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Amy "Addicted But Not Doomed" Says Top Shrink

Winehouse had every risk factor for addiction, but her death was still far from inevitable, argues New York Times sage.

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Friedman: Ever hopeful

By Walter Armstrong

08/03/11

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Yesterday Dr. Richard A. Friedman—psychiatrist, professor and researcher at Weill Cornell Medical College and top expert on the psychopharmacology of depression—weighed in on the discussion of Amy Winehouse's demise in The New York Times. He questioned the consensus that, as Winehouse's own mother said, “it was only a matter of time.” “But was it?” Friedman asks. “Why is it that some people survive drug and alcohol abuse, even manage their lives with it, while others succumb to addiction?” He doesn’t offer any new solutions, but he does provide a lucid state-of-the-art summary of those at increased risk:

People who suffer from depression, anxiety and other mood disorders, or from personality disorders like pathological narcissism or borderline personality, have triple the risk of addiction. The first group tends to “self-medicate” with sedatives like alcohol, opiates or benzos. Narcissists go for stimulants like cocaine and borderlines are all over the self-medication map.
People whose brains have too few dopamine receptors in the reward pathways where pleasure and desire are galvanized: New brain-imaging reveals that non-addicts have an adverse experience when taking a stimulant; addicts find it pleasurable. This suggests the addictable brain has impaired reward pathways: “Everyday pleasures don’t come close to the powerful reward of drugs.”
People who start drinking or drugging in adolescence: The brain has a high degree of "plasticity" until fully maturing around age 20. That means healthy reward pathways are more easily blunted, setting the stage for addiction.
People in the music business! Winehouse was a member of a community in which drugs are as common as tattoos.

In short, Amy Winehouse was dealt a bad hand as far as risk factors for addiction go. But Friedman still refuses to conclude that her case was hopeless.

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