Baltimore Colts Owner Jim Irsay – Too Rich To Need Help?

This story found me in the headlines: “Colts’ Jim Irsay discusses addiction.” I had never heard of and would not have been able to cite the name of the owner of the Baltimore Colts. I certainly am no fan of professional football.  I have reviewed recent problems in other posts. It seems to me that football — seemingly more than other sports — breaks brains, heads, bones and lives and may foster drug addiction to boot. I might be alone in the U.S.A. in believing that professional football is so dangerous it should be strictly illegal for humans and should be played by some kind of android robots. I gathered from the interview of the owner of the Baltimore Colts that he seems to be in enough trouble from substance abuse to be awaiting sanctions from the NFL. I find worthy of (serious professional level) comment the statements about addiction which have been made by Mr. Irsay, as well as the discussion and response from the public. My primary interest is in trying to locate — as well as tell — the truth. Yes, alcoholism and addiction are real diseases. As far as I am concerned, anything that messes up the function of human beings is certainly a disease and substance abuse sure fits the bill. It is listed in every classification of human disease known to me. Yes, they are “stigmatized.”  People do really seem to think less of people who battle this kind of problem. It is, however, more than a little different from bipolar illness or depression. Addiction involves the use (and/or misuse) of substances that are sanctioned by society.  From a wedding toast, obviously with alcohol, to the high school or college guys getting together to try anything from marijuana to souped-up versions of cocaine, we have something that is looked at like a “normal” life experience or even a rite of passage. As long as society treats alcohol and drugs that way–and it has done so for thousands of years–it will be difficult to tell when someone has compromised the quality of his or her life enough to tell if this qualifies as a problem. There will always be some kind of a process, whether it is the “intervention” consecrated by substance abuse treatment programs or the process of medical diagnosis, to assess when someone has crossed the line. It is destined to be met with anger and opposition most of the time, because it involves what can feel to the patient like an assault. It is pretty tough not to become defensive.  Such situations always run the danger of escalating in anger and blame. This in no way disputes the status of alcohol and drug addiction as “real” diseases. As of right now, there is absolutely no objective lab test that can “prove” somebody is an alcoholic or an addict. You can observe behavior. You can locate the substance in the body with a test of blood or urine.  You can, however, suspect and measure and even try to medically repair whatever harm has already been done to their body. People are born with different genes.  People produce in their bodies different amounts of different kinds of proteins for their metabolism. There are certain patterns of DNA (deoxyribonucleic acid, the material that makes up chromosomes and transmits hereditary information) that are characteristic of bipolar illness.  I have never, ever heard of anybody use such testing to make the diagnosis. You tell what is going on “clinically,” by talking to the patient (and relatives, often) and getting their story. As for depression, there are more theories (and more real facts and data) about what causes it than I can count.  No lab test can help much, except to rule out other illnesses that can cause depression, with diabetes and thyroid disease probably being the most common. It can even be a medication side effect. Depression and bipolar illness and substance abuse problems can and often do co-occur. As a matter of fact, the estimates I have seen suggest about 60% of bipolars have substance abuse problems before anybody figures out they are bipolar. It is pretty different from leukemia.  A doctor can get the story, and can (and should) do a physical examination, but the diagnosis is made and confirmed with a blood test.  It is “objective.”  The diagnosis becomes something that any doctor could confirm from the lab test, without even seeing the patient. Although people are always looking for “objective” markers for psychiatric illness, they remain scarce and often not specific.  So the bottom line is that behavior and interview, “clinical” factors, make the diagnosis. When people have both a substance abuse problem and another psychiatric (underlying) diagnosis at the same time, the situation is called one of “dual diagnosis.”  to my personal understanding, this simply is an artifact of our diagnostic (and treatment) system. (I tell this to hurting patients all the time.) If someone is anxious (or manicky or has pretty much any sort of psychological symptoms, really) they are highly unlikely to look in the phone book for the nearest psychopharmacologist and telephone asking “Hello Sir or Madam, would you please adjust my brain chemistry?”  They are going to go out with the guys (or gals) and imbibe or otherwise assimilate the substance that group uses. This substance may alleviate some symptoms. They call it “self-medicating.” No, nobody is going to take blood samples (and certainly not samples from a living brain) to research what is going on each step of the way.  But it sure seems to me that people have different brain chemistries and sooner or later, end up in some kind of a search for the elusive “feeling normal.” I especially like to use the term “self-medicating” with patients because it tends to alleviate feelings of guilt for past actions.  A fair amount of people get stuck in past guilt. I do not want to judge people.  I do not want to let them get stuck in guilt for past actions, or to let those feelings get in the way of present treatment. As far as I am concerned, treatment for my patients always includes attaining sobriety from the substance(s) in question, as well as dealing with the appropriate medical treatment for the underlying illness.  Some patients do not like or want to go through the substance abuse part of treatment, believing it not to be helpful.  I feel this decision sometimes looks very seductive because the stigma associated with the substance abuse problem is usually far greater (even) than any stigma associated with the underlying illness.  Still, the substance abuse problem seems to have had a reason for being, often denying or at least avoiding some pretty strong feelings. It simply is not something to sidestep and avoid completely. The first comments on the ESPN page cited initially as part of this essay reference the fact that the person talking about substance abuse here, Mr. Irsay, is a wealthy and powerful man. His story may indeed have been different if he were a simple “working man,” perhaps dealing with criminal charges, unable to afford high-quality legal representation. Neither wealth nor any entities related to social class or education protects from substance abuse.  It is no less real a problem for the perceived elite. Nevertheless, I have spent a lot of time treating the indigent, not to mention the incarcerated. I have diagnosed underlying mental illness in criminals incarcerated on drug charges. I cannot pretend that life is “fair,” nor can I pretend that Mr. Irsay is dealing with the same level of financial and (perhaps consequent) psychosocial problems as the indigent. As for substance abuse problems, Mr. Irsay seems to have quite an impressive history. This gentleman seems to have had a (pardon the pun) “major league” prescription drug problem. Me, I think that wealth and privilege may actually serve as a sort of insulator to protect people from adequate diagnosis and treatment. I remember all the tales about what Howard Hughes was really like.  I especially remember vividly the scene in the movie “The Aviator” where he was played by Leonardo di Caprio and was lining up his collection of bottles of his own urine.  This was actually a fairly nauseating depiction of obsessive-compulsive disorder, which can admittedly present some challenges in the more severe cases. I remember thinking when I saw that scene: “Good God, I would never let any of my patients get that sick!” As I look back, that thought may not have been exactly accurate. Of course, I would have tried at the very least to send someone to the house and fix this wildly dysfunctional behavior. Maybe, just maybe, a patient like that would have enough other things going on to merit involuntary commitment.  Maybe I would even send the cops (or their designates) for a “health check.” But the first part of the truth is that I simply never had patients who could afford to pay other people to go to extraordinary lengths to put up with them, the way it seems that Howard Hughes did. Oy! A long time ago President Kennedy made sure that every county in these United States had some kind of mental health services.  Now, those that can’t afford them (at least in California) seem to contract with a nearby county, or private providers. If you are wondering if life is rotten, just go find help. From a pro. Even if you are smart and rich.