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How Addiction Treatment Killed Cory Monteith

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

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Monteith played Finn, school quarterback, in Glee
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By Maia Szalavitz

07/23/13

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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 a 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).

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