Actress Debra Winger: “Everyone is touched by addiction.”
Drug addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the addicted individual and to those around him or her. Although the initial decision to take drugs is voluntary for most people, the brain changes that occur over time challenge a person’s self control and ability to resist intense impulses urging them to take drugs.
Many people do not understand why or how other people become addicted to drugs. It can be wrongfully assumed that drug abusers lack moral principles or willpower, and that they could stop using drugs simply by choosing to change their behavior. In reality, drug addiction is a complex disease, and quitting takes more than good intentions. In fact, because drugs change the brain in ways that foster compulsive drug abuse, quitting is difficult, even for those who are ready to do so.
Recent scientific advances, including those supported by the National Institute on Drug Abuse (NIDA), have enlightened our view of drug abuse and addiction, which is now recognized as a chronic relapsing brain disease expressed in the form of compulsive behaviors. This understanding has improved our ability to both prevent and treat addiction.
“We now know that addiction is a disease that affects both brain and behavior,” says NIDA Director Nora D. Volkow, M.D. “We have identified many of the biological and environmental factors and are beginning to search for the genetic variations that contribute to the development and progression of the disease.”
With nearly one in 11 Americans over the age of 12 classified with substance abuse or dependence, addiction takes an emotional, psychological, and social toll on the country. The economic costs of substance abuse and addiction alone are estimated to exceed half a trillion dollars annually in the United States due to health care expenditures, lost productivity, and crime.
Scientific research has revolutionized our understanding of drug abuse and addiction
Long acknowledged as one of Hollywood’s finest actresses, three-time Academy Award nominee Debra Winger recently appeared at the National Institutes of Health in a dramatic reading of Act III of Long Day’s Journey into Night, Eugene O’Neill’s gripping 1941 play of family alcohol and drug addiction. It was part of the Addiction Performance Project, developed by the National Institute on Drug Abuse (NIDA) to help healthcare providers remove the stigma associated with addiction and promote a healthy dialogue that fosters compassion, cooperation, and understanding for patients living with the disease of addiction.
Why are you participating in the Addiction Performance Program?
Ms. Winger: I was in high school in the late ’60s and early ’70s. Everybody came in contact with somebody whose recreational use turned into something else. And we didn’t know what that was, really. But you knew that some people were different.
I never intended to be an actress. In fact, I was a sociology major and wanted to go into criminal rehabilitation counseling. And one of the most interesting questions of that for me was, “How did they get there?” I learned that 80 percent of the guys on death row were without their mother’s presence as kids. You start to understand how drugs and alcohol just … it’s almost like not even a question because it’s part of the picture.
Drug and alcohol use has become part of the fabric of American life. My connection is partly from my family experience and a little bit from the world at large. Everyone is touched by addiction in one way or another.
How do you mean?
Ms. Winger: Because we assume addiction is woven into our everyday tapestry, we address it as a medical problem. But it is more than that. I had a fellowship at Harvard with Dr. Robert Coles, a world-renowned child psychiatrist, who created a wonderful course called “The Literature of Social Reflection” for undergrads just going into pre-med and areas of psychiatric care. He gave them literature, most times written by doctors, for example, William Carlos Williams. The purpose was to absorb the emotion, of someone dying; for example, Ivan Ilyich, in Tolstoy’s famous The Death of Ivan Ilyich.
You mean using the power of drama to get the emotion?
Ms. Winger: Yes. Let’s talk about what’s going on around him and the family. Basically, this is what we’re trying to do here, bring humanism back into medicine.
Who is your audience?
Ms. Winger: The Addiction Performance Project is for healthcare professionals and scientists, who often are not given the training to help with the things that happen to a person after the medical problem is diagnosed.
What is the message to them?
Ms. Winger: My goddaughter suffered from cystic fibrosis, which is a chronic disease. She spent a lot of time at the hospital, and I spent a lot of time with her. And I watched residents, interns, and then doctors; they can’t take it in all the way because they would be trashed inside of five years. But when someone’s in your office, include yourself in the conversation. It’s going to help you bring yourself to the room.
The message is, listen carefully. There are two people in the room, you and the patient, so listen carefully. The healthcare professional must be ready for the full picture: what family life is like, the level of education, money issues; everything needs to be considered.
NIDA Raises the Curtain on Addiction
Why the “Addiction Performance Project”?
In 2010, 23.1 million people needed treatment for a drug or alcohol problem, and only 2.6 million, or 11.2 percent, received it, according to the National Institute on Drug Abuse (NIDA). Research suggests that primary care providers could significantly reduce drug use, before it escalates to abuse or addiction. However, many express concern that they do not have the experience or tools to identify drug use in their patients.
That is a primary reason that NIDA is working with actors and actresses to bring to physicians educational performances that help reduce the stigma associated with drug or alcohol addiction. (See accompanying Debra Winger interview.) The Addiction Performance Project includes a dramatic reading of Act III of Eugene O’Neill’s Long Day’s Journey into Night, which portrays a family’s struggle with addiction. The reading is followed by a dialogue among the participants, aimed at fostering compassion, cooperation, and understanding for patients living with this disease.
“Primary care providers can play such a vital role in screening for drug abuse,” says NIDA Director Nora D. Volkow, M.D. “Yet, for many providers, discussing drug abuse with their patients is beyond their comfort zone. In portraying a family devastated by this disease, the Addiction Performance Project humanizes addiction, which we hope will reduce the stigma around it and encourage physicians to confront potential drug abuse with their patients.”
Performances of the innovative project for physicians continue at selected locations through 2011 and into 2012.
For more information on the Addiction Performance Project,
or to register for a performance,
And what should patients hear?
Ms. Winger: Get ready. Be ready for your appointment. The patient has the responsibility to bring his or her one-in-the-morning fears to the 3 p.m. appointment. Often when we go to the doctor, we’ve had this and that happen. Our body doesn’t hurt so much, and maybe we have already taken an aspirin.
But don’t think that just because you feel okay right now you are. We have a tendency to discount what we were feeling as “just nerves”—and then ask for sleeping pills.
How do you feel about your role in the Addiction Performance Project?
Ms. Winger: It’s an ongoing process of staying awake in my chosen profession, staying awake as a human being. I’m a mother, and although my parents are gone and I’m no longer a daughter, I’m a member of a family in all its different aspects. So I’m just trying to stay busy and involved.