Behind the Addict Door: HBO Project Takes a Humanistic Approach to Understanding Substance Abuse

A hurried gurney leads the way, as we begin our education following an anonymous patient with a severe head wound into a hectic, yet hushed Dallas emergency room on a Saturday night. Briskly, we scan from sprained ankle to stab wound to hopeless resuscitation effort. While we may be jarred by the fleeting glimpse of a bloody gash, the real shocks are delivered in interstitials such as the one informing us that half of the 30,000 injury-related visits to this ER each year involve drugs or alcohol.

"Addiction is one of the most expensive diseases that we face in modern society," Dr. Larry Gentilello, chief surgeon of the trauma unit, informs us as he supervises his team's effort to save a life.

"That's just so Jon Alpert--in the middle of the action," enthuses producer Susan Froemke.

With this opening call-to-attention, video journalism pioneer Alpert startles us, while allowing Dr. Gentilello to set the sobering, troubled, empirical and compassionate tone that resonates throughout the other eight segments of HBO's robustly informative Addiction, an omnibus film project and the centerpiece of a massive multimedia campaign to raise awareness about the latest advances in the understanding of addiction and recovery.

The nine veteran directors chosen for the project were given no stylistic guidelines, although they were conscious of the HBO style of vérité and all were given an exhaustive "content bible" before shooting began. There is a remarkable cohesiveness to the final film, yet, as Froemke states, "Each of the segments is very reflective of its director's style. The second segment, for instance: the scene in the car is very Albert."

Froemke is referring to her mentor, the legendary Albert Maysles, another of the nine master storytellers, each of whom, at the invitation of executive producer Sheila Nevins and producer John Hoffman, contributed ten-minute segments as well as many of the project's 13 supplemental programs. Addiction airs on HBO March 15. The supplemental programs--which include informational segments on addiction, relapse, treatment, legal ramifications and options; interviews with experts on brain disease, alcoholism and substance dependence; and a complete version of "A Mother's Desperation," one of the segments in the centerpiece film--will air later in March on HBO On Demand, HBO Multiplex Channels, HBO Broadband and other new media channels.

Froemke and Maysles collaborated on "A Mother's Desperation," in which the aforementioned scene patiently captures the tenderness and exasperation of a mother driving her runaway, heroin-addicted daughter home after having her arrested.

"I could run a rehab," pronounces Aubrey, the strung-out, 23-year-old all-American blonde. She betrays hints of surprise, confusion and long-lost confidence in her bleary eyes as she gazes out the window at her middle-class neighborhood. Aubrey has been in and out of rehab 12 times in the last seven years.

Make no mistake: Addiction isn't Reefer Madness, or even Traffic, for that matter. The project strives to be a reasonable, humanistic antidote to all the hyperbole, histrionics, sensationalism and propaganda that so often clouds and stigmatizes these sensitive, obstinate issues. There is no mention of the drug war, and little attention is paid to the justice system. This is an encyclopedic public service announcement about a medical disorder with medical solutions.

"One of the most important things we wanted people to take away was that addiction is a brain disease--a chronic, relapsing brain disease," Hoffman maintains. "We knew we wanted to tell these stories, as much as possible, in the 'HBO style' of vérité filmmaking, but it was a bit of a challenge to say, 'Can we make a show that we know will have talking heads atypical of HBO, but still maintain our documentary personality?' That was how we arrived at the decision to work with the best storytellers in the business."

As with HBO's last public health program, Cancer: Evolution to Revolution (1999), the inspiration for Addiction came from within the company. "We took this on because we've been affected by it and we're comfortable saying so," states Hoffman. "We've all been affected by addiction, whether through our experience, our family or friends," Froemke adds. And, indeed, one of the supplemental films informs us that over 40 percent of Americans say that a family member's addiction to drugs or alcohol has impacted their lives. "We think that it's really just good corporate citizenship to give back to our subscribers, to communicate about issues that people often find confusing," Hoffman explains.

To tackle the subject of the chemical hijacking of the brain's dopamine pathways, HBO partnered with the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, as well as the Robert Wood Johnson Foundation, which funded the 13 supplemental programs. The project also includes a forthcoming companion book, a bountiful website, a variety of other partnerships with nonprofits and media outlets, and four addiction-themed independent films that will air in March on HBO2. These films include Cracked Not Broken (Paul Perrier, dir./prod.), Montana Meth (a series of PSAs produced by Venables Bell and Partners for the nonprofit Montana Meth Project); TV Junkie (Matt Radecki, dir.; Michael Cain, dir./prod.; Fred Bodner, Gregory Lanesey, Jeff Schedfel, Amanda Stern, prods.), and A Revolving Door (Marilyn Braverman, dir.; Chuck Braverman, prod.).

Each of the nine short films cuts a new facet onto this mammoth, often opaque and thorny issue, interviewing experts and following addicts as they fight their latest battles with the disease and seek a way through the labyrinthine recovery process.

Eugene Jarecki (Why We Fight) teams with Froemke to get us up to speed on the intro-level neurology of addiction in "The Science of Relapse." One of the film's most compelling subjects, William, points at the impoverished neighborhood that surrounds him. "This is the trigger," he says. "All of this around me." Pointing to his head, he adds, "The trigger is not only up here. The trigger is when I walk out, open my eyes, and see what I see." The neurologist conducting the trial in which William is participating says that the hope for the future "is medication and behavioral treatments that can combine to literally reset the brain."

For their segment, Kate Davis and David Heilbroner (Pucker Up) spend quality time with a teenage boy and his frustrated family as they persist with therapy and treatment. The adolescent in this case is suffering from a complex of behavioral disorders that are common in teen addicts: cutting, anxiety, depression and rage episodes. We are informed that only one in ten teen addicts receive treatment for the disease.

Liz Garbus and Rory Kennedy (Ghosts of Abu Ghraib) take us near the forefront of brain imaging research as it reveals the ambivalence and self-deception of a lifelong drug abuser. "I started with the meth to get me off the coke," the patient states plainly about his ten-year addiction to methamphetamine. After being shown images of his damaged brain juxtaposed with an image of a healthy brain, the 43-year-old is asked, "Do you feel concerned about the images of your brain?" He responds, "Not really...Whether they can really tell or whether they're fudging the picture, I don't know."

DA Pennebaker and Chris Hegedus (The War Room) follow a young couple as they enter treatment in Maine for opiate addiction; Maine is the most opiate-addicted state in the country. Both of the mild-mannered, 20-something subjects struggle to afford the medication they need to get through Post Acute Withdrawal Syndrome. "But that's just a fancy word for feeling like shit for days, weeks, months on end," their treatment specialist relates. "That's why 90 percent of people who don't use replacement therapy relapse." He says that the biggest problem his patients face is affording the medication.

Alan Raymond (I Am a Promise) follows the separate journeys of two Virginia men--one aging, one emerging--as they participate in a clinical trial for Topiramate, a drug designed to reduce an alcoholic's craving during withdrawal. "My drinkin's killin' me," says the elder man. "I desperately need help." Both of the men find that the drug facilitates their transition into sobriety. The younger man states, guitar in hand, that the "depression lifted and I started listening to Beethoven. I started to feel like I could write music."

Barbara Kopple (Harlan County, USA) treads familiar ground from a new perspective in Steamfitters Local Union 638, in which some of Boston's hardest working, hardest drinking manual laborers struggle to change their ways, achieving inspiring success with an in-house treatment program that proudly refuses the involvement of insurance companies.

"We started looking at the stories that we wanted to focus on and matching the most suited [filmmakers]," recalls Hoffman. "Steamfitters to Barbara Kopple--you can't get better than that."

In the final segment, Froemke captures the scene of anguished, determined mothers providing vivid, articulate and heart-wrenching testimony before the Pennsylvania State Senate about their tragic experiences at the hands of the managed care system and stingy insurance companies that turn a blind eye to addiction issues. One mother testifies that her daughter was released from a treatment facility long before the agreed upon date because the insurance company refused to cover the cost. Shortly thereafter, she found herself giving her daughter CPR, but it was too late.

With this somber note, HBO punctuates an unmistakable message to the whole of American society. To the government, the medical community, the insurance companies, the families and all of those suffering addictions, the message is clear: Our ignorance is killing us.

"There is a propensity for addiction in our culture," Hoffman notes. "It will always be there, whether people are using legal or illegal substances. What needs to change is how we deal with it."

But we must never forget the unending reality of those who are addicted. One of the film's recovering addicts puts it best: "Even though I lived through it, I still don't understand it."

Taylor Segrest is a writer and filmmaker living in Los Angeles.