feelings to the degree to which he’d become accustomed.

To be sure, he likely felt a great deal of shame during his relapse. One of the more damaging aspects of some 12-step groups, in my opinion, is their focus on “sober-time”: to “come back” from a relapse after a sober period of 23 years—half one’s life—would have been not only extremely embarrassing for anyone but also physically difficult, given that the heroin available these days is wicked strong.

But no way could Hoffman have wrecked his neurology permanently by using heroin for less than a year. I think it’s likely he did what so many who use heroin do: he chipped heroin, then switched to bupe, thinking it might remove his cravings. In fact, buprenorphine reliably does this for many opioid addicts who take it.

But craving is a feeling, and you can’t numb feelings selectively. My bet is that, feeling not-high but not-normal—after all, he’d been sober for 23 years: he knew what His Normal felt like; he knew what it took for him to do his job with the precision and quality with which he was used to doing it—he said what so many of us say when we’re caught between a rock and a hard place.

Fuck it.

What he needed was not more drugs. What he needed was a better form of treatment, perhaps the best evidence-based addiction treatment system we have going: the time-consuming, attentive one we give to doctors, the people we trust to protect other people’s lives.

But because Hoffman was “just” an artist, he followed the cheap, easy, brief trajectory that ordinary people in this country follow.

Pills. Then heroin. Then Suboxone. Then heroin again. Then death.

Hoffman in perhaps the last photo ever taken of him, a tintype made by Victoria Will two weeks before his death.

Hoffman in perhaps the last photo ever taken of him, a tintype made by Victoria Will two weeks before his death.

Philip Seymour Hoffman.

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As Truman Capote, the role that won him the Academy Award.

As Truman Capote, the role that won him the Academy Award.

It’s being widely reported that Philip Seymour Hoffman died of a drug overdose. He was found in a West Village apartment with the sharp still in his arm and several bags nearby.

He had 23 years sober before he relapsed on painkillers and heroin in 2012.

In "Almost Famous," as legendary 1970s music critic Lester Bangs.

In “Almost Famous,” as legendary 1970s music critic Lester Bangs.

The news literally knocked the wind out of me and I cried, the way I cried the day I heard David Foster Wallace (another person recovering from addiction) hanged himself. My first thought in both cases was selfish: Now we never get any more of their brilliant work. 

My second thought was for their partners, and for Hoffman’s kids. Hoffman had—has? had?—three kids. “Young children,” they are described in the New York Times story. Village residents who saw him around the neighborhood are describing him on Twitter as a generous dude who was kind and unpretentious when he brought his kids to the coffee shops.

As the kind, unpretentious home-health worker in "Magnolia."

As the kind, unpretentious home-health worker in “Magnolia.”

I loved him in this role in “Magnolia.” There is a video circulating on Twitter, a clip from “Before the Devil Knows You’re Dead,” showing him being shot up with drugs and mumbling while he nods. The author of the Tweet wrote,

How art more than imitates life.

Well, sure. Those of us who used to nod out may remember how to act like that. It’s more challenging to really BE kind and unpretentious. I prefer to remember him in this role—the attentive nurse who helps Tom Cruise’s father die.

(There’s an even better scene here. The dying guy is played by Jason Robards, who was a recovering alcoholic. Robards’s character admits how shitty he feels about having cheated on his wife, and later Hoffman’s character takes pity on him in the extremity of the guy’s suffering and uses the morphine to put him out of his misery, kissing the guy’s forehead while he dies. A bunch of commenters blasted this scene by calling it for example, “white-knight pussy propaganda,” but to me it looked like two recovering drunks listening to the wreckage of the past—a practice that is sometimes criticized by those who hate 12-step-recovery as being holier-than-thou superfluous moral bullshit, but which can be very helpful for recovery if it’s done well.)


The fact is, Philip Seymour Hoffman’s work made him an extraordinary artist, but with regard to this disease, he was just an ordinary person with addiction. 

The illness of addiction is the most endemic and perhaps the most invisible in our society. It is connected with so many other illnesses—HIV, heart diseases, lung diseases, liver diseases, cancers of all kinds; and also depression, anxiety, and other mental illnesses—as well as car accidents, accidental shootings, murders, and other forms of death. PLEASE LISTEN: every 19 minutes an American dies of a drug overdose. Here in Pittsburgh two dozen have died in the past two weeks from a fentanyl-spiked cut of heroin. That cut is making its rounds to bordering states, and I wonder whether that’s what killed him. I’m glad fentanyl didn’t kill me

These numbers ought to be unacceptable to any sane citizen or leader—and remember, we elect the leaders.

As someone who writes and speaks about the dangers of this illness and the possibilities of recovery, news like this makes me feel at once nearly despairing and also recommitted to letting the public know that with appropriate help people with this disease can recover.

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