Baffling, cunning and confusing addictive thinking ruins lives.

Wednesday, March 21, 2012

Why Did Whitney Fail Rehab?

 This article is included along with Bishop's article because they demonstrate the burgeoning Rehab Industry and the complications and disagreements and contradictions you must navigate to find a useful method for getting sober and staying sober.

Why Did Whitney Fail Rehab? Too Much Talent. - Charles Duhigg
February 13, 2012

How the Science of A.A. Explains Whitney Houston’s Death

It’s easy to forget, given her scandal-tinged life and tragic death, how incredibly talented Whitney Houston was. She holds the world record as the most-awarded female act of all time, with over 415 major recognitions during her career. She is the only artist to chart seven consecutive number one songs.

And she was smart: every time she fell from grace – a disastrous marriage, admitting to drug use on national television, narrowly fleeing arrest when drugs were discovered in her luggage by jumping onto a departing plane – she rehabilitated her public image with an astoundingly savvy move: starring in a hit film, going on Oprah, becoming the unexpected (and sympathetic) star of a reality television show.

So why, given Houston’s obvious and prodigious talents, did she fail at rehab so many times? And why – as is now suspected – did she have such little control over a drug habit that it took her life?

Because she was too talented. Because 12-step programs are predicated upon learning to believe in a group – and someone as unique and famous as Houston will always be an individual first. What happens psychologically when you become a diva, it turns out, makes it almost impossible for rehab to succeed.

To understand why, consider the amateurish and completely unscientific origins of the first 12-step program, Alcoholics Anonymous.

A.A., in a sense, started in 1934 when an alcoholic named Bill Wilson checked into an upscale Manhattan detox center. It wasn’t his first visit. He’d been to other centers. He’s gotten into fights – including one at a country club that had cost him his job. He’d made promises to his wife and joined abstinence groups. None of it had worked.

Inside the Charles B. Towns Hospital for Drug and Alcohol Addictions, a physician started hourly infusions of a hallucinogenic drug called belladonna. Wilson floated in and out of consciousness. The withdrawal pains made it feel as if insects were crawling across his skin. “If there is a God, let Him show Himself!” Wilson yelled to his empty room. At that moment, he later wrote, a white light filled his room, the pain ceased, and he felt as if he were on a mountaintop. “And then it burst upon me that I was a free man,” he later wrote.

Wilson would never have another drink. For the next thirty-six years, he would devote himself to building Alcoholics Anonymous by essentially making up – out of thin air – the rules that today help an estimated 2.1 million people each year. (The program’s famous 12-steps, for instance, were written by Wilson in a rush one night while siting in bed. He chose the number 12 because there were 12 apostles.)

What’s interesting about AA is that the program doesn’t directly attack many of the psychiatric or biochemical issues that researchers say are often at the core of why alcoholics drink. In fact, AA’s methods seem to sidestep scientific and medical findings altogether. What AA provides instead is a method for attacking the habits that surround alcohol use. AA, in essence, is a giant machine for changing the habits in peoples’ lives.

For years, A.A. was seen among researchers as almost a cult, an unscientific backwater hardly worth mentioning, much less studying. But about a decade ago, attitudes began to change. Scientists noticed that over 10 million Americans had credited their recovery to A.A.. Something that helped so many people, academics figured, must be doing something right.

And so a series of studies began exploring precisely why A.A. was so successful. The first big lesson was that A.A. worked by slightly tweaking comfortable habits. A.A., for instance, provides people with the same cues and rewards they’ve always been accustomed to. All it does is change the routine. Many alcoholics, say studies, essentially suffer from habit dysfunctions. They have learned to react to a cue (“I’m stressed. I need to relax at a bar.”) with a routine (“Bud Light, please.”) to receive a reward (“I always feel better after unloading to my friends over a beer.”)

A.A. just tweaks that formula slightly. There is a still the same basic cue (“I’m stressed. I need to relax at a meeting.”) a slightly different routine (“My name is Jim, and I’m an alcoholic.”) and, essentially, the same reward (“I always feel better after unloading to my friends over coffee.”)

Anyone – including Whitey Houston – can take advantage of this basic therapy. (And, in fact, Ms. Houston did numerous times, to apparent – short-tem – success.)

But eventually, researchers started asking another question: if A.A.’s ability to change habits is so effective, than why does it eventually fail for so many people? In other words, why do some people fall off the wagon, while others keep their new sober habits for years?

Researchers began finding that habit replacement worked pretty well for many people until the stresses of life — such as finding out your mom has cancer, or your marriage is coming apart — got too high, at which point alcoholics often relapsed. One group of researchers at the Alcohol Research Group in California began conducting interviews, and found that the difference between people who stayed sober, and those who re-succumb to addition, was that the sober participants had learned how to believe in something. Practicing at belief inside A.A. meetings was a skill that eventually spilled over to other parts of their lives – until they started believing they could change.

“At some point, people in A.A. look around the room and think, if it worked for that guy, I guess it can work for me,” Lee Ann Kaskutas, a senior scientist at the Alcohol Research Group, told me. “There’s something really powerful about groups and shared experiences. People might be skeptical about their ability to change if they’re by themselves, but a group will convince them to suspend disbelief. A community creates belief.”

And this helps explain why programs like A.A. worked so well for Whitney Houston – as long as she was inside a rehab center – and why they fell apart when she got out. For one thing, according to reports, Ms. Houston often returned to the same environments and people who had previously triggered her abusive tendencies. But that shouldn’t make it impossible to stay sober. Most former addicts don’t have the money or ability to change their homes or find new friends or families once they kick their bad habits – and yet they stay away from beer or drugs nonetheless.

But what Ms. Houston couldn’t do – because her life catered to the belief that she was peerless, the star of the show, an incomparable diva – was find a group of peers whom she could compare herself to, and believe that if they can struggle and persevere, so can I. Her life was not constructed to subsume her ego into the communalism of a group. And so she never found a safe place to practice believing she could change. And so as soon as the pressures hit, all the new habits broke down, and the old patterns took over.

Which raises a tough question: how can people who are talented and successful in many realms find opportunities to attack their worst habits? How does someone running for President (or within the Oval Office) create a structure that allows them to change their worst habits? What powerful and talented people have you seen struggling with bad habits? How did they figure out how to change them?

Responses to “Why Did Whitney Fail Rehab? Too Much Talent.”

Beatrice says:

Ninety-six percent of AA members relapse.

The “higher power” that actually works for the 4% who remain sober and the members who return and recover after each relapse is not a deity; it is actually the power of the group, the friends and “family” who walk with you on the journey.

If I could share anything with new AA members, it would be these words of wisdom – the first step in AA should be changed to say that we are powerful enough to change our lives all by ourselves, but the journey will be better and far easier when we share it with others who understand our struggles and share our successes.

Good journey!

Tom says:

Nice and timely article. I respectfully disagree with the comments from Edward D however. There are many people who have successfully overcome addiction who have not humbled themselves through a connection to a higher power. If a higher power works for anyone, that is wonderful. However, there are many who have a realistic sense of their humanity and connectedness to others that a belief in a higher power is not an absolute requirement. I suggest that simply understanding the imperfection of humanity can be humbling enough.

Ed says:

The difficulty with the rejection of the “higher power” is that it leaves you with nothing but a rationalistic and relativist paradigm, which is highly mutable. The “higher power” provides a moral and constant framework within which to operate. There is no true humility without recognition of a “higher power.”

spiritedcrone says:

Fascinating read – thank you. The first time I’ve seen AA deconstructed in such a positive, helpful way. I don’t think what you’ve done detracts from the believing in side at all, instead makes it more believable!


Ieva says:

I don’t think that it’s about “inferiority”, it’s about differences in very basic things. The very things that make somebody “superior” in others’ eyes (the chance to live one’s dream; to realize one’s talents, to have lots and lots of money etc.) damages social relationships in major ways because it creates the feelings of guilt, of overbearing responsibility, even of inferiority (“if those people who have it so much worse than me can get by, then why can’t I?”). Irrational feelings, I guess, but also big stumbling blocks in forming a decent, equal group relationship.

L says:

Whitney made the connection of love with her addiction to drugs given to her by her husband, who was not for her but against her,therefor was competing against her success. It was not love but an obsession that self-destructed her. Bobby Brown was part of that obsession with drugs,and Whitney was unable to separate drugs from love in her very emotional state of intense talents.

dave says:

Interesting take, Mr. Duhigg. I believe there’s something to your argument, as we see time and time again celebrities unable to remain sober. Twelve-step programs work first and foremost because one can identify with others in the group. Without identification, or empathy, an individual simply will not change their behaviors sufficiently to effect a change. As you point out, people like Whitney Houston are surrounded by people and a life that screams “you are different.” Not impossible to overcome, but certainly not at all like most peoples’ obstacles. Still, everybody believes they are unique; it is, ironically, the one characteristic all people in twelve-step programs (and those “needing” twelve-step programs) share.

WhatThe says:

Whitney Houston was a drug addict, and required the help of others facing addiction problems.

Your slur on Bill W, and your moronic attempt to create content out of is shameful.

Why do you know so much about A.A?

Remember the door is open for you. Any addict, any addict with a desire to stop using may join – including Whitney.

OmahaAngel says: 
Whitney had enablers, instead of a continued support system…you are correct.

Noko says:

Oh, I just love comment #9 — a piece of defensive ranting from someone who can’t tell the difference between an analysis of why something works for some people and a debunking.

Sobriety is hardly served by the attitude of way too many twelve-steppers that THEIR way is the ONLY way and that Bill Wilson sat at the right hand of God. People who are not joiners (divas or otherwise), who have no inclination towards religion or mysticism, and who resist the reduction of life into aphoristic pablum, are simply given another hurdle to overcome when the medical, legal and social culture prescribes twelve-step for every destructive habit.

I am impressed by Mr. Duhigg’s deconstruction of the process, which makes it more accessible to people put off by tent-revival attitudes, and think he has done a service. I’m also pretty intrigued by the use of belladonna. Timothy Leary used LSD on recidivist convicts and substance abusers, contending, more or less, that LSD removed the usual “filters” from brain activity, which I guess would create a period of plasticity in which habits would lose their grip and experience could be embraced in a new way. According to Leary, he conversed with Bill Wilson about it and Wilson regarded LSD as a “natural and inevitable cure.” Things like this deserve more attention; instead, it’s illegal to even do the research.

S says:

A fascinating window into the human brain. There is no doubt that there are neurological reasons why 12-step programs work, but harder to “measure” are the spiritual reasons why 12-step programs work. Duhigg’s analysis focuses on the neurological only. But we are inherently spiritual beings having a physical experience in mortality. Nobody can fully assess why 12-step programs work by focusing solely on the neurological without the spiritual. Mind and spirit are intimately connected but uniquely different at the same time. Knowledge of how habits work and why we do them (trigger – routein – reward) is absolutely helpful and can be a key to changing behavior, but knowledge alone is insufficienct until one humbly admits in total honesty and then decides (i.e. chooses) to BELIEVE that they need help from someone else (such as a Higher Power and social support from other people who can emphathize and encourage in a spirit of love, acceptance and accountability), then relapse is inevitable. Knowledge is never sufficient enough enable lasting behavior change. Choice is a requirement. For those who are able to successfully live in sobriety and recovery, their choice is more spiritual (i.e. “humble and submissive sobriety) than mental (i.e. “white knuckling” sobriety). The 12 steps work when you work them. That’s all you need to know.

S says:

Typo correction… I meant to say, “…but knowledge alone is insufficienct and relapse is inevitable until one humbly admits in total honesty and then decides (i.e. chooses) to BELIEVE that they need help from someone else (such as a Higher Power and social support from other people who can emphathize and encourage in a spirit of love, acceptance and accountability).

Danielm says:

What makes a high achiever may be the bad habits of addiction to success or outcome, or addiction to self-belief. Ignorance and high tolerance to pain, isolation, anguish, loneliness and disbelievers. The highs of lows of blind devotion to the goal at the cost of many social conventions and relationships. So perhaps high achievers are immune to AA not because they have no peer group but because to undo their bad habits would be to completely undo their raison d’ĂȘtre, and leave them in the land of mediocrity just like everyone else. And that is worse than death. DM

Binne says:

Interesting article. But Whitney didn’t fail because she was talented. Plenty of supremely talented people get and stay sober. And plenty of supremely untalented ones fail as spectacularly as she did.

I fall somewhere north of the middle on the talent spectrum, and I celebrate this week 30 years of sobriety in AA. It’s rather mysterious to me, why and how this happened. Being a member of a group helps, but it’s not the only component of the process. The AA literature talks about isolated alcoholics getting sober by practicing the 12 steps.

I believe that the answer is in the notion of powerlessness, and in the second step: “We came to believe that a power greater than ourselves could restore us to sanity.” Sobriety is an inside job, but we need to look outside ourselves, to a trusted power source, for sustained healing. I took to this concept immediately, 30 years ago, since I had for many years before that given my life over to an inimical power greater than myself, i.e., alcohol. This power source (“higher power” has become such a clichĂ©!) can be the group, or God, or some vague notion of Better Angels or something else. The point is, it wasn’t *me*.

Alcoholics are notoriously stubborn, with a notoriously stubborn belief in their ability to sustain themselves. If, with a sigh of relief, we give up this flawed and refractory self-sufficiency, our chances of getting and staying sober go way up.

The sad quietus of a gifted person like Whitney lies not in her talent and skill, but in her failure — and the failure of those around her — to realize that despite her formidable success, she had made an incomparable bungle of it. She needed to find something or someone better and stronger and wiser than herself to lay down the law, or at least to make the law, and the way, clear to her.

It’s a profound paradox, the way to sobriety. The requirement that we do it alone has to coexist simultaneously with an acknowledgement and trust of and reliance on something outside ourselves.

Binne says:

PS: What is this interesting font used on this page? It looks like an ordinary sans serif, until you look at the lowercase “f” with its odd little descender.

Evelyn says:

I wondered about the font too – it’s attractive.

Also been in recovery a pretty long time – 25+ years, no relapses – it’s amazing to me at times. Program has been a big piece of it, but so has other community. Being part of something and allowing people to get to know me.

I also found that lifestyle changes were necessary – my eating, exercise habits and sleep patterns have changed. My social behavior is different. I currently work as a substance abuse counselor but even came to that through the “back door” by beginning to teach yoga (which I’d practiced since the beginning of my sobriety).

We all take a different path and I think that tolerance, willingness to change, vulnerability, humility, are all part of my ever evolving recovery process. Great discussion, thanks.

Lin Cochran says:

“It’s a profound paradox, the way to sobriety. The requirement that we do it alone has to coexist simultaneously with an acknowledgement and trust of and reliance on something outside ourselves.”

Acknowledge, trust and rely on … something bigger than our egos. Believing we are “peerless” is fatal.

Thor says:

Those who succeed within AA do so despite and not because of AA dogma (12 steps). One of few studies on the effectiveness of AA vs. going it alone show that there is no difference in how long people abstain, but a big difference in how much is consumed after starting to drink again, those from AA consume more and it takes them longer to get on the wagon again.


SWB says:

It is lonely at the top.

Mina says:

Does this mean that Eric Clapton has less talent?

Robert Krause says:

It’s a shame to lose such a talent, but I have to agree for any change to occur, a person first and foremost must “believe” there’s a better way to follow. In addition, no one truly understands all the wiring that goes into the human brain….why one person gets caught by their desires, the other one overcomes it. There’s no simple answer. But please understand that Whitney was raised in a church, sang in a church, and was surrounded by family members who shared her faith. Everyone should respect that; in spite of all the other influences in her life and the choices both good and bad that she made. I sympathize with those of celebrity status…so many others depend on their persona and perceptions that for some, separating fact from fiction is nearly impossible.

Jim Martin says:

The fact that AA was founded outside any scientific process is irrelevant to whether it “works” or not. The author simply states it to be successful, although there doesn’t seem to be any evidence for that other than many people make that claim. I suppose this is the kind of thing that everyone just knows, right? The weird thing is that the author contradicts the notion that AA really works (“why does it eventually fail for so many people?”), but apparently that information is only included in order to talk about how it is hard to change habits in the face of other stressors. So does AA work or not? The author seems to be saying that yes, it works, but just not in real-life situations for lots of people!

This is reminiscent of a Wired magazine article a while back about AA and how it works. Same basic premise: AA works for a small number of people who try it, but doggone it, what makes it work so well?