How Addiction Treatment Killed Cory Monteith


Source: The Fix

From his first rehab in his early teens to the intervention staged by Glee co-creator Ryan Murphy in March, the star was failed in every possible way by an abstinence-only recovery culture.

By Maia Szalavitz

Glee star Cory Monteith's tragic death on July 13 was preventable. Now that more details have emerged about what led up to his fatal alcohol and heroin OD, that conclusion is inescapable. As an adolescent, he was sent to many potentially traumatizing “troubled teen” schools—and as an adult, he received addiction treatment that did not follow government guidelines for effective care and did not provide potentially lifesaving harm reduction information.

Meanwhile, the media is doing its usual best to obscure the problem and keep stereotypes about addiction alive. Portraying Monteith as the “new face of” and pretending as though the drug hasn’t long been used by both celebrities and the middle class, the networks and online media are recycling the idea that heroin is just starting to escape the ghetto and affect people who don’t look like an addict “should.” That’s not news.

But what is important—and is not getting enough attention—is the fact that Monteith has just joined fellow heroin addict Kurt Cobain as yet another famous and beloved victim of tough love and, as Anne Fletcher wrote in The Fix on Monday, anti-maintenance stigma.

Monteith’s history with ineffective and harmful anti-drug programs started almost as soon as he began using, at 13. Between that age and 16, he attended some 12 different schools, including several aimed at “troubled teens,” a phrase that has become shorthand for harsh programs that we now know can backfire.

During the years when he was locked inside troubled teen programs—1995-1998—tough love reined. Tactics were aimed at “breaking” youth through physical and emotional abuse—everything from solitary confinement, punitive restraint and sleep and food deprivation to public humiliation like wearing signs saying, “I am an asshole,” being made to dress in drag and being forced to scrub bathrooms with the same toothbrush you must later use to brush your teeth.

It was Monteith's discovery of his talent as an actor rather than anything in rehab that sustained his recovery during his 20s.
For a sensitive and depressed adolescent, these tactics are counterproductive. They can exacerbate any pre-existing mental illness, a condition of virtually all addicts whose use starts in pre-adolescence like Monteith’s. They can worsen the odds of relapse. Most perversely, they can turn a mild drug misuse problem into a chronic addiction.

So, this is the initial instance where tough love was likely to have harmed the future star. And it probably did so in two ways. First, by the damage itself that comes from harsh treatment. And second, by creating a fear of treatment as disrespectful and even brutalizing.

None of the “care” Monteith received as a teen “stuck.” And while the first “my way or the highway” intervention he got at 19 did initiate a period of sobriety, it was almost certainly his discovery of his talent as an actor at this time rather than anything he experienced in rehab that sustained it. Parade described Monteith’s first experience in front of a camera (in the role of a man contemplating suicide) as “life altering.” The actor told the magazine that it was the first time he’d felt the joy of “working hard and being good at something.”

Fast forward to 2013. Ryan Murphy, the co-creator of Glee, learns that Monteith is using again—and probably, that opiate use was involved.

As Deadline Hollywood reported:

“As soon as I heard what was happening, when we had two episodes left to go, I brought him to my office where we had the intervention,” Murphy said. “He said he wanted to finish the rest of the season, and I said absolutely not. We were not going to put a stupid TV show before his sobriety. I assured him he was not fired, that his job was secure, that he would leave today. He went with a whimper and not a bang and it was very emotional. On one hand, he was thrilled that people wanted to take care of him, though he also felt shame and regret. We had experts in the room and tried to let him know this was a disease. It was a tough and very emotional day and the last thing he said before he left was, ‘I want to get better.’ And I believed him.”
Apparently, these “experts” suggested Eric Clapton’s Crossroads rehab in Antigua, an old-school program that does not “believe in” using medications to treat opioid addiction, despite all the data favoring them as lifesaving for people whose problems involve heroin or painkillers. Murphy implies that Monteith was in another rehab (reportedly Betty Ford) that “didn’t work”—but that after the second program, “all indications were that he’d gone through the Steps.”

We all know what happened next. Although the intervention did get him into treatment—unlike the one conducted on Cobain, which was followed directly by his suicide—Monteith followed the pattern of the 90% of opioid addicts who are coerced into 12-step recovery and denied an adequate period of maintenance treatment: He relapsed.

He also followed two other predictable and dangerous patterns.

First, the risk of overdose is highest in the initial few months after being in rehab or any other situation where a period of abstinence has occurred. After a complete detoxification, a person’s tolerance drops precipitously—meaning that the dose they took before treatment without even getting very high may now be potentially fatal. The first two weeks following prison, for example, were shown by one study to carry a greater than 120-fold increased risk of overdose death; that extreme risk elevation holds for whenever the person first uses again after a period without opioids.

Monteith took the deadliest possible combination—alcohol and heroin—at the deadliest possible time.

Second, the vast majority of “opioid overdoses”—overdoses involving drugs like heroin or Vicodin—are not accurately characterized by that name. Instead, they are really “opioid mixture overdoses,” typically including an opioid and other depressants like alcohol and/or benzodiazepines like Xanax and Valium. Opioids are the drug that most often makes these mixes turn deadly—but only one third or fewer of so-called opioid overdoses involve those drugs by themselves.

Monteith took the deadliest possible combination—alcohol and heroin, whose actions to slow breathing are not additive but multiple—at the deadliest possible time. He was likely not informed about the risk because abstinence-focused rehabs typically don’t provide harm reduction advice. He certainly was not provided with maintenance medication like methadone or buprenorphine that can dramatically reduce that risk; he may not even have know that maintenance was an option—just as Cobain was told he could not take any more opioids, even for his chronic pain. Nor, apparently, were Monteith or his loved ones given naloxone, which can reverse opioid overdose, or instructed on how to use it.

And this is where stigma, and the fact that addiction medicine generally isn’t practiced like real medicine, take over.

In no other type of treatment are FDA-approved medications seen as appropriate to withhold—without even informing the patient of their existence. No cancer center in the US provides only chemo while refusing to inform patients about radiation treatment or putting it down as something “we don’t believe in here” because it is “cheating” rather than “real recovery.” But the equivalent is done in addiction treatment—even for celebrities—every day. If we don’t want to keep losing patients, we’ve got to actually treat addiction like a disease, by providing evidence-based treatment, not just repeating faith-based philosophies.

Ryan Murphy has said that Glee will soon return and will deal with Monteith’s death in its storyline. “What we’ve been talking about in the writer’s room is that maybe the way we deal with this tragedy might save the life of someone,” he told Deadline Hollywood. If he really wants to do that, Murphy needs to fire his current “experts” and learn the truth about addiction.

Denying people access to maintenance care costs lives—and so does failing to provide harm reduction information and tools like naloxone to reverse overdose. The 12 Steps and abstinence are not the only way. If Glee can teach this, Monteith’s death truly could prevent thousands of others—and help finally bring addiction treatment into 21st-century medicine.

Maia Szalavitz is a columnist at The Fix. She is also a health reporter at Time magazine online, and co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010), and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006).

http://www.thefix.com/content/cory-monteith-addiction-treatment-maintenance-therapy8023
 

Comments

That was a good article and I hope some people take notice. I can't say I even knew who this guy was before he died but it is sad to see how the shortocmings of the treatment he recieved may have contributed to his death.

I would also like to say that some of the things described in those 'troubled teen programs' are fucking horrible and I can't believe that shit went on so recently. Is that shit honestly legal? Assuming not I hope there is some follow up on these claims that places are making people scrub toilets with their own toothbrushes and being made to dress in drag, that is some messed up shit and someone should put a stop to it immediately.
 
I didn't know Kurt Cobain had escaped a detox shortly before shooting himself. That was before suboxone, so I guess everything was cold turkey.

Do a lot of detoxes still force you to withdraw without suboxone?
 
First I'd heard about Kurt recently coming out of a detox as well. I did know that he suffered from chronic pain, I think from one of the many on stage "accidents" that he had.

It would be good if Glee managed to bring Harm Reduction to the show, I've never watched it but from all reports, it seems pretty popular. Education is the key to saving lives and changing laws. Abstinence only has a terrible long term record and to me, simply sounds like something that should have gone the way of the dinosaur years ago.
 
The maltreatment of these kids is not legal. It is child abuse, plain and simple. I know that it does happen at some of these places but I think it is implemented by individuals who work there and not by policy of the institution.

I worked at a juvenile detention center for boys (who were ajudicated there for sentencing following crimes) as a nurse and there was a Residential Treatment Center there also on the other side that I occasionally helped out at when they were short staffed. I was there for about 5 years and I know there were very strict policies about how these kids were treated. That is not to say that there weren't individuals that worked there that were total assholes and got off on a power trip and had their own ideas of "rehabilitation" for these kids but most of those guys didn't last long before they were fired. I am sure though that there are facilities that maybe the director or some other high up might not be there for the right reasons (to help these kids) and therefore the place is not run like it should be.
 
Yeah, that sucked. My last treatment 23 months ago was really the best aaaaaai've been to. I was knocked out with an ativan iv for 84 hours. They immediately began librium tid 25 mg. Once I was on my feet so to speak I met w/ my addiction dr. an therapist. We decided to start suboxone 8mg. After 2 days and that dose not holding me well I started 16mg. Finally relief. I stayed this cours for 20 months and then began to taper my dose.
I am now at 1mg. every third day. Next week I'm jumping.Throughout I met monthly with my dr. He has approved this course of action. I do still have emergency subs and will prn my klonopin. This is the most successful I have been with treatment. And yes I've been through several of the old 12 step no meds treatments in the past.
'
.
 
Bob Loblaw;11717964 said:
That toothbrush shit is so fucked up. How the hell can those people live with themselves?
I was surprised to know that it was legal at all. Seems like that is a very serious health risk.
 
drug_mentor;11717198 said:
That was a good article and I hope some people take notice. I can't say I even knew who this guy was before he died but it is sad to see how the shortocmings of the treatment he recieved may have contributed to his death.

I would also like to say that some of the things described in those 'troubled teen programs' are fucking horrible and I can't believe that shit went on so recently. Is that shit honestly legal? Assuming not I hope there is some follow up on these claims that places are making people scrub toilets with their own toothbrushes and being made to dress in drag, that is some messed up shit and someone should put a stop to it immediately.
Troubled teen programs are still functioning with little state oversight and zero federal oversight. A google search on wwasp schools such as cross creek academy will yeild much more information.
 
bukweat;11718422 said:
Yeah, that sucked. My last treatment 23 months ago was really the best aaaaaai've been to. I was knocked out with an ativan iv for 84 hours. They immediately began librium tid 25 mg. Once I was on my feet so to speak I met w/ my addiction dr. an therapist. We decided to start suboxone 8mg. After 2 days and that dose not holding me well I started 16mg. Finally relief. I stayed this cours for 20 months and then began to taper my dose.
I am now at 1mg. every third day. Next week I'm jumping.Throughout I met monthly with my dr. He has approved this course of action. I do still have emergency subs and will prn my klonopin. This is the most successful I have been with treatment. And yes I've been through several of the old 12 step no meds treatments in the past.
That sounds like a dream. Do they really put you in a coma for the first 3.5 days of withdrawal?
 
I thought this article was going to be something like he had a detox using iboga and died or something since he was in canada. but to say he took the deadliest combintation is horeshit, i know ppl who take all that everyday and more for breakfast. He overdosed plain and simple. i dont know his work (im not 16 and dont watch glee) but its horribly sad to see any young life snuffed out by not NOT KNOWING ABOUT HARM REDUCTION. and it think this article did a good point poiting out that if he had someone around with a shot of narcan or some other way to help him he still might be alive today. its a shame especially bc it could have been prevented.

oh and about the treatment in some of these "rehabs" and that is to be put lighter than helium, they practically torture you. make you eat food that is unpalatable and has no nutritional value, thus not giving your body and nutrients and they sure as hell were not giving out vitamins, just butt loads of seraquel and trazadone. they would make you strip, spread your butt, lift you sac, i cant even imagine what the poor girls had to go through. and i woudnt even be surpised if it was a man doing it to them. _edit: that was during the check in process, not like an every day sac check.

more people have to realize that once addicts are locked in these places they just come out worse because no one cares. they junkies, most of them will od, end up in jail or just dissapear so who cares and that coulodnt be any more fucked up. sadly ive been to 2 inpatient rehabs and they all were jerks. didnt give two shits about any of the patients, to empathy, only apathy, and until someone in a position of power steps up and makes changes, this shit will go on forever...end rant.


to answer the aboive post, each dr has their own method of dealing with opiate WD, drugs, food, sleep, like every facet imaginable. some of the more caring ones will keep you on a long acting benzo like valium just to make the whole process more bearable, thus negating the need for all the other meds they give you, that cause side effects, which they will give you more meds for.

most place dont put you in a coma for the first few days, there are places where for a LARGE fee they strap you to a bed, basically put a diaper on you, snow you out with liquid ativan then pump you full of narcan, ive even heard it go so far as once the procedure is done to put you through dialysis, tho i dont know how true that is. but anyways, its called rapid detox. its the kind of shit ppl like lindsey blowhan and other hollywood types can afford. its gotta be absolutely TERRIBLE on your body. and id imagine youd still have some type of paws. i think if there were really a magic treatment where you wake up and "yay! i feel normal again! matter of fact i feel so good im gonna get high!" lol

iboga is supposed to work pretty well but there are dangerous associated with that as well since its a strong psychadelic and has seom serious nonunderstood action in the brain. some ppl swear by it tho.
 
[QUOTE='medicine cabinet';11718774]I thought this article was going to be something like he had a detox using iboga and died or something since he was in canada. but to say he took the deadliest combintation is horeshit, i know ppl who take all that everyday and more for breakfast. He overdosed plain and simple. i dont know his work (im not 16 and dont watch glee) but its horribly sad to see any young life snuffed out by not NOT KNOWING ABOUT HARM REDUCTION. and it think this article did a good point poiting out that if he had someone around with a shot of narcan or some other way to help him he still might be alive today. its a shame especially bc it could have been prevented.

oh and about the treatment in some of these "rehabs" and that is to be put lighter than helium, they practically torture you. make you eat food that is unpalatable and has no nutritional value, thus not giving your body and nutrients and they sure as hell were not giving out vitamins, just butt loads of seraquel and trazadone. they would make you strip, spread your butt, lift you sac, i cant even imagine what the poor girls had to go through. and i woudnt even be surpised if it was a man doing it to them. _edit: that was during the check in process, not like an every day sac check.

more people have to realize that once addicts are locked in these places they just come out worse because no one cares. they junkies, most of them will od, end up in jail or just dissapear so who cares and that coulodnt be any more fucked up. sadly ive been to 2 inpatient rehabs and they all were jerks. didnt give two shits about any of the patients, to empathy, only apathy, and until someone in a position of power steps up and makes changes, this shit will go on forever...end rant.


to answer the aboive post, each dr has their own method of dealing with opiate WD, drugs, food, sleep, like every facet imaginable. some of the more caring ones will keep you on a long acting benzo like valium just to make the whole process more bearable, thus negating the need for all the other meds they give you, that cause side effects, which they will give you more meds for.

most place dont put you in a coma for the first few days, there are places where for a LARGE fee they strap you to a bed, basically put a diaper on you, snow you out with liquid ativan then pump you full of narcan, ive even heard it go so far as once the procedure is done to put you through dialysis, tho i dont know how true that is. but anyways, its called rapid detox. its the kind of shit ppl like lindsey blowhan and other hollywood types can afford. its gotta be absolutely TERRIBLE on your body. and id imagine youd still have some type of paws. i think if there were really a magic treatment where you wake up and "yay! i feel normal again! matter of fact i feel so good im gonna get high!" lol

iboga is supposed to work pretty well but there are dangerous associated with that as well since its a strong psychadelic and has seom serious nonunderstood action in the brain. some ppl swear by it tho.[/QUOTE]

just because you keep reckless company doesn't mean it isn't one of the most lethal combinations of CNS depressants.



i cant believe that people still OD in this manner this day in age. you would think with as much "treatment", however bad it was, that he would have picked up the facts about tolerance etc...
 
Ehh sometimes facts dont really help. One look into the shrine here confirms that. Im not sure what the answer is. I just know something needs to change because too many of my friends are dying.
 
crimsonjunk;11719003 said:
Ehh sometimes facts dont really help. One look into the shrine here confirms that. Im not sure what the answer is. I just know something needs to change because too many of my friends are dying.
We play a dangerous sport.

Have a look at the memorial board on the Mountain Project forums.

If it were 100% safe, we wouldn't need Bluelight.
 
This thread is now on the front page of BL and has had a BL tweet about it (something that doesn't seem to happen much). Good.
 
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