DRUGS: A DECISION, NOT A DISEASE

Robert Downey Jr. is in trouble again. Los Angeles police took him into
custody this week for public intoxication, the latest arrest in a long
series of legal problems dating back to 1996 when he was charged with
heroin, cocaine and weapons possession.

While sympathy for the actor may be wearing thin -- his "Ally McBeal"
producer is said to be "furious" -- there remains profound hand-wringing
over what to do now. Should he be treated for his addiction? Should he go
to jail? Do we hold him accountable? And if so, how?

A week from today, a judge will decide whether Mr. Downey goes to prison
(again) or to a treatment program (again). Good arguments, I think, can be
made for either.

Predictably, Mr. Downey is being used as a poster boy for the failure of
our drug policies. "A perfect face of the war on drugs," lamented
Washington Post columnist Richard Cohen. "A target and victim in the war on
drugs," opined Ethan Nadelmann in the New York Times. Yet the actor has
been given chance after chance in treatment programs.

More troubling to me, as a psychiatrist, is that the Downey case is being
cited by my colleagues as proof that people who abuse drugs are incapable
of self-control. Mr. Downey, they claim, is an example of how relapses to
drugs are "inevitable," and how addicts are at the mercy of their brain
chemistry and genetics. "When you're hooked on something it changes your
brain," says former Health and Human Services Secretary Joseph Califano.
The changes "make you compulsive about the drug," declares Alan Leshner,
the head of the National Institute on Drug Abuse.

Yes, it's true that an addict in the midst of a cocaine binge or heroin
withdrawal is in thrall to a neurobiological storm. But addicts rarely
spend all their time in that state. Typically, hours and days are spent in
relative lucidity, the addict making all kinds of decisions -- some
rational, some stupid -- even if brain function isn't completely back to
normal.

In Mr. Downey's situation, some of his most fateful decisions were made
while sober. From August 1999 to August 2000 he was drug-free, living in a
rehab program within the Corcoran State Prison. Once released he attended
outpatient drug treatment for two months and passed regular urine tests. By
November, he started using cocaine again. It was a conscious decision. "I
don't discount the fact that addiction or alcoholism is a disease. But I
still feel that, at every turn, I was choosing to keep going with it," he
told Playboy.

The actor, in fact, made a lot of choices over the years that culminated in
this week's events. In 1996 he walked out of a treatment center and started
using again. In 1997 he skipped urine drug tests ordered by his probation
officer, went to jail for about four months, and then started using again.
In 1999 he again missed urine tests. That time, Malibu, Calif., Municipal
Judge Lawrence Mira gave him back-to-back sentences on the 1996 charges for
drugs and weapons.

And what Mr. Downey did each time he emerged from detox, from a treatment
center or from incarceration, was to violate a key rule of staying sober:
He plunged headlong into the tumult of Hollywood. He went straight back to
the infamous triad of "people, places and things" associated with his old
lifestyle.

Pavlov himself couldn't have designed a better system for inducing relapse.
Some addicts actually move out of their old neighborhood as part of their
recovery plan. I know of a former investment banker who had to leave Wall
Street, literally, to avoid the pressure and cues (people he used with,
places he bought drugs) before he could finally quit.

An addict new to recovery may not appreciate the vulnerability that comes
with returning to an old environment, but after going through this cycle so
many times, how could Mr. Downey not know? Yet within 48 hours of his
release in August, the actor was negotiating with his Hollywood agents. He
was on the set of "Ally McBeal" within two days of posting bail in Palm
Springs, Calif., on Nov. 27.

Mr. Downey had a responsibility to learn from experience. It was his job to
understand that reimmersion in Hollywood was too risky a proposition.
Hollywood is, after all, a culture of exceptionalism. People want to be, or
think they are, the most beautiful, most talented, most in demand. Stars
are cut slack when they enhance ratings and win Golden Globes (both of
which Mr. Downey did for "Ally McBeal"). They are adored, they feel
invincible. After a while they must question whether the rules also apply
to them.

Mr. Downey is a supremely talented but deeply troubled man. What moves him
to cheat authority, to knowingly imperil his own life? A few years ago he
told Judge Mira, "It's like I've got a shotgun in my mouth with my finger
on the trigger and I like the taste of gunmetal." Does his artistic
creativity thrive on this chaos? Granted, his childhood was complicated --
he was raised by a father who had his own drug problems, and who gave Mr.
Downey a joint when he was just six years old -- but we can't confuse
explanations with excuses.

We must not make Robert Downey Jr. into a symbol of anything larger than
himself. He is not an icon of a botched war on drugs; he is not evidence of
the failure of criminal sanctions; his situation shouldn't be used to argue
against the virtues of drug treatment.

In a few days Mr. Downey may be sent to prison or to treatment. When he
gets out, he'll need to make choices. If he turns to drugs again, that will
be his decision, not his disease.