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Whitney Houston’s Death: Hallmarks of a Battle Against Addiction and Overdose

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By MAIA SZALAVITZ | @maiasz

Whitney Houston’s Death: Hallmarks of a Battle Against Addiction and OverdosePop legend Whitney Houston was apparently found unresponsive in her bathtub at the Beverly Hilton Hotel, with bottles of prescription sedatives in her room. The cause of the singer’s death at age 48 has not been confirmed as an overdose — and the results of a toxicology report may not be available for weeks — but the circumstances bear many of the hallmarks of such a death.

Like most overdose victims, Houston had a long history of addiction. Her ongoing and distressingly intense battle with cocaine had received extensive media coverage. She had tried rehab at least three times; her latest stay was last May. Like her, the majority of overdose victims typically attempted rehab previously.

Victims of unintentional overdose also show clear signs of drug misuse before or at the time of their death. In a 2008 study in West Virginia — a state with a high rate of overdoses — researchers found signs of drug misuse, including shooting drugs intended to be taken orally or drinking alcohol while taking depressant drugs like Xanax, in 95% of the deaths.

In the days before Houston’s death, she was seen drinking excessively — something that is not recommended for people who are in recovery from other addictions, especially if they’ve only recently left rehab. Some people find that their addictions are limited to particular substances, but for many others, alcohol increases the likelihood that they’ll return to their drug of choice. Alcohol — even just one drink — tends to lower inhibitions, which can thwart people’s ability to avoid taking other drugs.

Houston’s age also fits the profile of typical overdose victims. Although we think of drug abusers as invariably young, there are actually three periods during addiction, at different ages, when death risks are highest.

The first is when the user is inexperienced — which does tend to apply to young people — but these deaths are much less common than in older users. The second risk period is just after of a bout of abstinence, whether the person is forcibly made (as in prison) or volunteers to stop using. Becoming abstinent reduces the tolerance to drugs that people build up during addiction, which leaves them at greater risk of overdose from the same amount of drugs that they formerly took safely.

The third period of high risk is middle age. Indeed, according to the CDC [PDF], the largest proportion of overdoses occurs among people ages 45-54, with the second largest group at ages 35-44. Men are more likely to die than women, however: two-thirds of overdose deaths occur in men, reflecting the higher prevalence of addiction in males.

Houston’s death stands out in that — so far, at least — it does not seem to have been associated with prescription opioid painkillers, which are found in 40% of overdose victims. Most overdoses involve some combination of sedative drugs other than opioids, including alcohol and benzodiazepines like Valium (diazepam) and Xanax (alprazolam). Prescription drugs said to have been found in bottles in Houston’s hotel room include Xanax, Valium and Ativan (lorazepam); all three are benzodiazepine antianxiety medications.

Taken in combination with one another — especially with alcohol on top — these drugs can be fatal. They can leave people vulnerable to drowning in shallow water (as in the bathtub where Houston was found) or choking to death on vomit.

There are some important ways to reduce the risk of overdose. Obviously, the first is not to take drugs to begin with, but for those who don’t heed that advice, it’s important to not mix drugs that have the same kind of effects, particularly not those that have a depressant or sedative effect, known as “downers.” Mixing stimulants like cocaine and amphetamine is also a bad idea, but it is less likely to result in death than combining drugs that slow or, at high doses, stop respiration.

For overdoses involving opioids, the problem can be reversed with an antidote known as Narcan (naloxone) if caught quickly enough. The drug, which is safe and nonaddictive, is distributed at needle-exchange programs and other locations in some states (call 311 in New York City to find sites in the five boroughs), but most people still don’t know about it or have access to it.

Few overdose victims have the talent of Whitney Houston. But while we mourn the loss of a legend who had great difficulty achieving recovery, we should consider how to prevent similar deaths. It is important to educate people who are at particular risk of overdose — such as those leaving treatment or prison — about the tolerance effect, the danger of mixing sedatives and the existence of naloxone if relevant. Making naloxone available over the counter also could make a real difference in reducing death rates.

Addiction is often chronic and marked by relapse. But overdose ends all hope of recovery.

Source: http://healthland.time.com/2012/02/13/whitney-houstons-death-hallmarks-of-a-battle-against-addiction-and-overdose/?xid=gonewsedit#ixzz1mMowfvcS

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I Had Asperger Syndrome. Briefly.

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By Benjamin Nugent

FOR a brief, heady period in the history of autism spectrum diagnosis, in the late ’90s, I had Asperger syndrome.

Asperger's syndromeThere’s an educational video from that time, called “Understanding Asperger’s,” in which I appear. I am the affected 20-year-old in the wannabe-hipster vintage polo shirt talking about how keen his understanding of literature is and how misunderstood he was in fifth grade. The film was a research project directed by my mother, a psychology professor and Asperger specialist, and another expert in her department. It presents me as a young man living a full, meaningful life, despite his mental abnormality.

“Understanding Asperger’s” was no act of fraud. Both my mother and her colleague believed I met the diagnostic criteria laid out in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The manual, still the authoritative text for American therapists, hospitals and insurers, listed the symptoms exhibited by people with Asperger disorder, and, when I was 17, I was judged to fit the bill.

I exhibited a “qualified impairment in social interaction,” specifically “failure to develop peer relationships appropriate to developmental level” (I had few friends) and a “lack of spontaneous seeking to share enjoyment, interests, or achievements with other people” (I spent a lot of time by myself in my room reading novels and listening to music, and when I did hang out with other kids I often tried to speak like an E. M. Forster narrator, annoying them). I exhibited an “encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus” (I memorized poems and spent a lot of time playing the guitar and writing terrible poems and novels).

The general idea with a psychological diagnosis is that it applies when the tendencies involved inhibit a person’s ability to experience a happy, normal life. And in my case, the tendencies seemed to do just that. My high school G.P.A. would have been higher if I had been less intensely focused on books and music. If I had been well-rounded enough to attain basic competence at a few sports, I wouldn’t have provoked rage and contempt in other kids during gym and recess.

The thing is, after college I moved to New York City and became a writer and met some people who shared my obsessions, and I ditched the Forsterian narrator thing, and then I wasn’t that awkward or isolated anymore. According to the diagnostic manual, Asperger syndrome is “a continuous and lifelong disorder,” but my symptoms had vanished.

Last year I sold a novel of the psychological-realism variety, which means that my job became to intuit the unverbalized meanings of social interactions and create fictional social encounters with interesting secret subtexts. By contrast, people with Asperger syndrome and other autism spectrum disorders usually struggle to pick up nonverbal social cues. They often prefer the kind of thinking involved in chess and math, activities at which I am almost as inept as I am at soccer.

The biggest single problem with the diagnostic criteria applied to me is this: You can be highly perceptive with regard to social interaction, as a child or adolescent, and still be a spectacular social failure. This is particularly true if you’re bad at sports or nervous or weird-looking.

As I came into my adult personality, it became clear to me and my mother that I didn’t have Asperger syndrome, and she apologized profusely for putting me in the video. For a long time, I sulked in her presence. I yelled at her sometimes, I am ashamed to report. And then I forgave her, after about seven years. Because my mother’s intentions were always noble. She wanted to educate parents and counselors about the disorder. She wanted to erase its stigma.

I wonder: If I had been born five years later and given the diagnosis at the more impressionable age of 12, what would have happened? I might never have tried to write about social interaction, having been told that I was hard-wired to find social interaction baffling.

The authors of the next edition of the diagnostic manual, the D.S.M.-5, are considering a narrower definition of the autism spectrum. This may reverse the drastic increase in Asperger diagnoses that has taken place over the last 10 to 15 years. Many prominent psychologists have reacted to this news with dismay. They protest that children and teenagers on the mild side of the autism spectrum will be denied the services they need if they’re unable to meet the new, more exclusive criteria.

But my experience can’t be unique. Under the rules in place today, any nerd, any withdrawn, bookish kid, can have Asperger syndrome.

The definition should be narrowed. I don’t want a kid with mild autism to go untreated. But I don’t want a school psychologist to give a clumsy, lonely teenager a description of his mind that isn’t true.

Benjamin Nugent, the director of creative writing at Southern New Hampshire University, is the author of “American Nerd: The Story of My People.”

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