Analyzing Philip Seymour Hoffman's Heroin Addiction

An expert's take on why Hoffman may have struggled with heroin addiction.

Phillip Seymour Hoffman at an NBA basketball game.

Actor Philip Seymour Hoffman, who was found dead Sunday with a syringe in his arm, watching an NBA game at Madison Square Garden in December 2013.

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Oscar-winning actor Philip Seymour Hoffman was found dead in his Manhattan apartment Sunday of an apparent drug overdose, according to law enforcement sources. He was 46.

Police found Hoffman, who won an Academy Award for his role in the film "Capote," unresponsive, with a syringe in his arm and surrounded by glassine-type bags containing what was suspected to be heroin.

“I’m rattled by this,” says Paul Hokemeyer, a New York-based senior clinical adviser for the Caron Ocean Drive addiction treatment center in Florida. “It’s another tragic example of the perils of living at the intersection of material success, celebrity and addiction.”

Hoffman had spoken candidly about his struggles with drug addiction in the past, and after 23 years of sobriety, he admitted last year to falling off the wagon – and completing a 10-day substance abuse program for heroin.

In an interview with U.S. News, Hokemeyer explained the intricacies of heroin addiction and why Hoffman may have struggled to emerge from its clutches. His responses have been edited.

What’s your initial reaction to this news?

We can talk about him in terms of being a celebrity, but he was really an actor. He was extraordinarily devoted to his craft and really didn't play in the celebrity circles. There was an element of real authenticity to him. He had a long-term relationship and three children, and he got clean very early in life. The trajectory of his life was stable and steady, and there was this progression that – from all outside appearances – seemed like it was progressing upward. 

When a middle-aged man dies so tragically, you kind of have to reflect on, developmentally, how was he struggling? What were his struggles? Typically, people who have an emotional crisis in their development feel stagnant – they don’t feel like they’re moving forward with this life. His career seemed like it was progressing beautifully, but internally, he clearly was struggling. And so we need to get to the heart of that, and peel back the veneer and the cultural and social expectations of what we think it is to be a materially successful person in this world.

[Read: A Mother's Perspective on Her Son's Addiction.]

What makes heroin so lethal and addictive?

It’s really the nature of the drug. It’s incredibly intoxicating and addictive because it releases all pain and puts the person in a euphoric state. It’s like they’re cold and lonely, and they get wrapped up by a beautiful, warm cashmere blanket. It’s one of the most powerful, seductive, addictive drugs out there. And once that registers in the brain, it really heightens their baseline of happiness, satisfaction, euphoria and well-being. It gets amplified to an artificial level – so all experiences after that become subpar and seem inadequate and inefficient. 

Recent news reports suggest heroin is becoming more available, cheaper and perhaps more poisonous. 

People have better access to the drug, and they have the money to buy it, because it’s becoming less expensive. I’ve treated a number of heroin addicts, including people you would not think would be addicted to heroin. We typically think of people down in needle parks. But it’s become the drug of choice for highly successful, creative, sensitive people. In my experience, the people who suffer from this addiction have a heightened sensibility to the world, and they feel everything much more intensely than other people.

[Read: One Man's Story: How I Beat Addiction.]

Hoffman was 46 – perhaps older than the typical age that comes to mind when we think about addiction.

We have to look at his age group, and we have to look again at his level of success. Externally, he had an enormous amount of success – and with that very often comes a price. When a person is in their middle age, the fantasy of being successful is typically better than the reality. There’s a profound sense of disappointment in achieving a level of success – that, “is that all there is?” phenomenon. And if you’re successful in a creative space, there’s incredible pressure to maintain that, to maintain your level of creativity and genius. This pressure and disappointment that comes with obtaining success in middle age often leave people in what can only be described as an existential crisis. Is that all there is?

For somebody who has a history of addiction, and a profound addiction like heroin addiction, that pain becomes so great that they feel the need to re-engage with their drug of choice. When you look at the younger population, their prefrontal cortex isn’t fully developed, so they can’t make the decisions. They’re acting all on impulse. Somebody in middle age has a very developed prefrontal cortex, and either consciously or unconsciously, the emotional despair becomes so great that they say screw it. They make an intellectual decision to go back to their drug of choice.

[Read: Cory Monteith's Death Highlights Addiction 'Crisis.']

Last year, Hoffman completed a 10-day stint in rehab for his heroin addiction. Might that have been too short?

This is another example of how celebrity and material success can work against a person. A longer-term stay is definitely preferred, especially for heroin addiction. And I suspect that because of his position, because of his power in the world, he was able to drive his treatment and make the decisions – and not surrender to his disease and to the care of the professionals who should have been compulsively taking care of him. They should have been able to manage that power dynamic and his position, and not play into the manipulation that comes from being a person of power, fame and success in our world.

The typical recovery process includes a detox, substitution maintenance with methadone, and then absence-oriented treatment. The goal is for a person to obtain abstinence. But for someone who occupies a position of celebrity and success in the world, it’s very difficult to find the proper support they need to maintain that – because it occurs in a community setting. And it’s hard for celebrities to find those communities, because the world wants to view them as the famous actor, as opposed to the suffering human being.

[Read: Justin Bieber's Arrest: Addicted to Wealth and Power?]

What lessons should we take from this tragedy?

Addiction and recovery are a lifelong process. Just because you’re in possession of the material trappings of success doesn’t mean that, emotionally or physically, you have achieved piece of mind, serenity and stability in your life. 

Everyone is human and everyone suffers, and we need to be doing a better job of supporting everyone – regardless of their position in the world – in getting the compassionate and clinically-component care they need. This is a huge loss. Hopefully we can do a better job of increasing awareness and getting celebrities proper care.