It took 15 entries into rehab before the late actor Matthew Perry found long-term sobriety, he wrote in his memoir, Friends, Lovers and the Big Terrible Thing. And after his death, loved ones and fans alike are honoring his commitment to recovery.
"I've had a lot of ups and downs in my life and a lot of wonderful accolades," Perry told The Hollywood Reporter in 2015. "But the best thing about me is that if an alcoholic comes up to me and says, ‘Will you help me stop drinking?' I will say, ‘Yes. I know how to do that.'"
Having spent years advocating for people with substance use disorder, why did it take so long for him — and so many others in the public eye — to reach a point of sustained sobriety?
While admitting there is a problem and getting into treatment such as a rehabilitation center is an important first step, it isn't the end of the journey as movies and TV shows often portray, said Dr. Danielle Dick, director of the Rutgers Addiction Research Centre in Piscataway, New Jersey.
In fact, much of what the general public thinks about addiction doesn't fully capture the difficulty and complexity of the experience, said psychologist Dr. John F. Kelly, Harvard Medical School professor of psychiatry and director of the Massachusetts General Hospital Recovery Research Institute.
"Nobody ever plans on becoming addicted," he said. "Yes, people make a decision to use alcohol and use other drugs. But no one ever says, ‘I want to be addicted to a drug.'"
More than 140,000 people die from excessive alcohol use in the United States each year, and another more than 106,000 die from drug overdoses, according to the US Centres for Disease Control and Prevention.
To understand why the problem is so widespread, people must recognize the complexities around not just getting sober — but staying sober, Kelly said.
Addiction is both biological and social
First, it is important to know where addiction originates.
It is not a choice someone made. Addiction is "a biomedical condition, and it is a condition that you need sustained treatment for," Dick said.
Many factors contribute to the development of the chronic disease, Kelly said.
"Some people right out of the gate have a genetic predisposition, where their family has history of an alcohol or other drug addiction," he said.
Those predispositions can combine with a history of trauma or developmental experiences to make someone much more likely to develop an addiction, Kelly added.
When thinking about addiction, people need to remember that because of genetic factors and how different bodies react, the feeling of craving a drink may be entirely different for someone with substance use disorder than it is for you, Dick said.
Sobriety is a long-term practice
"The thing that everyone in the public still seems to think about is getting into rehab or getting their loved one into rehab," Dick said. "That is just like one teeny, teeny piece of the addiction treatment landscape."
Entering treatment is not a cure for addiction, and it is certainly not a guarantee, Kelly added. About 25% to 40% of people with substance use disorders don't maintain sobriety long term and go into remission — which is defined as a year or more of sustained abstinence from use, Kelly said. Those who sought some form of treatment were more likely to have success in recovery, according to a July 2020 study authored by researchers at the CDC and the National Institute on Drug Abuse.
"It takes a continuous vigilance and effort to be able to maintain the gains made," Kelly said.
"It's a bit analogous to kind of like physical fitness," he added. "You can't go to the gym for a year and then stop going and expect to be fit in the next year."
Like other physical illnesses, even when there are great improvements, it is crucial to maintain health to reduce the risk of recurrence, Kelly said.
Part of that path to health is finding ways other than substance use to respond to other mental health concerns, Dick said.
For some people, mental illnesses such as depression or anxiety occur alongside but independent of their addiction, Kelly said. And for some, their addictions help to alleviate those concerns.
"Some of us have brains that are just more wired toward anxiety or toward more hopelessness and kind of depressive aspects," Dick said. "You can imagine that substances that are anxiolytic — that relieve some of those anxiety feelings that make you feel more normal, less worried — that's really powerful."
That means it is often important to have a plan in place for continued mental health care or therapy for that anxiety or depression when leaving treatment for addiction, so that those feelings don't pose such a threat to sobriety, Dick said.
If they've put down the drink, why pick it back up?
On average, it can take a person eight years of trying to get sober before they reach their first year without their drug of choice, Kelly said.
That process of recovery and relapse is not a sign of failure — it's part of the process, Dick said.
"It does not mean that this individual is never going to be able to achieve recovery," Dick said. "Think of it as a key part of the learning process. ‘OK, so what happened, and how do we do better?'"
Sometimes, the relapse can indicate a need for changes in socialization, environment or stress levels to reduce the urge to use, Dick said.
For others living with addiction, it's a process of working on the biological side, she said.
"The devious nature of drugs means that when an individual has been using heavily, it also changes their brain and that makes it harder to maintain recovery," Dick said. "It creates these cravings because you've literally changed the receptors in your brain, your brain wiring."
The natural rewards we get in life, such as affection from a loved one or an accomplishment at work, are no longer as powerful or reliable compared with the reward our brains feel with drugs or alcohol, she added.
"It takes a while to kind of retrain the brain," Dick said.
Don't give up hope for you or your loved one
"Despite common views that (alcohol use disorder) is an inevitably worsening disorder, most people with AUD can and do recover, and their individual paths to recovery vary widely," said Dr. Nancy Diazgranados, deputy clinical director of the National Institute on Alcohol Abuse and Alcoholism.
There may be a lot of things working against sobriety, but the prognosis is generally good, Kelly said.
A majority of people living with addiction will reach remission — somewhere between 60% and 75%, he added.
"It can take many years, and a lot of bumps in the road of recovery, to be able to achieve that," Kelly said.
And although relapses and restarts may be discouraging, they are often still a sign of progress, he added. Often the periods of sobriety between relapses get longer.
First an addict may get three months of sobriety and then relapse, but the next period without using may then be six months, Kelly said.
"Drinking patterns in the first year of recovery often include one to several short periods or a few longer periods of heavy drinking," Diazgranados said. "With time, drinking episodes tend to become less frequent."
It is important to remember that there are good treatment centers — inpatient and outpatient — and long-term support programs to help people get sober, he said.
"We should not give up, and I don't think Matt would want people to give up hope," Kelly said.
- CNN
