Authorities
looking into his death now say they believe Mr. Jackson, who in 1993
was treated for a painkiller addiction, had prescriptions written under
more than a dozen assumed names.
“He
was surrounded by enablers, including a shameful plethora of M.D.’s in
Los Angeles and elsewhere who supplied him with prescription drugs,”
Deepak Chopra, the high-profile spiritual guru and a friend of Mr.
Jackson’s, wrote on the Huffington Post Web site on June 26, shortly
after the singer’s death. “As many times as he would candidly confess
that he had a problem” to Dr. Chopra, he wrote, “the conversation
always ended with a deflection and denial.”
Specialists
in drug interventions — a rapidly growing field since the concept was
developed in the late 1960s — have watched the Jackson case closely,
viewing it as a classic example of lost opportunity. Denial is at the
core of addiction, and breaking through it, many experts say, can
require extreme measures, particularly with celebrities, who can
procure an endless supply of drugs and are cocooned by people with an
interest in keeping the star’s earnings flowing.
Whether
Mr. Jackson was addicted has not been established, but investigators
are proceeding under the assumption that drug abuse was involved. They
are pursuing a homicide case against his personal physician, who
reportedly administered a dose of a powerful anesthetic, propofol,
before he died. The drug is sometimes used for sleep by painkiller
addicts, experts say.
Mr.
Jackson’s biographer, J. Randy Taraborelli, who knew him for 40 years,
said in an interview that family members had made attempts at
interventions in recent years. Another source close to the family
confirmed there were two attempts.
The
most common form of intervention, known colloquially as a “living room
ambush,” relies on surprise and an ultimatum. The addict is lured to a
meeting with a promise like “Grandma has a check to give you this
Sunday.” Bags are packed for a stay in a treatment center, and the
family is encouraged to draw the line in unison: get clean and sober,
or get out.
This
approach is also called the Johnson method, named for an Episcopal
priest, Vernon E. Johnson, whose seminal book, “I’ll Quit Tomorrow,”
gave rise to the belief that family and friends, aided by a
professional interventionist, could break through the alcoholic or
addict’s denial. It was intended to avert disaster before an addict hit
rock bottom or died, although it has drawn criticism for doing more
harm than good, and since the early 1990s, less draconian methods have
arisen.
Some
experts now caustically refer to traditional intervention as the
“A&E model,” a reference to the popular reality show
“Intervention,” which profiles families and addicts and which always
ends with a surprise confrontation.
But
critics say such a showdown can add more trauma to already devastated
families and addicts, and deter an addict from getting help.
Just
as Mr. Jackson’s death has highlighted the difficulty of trying to help
a chronic drug abuser, it was the death of another celebrity, Kurt
Cobain in 1994, that added momentum to an alternative philosophy of
intervention known as “motivational interviewing” or “invitational”
intervention.
Mr.
Cobain, a heroin addict, committed suicide days after disappearing from
a rehab center he had agreed to enter after a classic tough-love
intervention staged by his wife, Courtney Love, and his Nirvana
bandmates, according to news accounts at the time.
It
prompted concerns about all-or-nothing interventions among
psychologists and addiction experts, according to G. Alan Marlatt,
director of the Addictive Behaviors Research Center at the University
of Washington. Dr. Marlatt said he spoke with a record label executive
who was present at Mr. Cobain’s intervention, who recounted that the
musician asked friends and family if he could meet them “half way” and
cut down on his heroin use, rather than stopping entirely. The answer
was no.
It
is unlikely there was a single cause for Mr. Cobain’s suicide. But it
has spurred Dr. Marlatt and others to speak out in support of
nonconfrontational approaches. “Many people are unwilling to maintain
abstinence, but what are you going to do, wait until they hit bottom,
if they even survive?” he said. “Everything is all or none, you’re
either using or not using, there’s no safe middle way from that
perspective.”
“Motivational
interviewing” and other less confrontational approaches involve asking
an addict to join family members, who may attend lengthy counseling
before and after the encounter with the addict. The family does not
necessarily demand that an addict or alcoholic quit using or drinking;
they may be asked to cut down their use — part of a treatment known as
“harm reduction,” which is itself controversial.
“I
guess motivational interviewing is not going to be the next reality TV
show because it’s so boring,” said Jeffrey Foote, a founder and the
executive director of the Center for Motivation and Change, a treatment
and research center in New York. “It’s nuanced, it’s gentler, it’s
working with people in a slower way, and it’s effective. But that’s not
good TV. What’s good TV is taking drug addicts, harnessing the anger
people feel toward addiction and drug addicts, and smashing them in the
face.”
To
traditional interventionists and critics of harm reduction — including
12-step programs, which call for total abstinence — many addicts are
both unable to control their intake and stubbornly resistant to getting
help unless the consequences are incredibly dire, such as being cut off
financially, divorced or faced with jail.
“I
have never had anyone call me or e-mail me to say they wished they
wouldn’t have given someone an ultimatum,” said Jeff VanVonderen, one
of the three interventionists on the A&E show, who has worked in
the field for 25 years and is certified by the state of Illinois to
work as an interventionist. “But I have a couple of dozen times had
some contact me to tell me that they wish they wouldn’t have backed
down or waited, because now the person is dead.”
Mr.
VanVonderen said that of the 137 interventions filmed for the show so
far, 135 of the subjects agreed to go to treatment, and 111 are
currently sober.
He
and other interventionists agree that Al-Anon, the popular 12-step
program for the families of alcoholics and addicts, which holds that
relatives should “detach with love” because an addict will only seek
help at rock bottom, is a powerful support but that waiting for that
bottom risks lives.
Research
about the success of competing approaches to intervention is not
definitive, in part because the data on recovery is unreliable: why an
addict stays sober or relapses is hard to measure. But some studies on
the nonconfrontational approaches, described by independent researchers
not doing the interventions themselves as statistically sound, have
shown the Johnson model to be both less effective in getting an addict
into treatment and linked to higher relapse rates, compared with softer
approaches, including one called “carefrontation.”
Interventions
of any kind can be costly, ranging from $1,500 to $15,000, depending on
the interventionist and whether travel is involved, said Corinne
Butler-Williams, president of the National Association of Drug and
Alcohol Interventionists, which she founded in 1985. She could not
estimate the number of working interventionists because they do not
need to be certified by state boards or her own association to
practice. But her group is certifying a growing number, she said, and
interest in the field has exploded because of the A&E show.
Most
interventionists agree that no matter the approach, an addict has to be
made aware of the enormous consequences of his addiction and behavior.
Drug courts, which give nonviolent substance abusers the option of
undergoing treatment rather than going to jail, have spread across the
country in the last two decades — and they certainly espouse a
philosophy of tough love.
R.
Gil Kerlikowske, who in May was sworn in as the Obama administration’s
director of the Office of National Drug Control Policy, is a supporter
of drug courts as an alternative to mandatory drug sentencing. The new
drug czar and the man nominated as his deputy, A. Thomas McLellan, are
viewed by many addiction experts as representative of a sea change in
thinking about treatment: away from the punitive, toward more
acceptance of nuances and complications of addiction.
“Ten
years ago, if you would have asked me this question about addiction, I
would have said it’s obviously a moral failure and I don’t know why
people can’t pull themselves up from their bootstraps and handle this
and get themselves totally clean,” Mr. Kerlikowske, a former police
chief in Seattle, said in an interview. “But we can be going in a
different direction. We can look at this from different viewpoints now.”
One
of the newest alternatives to the Johnson model, developed by Brad
Lamm, a New York City interventionist, relies heavily on technology
like Skype, podcasts and Internet chatting to connect families with
addicts in an effort to include as many significant friends and
relatives as possible, far flung as they may be.
Ideally,
he said, the families continue to “meet” as a group weekly while the
addict is in treatment and for up to six months after that. He makes
podcasts of the meetings so both family members and addicts can revisit
the meetings, as a reminder that they are all in it together, he said.
“The
thinking was that the addict needs to be captured, then once captured
needs to be treated,” Mr. Lamm said. “But what I know from working with
families is that we can use the family strength to get us where we want
to go, to healthier relationships, even in the face of crushing
addiction.”
