"Glee" star Cory Monteith was found dead in his Vancouver hotel room Saturday – leaving Hollywood stars and TV fans reeling. He was 31.
Although officials had not confirmed his cause of death as of Monday afternoon, police said there was no indication of foul play. Autopsy results are expected this week.
Monteith, who played football star Finn Hudson on the popular Fox show, had been open about his struggle with drugs and alcohol. In March, he voluntarily checked into a rehabilitation facility for substance addiction; he first went to rehab after his family staged an intervention when he was 19. "I was out of control," Monteith said in a 2011 interview with Parade magazine. "[I used] anything and everything, as much as possible. I had a serious problem."
U.S. News spoke with Paul Hokemeyer, a New York-based senior clinical adviser for the Caron Ocean Drive treatment center in Florida, about addiction in young adults. His responses have been edited.
Addiction in young adults is clearly a significant problem. But how big is it, exactly?
Well, I think we're having a crisis in terms of young adults and drug abuse. The problem seems to be getting worse rather than better. There's this social and cultural acceptance of drug abuse, and we really accept it as a problem that just exists – there's almost a celebration and glamorization of it. When a celebrity dies of an overdose, we tend to glamorize it – think Marilyn Monroe and Heath Ledger. We don't see it as what it is, which is a chronic problem with a solution.
It's important for us to remember that for every addict, there is an entire family that suffers. We often forget about the entire family system that person operates in, along with their friends and loved ones. I think addiction is one of the largest problems we're struggling with as a society and culture, particularly among certain demographics, and young adults and successful people are one. We tend to think of addiction as an issue that affects lower socioeconomic groups, but people who are successful – who are wealthy and powerful and hold the keys to the kingdom – we tend to forget that there's a huge problem of addiction in that population. And it's more hidden, it's more difficult to get at and it's not treated properly, quite frankly.
What do people need to understand about addiction?
Addiction is what we call a biological, psychological and social disease. Biologically, the body reacts differently to substances that are put in it – be it alcohol or milk. The brain of an addict is set up so that when they put the intoxicating substance in it, it pushes on the gas pedal. For a person who doesn't suffer from the disease, it will push on the brakes. Think about people you know who have a glass of wine and say, "Oh, I need to stop." This notion of stopping just doesn't occur in the brain of an addict.
And psychologically, we know that there tends to be a history of trauma. People who suffer from addiction have much higher rates of trauma than the normal population; often, it's child abuse. And they also often suffer from co-occurring disorders, which are underlying emotional issues, and they're trying to self-medicate. Typically, these are depression or anxiety, but they could be a whole host of other mental illnesses, like bipolar disorder.
And then socially – let's say a teenage son suffers from addiction. His parents are profoundly impacted, and they're put in a dilemma in terms of how do they deal with it, how do they address it, and they suffer as well. The other children in the family suffer, the person's friends suffer; addiction takes a toll on everyone. That's why you cannot treat addiction in isolation. You have to bring in, for example, the entire family that has dealt with it.
How do high-functioning addicts remain successful as they're struggling?
Often, they go hand in glove. Addiction often starts as something that has served them well. It's what we call adaptive. Let's say a young Broadway star, for example, has stage anxiety, so she decides that if she has a drink before she goes on stage, it will quell her anxiety and enable her to perform. So what happens is that then her brain says, "Oh, anxiety. Alcohol." It establishes that connection. And then that person feels like they need this alcohol to perform. There are two elements to addiction, and the first is tolerance; at first she needed one drink, but now she needs three. And then withdrawal. When she doesn't have it, she's constantly thinking about it.
I work with high-functioning men and women, and I tend to find that they engage in binge drinking. Let's use, for example, a lawyer who's able to put a box around the alcohol or drug use from Monday to Friday. But come Friday afternoon, the obsession kicks in, the thought kicks in and they're off to the races. And they cram a week's worth of drinking into a weekend. So they're able to contain that drinking during the week, but then the pressure to use just builds up and they completely overuse.
What do we need to know about male addicts in particular?
Males are much less willing to ask for help. They'll struggle with their addiction in secrecy and isolation for much longer than women, who are more relationship-oriented. There's a real sense of pride and ego that goes along with it. They think they can handle it, that they're not out of control, that they're masters of their destiny.
And then there are also three big defenses: denial, rationalization and minimization. Men will deny they have a problem, or they'll minimize it – "Yeah, I got drunk last weekend. It's no big deal." Or they'll rationalize it: "I have a really stressful job, and I make a lot of money, so I deserve to drink. Leave me alone." It's much harder to get to them and to really show them the insidious and destructive nature of their disease.
So how do we get through to men?
The important thing is to use "I" terms instead of "you" terms. Say, "I feel really unsafe and insecure when alcohol gets introduced to this relationship," so you're doing it in a way that's really nonthreatening. Because if you point your finger and say, "When you drink, you turn into a jerk," you're not going to get very far with that conversation. The other thing that's critically important is to have gender-specific interventions. Have a man speak with a man; have a woman speak with a woman.
Not every addict is able to overcome the disease. Why doesn't rehab work for everyone?
Because, first of all, their pride and ego get in the way. They think they have all the answers, and that they don't need to listen to what they were told in rehab – and by the way, what they paid a significant sum of money for. They basically say, "I have this under control, I don't need to comply with the terms of my aftercare program," and their life intervenes. They put their career before their sobriety, they put their relationship before their sobriety. And because the disease is so chronic and progressive, and so insidious, they need to be diligent about putting their recovery first. Because whatever they put in front of their recovery is going to be the second thing they lose – the first being their recovery. It's a lifelong process.
Is a monthlong rehab stay adequate?
People think 28 days is appropriate – that they can go in and get cleaned up and have all the solutions. But we find that the outcome rate improves exponentially with the longer stays. It takes the brain 90 days to rewire itself and learn a new habit or unlearn old behaviors. So 90 days is a really critical element here. And we really need to treat it in a systemic way – we need to address the family situation, the work environment and the underlying emotional life. We need to look at it in a contextual frame rather than just an isolated frame. Addiction is very complicated and complex, so we need complicated and complex solutions.