Why Honesty About Hitchens’ Addictions Matters

Since I started reading tributes to the late Christopher Hitchens last week (such as Toby Young’s), I have been torn between the impulse not to upset anyone grieving the loss of a loved one and my own despair at what is inadvertently becoming an international public health miseducation campaign about addiction. Encouraged by Katha Pollitt‘s candor (h/t Harold Pollack), I will now allow the latter set of emotions guide my writing.

Diagnosing people you don’t know is hazardous for people in my line of work, and I therefore tend to refrain from it. But when a life is as well documented as was Hitchens’, personal knowledge isn’t necessary to determine that someone has an addiction. The accounts of Hitchens’ physical dependence on alcohol are suffused through his own writings and in those of virtually everyone else who has written about him in recent days. Much of this writing has breathed life into three myths that are not only wrong, but dangerous.

Myth #1: Christopher Hitchens could not have been an alcoholic because he was successful and hard-working.

So argues Francis Wheen, as did Hitchens himself on numerous occasions. But this is a non-sequitur. Within the limited range of my personal acquaintances have been people who in the active stage of alcoholism have filled the following roles: U.S. Senator, Member of the House of Representatives, member of the Cabinet of the President of the United States, professional athlete with a 7 figure salary, television star, Pulitzer Prize winner, CEO of a NYSE-listed corporation, police chief, high ranking military officer, nationally recognized scientist, jet airline pilot and noted thoracic surgeon (On those last two you are thinking “But surely when they were drunk they never…” I am afraid they did. Many times.).

Only a small minority of alcoholics are homeless and unemployed, and some are extraordinarily accomplished people. Many alcoholics in that latter group tell themselves and their families that they can’t have an alcohol problem; after all, just look at their high-powered job and their big income and their fancy car and yadda yadda yadda. As the “alcoholics are never professionally successful” myth is disseminated in the deluge of Hitchens’ coverage in the media right now, many people who should be seeking help are instead having their rationalizations reinforced.

Myth #2: Okay, maybe Hitchens drank to excess, but that is precisely what made him such a great writer and thinker.

People in the arts and culture line often buy into the idea that active addictions fuel creativity, and it keeps many of them from trying to change. But there is no evidence that this fear has a rational basis; indeed just the opposite may be true. Bonnie Raitt said that what gave her the courage to admit her alcohol problem and put the plug in the jug was seeing that Stevie Ray Vaughn was an even more soulful and dazzling musician in his recovery than he was when he was loaded. And for what it’s worth, all the people I alluded to above were more successful (in some cases, to their own surprise) after they stopped drinking. Of course whether Hitchens would have been more or less successful as a writer and social critic if he had sobered up is (tragically) not something any of us can know, but that uncertainty is all the more reason to stop spreading that myth that recovery from addiction will invariably sap a creative alcoholic’s mojo.

Myth #3: Hitchen’s addictions didn’t kill him.

Even though substance use contributes to about 1 in 4 deaths in the United States, it is still rare to hear people come out and say that someone they know died because of an addiction. Instead people say things like “He was in a car accident” (leaving out that he was driving drunk again) or “She died of a stroke” (omitting that it was brought on by methamphetamine use).

Andrew Sullivan was friends with Hitchens and has written movingly about him. He had the forthrightness to describe Hitchens as addicted, yet also maintains that

What killed him was not the alcohol as such or the many years of smoking, but the force of will that simply didn’t rest, and seemed to punish his body with ludicrously brutal days and nights of sleepless drive.

People said similarly romantic things when the great Amy Winehouse died, e.g., “Her heart was just too sensitive for this aching world.” But a sensitive heart no more killed that poor woman than force of will caused cells in Hitchens’ esophagus to become cancerous.

Hitchens’ prided himself on his honesty and his courage, so let’s honor his memory by facing up to the fact that his addictions to alcohol and tobacco are almost certainly why his life ended well before his time. The National Institutes of Health estimates that about 75% of esophageal cancers are caused by chronic heavy drinking. For people who are also addicted to tobacco (as Hitchens was) risk of this form of cancer is even higher than that grim statistic suggests.

Many alcoholics would like to believe that their problem in life is something — anything — other than alcohol. To wit, there is a joke among Alcoholics Anonymous members about the guy who gets drunk for the thousandth time and wrecks his car, leading him to solemnly swear off driving. When we put into cultural discourse the myth that an alcoholic’s problem really isn’t alcohol, whether we want to or not we are feeding the denial of people who need to face some unpleasant facts, including that among a thousand other risks they are greatly increasing their risk of dying from cancer.
The world has lost a unique human being to addiction. Let’s not avoid that sad reality and lose even more people in the process.

Author: Keith Humphreys

Keith Humphreys is the Esther Ting Memorial Professor of Psychiatry at Stanford University and an Honorary Professor of Psychiatry at Kings College London. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans, drugs, crime and correctional systems. Professor Humphreys' over 300 scholarly articles, monographs and books have been cited over thirteen thousand times by scientific colleagues. He is a regular contributor to Washington Post and has also written for the New York Times, Wall Street Journal, Washington Monthly, San Francisco Chronicle, The Guardian (UK), The Telegraph (UK), Times Higher Education (UK), Crossbow (UK) and other media outlets.

27 thoughts on “Why Honesty About Hitchens’ Addictions Matters”

  1. Thank you for pointing out what should be obvious, but thanks to both denial and advertising dollars is not. Your three myths are spot on. Alcohol abusers generally haven’t a clue about how much pain they cause those around them, seeing anyone who wants to stop them from having their deathly “fun” as uptight party-poopers.

    The pervasive messages about alcohol in every medium are positive ones, extolling flavor, and status, and glamour, and fun, and excitement, and sociability. Everywhere you look, alcohol positively sparkles! Crediting alcohol for the creativity of artists and writers is the worst sort of mendacity, and all too common.

    Unlike tobacco, alcohol has no major advertising campaign detailing the realities of alcohol and its effects on the mind, the body, and society. The closest would be the MADD ads, but what we need is to actively de-glamourize its use. Instead of gorgeous, gowned models tipping back their martinis, we need images of habitual drunks, staggering and drooling and fighting and retching on the floors of dirty restrooms. We need images of drunks veering down the highways, killing innocent people, and then in the dock being sentenced for murder. We need images of long-term drunks, with yellowing eyes and the glassy stare of cerebral edema.

    We need the images of lovely holiday dinners shattered by the excess drinking of one family member, the terror in the eyes of children when a parent is drinking. We need to hear the stories of families who have tried to rescue their kin from the street when drinking has resulted in homelessness and all the person wants is that next drink. We need all of these images, and more, lurking everywhere, on billboards and in magazines, on the sides of buses, on television and in movies and in newspapers.

    To those who think their wit and that of their friends becomes lightheartedly scintillating after downing a few drinks, I have this suggestion: go to one of these soirees stone cold sober, and just listen to the rank stupidity that passes as levity as the evening wears on. Sure made a teetotaler out of me! Or, maybe it was watching over decades what alcoholism has done to some friends and family–there’s nothing more sobering than having to ask the police to break down a sibling’s front door to interrupt a suicide-in-progress.

  2. We ought to be clear that, although Hitchens was a reasonably talented writer of vitriol, he showed little or no capacity for original thought, had a prose style distinguished largely by self-righteous belligerence, and is unlikely to be remembered as anything other than a minor celebrity who made some very poor judgment calls. Let’s not reduce the status of genuinely great writers by giving Hitchens an accolade which he did not deserve.

  3. If it’s possible to manage a career as a Senator/CEO/surgeon while actively addicted to booze, what does that say about those professions? Is it really the case that “most people use only 10% of their brain capacity”, so they can afford to waste the other 90% on alcohol? Or did these people start their career trajectories while sober and then figure out how to coast on the reputation and connections they built up in their early years?

    1. what does that say about those professions?

      Absolutely nothing, that is the point. Every profession, trade, line of work call it what you will has people in it with alcohol problems (including people who had them long before they got successful — if you want to see some heavy substance use, hang around medical students).

  4. There’s a myth in general that writers and artists have to have demons to be “truly creative”. Doesn’t matter whether it’s addiction, some terrible handicap, mental illness, miserable circumstances. That myth makes sense in the face of the fact that for almost everyone else making a living involves acting against everything they want to be doing…

    1. “That myth makes sense in the face of the fact that for almost everyone else making a living involves acting against everything they want to be doing…”
      I may be misreading you, but I don’t think this is fair. The artists I’ve known have had to be quite brave in sacrificing much for their art. Most have given up on careers or stability in the hope that what they must believe is a talent will turn into something beautiful and successful. As more of an art-hobbyist myself, I feel like I truly appreciate the courage it must take to roll the dice like that. I was much too afraid of failure to make more of myself through my art. After all, you could spend decades working minimum wage jobs, scrimping and saving, just to support an art that most artists can only doubt is something great. And what then, if you fail? You’re nearly forty years old and have little to show for your life but a handful of poorly received gallery shows, one or two quietly successful record albums known only to a handful of faithful fans, a publishing deal that you felt never got the media attention it deserved, etc. Many artists are indeed “tortured”, but sacrificing so much for your art can also be torturous. It shouldn’t be seen as indulgent, but rather a noble endeavor.

      1. Eli: I think you are misreading, and it’s my fault. When I said “that myth makes sense” I meant “that myth is understandable”. Because if an artist (or for that matter an engineer or a scientist) somewhere is happily doing the thing they love to do, and getting paid decently for it, that’s an implicit indictment of the system that forces so many others to do work they don’t believe in (or even believe in the opposite of) under conditions that are dangerous, abusive, or merely stultifying. So we like to believe that artists are broken in some way, either by addiction or personality flaws or poverty or whatever.

  5. Whether it’s alcohol or some other drug of choice, I have noticed that one’s drug-induced feeling of power and insight is inversely proportional to the reality of the situation nearly 100% of the time, which is to say, the smarter a drunk feels, the stupider he actually gets. It doesn’t really matter what the drug is. I watched my sister when we were both in high school say and do the stupidest things under the influence of speed and hallucinogens when she thought she was an invincible genius, and vowed never to be like her.

    Yes, of course smoking and alcohol contribute to cancer. Please don’t tell me we are now going to deny this because a smart author died of cancer, sort of how some people now think that Steve Jobs odds of beating cancer could not possibly have been affected by his decision to delay surgery. It doesn’t take a lot of statistical literacy to know that just because you can’t prove that alcohol contributed to a single person’s cancer that doesn’t mean that epidemiological studies have failed to prove that alcohohol abuse is clearly causing lots of cancers.

  6. I thought this when I saw a quote of his: “Writing is what’s important to me, and anything that helps me do that — or enhances and prolongs and deepens and sometimes intensifies argument and conversation — is worth it to me.” An alcoholic’s excuse to keep drinking.

  7. Keith, was there anything you could do with respect to the surgeon or the pilot? (I wish that you hadn’t told us that.)

    1. They are both securely in recovery after having been through their respective industries management programs (a mixture of treatment and long term monitoring with regular testing).

      The pilot is retired and it would be harder today to have the problem he did for as long as he did without getting caught because they are tested more often and because social attitudes around drinking are different.

      But, on a less reassuring note, repeated studies have shown that the addiction rate among physicians today is the same or slightly higher than the general population.

      1. Continuing on the less reassuring note, I don’t suppose that surgeons would put up with the sort of regular testing that pilots must. There ought to be a way for a nurse in the operating room to prevent the operation if the surgeon is intoxicated, and not face retaliation, even if he or she misjudged the surgeon’s condition.

      2. One of the stats that used to be true (don’t know if it still is) that the most common sign of relapse among physicians with access to really interesting drugs was sudden death. I hope the monitoring has gotten better.

  8. I agree with almost all of this. The one thing I disagree with is your argument that the alcoholic’s problem is purely alcohol.

    I’ve known some people with addictive personalities. I myself have a bit of one – not so bad I’ve gone off the rails, but it’s there. I latch on to things and get really enthusiastic about them. Too enthusiastic. This is true whether it’s red wine, a series of books or a computer game. I can take both of those things too far – a glass or two too many, read/playing until 2am on a work night…

    In a world w/o alcohol, I think Hitch would’ve been addicted to some other substance (well, he was, tobacco. Ok, yet another one. You know what I mean).

    None of this detracts from your main point, which is correct.

  9. Ordinarily I would not bother to respond, but one assertion in your post is incorrect, and potentially hurtful. There are two forms of esophageal cancer, and in only one of them is drinking and smoking a factor. The other form is mostly caused by reflux, and is the form my husband has recently had surgery for. Quite a few people have asked me if he is a smoker – so far no one has suggested that he must be a heavy drinker. He is neither. There is a well known tendency for people to want to find a cause of a devastating disease so they can feel that they themselves are immune. Thanks. I read your blog daily and enjoy it very much.

    1. Hi Marilee: Thanks for reading and for making this point about non-squamous cell esophogeal cancer (adenocarcinoma), for which the link to alcohol and smoking is much weaker (though not non-existent) compared to the squamous cell cancer that claimed Hitchens’ life. Please accept my best wishes to you and your husband.

      1. My friends’ late cat had squamous cell cancer under her tongue. I’m pretty sure she neither drank nor smoked.

  10. Thanks, Keith. Yet again, you gently point out that the emperor appears to be, er– wearing fewer items of clothing than one might expect, while the rest of us are glancing to the left and right, and figuring there must be something wrong with our vision.

    Readers, don’t panic about drunk surgeons. Hospitals and the medical profession in general have come a long way. It is actually the case that a nurse (or any hospital employee, including the housekeeper) may pick up the phone and report that Dr. So-and-so appears to be under the influence. Unfortunately, the entire subject is so stigmatized that most of us are reluctant to report that a colleague seems off the beam. Despite everything I know, I made the same mistake myself. I gave a grand rounds presentation at a community hospital and noticed that the doctor who introduced me smelled a little boozy at 9 a.m., and his fly was down. I was entirely ready to question my own judgment. Only as I drove home did I think, “holy @#$%, what if he was seeing patients!” Until then, I had simply fallen prey to the conventional thinking that it would have been a vicious and horrible thing to subject the poor man to scrutiny that may have proved me wrong.

    The lesson is that we have to practice what to do before the need arises. I sincerely hope that hospitals train all employees in when to take action, and how to do it. Lesson #1 ought to be “err on the side of caution.”

  11. This is worth reading in the interest of dispelling the myths about alcohol abuse and the good life. There are many books and articles about the romance of moving to France and writing the great novel or rebuilding that stone farmhouse. This is a good antidote to the fantasies of sitting in a Paris bistro downing bottles of white wine and conversing wittily in two or three languages. It doesn’t always work out that way and there are darker and, in my opinion, better stories to be told for those who might be interested in something a little more reality-based.

    Falling Down

    A Bipolar Drunk on the Streets of Paris

  12. When discussing Hitchens’ alcoholism, I think it’s important to make a distinction between different types of alcoholics. The reason why many people don’t believe he was an alcoholic (aside from his output and success) is because he never made a total fool of himself in public. In other words, he could hold his liquor. He drank a lot but didn’t seem so drunk to people. He was the sort of drinker who drank every day but rarely or never to the point where he was blacked out drunk or passing out. He wasn’t a binge drinker.

  13. I think you are confusing drinking/drug use with being an addict. Chronic use of large quantities does not contribute to creativity, and the last story I read about Hitch said he consumed a liter and a half of Johnny Black in one evening – and we don’t know what he had during that day. Many artists find their creative abilities improve tremendously after getting sober. Imagine Hitch’s untapped potential.

  14. There are so many myths about addictions, and the ones you mention here are all valid and should be recognized.

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