Whitney Houston and the struggle of addiction

Deni Carise, Ph.D. is chief clinical officer of Phoenix House, a leading drug addiction center. She is also a recovering cocaine addict.

Whitney Houston, one of the most powerful and talented entertainers of her generation, is being mourned today as people across the world try to cope with this tragic loss.

While no one knows for certain whether drugs — particularly cocaine — were linked to her death, many fans have followed her publicly acknowledged cocaine addiction. We watched Whitney become a brilliant superstar, and then a struggling addict, and then a new woman with full hopes for recovery.

Today, many are asking “Why?”  It’s a common question when addiction is involved: Why can’t you just stop? Why do you keep using?

For me, that question evokes a particularly painful response, especially when the drug in question is cocaine.

As a person in long-term recovery from cocaine addiction, I don’t have to ask why. I know. As an addiction specialist and the Chief Clinical Officer of Phoenix House, the nation’s largest non-profit substance abuse treatment organization, I understand why when people with everything to lose continue to use cocaine.

A powerful stimulant

Cocaine is a powerful, addictive stimulant.  It can be inhaled, dissolved in water and injected, or smoked.  How quickly the high arrives and how long it lasts both depend on the route of administration and the purity of the drug. The faster cocaine is absorbed into the bloodstream and delivered to the brain, the more intense the high. Smoking cocaine produces a faster, stronger high than snorting it — some even think it’s faster than injecting it.

I started using cocaine in 1980. Cocaine did for me something I felt I could not do for myself in my teens and early 20’s — it made me feel stronger, more competent and confident. Actually, it made me feel a little like a superstar. This was particularly useful (and completely accepted) in my chosen field of modeling. Having grown up as the classic “ugly duckling,” I had no confidence and no ability to exude the self-assurance needed for young models. Cocaine came to my rescue — or so I thought.

How does cocaine work?

Cocaine stimulates the brain to increase levels of dopamine, a neurotransmitter primarily associated with the ability to feel pleasure.

Some (very important) brain cells use dopamine to communicate. Without cocaine, dopamine is released by the cell, and then recycled back into the cell that released it.  Cocaine increases the available dopamine from the cell and then blocks it from being recycled, causing a flood of dopamine which amplifies the pleasure signal.  Simply put, cocaine instigates dopamine to over-stimulate the reward center of the brain, and that feels almost inhumanly good.  Other things that stimulate this reward center, dopamine, or similar neurotransmitters are chocolate, an orgasm, and various forms of excitement.

A major problem is that cocaine is “the MORE drug.”  Using it makes you want MORE of that great feeling, MORE of that pleasure. And more cocaine, at least initially, will get you there.

Repeated cocaine use, however, can lead to long-term changes in the brain. The cells get the message that there’s tons of available dopamine and may stop producing even normal amounts. The dopamine is depleted because the cells don’t recycle it, and now the brain is used to these floods of dopamine, and has come to expect it in order to feel any pleasure. Although I felt terribly confident when I was on cocaine, in reality I was unable to really finish or accomplish anything — because all I wanted to do was keep that dopamine flowing.

It didn’t matter that I suffered a stroke at 21, had to quit college twice in two semesters, couldn’t keep an apartment or a job or a relationship for more than 4-6 months; I still just wanted to feel that good all the time. I wanted MORE.

When I first quit using cocaine (and other drugs) it took years before I could really feel pleasure at everyday events.  It felt like all of my dopamine had been worn out and used up, but my brain kept yelling “ MORE!” It was painful.

Recovery

I was lucky to start my path to recovery in my early 20’s; I had youth on my side. As difficult as it was to feel pleasure without drugs, I was nonetheless intensely determined to make something of my life.

Stopping cocaine use must have been even harder for Whitney Houston, since she had already made her mark and was able to have a number of successes even when she first started using.  I didn’t have that background of success, and that led to my determination to stick with recovery as my only hope of getting somewhere in life.  I started at the only school that would take me, a community college.  Nine years later I finished my PhD in Clinical Psychology and started a fellowship at the University of Pennsylvania.

I’m now the Chief Clinical Officer for Phoenix House, which provides substance abuse treatment services in 120 locations in ten states and serves thousands of people daily. It’s a career I find personally and professionally satisfying. I also have a great husband of more than eleven years and two grandsons whom I adore.

So, why do I understand how people with everything to lose continue to use cocaine? It’s because I still think about using now and then. I want that incredible high, that super-human feeling, like I can take on the world.

But three things stop me. First, I’m not willing to pay the price that I know would include losing my career, my husband, and my lifestyle.  Second, when that feeling comes along, I understand it and I don’t entertain it. Of course I might feel like using now and then; I had an addiction to cocaine, and my brain is forever changed because of it. Third, on a good day, I actually do feel like I could take on the world  — without cocaine.

I wish Whitney would have had this and more.  I wish that everyone struggling with this disease could know that the possibilities of what you can accomplish in recovery are endless.

Deni Carise, Ph.D. is chief clinical officer of Phoenix House, a leading drug addiction and alcohol abuse treatment and rehabilitation center that operates a number of facilities in New York City. She is also a recovering cocaine addict.


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