Addiction
HBO Home Video
90 minutes $24.98

Addiction: Why Can't They Just Stop?
By Susan Cheever, John Hoffman, Susan Froemke, and Sheila Nevins
256 pp $25.95 Hardcover

"This is your brain," the announcer intones. "This is drugs. This is your brain on drugs. Any questions?"

Who can forget the sizzling egg in the frying pan -- ostensibly the brain on drugs -- a campaign as memorable in the War on Drugs as Nancy Reagan's reminder to "Just say no"?

Whether either succeeded is unknown, but both efforts no doubt came from the same deep concern that prompted HBO's multimedia extravaganza Addiction.

With the help of numerous documentary directors and highly credentialed addiction experts, the cable network last spring aired its 14-part series, now available in DVDs with an accompanying book Addiction: Why Can't They Just Stop? While HBO has brought us such gritty fictional masterpieces as The Sopranos, Six Feet Under, and The Wire, its series on drug and alcohol abuse refrains from whacking us with a dark, harrowing vision of life on the streets and in crack houses.

In fact, it is powerful because it mostly steers clear of such sadly all too predictable images, focusing instead on a message articulately and relentlessly delivered: Addiction is not a character flaw. It is an organic condition that plays havoc with your frontal lobes, where damage can be readily seen in the frightening red blotches that show up in advanced electronic imaging. In some cases, new medications make the disease treatable. In other cases, science is still feeling its way. That is your brain on drugs.

For families trying to deal with the addiction of a loved one, this is a hopeful and helpful body of work. Many will meet people they know all too well.

There is Colorado teenager Ted -- a struggling kid in recovery who blames a profound sense of boredom for years of self-destructive behavior.

"I'd get up some mornings and say, 'Man, today's gonna suck,' and so I'd put a little vodka in my coffee just to get a buzz goin' and then I'd go and smoke my joint," Ted relates in a weary monotone. "Some days, if I had some prescription pills left over from the weekend, I'd pop a couple of those."

There's Donna, the end-of-her-rope Pittsburgh mom who had her 23-year-old crack-addicted daughter arrested. On their way back home from jail, Donna vows to run her house like a rehab center, shakily asking daughter Aubrey, stretched out in the back seat, whether a "contract" enforcing good behavior would help. Aubrey, once a gifted student who had been captain of her cheerleading squad, really couldn't say.

There are heroin addicts who promise to do better, tearful kids graduating from a treatment program, a judge doling out tough love to meth users in a South Boston drug court, a well-put-together middle-aged woman who tells an interviewer she had been sober for 17½ years.

"Some personal things happened in my life," she admits, "and I've been drunk ever since."

Against this familiar backdrop, there are plenty of surprises. In segments that can be repetitive -- is it OK to dose up on caffeine before watching the series? -- researchers blast the myths that have been conjured to avoid dealing with addicts and their problems. One of the most damaging, according to Dr. Kathleen Brady, president of the American Academy of Addiction Psychiatry, is "the whole idea that an individual needs to reach rock bottom."

Wherever that is, the way toward it can be lethal. And, the experts say, something still left to live for -- a spouse, family, a career -- is almost always a more powerful motivator than grief over things that are already lost.

Time and again, the series and the book cast addiction largely as bad chemistry -- a welcome surprise for millions of parents wondering what they did or didn't do to produce children whose ambition extends only to their next high.

Most people figure that alcoholism "running in the family" can play a role in their children's drinking habits. However, most don't know just how big a factor that can be. According to one eye-popping study cited in the book, children of alcoholics who are adopted at an early age into nonalcoholic homes still risk addiction at a rate three to four times higher than everyone else.

PET scans and other electronic imaging techniques have given scientists a fascinating ringside seat at the battle between addiction and sobriety that takes place inside users' brains.

In one segment of the Addiction series, a soft-spoken recovering cocaine addict named William is flashed images of coke spoons, needles, and his old neighborhood that last no longer than a half second as his brain is being scanned.

"His hippocampus and amygdala light up like a Christmas tree," the book recounts, "in spite of his sobriety and what his conscious mind knows about that 'old' life, where it led and what it cost him." When he was shown pictures of sunsets and laughing children, there wasn't much reaction.

The bad news is that William's response reflects a typical, drug-induced brain rewiring that makes repeated relapsing a normal -- if tragic -- pattern on the road to recovery.

The good news is that increasingly precise knowledge of brain chemistry has triggered the development of medications that can be valuable aids, in tandem with 12-step programs and psychotherapy, to addicts trying to quit.

Of course, paying for all that, not to mention costly stays in rehab facilities, is another matter.

One of the series' most compelling segments is about Local 638 of the Steamfitters Union coming to grips with insurance limits on its members' addiction and alcoholism treatments. New York tough guys who downed booze on the job like it was soda, the steamfitters booted their insurance carrier in 1986, self-insured, and provided members with a generous treatment plan that has become a national model.

In the segment, a member calling for help and a union official who has battled alcoholism himself waste no words about going to a detox facility.

"How quick can I get in?" the member asks.

"Can you be ready at 10?" the official replies.

For most families trying to find help, it's not that easy. As they try to cope with the crisis of a lifetime, they can be hurt even further by their insurance companies' refusal to pay for more than nominal treatment. In Addiction, a mother named Roberta Lujak tells a Pennsylvania legislative committee that her insurer forced her to pull her daughter Ashley out of a 28-day rehab after just a week.

It wasn't Ashley's first rehab, but it would be her last. Back home that night, she overdosed.

"I tried to do CPR on my daughter," Roberta Lujak tells the committee. "But she was already dead."

If policy makers were to view addiction as the disease that scientists say it is, treatment would be more accessible, the makers of the HBO series say. They point to an effort by congressmen Jim Ramstad and Patrick Kennedy -- who both acknowledge their own addiction struggles -- requiring insurers to cover addiction as they would any other major illness.

"A lot of plans cover seven days of detox," says Minnesota's Ramstad. "Well, the medical experts know that effective treatment requires months of care. Would you tell a cancer patient, 'We'll pay for seven days of treatment and then you're on your own?' "

Their bill, which includes coverage of mental illnesses, has jumped a committee hurdle but has yet to be considered by the full House of Representatives. To similar legislation in the past, congressional leaders have just said no. This time, let's hope that wiser minds prevail.

-- Steve Chawkins is a regular contributor to Consumer Health Interactive and a staff writer who reports on regional and statewide issues in California for the Los Angeles Times.

First published December 3, 2007
Copyright © 2007 Consumer Health Interactive

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