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Vol. LXIII, No. 18
September 2, 2011
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Fighting Stigma with Theater
Addiction Performance Project Brings Ailment to Life

On the front page...

According to NIDDK’s Dr. Ziya Kirkali, “Someone who is particularly at risk for stones should be drinking at least 12 glasses of water each day, especially during the summer.”

Actress Debra Winger at NIH on Aug. 5

Despite profound societal changes over the past century, the Addiction Performance Project demonstrates that society’s experience of addiction has stayed much the same. In its Aug. 5 appearance at NIH, this NIDA-supported continuing education project combined theater and discussion to educate health care providers about addiction. The goals of the APP are to remove the stigma of drug abuse, promote dialogue between patients and caregivers and engender compassion for patients with the disease.

Act III of acclaimed playwright Eugene O’Neill’s Long Day’s Journey into Night is the cornerstone of each appearance of the project, which has traveled around the country to professional meetings and medical schools.

Continued...

A group of four acclaimed actors (including the Academy Award-nominated Debra Winger) read characters based closely on O’Neill’s own family, whose devastating experiences with morphine and alcohol addictions are brought to life in the play.

In Act III, set in 1911, addiction finally cracks open rifts in the Tyrone family. Infused with despair and shame, the dialogue is a volatile mix of accusations alternating with professions of love and denial mixing with uncomfortable truths.

Bob Braswell, Arliss Howard, Debra Winger and Sara Waisanen perform at NIDA’s Addiction Performance Project, held Aug 5 on campus. Expert panelist Dr. Paul Christo, pain medicine specialist at Johns Hopkins Medical School, gives his reaction to the actors’ readings. Listening is Dr. Nora Volkow, NIDA director.

Actors (from l) Bob Braswell, Arliss Howard, Debra Winger and Sara Waisanen perform at NIDA’s Addiction Performance Project, held Aug 5 on campus.



Expert panelist Dr. Paul Christo, pain medicine specialist at Johns Hopkins Medical School, gives his reaction to the actors’ readings. Listening is Dr. Nora Volkow, NIDA director.

Winger read the part of Mrs. Mary Tyrone, who became addicted to the morphine she was prescribed after giving birth to Edmund—just as O’Neill’s mother was addicted after his birth.

“It kills the pain,” Mary says about her “medication for rheumatism…You go back until at last you are beyond its reach. Only the past when you were happy is real.”

At the end of the tumultuous act, Mary goes upstairs alone to take the drug. She hopes that she will accidentally kill herself with an overdose, explaining, “I wouldn’t do that on purpose; there would be no forgiveness.”

Other actors included Winger’s real-life husband Arliss Howard as Mary’s husband James, Bob Braswell as Edmund and Sara Waisanen as servant Cathleen.

Winger, Volkow and David Mineta, deputy director of demand reduction, White House Office of National Drug Control Policy, converse prior to NIDA’s Addiction Performance Project.

Winger, Volkow and David Mineta, deputy director of demand reduction, White House Office of National Drug Control Policy, converse prior to NIDA’s Addiction Performance Project.

Photos: Ernie Branson

The performance elicited strong emotions. Panelist and NIDA director Dr. Nora Volkow told the audience from her personal experience that the play’s heartbreaking depiction of family life with addiction “is not an exaggeration.”

Stigma is a strong current throughout Long Day’s Journey into Night, particularly in narcotic addiction. O’Neill may have been under the weight of the same stigma when he completed “this play of old sorrow, written in tears and blood,” sealed it in wax and forbade its publication until 25 years after his death.

Volkow emphasized that the health care providers in the audience were “in a unique position to change” this stigma, which continues today. “Addiction is not something we choose,” she said.

For panelist Dr. Paul Christo, pain medicine specialist at Johns Hopkins Hospital, the reading evoked thoughts of a physician friend who struggled with addiction. Christo’s presence in his friend’s life through treatment and relapse made a huge difference, Christo said. He emphasized that “we can’t drop our patients with addictions.”

Discussing the reading, the medical professionals and others in the audience commented on its relevance to contemporary medical practice, including its depictions of the social acceptability of alcohol abuse and society’s stereotypes about people with addictions.

“The challenge is that many doctors feel very uncomfortable with the possibility of addiction,” said Volkow. “They’ll say, ‘This woman looks respectable. I don’t want to ask her about it.’”

Christo agreed, adding, “Addiction has no boundaries. I’ve learned that I can’t guess who will develop an addiction.”

On hand at the APP performance were (from l) Winger, Volkow, Mineta and Dr. Kenneth Warren, acting director, NIAAA.

On hand at the APP performance were (from l) Winger, Volkow, Mineta and Dr. Kenneth Warren, acting director, NIAAA.

In his practice, Christo proactively monitors the patients who are taking narcotics, observing whether they meet goals and even counting their pills. “The struggle is confronting them when you think they’ve lost control,” he said, emphasizing that this confrontation is a positive thing, an opportunity for the patient to get treatment.

NIDAMED, NIDA’s medical professional resource program, provided a range of products at the event. Attendees picked up patient materials, including waiting room posters on drug use disclosure and drug-specific handouts. Professional resources included simple screening tools and guides on working with addicted patients.

“NIDA believes that we can change addiction in the U.S.,” Volkow said. Currently, some 22 million Americans require treatment for a substance abuse problem, but fewer than 15 percent receive treatment. “Of course we can do better. What is required is the will to do so and the participation of the health care system.” NIHRecord Icon


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