Philip Seymour Hoffman’s and Cory Montieth’s Death From Heroin: Why?

Philip Seymour Hoffman, the great actor, was found dead a few days ago with a needle in his arm. Last year, Cory Montieth, the actor, died in similar circumstances. Why did they die? It was hardly the first time they’d taken heroin.

Starting in the 1970s, Shepard Siegel, a psychology professor at McMaster University, did a series of rat experiments that showed that drug tolerance and craving involved a large amount of Pavlovian conditioning. Repeated exposure (e.g., injection) of Drug X in Situation Y (e.g., your bedroom at 11 p.m.) will cause learning of an association between X and Y. This association has two effects. First, when exposed to Y, you will crave X. Second, when you take Drug X in Situation Y, the effect of the drug is diminished. You become “tolerant” to it.

You have probably experienced both effects — they occur with caffeine, chocolate and alcohol, for example — but are unaware of Siegel’s explanation: Situation-drug associations. After you learn the association, Siegel said, the situation generates a response in your body that opposes (reduces) the drug effect. If the drug makes you less sensitive to pain, the conditioned response is more pain sensitivity. If the drug makes you awake, the conditioned response makes you sleepy. It’s easy to realize that drug craving involves associative learning: You notice that you crave coffee or whatever in familiar situations but not unfamiliar ones. You crave Drug X at college but not at home. It’s much harder to grasp that the tolerance involves associative learning.

Drug users, such as Hoffman and Montieth, as they become “tolerant”, take larger and larger doses, not realizing that their “tolerance” depends on a learned association. The situation becomes more and more dangerous because if you take the drug without eliciting the conditioned compensatory response, you may die. Without the conditioned response, a drug amount you survived yesterday may kill you today.

Siegel explored the possibility that this actually happened — that drug addicts died of “drug overdose” because they took the drug under unusual circumstances that didn’t evoke the compensatory response. He found plenty of support for this idea. One sort of support was interviews with “overdose” survivors. They often described unfamiliar circumstances at the time of the injection — e.g., there’s usually music, but this time there wasn’t. Another sort of support was a rat experiment with heroin. After developing tolerance to heroin, rats injected with a really large dose in a strange situation were much more likely to die than rats injected with the same dose in the same situation where they became tolerant.

I am pretty sure Hoffman and Montieth didn’t know about this research. There is a connection with the Shangri-La Diet. In both cases, Pavlovian learning has a big effect on something we care a lot about (life/death in the drug case, body weight in the diet case) and this connection is highly non-obvious.

31 Responses to “Philip Seymour Hoffman’s and Cory Montieth’s Death From Heroin: Why?”

  1. Xav Says:

    I was thinking about your ideas from the Shangri La Diet earlier today.

    I was wondering if the fact that so many hygiene related products have food related scents added in affects appetite in the general population as we are constantly exposed to smells associated with food.

    Just this morning I counted orange (in shower gel), various fruit smells (in handwash), lemon (in washing up liquid), and cocoa and vanilla ( in perfumes of people I passed in the street).

  2. CC Says:

    This might be a dumb question, but does this mean we should mix up the “situations” in which we take ELOO? Don’t do it in the same room at the same time each day?

    Seth: No, because learned CS-US associations when the US is a food (rather than a drug, such as caffeine) seem to involve purely CS’s that are smells. There is association with the smell of the food but not the place where you ate it. It is when the US is a drug that you get associative learning where the CS is a situation, such as a place and/or time of day.

  3. Alex Blackwood Says:

    Another factor: when you are taking a street drug the purity and strength are not predictable. There is speculation about whether PSH’s overdose was linked to heroin mixed with fentanyl–no worthwhile sources to cite, since it’s all speculation at this point. But the variability in how much drug you are actually getting and what adulterants are enhancing the effect may be adding a variable schedule of rewards, a powerful reinforcer, to the addiction situation.

  4. Gina Says:

    They both recently went to rehab. Overdoses following rehab (e.g. Amy Winehouse) are common. Rehabs are not interested in teaching people how to be safe when they relapse, even though they know how likely people are to relapse, so there’s no way they would be told about Siegel’s research or any other information that could be useful in saving their lives.

  5. Joe Says:

    I’m with Alex. I think it was a “hot shot.” Something added to the heroin, or maybe a far more pure (stronger) heroin.

    He had (apparently) injected the heroin in a familiar setting, so any conditioned response should have been present.

    Sad story. He was a hell of an actor.

    Seth: If he was exposed to the familiar situation many times without exposure to the drug, the familiar situation-drug association may have gone away — been “extinguished” to use the technical term.

  6. Al Says:

    You wrote: “After developing tolerance to heroin, rats injected with a really large dose in a strange situation were much more likely to die than rats injected with the same dose in the same situation where they became tolerant.”

    But, what about comparing rats injected with the same dose in a strange situation to rats injected with the same dose in the same situation? How does that comparison work out?

    Seth: by “injected with the same dose” I meant injected with the same really large dose.

  7. Adam Says:

    Al, I think “same dose” in that paragraph is referring to the same _large_ dose, not the dose they were previously treated with.

  8. eric Says:

    Real cause of death is the fact that they were obliged to purchase their drug of choice on the black market, which practically by definition includes unknown dosage and ingredients. If addicts were (not criminalized and) permitted to purchase heroin by prescription at pharmacies, there would be close to zero deaths from overdose. Almost all heroin deaths in the USA are directly attributable to the US government, which makes its sale and possession a crime. Ergo like anything illegal that is in demand, a black market springs up with questionable quality in its goods.

  9. Seth Roberts Says:

    “If addicts were (not criminalized and) permitted to purchase heroin by prescription at pharmacies, there would be close to zero deaths from overdose.”

    What about the work I describe, which suggests this is wrong?

  10. kayvee Says:

    HI Seth

    I found your blog through your presentation at PaleoCon

    Your ideas were fascinating and I find your writing the same

    I have an odd question:

    What do you think of Ayahuasca tea and Iboga.

    They are used as a means to heal past traumas
    that is believed to be the cause of addictions?

  11. kayvee Says:

    To add:

    http://www.ibogaine-therapy.net/index0a14.html?PAGE=40

  12. Al Says:

    I read it wrong. Thank you for the clarification.

  13. Joe Says:

    Seth: “If he was exposed to the familiar situation many times without exposure to the drug, the familiar situation-drug association may have gone away — been “extinguished” to use the technical term.”

    Seth, from all reports, he’s been exposed to the situation AND to the drugs, for quite some time. I don’t think anything was ever truly extinguished. Nor do I think he was ever “dry” for 22 years.

    Until more information develops that could change my mind, I’m sticking with Occam’s Razor: He died of a “hot shot.”

    Nota bene: I raised and trained field-trial retrievers for many years. I used the principles of classical AND operant conditioning in training. But certain dogs just didn’t respond in the anticipated way. E.g., the same principle that would work so well on dog A wouldn’t work at all on dog B. Behaviorism is a great guideline for training dogs (or as learning theory per se), but it’s riddled with exceptions. Hoffman could be an example of such.

  14. Joe Says:

    New developments regarding Hoffman:

    “I was Philip Seymour Hoffman’s gay lover and saw him freebasing cocaine the night before he died’, says writer who found his body”

    http://www.dailymail.co.uk/news/article-2552207/I-Philip-Seymour-Hoffmans-gay-lover-I-saw-freebasing-cocaine-night-died-says-Manhattan-writer-star-body.html

    I don’t think anyone is ever going to untangle this man’s psychological turmoil.

  15. Nancy Lebovitz Says:

    How stressful do rats find strange situations? They’re just put into a strange situation, and this might be different from a human who’s gone somewhere they want to go.

  16. Seth Roberts Says:

    “How stressful do rats find strange situations? They’re just put into a strange situation, and this might be different from a human who’s gone somewhere they want to go.”

    The rat experiments equated novelty of the injection situation between the two groups. Both groups were injected with a very large dose in a situation with which they were equally familiar. In other words, the injection situation was equally “strange” for the two groups.

  17. Alex Chernavsky Says:

    Psychologist Stanton Peele argues that heroin overdoses, as such, are rare. He claims that overdoses are usually caused by mixing heroin with other drugs. It’s an interesting article.

  18. Alex Blackwood Says:

    Seth, what changes to the treatment of drug addiction do you think would be warranted by these findings?

  19. eric Says:

    Seth Roberts Says:
    “If addicts were (not criminalized and) permitted to purchase heroin by prescription at pharmacies, there would be close to zero deaths from overdose.”

    What about the work I describe, which suggests this is wrong?

    Notice I said “close to zero”.

  20. Suzanne Says:

    I understood he nearly died before and the shock of THAT experience pushed him into rehab.

  21. Seth Roberts Says:

    Seth, what changes to the treatment of drug addiction do you think would be warranted by these findings?

    1. Further study of the issue, so it can be better said what circumstances are likely to trigger “failure of tolerance”.

    2. Publicize the findings.

  22. Alex Blackwood Says:

    My conjecture was that the variable schedule of rewards from street drugs of unpredictable purity and strength could be a significant factor in addiction. Well, these figures on the rising death toll from overdose of prescription opioids don’t exactly support that.

    http://www.washingtonpost.com/national/health-science/philip-seymour-hoffman-heroin-death-points-to-broader-opioid-drug-epidemic/2014/02/07/42dbbc5a-8e61-11e3-b46a-5a3d0d2130da_story.html

  23. Weekend Link Love - Edition 282 | Mark's Daily Apple Says:

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  25. D. M. Mitchell Says:

    That was quite interesting and seems to be a valid explanation for some heroin “overdose” deaths. However, years ago I read about a re-study of heroin overdose deaths in Baltimore. The researchers found that in two-thirds of those deaths both heroin and alcohol was involved. Two downers at the same time can quickly lead to death.

  26. Weekend Link Love | Kate's Healthy Living Says:

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  27. Mark Cancellieri Says:

    This is very interesting. It also seems to be consistent with the “opponent process theory.”

    http://gettingstronger.org/2010/05/opponent-process-theory/

    Seth: True. Unfortunately, opponent process theory was a dead end. It led to no predictions, no interesting experiments. Whereas Siegel’s theory of drug tolerance led to many experiments, including with quite different phenomena.

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  30. Alex Schell Says:

    Another case report: http://www.harmreductionjournal.com/content/2/1/11

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