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Stardom made Amy Winehouse's addiction battle tougher, experts say

July 26, 2011

Stardom made Amy Winehouse's addiction battle tougher, experts say

By Alan Duke, CNN Ent Ed.

Los Angeles (CNN) -- Amy Winehouse's death, a month after fans in Belgrade booed her from a stage for slurring and forgetting lyrics, raises questions about what could have prevented the tragedy.

While it will likely take weeks before toxicology tests reveal what killed her, Winehouse made it no secret that she had a substance abuse problem. She turned her defiance to rehab into her biggest hit song. "They tried to make me go to rehab, I said 'No, no, no,' " she sang.

Despite those lyrics, Winehouse sought help in rehab several times during the height of her career, often ahead of an important performance or a tour.

When she entered rehab in January 2008, her record label said it was "to continue her ongoing recovery from drug addiction and prepare for her planned appearance at the Grammy Awards."

Her last rehab stint was just two months ago. People magazine quoted a source close to the singer saying her father urged her to seek the treatment to keep excessive drinking from "becoming a bigger problem." The singer's representative told CNN at the time it was "to seek an assessment" before Winehouse began a summer tour of Europe.

That European tour was abruptly canceled after the first show, that disastrous Belgrade, Serbia, performance. She returned to London, but not to rehab.

Winehouse is the newest member of what is darkly known as the "Forever 27 Club," a list of music legends whose lives and careers ended at the age of 27. Janis Joplin, Jim Morrison, Jimi Hendrix and Kurt Cobain are headliners of the group, stars whose deaths could be linked to drug use.

Dr. Reef Karim, who runs the Control Center for Addiction in Beverly Hills, California, said it can be harder for celebrities to battle addiction for several reasons.

"They are allowed to continue to do their movies while in rehab, to go on tours before they are ready," he said. "So many people are relying on them for their income, their agents, their handlers, their entourage, their fellow musicians, and so many people want them to get better quickly."

Those "peripheral people" make it tougher to keep the musician on the prescribed treatment, Karim said. "We have to fight a lot of the handlers, the entourage, in order to get them the treatment they need."

They "jump back into the craziness and touring before they are ready and they are much more likely to relapse because of it."

Musicians sometimes believe they need drugs to perform and please fans, Karim said. He recounts what one rock star patient told him: "When I'm loaded or when I'm under the influence of something, people are really interested in me. When I'm sober it feels like nobody cares."

"Some people go through recovery and if they are producing great music, then great, but if they are not, the fear is that they'll disappear permanently," Karim said.

While true fans may care about the person, "the average fan may just care about what kind of things you are doing and how you make headlines," he said.

It may be easier for a celebrity to get noticed for a drug arrest, a drunken video or a trip to rehab than for a movie premiere. Every time Lindsay Lohan goes to court dozens of photographers line her path, yet her career is so stagnant her Screen Actors Guild insurance expired.

Lohan, who has spent eight months of the last four years in rehab, is having trouble paying for court-ordered psychiatric counseling, her lawyer told a judge last week. The judge agreed that Lohan needs the more expensive one-on-one help, not group sessions, which are cheaper.

Pax Prentiss, the CEO of the Passages Malibu rehab program, suggested that Winehouse's relapses into addiction were the result of a lack of one-on-one treatment.

"The treatment centers where she went to did not do individual therapies," Prentiss said. "They were group treatment facilities."

Prentiss said he was addicted to heroin, cocaine and alcohol for 10 years. "I was on death's bed for many years," overdosing several times, he said.

"I was at one time like Amy, going in and out of treatment centers, relapsing, sitting in group meetings," he said. His healing happened when he got the kind of individual treatment that he now provides at his facilities, Prentiss said.

Self-introspection is key to recovering from addiction, Karim said.

"A big part of recovery is looking at why you are so self-destructive and what it is about you," Karim said. "It's a spiritual disease as much as a social and biological disease. A big part of it is looking deeper at what's going on within you, how you feel about yourself."

Prentiss speculates that Winehouse was in "deep psychological pain, which is why she was abusing drugs and alcohol, and nobody had diagnosed that and worked on healing the deep emotional issues."

Her father, in a statement released after her funeral Tuesday, said his daughter "conquered her drug dependency" three years ago. She recently "was trying hard to deal with her drinking and had just completed three weeks of abstinence," he said.

"She said, 'Dad, I've had enough, I can't stand the look on your and the family's faces anymore,' " Mitch Winehouse said.

Addiction, Karim said, is hard for family members to understand. "You don't conquer this disease," he said. "You manage this disease."

Why would addiction suddenly take Winehouse's life if she was sober for three weeks?

"Addiction deaths are not only due to instant overdose," Karim said. "The toll that addiction takes on your body, on your immune system, the toll on the lack of absorption of vitamins and nutrients in your system, on your heart, liver, kidney" can lead to death over time.

Mitch Winehouse described his daughter as being "in good spirits" the day before she died.

"That night, she was in her room, playing drums and singing," he said. "As it was late, her security guard said to keep it quiet and she did. He heard her walking around for a while and when he went to check on her in the morning he thought she was asleep. He went back a few hours later, that was when he realized she was not breathing and called for help."

Pax Prentiss says he's "heard from different people who had a family member who died that they were doing great one day and the next they were dead."

"That makes a lot of sense to me," he said. "If she hadn't had a drink for three weeks, her tolerance went way down, and if she relapsed, a pill mixed with alcohol, she overdosed and died."

"I've seen that a lot with people," he said. "They go back to using the same amount of the drugs that they used before they were sober. Their system is not able to handle that same dose anymore."







Addicted in Hollywood: Stars' Problems With Cocaine 'Still Going Strong'

July 29, 2011

Addicted in Hollywood: Stars' Problems With Cocaine 'Still Going Strong'

By Hollie McKay

According to the 2008 National Survey of Drug Use & Health, the number of young adults abusing cocaine has dropped significantly. However, in Hollywood, the use and abuse of the illicit drug continues unabated.

In fact, snorting cocaine can be as commonplace as sipping a glass of champagne. After a night out in the clubs, the party typically goes back to an oversized mansion somewhere in the Hollywood Hills. There’s music, a pool table, more alcohol and a bunch of pretty people doing a line or two.

Dennis Quaid described a similar scene, telling Newsweek that his "greatest mistake" in life was the cocaine addiction he developed in the 1970s and 1980s when he first encountered show business' pressures – and payoffs.

"It was very casual at first. That's what people were doing when they were at parties. Cocaine was even in the budgets of movies, thinly disguised," Quaid said. "It was petty cash, you know? It was supplied, basically, on movie sets because everyone was doing it. People would make deals. Instead of having a cocktail, you'd have a line."

And in a town founded on fame, cocaine is often synonymous with stardom. 

Last year Paris Hilton hit headlines after pleading guilty on two misdemeanor counts in a Las Vegas court of cocaine possession. Charlie Sheen was hospitalized in January following a porn-star fueled party complete with a reported "briefcase full of cocaine." In her recent memoir, Belinda Carlisle opened up about her battle with a three-decade coke addiction. And then there is the late Amy Winehouse, who’s own father was quoted three years ago saying the Grammy-winning songstress would die if she continued to smoke crack.

"In general, with cocaine abuse, or cocaine dependence, the numbers are dropping. They are not peaking or elevating. But in Hollywood, it’s still going strong," Dr. Reef Karim, a leading addiction specialist at The Control Center in Los Angeles told FOX411's Pop Tarts column. "You still see coke everywhere in Hollywood. It is still considered to be a party drug."

So what is it about cocaine that has so many Hollywood types hooked?

"Cocaine is unique in how it stimulates the brain’s reward center.  The chemical signal for pleasure in the brain is the release of dopamine in the nucleus accumbens in the midbrain," explained Dr. David Sack, CEO of the star-saturated Malibu rehab center Promises. "Cocaine strongly and selectively increases dopamine in this region, causing the ‘rush’ and euphoria."

FOX411 recently explored the use of cocaine as a popular weight loss drug and appetite suppressant in the image-fueled industry. But it also serves another critical function: sudden and abundant energy.

"It keeps you awake. And for a lot of people it makes them more hyper or more sociable, so, you’ve got people that want to party all night that don’t want to gain a lot of weight, that want to be able to talk to other people that they aren’t that interested in to start with, and want to have a good time in a pleasurable way," Reef explained. “Cocaine seems to make sense for them."

According to Dr. Eric Braverman, addiction specialist and author of “Younger You,” a big ego and money to burn also pave the way for cocaine addiction.

"[Celebrities tend to be] narcissistic, so cocaine gives them a sense of authority and power. Also, many rely on cocaine to fill voids in their lives," he said, adding that celebrities with the addiction may drop upwards of $1,000 per day on the stuff.

But anything that takes you too far up, can also take you too far down.

"It affects the brain. When you’re trying to talk to somebody on coke, it’s like someone injected ADHD into their brain and you’re trying to have a conversation with them while they’re talking about 10 different conversations, at a mile a minute, that make no sense," Reef continued. "From a body standpoint, there are definitive adverse affects. Coke constricts your blood vessels, which is why there is potentially all of these heart issues associated with taking cocaine. It can also leave you malnourished."

Karim recently treated "a Hollywood starlet type" with a cocaine abuse problem that left her shockingly thin.

"She wasn’t anorexic, but she was on her way. When I looked at her levels of vitamins and electrolytes, they were all off, because she wasn’t really eating. And she wasn’t really eating because she was doing coke every time she went out, which was like four or five times per week," he said. "So, it can have rapid effects like heart attacks and stroke, mental effects, and effects that involve your entire body system. It’s usually not a good end result."

While any form of cocaine can be addicting, Sacks said crack cocaine, which produces an immediate high, is the one most abusers get dangerously attached too.

"When cocaine is smoked, it is absorbed very quickly through the lungs and into the blood stream where it travels to brain," he said. "The addicting properties of crack cocaine and intravenous cocaine are similar, but with crack cocaine, the user repeats the dosing over and over again at very short intervals."

Unlike the stories from the days of Studio 54 of cocaine-snorting production lines, today its consumption is a little more discreet.

"If you go to a typical Hollywood house party and it’s after midnight, there’s going to be coke there, it’s just a matter of which bathroom it’s in and who’s got it.," Karim said, while Sack added that most celebrities easily get their fix via "friends" or direct through a dealer in an affluent community that can deliver straight to one's front door. Nightclub owners have even been known to dispense cocaine to celebrities as a "payment" or incentive for them come to a the club.

But those with a cocaine problem lose more than just money, weight and years off their lives. Like all addictions, sufferers also lose their sense of self.

"When someone is truly addicted to a substance or a behavior, their brain is hijacked by that substance or behavior, so you’re not thinking or acting as you, but the drugs or behaviors are talking," Karim said. "The sex addiction is talking. The gambling addiction is talking. The cocaine addiction is talking."

But in Hollywood, many don't seek the professional help they need or even acknowledge that there is a problem.

"The entertainment industry generally has a broader tolerance for recreational drug use than other fields. Illicit drug use is tolerated so long as it doesn’t interfere with production. Some of this probably comes in the spirit of tolerance and supporting personal liberty, particularly in artists, but it is misguided," Sack added.  "Higher social use of drugs leads to higher rates of problem use and drug dependency. Individuals whose drug use has become problematic or who have become addicted have trouble recognizing how their drug behavior is different from others who appear to be able to use socially. They will point to friends or colleagues or appear to use larger quantities, more often and use this to rationalize their own behavior. They don’t realize that individuals differ markedly in how they respond to and metabolize drugs."

Read more:




The Reality TV Obsession: A Psychological Investigation


By Psychiatrist and Addiction Specialist Reef Karim

Introductory note from BHC Editorial Director Robin Jay: In 1948, when the television show Candid Camera aired pranks designed to capture the reactions of embarrassed participants – participants who were the average joe’s on the street, not actors – no one would have categorized the show as “Reality Tv.” But by 2002, when the television series Survivor began to enthrall weekly viewers to voyeuristically watch jungle-ridden public citizens compete for $1 million, the term Reality Television was coined and quickly became a household term. In 2001, when the television writer’s strike took place, the genre of television known as Reality TV received the booster shot it needed to skyrocket. The unscripted nature of the programs was the ideal workaround for producers who desperately needed to produce television shows without professional writers – and it was nice on the purse strings, as well. On average, it costs about $3 million to produce a popular sitcom with paid writers and actors, but it costs about $750,000 per episode to make a Reality TV show.

As a result, today viewers can tune in to Reality TV shows to see chefs vie to become the next Iron Chef, to see dozens of women compete for a possible proposal of marriage from a bachelor, to see couples guzzle down live roaches and bathe in a vat of rats to win cash, and to see people undergo plastic surgery to become attractive. The Reality TV options are now too endless to list. And while this genre of television is less costly to produce – a positive virtue in this sluggish, advertiser-strapped economy – what is the potential long-term impact on the participants and viewers? For example, what happens to the participants who lose drastic amounts of weight and then return to normal life with no cameras? What happens to couples who become engaged to marry within six weeks of meeting their partner who has simultaneously been dating a dozen others? Is it just a curious coincidence that nearly every couple on a reality series – Britney Spears and K-Fed, Jessica Simpson and Nick Lachey, Hulk Hogan and Linda Bollea for example – have split? And what happens to children whose parents go through a nasty public divorce, as in the case of the couple in John and Kate Plus 8?

Behavioral Health Central decided to inquire about these issues and contacted Dr. Reef Karim, a Psychiatrist and addiction specialist in Beverly Hills who has appeared on many nationals television programs to discuss this very issue – and who has also appeared in Reality TV programs himself. Dr. Karim is the Founder of the Beverly Hills Center for Self Control & Lifestyle Addictions. The center focuses on treating impulsivity and self control including: anger management, stress management in addition to lifestyle addictions such as: sex addiction, gambling addiction, food addiction, shopping addiction and videogame addiction. He also treats mood (depression, bipolar), anxiety disorders, ADHD and chemical substance use disorders and is well trained in both psychotherapy and psychopharmacology. Dr. Karim researched this issue for us and provided the following commentary. You can also listen to our interview by clicking on the media player on this page. And for more information about Dr. Karim (or Dr. Reef as his patients call him), go to

The Reality TV Obsession: A Psychological Investigation
By Psychiatrist and Addiction Specialist Reef Karim

Are we all becoming obsessed with Reality TV? Seriously, think about it…
For some, it’s being on the show. It’s their 15 minutes of pure, exhibitionistic experience with fantasies of fame, stardom or at a minimum…popularity. Perhaps it’s an attempt to move up their social standing or a conscious or unconscious attempt to gain the attention they so desperately needed but never received in their developmental childhood years.
For others, it’s watching the show. It’s a voyeuristic digestion of “reality” while identifying with real life characters who openly display their eccentricities and/or pathology across our television screens. We watch sex appeal, flirtation, jealousy, rage, competition, conflict, anxiety, shame, impulsivity, hedonism, intoxication, narcissism, sex… the list goes on and on. In a way, it’s much safer to watch it play out on television than to experience it ourselves. And their lies the potential problem. Is reality television just entertainment or does it have a deeper psychological effect on us?

Unless you’ve been living in a cave the last decade (and I think even the Taliban knows about “Survivor” and “Big Brother), you’ve undoubtedly been exposed to this global phenomenon.
From a psychological perspective, reality television is fascinating. It makes the “fantasy” of celebrity status accessible to anyone – particularly if you’re willing to put it all out there. But, at what price? As a psychiatrist, addiction specialist and relationship therapist, I’ve been faced with many questions about the psychological impact of media and specifically reality television. As such, I decided to write this article and I’ve listed five questions I repeatedly get asked.

1) How do reality show participants deal with the “withdrawal” effect when the cameras are shut off?
I’ve interviewed many reality show participants and the “withdrawal” effect makes sense. When you’re basically “exposing” yourself mentally (and for some people - physically) for weeks at a time with constant cameras, crews, producers, experts and sometimes fans giving you constant attention and then suddenly it all abruptly ends, how do you deal with that? The answer: Aftercare Participants should continue on with treatment (if that was the focus of the show) or at a minimum, there should be a therapist brought in (during taping or after) to work with the participants. We need to realize that “Reality TV” does have a psychological impact on its participants.

2) Are Reality TV participants screened?
Obviously, every participant is “cast” on reality television shows. There are shows that utilize psych testing (a battery of written tests and sometimes interviews that are scored and can help evaluate one’s psychological health) which can be useful for screening. But, what are you screening for? If you screen out anyone who’s got a personality problem (narcissistic, borderline, histrionic) or poor coping skills, a producer may ask “well… then how do you get good television?” Reality television participants have occasionally had bad outcomes and perhaps screening for a significant psychiatric history or substance dependence history (like quite a few current shows do) would be helpful to avoid worsening their symptoms due to an acute stressor they may not be equipped to handle. If the show is about mental
health or addiction, then a strong support staff and aftercare is imperative.

3) Can Reality TV be damaging to someone’s mental health?
The answer is absolutely “yes”. If an individual is mentally/psychologically unprepared for the potential humiliation or competition or adoration that will be quickly be put upon them, it could have negative effects on their psyche. We’ve heard of mental breakdowns and even an occasional suicide after a reality television show finishes taping. Now, it’s much more likely that those individuals had predisposed mental health conditions but we can’t negate the stress of doing a show and/or not having aftercare as a great concern for certain individuals. Additionally, screening out major mental health disorders or major substance use disorders is very important.
And for those people watching at home, the hope is they don’t just live life vicariously through reality television participants. If an individual doesn’t need stimulation or activity in their own lives because they’re getting it on television (reality or not), that’s a problem.

4) What kinds of people are attracted to reality television?
Some people will argue that you have to “have some kind of problem going on” in order to want to be on a reality show – a personality disorder, an attachment problem from childhood, a desperate need to be famous, etc. I don’t necessarily believe that. Although there’s no doubt that some individuals are feeding their inner troubles by going on a reality show, there are other participants on shows for the money or for competition or they’re trying to jump start an acting or hosting career and some people just want to have fun and help people through the medium of television.

5) Can a Reality TV show be a good thing for its participants and viewers?
Although most reality shows play on our sensationalistic thirst for sex, competition and conflict, we sometimes learn from these shows. We might learn more about addiction or mental health or running a company or we might get more motivated to start dance classes. The shows could have a positive effect on our lives if they motivate us to actually go out and learn a new skill or read about a subject or get help for a friend or family member.

But we have to keep things in perspective. Our society has changed over the last decade. We’re now much more of an ADHD, distractible, novelty seeking, numb, over-stimulated, high tech society and we’re paying for it with our mental health. As one of my friends so eloquently says, “you always gotta pay, one way or another”. Although our technology is beyond impressive and changing every day, we are suffering in another way – our divorce rates are up; our family unity is down; our emotional skills in dealing with anger, conflict and anxiety are... not so good... and most importantly our ability to connect with each other authentically has been seriously challenged.

Personally, I have a problem with a few reality shows (particularly those dealing with kids because I don’t think kids are really mentally prepared for what they’re experiencing ) but overall I believe reality shows could do some good – they don’t have to just be sensationalistic - they could also be educational.

The way to improve reality television is to make it more “real” with more experts. The more authentic we can make reality programming, the more motivating and/or educational it can be. At one time, the average television producer thought reality television was “just a phase”. Well folks, it looks like it’s going to be here for quite a while. So we might as well try and make it more credible.

Experts can consult, create or produce shows that help people develop insight, coping skills and better functioning through instruction, expert treatment and experience. As life is all about human connectedness and passion, perhaps the voyeuristic nature of reality television could help motivate us to be better people.
One can always dream…

Dr. Reef Karim

“A great distracter is seeing someone else’s emotional pain so we don’t have to think of our own.”
Dr. Reef Karim