New details about actor's death raise questions about addiction and recovery

Fans of “Friends” star Matthew Perry may find new revelations about his final days both heartbreaking and puzzling. An addiction specialist at MUSC Health offers some insight about how and why somebody who seemed to be on the road to recovery died of an overdose – and what that specialist wants people to understand about drug and alcohol use disorders.

The final day

Court documents contain a sadly memorable line from Perry. “Shoot me up with a big one,” the actor allegedly told his personal assistant the day he died. The documents show that Perry was referring to ketamine. 

Perry had been undergoing ketamine infusion therapy for anxiety and depression, a legal treatment approved by the Food and Drug Administration. 

But prosecutors say the actor was also obtaining more ketamine with the help of his assistant and four other people who are facing charges in connection with Perry’s death.

The day Perry died, he had three ketamine injections in about five hours. He was found dead in his hot tub. It was a lonely ending to a life lived both in and out of the spotlight. Perry had gone public with his previous addiction issues, trying to help others dealing with similar problems, only to succumb to the draw of drugs once again.

Understanding the pull of addiction

Patrick Duffy, Ph.D., clinical director of the Center for Drug and Alcohol Programs at MUSC Health, offered insight into what Perry may have been going through based on the psychologist’s years of helping people facing some of the same challenges. The center is part of the Institute of Psychiatry at the Medical University of South Carolina.

“I guess my first reaction to his death was that it's really sad. It also didn't surprise me very much. You know, he's obviously had a lot of significant struggles, and it's really hard for people to overcome that. And I think he was probably living in a situation that was particularly difficult for him to escape,” Duffy said.

“What happens with a lot of people is that they’ll go to a residential place or in some short-term kind of detox program, and they say, ‘OK, I'm finished.’ And then they go back, and they live their own, try and live their own, life still surrounded by the same influences that predicted or sustained their use in the first place.”

Changes linked to addiction

Circumstances aren’t the only potential landmine for people trying to recover from drug and/or alcohol use disorders. Duffy said there are psychological and biological changes that come with addiction. 

 

“There are a lot of things in the brain that occur. Research has shown that it affects parts of the frontal cortex or prefrontal cortex, which is essentially the part that allows us to govern our own behavior. If that is weakened, then we tend to be more impulsive, and we don't have as much executive control over our decision-making.”

He also said drugs can hijack a person’s dopamine. “That’s essentially the hormone that would give us the pleasure. Because that has been hijacked, until that system comes back online, we're not producing that, and we have been relying on the drug, and we don't get the same pleasure out of things for a while, and it takes that the drug to bring that back.”

Duffy said it may take some time for that system to come back online. “There's some research that shows that that would probably start around three months, but to fully go back, between a year and a year and a half, you really start to get a lot of that back.”

Filling time in a healthy way

Duffy said people in recovery need to find new ways to fill their time, focusing on healthy activities. “I encourage people to think about the things that you've enjoyed in your life in the past. When you're a kid, everything is exciting. Maybe you thought astronomy would be cool, or playing a musical instrument, whatever. But fill your life with things that you find interesting and pleasurable and fulfilling.”

Also, fill life with people who will help, not hurt, whether they intend to do harm or not. “One of the biggest predictors of what we do is who we're spending our time with. And there are people that maybe you were friends with, and all you ever did was use whatever you used, and probably shouldn't be with them,” Duffy said.

“Then there are some that will take the substance you misused out of your hand. Figure out who the people are that you're unlikely to use with and who are going to be doing things that you find pleasurable.”

Addiction affects millions

Addiction affects not only the famous, such as Perry, of course, but also countless regular people. In fact, half of Americans 12 and up have used illicit drugs, according to the Center for Drug and Alcohol Programs, which offers comprehensive services and help to those with substance use disorders who may also have mood or anxiety disorders. Further, more than 28 million Americans in that age range have an issue with alcohol. And since the year 2000, more than 700,000 Americans have overdosed on drugs. 

Addiction is not a flaw but a health problem

Duffy said his team treats addiction not as a flaw but as a health problem that can be treated. That can be a relief for patients. 

“A lot of people are very hard on themselves and are saying, ‘Hey, why can't I stop this?’ And you know, ‘I shouldn't have this; what's wrong with me?’”

Those feelings can make seeking help feel difficult. “This is something that's very tough for people to do. They shouldn't be ashamed of it and let it keep them from reaching out to somebody,” Duffy said.

Like Perry, they may also find it tough to find a healthy place where they fit in for the long term. “I think it's important that people understand that we live in our own environment, surrounded by a lot of influences that sustain or predict that use. Some of them, of course, are internal,” Duffy said.

“We've kind of trained ourselves in different habits, but there are other factors around in our environment that sustain that. And if we don't change those things, then we're still living in that same environment that promotes the use while trying to stop. And it's just really tough to make that change. But you can if you find the right support and find a way to stick with it.”