“Friends” star Matthew Perry startled many of his fans by announcing that he had been to drug rehab 15 times and spent some $9 million on getting into recovery. He also may have scared some people experiencing addiction. Is it always that hard to quit? Is it always that expensive? And if you’ve tried to beat an addiction 14 times, does a 15th try really make sense?
The answer to those questions is no, no and yes.
About 3 out of every 4 people who have a substance use problem will eventually recover. The percentage is lower for more severely addicted people and those who have more challenging life circumstances (such as social isolation and unemployment), but even then perhaps half will ultimately achieve recovery, typically benefiting not only their health but also their relationships with their family, friends and employer.
Perry isn’t alone in his experience of one step forward, two steps back to get there, which he chronicles in his memoir “Friends, Lovers, and the Big Terrible Thing,” out on Tuesday. Changing behavior is hard even when an addictive substance isn’t involved. Most people who diet put all the weight back on and most people who make New Year’s resolutions to exercise more or criticize their spouse less find that their motivation wanes before spring.
Giving up addictive drugs and alcohol is a particularly challenging behavior change to attempt. Addictive substances are highly rewarding in the short term even as they do great damage in the long term. The temptation to return to use after a period of abstinence is great. A joke usually attributed to Mark Twain runs “I know it’s easy to quit smoking because I’ve done it a thousand times.” A study of over 1,000 Canadian smokers revealed the reality behind the quip: Many successful quitters had failed 30 times before.
Repeated addictive substance use alters brain circuitry, which influences what people find rewarding, what motivates them and how well they can control urges. At the same time, the world is saturated with cues that can trigger desires to return to substance use, such as advertisements for alcohol, cannabis and tobacco products. Friends and family who use may also undermine recovery by offering to share or sell drugs they have in their possession, or by applying peer pressure to join in. It is therefore not surprising that many people need multiple attempts to break an addiction.
But not all “failed” attempts are fruitless. Sometimes an unsuccessful attempt results in the person using less, or using in less dangerous situations. It can also help individuals learn which recovery strategies work for them, and which do not, and to identify high-risk situations for relapse that they should avoid.
While it is easy to become discouraged and self-blame after relapses, they are, in fact, often a part of the long-term process of recovery. Because addiction is a chronic disorder, recovery usually requires long-term changes in skills, motivation, behavior and environment. For most people, there is no way to tell in advance whether any particular attempt will succeed. All we can know is that it won’t happen without significant effort.
If recovery attempts involve seeking professionally provided addiction treatment, especially those delivered in high-end residential programs, repeated attempts can be financially ruinous. But the $9 million spent by Perry, who says he has abstained from drugs for 18 months, is unusual. Most addicted people do not need to stay in a traditional “28-day rehab” to recover.
Indeed, most people rely on outpatient care and free mutual help groups like Alcoholics Anonymous for emotional support and skill-building. This includes being exposed to role models who are further along in their recovery, being offered acceptance rather than being shamed for their addiction and having a safe environment to practice new behaviors. For at least some addictions, like the alcohol and opioids to which Perry was addicted, there are also effective FDA-approved medications available.
Some other good news: Because of federal legal reforms enacted over the past 15 years, health insurance is much more likely today to pay for some or all of addiction treatment. Most plans are covered by “parity” laws that require benefits for the treatment of addiction to be as good as those provided for other health conditions.
Even if you can pay, of course, you still want to avoid fraudulent and low-quality providers. Some treatment programs are better at separating you from your wallet than your addiction, acting more like hotels than health care facilities and offering practices that have no basis in evidence. Good treatment programs should offer evidence-based psychological and medical therapies, create a safe and respectful environment and engage the patient (and sometimes the family, as well) in planning and delivering care.
It is common to want to give up, especially after one or more failed efforts. Matthew Perry probably felt that way. If that’s how you feel, often the best thing to do is spend time with people in recovery, whether it’s a friend or family member or the people who gather at local 12-step fellowship meetings. When you see the lives that people in recovery enjoy, you may realize that the rewards are so enormous that they are worth striving for even if you stumble along the way.
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