Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: Robin Williams

Could Proper Standards of Care Have Saved Robin Williams?

Cross-posted with Recovery.org.

Robin Williams fish

Why does addiction care still, too often, lag behind the care you’d receive for other illnesses? I asked three addiction doctors how we can reimagine treatment as an ongoing collaboration.

When I first heard that Robin Williams died, of course I thought, Another overdose. But when I read “suicide due to asphyxia,” I remembered a 2013 statement from his publicist, which the media is now repeating into an echo chamber: Williams last year checked into rehab to “fine-tune” his sobriety.

What does fine-tuning your sobriety mean?

That the vagueness of this statement was accepted without question in the major media illustrates not only the media’s lack of knowledge about addiction but also the vast gray area in which addiction treatment operates. As a person recovering from addiction, I have the only life-threatening illness I know of in which I’m expected essentially to diagnose myself and oversee my own treatment and recovery.

Would we expect someone with cancer to diagnose herself? Hell, no. Does anyone with cancer check into the hospital to “fine-tune” her treatment? Well, in fact, maybe—if, for example, she were experiencing new symptoms that indicated a complication in her standard system of care. The physician might then use a physical exam and tests to retool the treatment accordingly.

And this is how some physicians are beginning to imagine addiction treatment: an ongoing collaboration between patient and doctor to carefully oversee lifelong recovery.

“I imagine people in recovery regularly seeing an addiction medicine physician,” Kevin McCauleyM.D., medical director of New Roads Treatment Center in Sandy, Utah, tells me. With his background as a Marine pilot and flight surgeon, and with eight years in recovery from painkiller addiction, McCauley talks about taking newly sober people through a system of recovery, in the way soldiers returning from war with injuries are led through recovery practices.

“The team assesses the condition, assigns names to the injuries, and takes the individual stepwise through exercises and therapies to get them where they can, for example, grasp a cup, and then walk again,” he says. “We would regularly see an addiction medicine physician. As I pass through my recovery through the rest of my life, I need to be in that collaborative relationship with a professional.”

But such a collaboration requires standards of care, which are sorely inconsistent—or even nonexistent—in addiction treatment.

Robin_Williams_fork

What is the Standard of Care for Addiction Treatment?

“I don’t think there is a standard of care—I think that’s evolving,” says Michael V. GenoveseM.D.J.D., the incoming medical director of Sierra Tucson in Tucson, Arizona. “It’s just becoming apparent to people that addiction is a disease. So that’s the first step, and now there will be a medical model that surrounds it.”

I don’t think there is a standard of care—I think that’s evolving…It’s just becoming apparent to people that addiction is a disease. So that’s the first step, and now there will be a medical model that surrounds it.—MICHAEL V. GENOVESE, M.D., incoming director of Sierra Tucson treatment center

Many people, especially some in 12-step abstinence-based recovery—which emphasizes humility—think that celebrities shouldn’t be given any more attention than any other recovering person, and there’s some truth to this. But when Philip Seymour Hoffman died, I wept. He was just a couple years younger than me, and what further choked me and so many others was the abbreviation of his artistic contribution.

McCauley blames the lack of a standard of care for such deaths. “It’s a terrible idea to leave detox and go home,” he says of Hoffman’s situation. Hoffman had relapsed after 23 years of abstinent recovery; he had apparently gone into rehab, been given Suboxone and gone home.

“If the standard of care had been [to give him] naltrexone for at least a year, and in that time get [his] rather considerable and proven recovery skills back up to snuff, that man would have lived,” McCauley says. Both Genovese and Harry HaroutunianM.D., medical director of the Betty Ford Center in Rancho Mirage, California, agree. Betty Ford is now a part of the Minnesota-based network of Hazelden, through which Williams sought to “fine-tune” his recovery.

Opinions differ on the kind of practitioner that might best oversee the process of recovery. “An addiction medicine physician also needs to be thought of as an addiction recovery physician,” says Haroutunian, who is himself a recovering alcoholic. “Certainly addiction physicians who are themselves in recovery and have good recovery may be best suited to help observe and guide someone who’s on that path from the dangers—everything from identifying other addictions such as workaholism, to relationship problems such as codependency, to excessive exercise or eating habits and nutritional deficiencies.”

“I understand [Haroutunian’s] point,” says Genovese, a board-certified addiction psychiatrist who is not in recovery, “but I think some of the best oncologists may never have had cancer. The best cardiologists don’t necessarily have cardiovascular disease.” He doesn’t think that the practitioner overseeing care needs to be a psychiatrist: “It could be an internist, an addictionologist, any practitioner with additional training in addiction.”

Many are saying that it was depression that killed Williams. People said the same thing about the author David Foster Wallace, who hanged himself at 48 after a lifetime of struggling with both addiction and mental illness. But you only have to look at the clips of Williams’ performances on YouTube to know that he had been a hard-core alcoholic and addict and that he negotiated sobriety on a daily basis. (Likewise, you only have to read Wallace’s writings—Infinite Jest, for example, or his essay, “This Is Water”—to find his struggle with addiction and his understanding of recovery.)

Robin-Williams-robin-williams-23183287-1600-1200

Williams’ cocaine clip has 2.5 million views, and his bit about alcohol and weed has almost 6 million. Some of my favorite bits—inexplicably, because I never copped on the street—are of Williams “doing” drug dealers. In a Thanksgiving appearance on Craig Ferguson’s show he does a “turkey-dealer” selling tryptophan; he and Ferguson (another recovering alcoholic) riff about knocking back heroin and Jack Daniels to get through the holidays and take turns making each other laugh their asses off.

Williams had been sober 20-odd years before he started drinking again in 2006. Nobody seems to know whether he carried on and that’s what necessitated the “fine-tuning” trip to Hazelden, or whether he’d climbed back on the wagon. But whatever happened, addiction was a major part of the mix, and like most of us in recovery who wake up and want to either bang our favorite drug or suck on our exhaust pipes, he wasn’t getting enough help.

Eventually, that help might look like the kind of support patients get when they have cancer, diabetes, cardiovascular disease, even near-sightedness—any chronic health problem that requires regular follow-up visits with medical specialists who operate according to scientifically backed protocols, measurable outcomes and standards of care. According to McCauley, “That’s what recovery oversight ought to look like.”

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Robin Williams, Alone.

Robin Williams

This morning I read a transcript of the coroner’s press conference about the scene of Robin Williams’s suicide. (I came across it on Facebook, where it was posted by Salon’s social media person with the strange warning, “Proceed with caution.” Badly done, Salon. Linking to a gruesome description of someone’s hanging body with a note that sounds flippant is at the very least mean.)

I read the transcript three times. I read it the second time because, the first time around, I couldn’t understand how his body was positioned. I still can’t. Frankly the first thing I thought of was that scene in season 2 of “The Wire” when D’Angelo is strangled to death by Stringer’s guy, but Dee’s body is left to look as if he’d hanged himself by a belt suspended from a door. It doesn’t work: there’s not enough gravitation to cut off the airway.

But I read the transcript a third time because I couldn’t understand how Williams could have been left alone for so long. In other words, how he could have been found so many hours after he had died.

He was living in a house in Tiburon, on San Francisco Bay, with his wife of three years. The report said she’d last seen her husband at 10:30 p.m. Sunday night, when she went to bed. Or, as the report said,

when she retired for the evening in a room of the home. 

By herself, is the tacit qualification here. I mean, if she’d been sleeping in the same room, to say nothing of the same bed, as her husband, it would have been more likely that she’d have noticed him getting out of bed in the middle of the night and scurrying off down the hall to loop a belt around his neck, shove the other end between the door and the jamb, and somehow—I don’t understand how, probably because I don’t really want to understand—suspend his body to hang himself.

So they were probably sleeping in separate rooms.

And here’s the thing. He wasn’t found by his wife. He was found by his personal assistant. The employee knocked on the door at 11:45 a.m., more than 12 hours after Williams’s wife had last seen her husband, and couldn’t raise his boss. So the assistant went into the room, the assistant found the body.

Robin Williams and Matt Damon

I’m thinking about this report in this way because I think a lot these days about the commonalities of people who are suffering for various reasons. If Williams died in this supremely lonely way, then you can bet there are hundreds, thousands of others who have died this way: sneaking off to loop belts around their necks, suck on exhaust pipes, take too many pills, shoot too much dope. Stick guns in their mouths. Jump off bridges.

I’m also thinking about the fact that Williams went back to drinking after having quit for more than 20 years. One of my friends, who has several more years sober than I do, wrote on Facebook yesterday afternoon:

It’s hard to describe the agoraphobic, upside-down sensation that strikes me when I read the words “falling off the wagon after 20 years of sobriety.”

That’s what the press kept saying about Williams: he’d fallen off the wagon after 20 years.

(They also kept saying he went into rehab last year to “fine-tune” his sobriety. Which doesn’t mean a damn thing. The fact that this statement by his publicist was accepted without question is proof of the huge gray area in which addiction treatment is allowed to operate.)

But most of all I’m thinking that stories like this one—which are emblematic of the untold stories of ordinary people who die similar deaths, who wade through similar struggles to stay sober, do their work, love their kids, pay their bills, survive divorces, and just be human—make me grateful for a quiet, ordinary life. Famous people can’t go anywhere without people recognizing them and wanting a piece of them. While this may not generally be something to pity them for, it puts real restrictions on recovery practices. Eminem, for example, doesn’t go to meetings, because when he does, people want shit from him all the time. This is true of most famous people. When Williams went to rehab last year he clearly couldn’t even buy an ice cream cone without the dipper asking him to pose for a picture and without some fucking journalist (we pain in the ass journalists, oh man) writing a bit about it.

Robin Williams Dairy Queen Minnesota

When I was using I used to think that no amount of fame or money would be enough to make me safe and prove I was worth the space that my feet take up on the planet. I used to lie in bed, eyes riveted open by hunger and whacked out diurnal cycles and fear, wondering what was the amount that would make me safe—$1 million? $5 million?

Any amount is too much, and no amount is enough.

Of course on the other side of this statement is the quiet little whispering voice that Williams himself called “the lower power,” the voice that whispers You can have just one little bottle of Jack Daniels or You can steal those Vicodin and be OK. Or: $5 million, I think about $5 million would do it. Which is exactly the reason I go to meetings, because none of those options are possible. Even if I had $5 million, which I don’t, $5 million would be way too much and not nearly enough to solve the problem of the kind of sickness Williams had. That I have.

Williams (Winehouse, Houston, Ledger, Jackson, Hoffman) had big houses, cars, fans, millions of Twitter followers, check-mark-verified social media accounts. They had personal assistants or private physicians or physical trainers who shot them up with drugs (in Jackson’s case) and knocked on their doors in the morning, couldn’t rouse them, called the cops (or strangely enough, in Ledger’s case, called either Mary Kate or Ashley Olsen—I can’t remember which. As if it matters).

They had all that stuff. But they didn’t have the component of life that, in Stephen King’s words, “stills the demons.”

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Sober life: Contentment and Comedy

On random play on the iPod this morning:

“Penny Lane” by the Beatles (1967)

I have a good friend who says that in early sobriety she asked herself every morning, “God, what would you have me be today?”

What came to me this morning when I asked this: What if God just wants me to be happy today?

I was cleaning the bathroom when this came to me.

Thich Nhat Hanh says cleaning bathrooms can be a meditation. Actually what he says is that anything can be a meditation if you do it with full attention. “Breathing in, I know I am cleaning the toilet…”

Usually, I hate cleaning the toilet. It was one of my jobs as a kid: cleaning our one bathroom that five people used. But this morning “Penny Lane” was playing and I was noticing how beautiful the master bath was looking as I was cleaning it. Today I don’t only have one bathroom; I get to have more than one. I get to have a master bath. I get to clean it. Breathing out, I can see the bathroom is becoming shiny…

Also I was noticing that, because I’d gotten up at 8 o’clock to clean, other people in my house had followed… People were stripping beds, gathering laundry, tidying up, taking care.

In AlAnon there’s a saying: “Let it begin with me.” I’ve never thought of myself as a leader. I was trained to follow. But one of the promises of AlAnon is that “the family situation is bound to improve as we apply the AlAnon ideas.” This also works in AA. It works in Zen. It works in athletics—Tae Kwon Do, Tai Chi, yoga, tennis. People are attracted to improvement, progress. Happiness.

Contentment, my AlAnon sponsor calls it.

When I’m happy, people around me are usually happier. I give it away, and I get some back.

Lately it’s hard for me to be content. It’s not only when things go wrong that I screw up… it’s also (maybe even more) when things are good that I tend to screw up.

I’m used to creating drama so I can solve problems and feel good about myself. Contentment feels dangerous, static, boring, and boredom sometimes leads me back to bad habits. I get squirrelly, panicky. Taking contrary action helps…

This morning I had to play two hours of tennis to get out of my head.

Another way I create drama: I worry about my kid. My friend Mary suggested I take an inventory of all the good things I’ve done in my mothering. Also, to watch some comedy. So here’s some comedy: Robin Williams on parenting.

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