Grammy Award-​​winning pop singer Amy Wine­house, whose drug and alcohol abuse over­shad­owed her musical talent, was found dead last weekend at her London apart­ment. We asked Hort­ensia Amaro — pro­fessor and asso­ciate dean in the Bouvé Col­lege of Health Sci­ences and director of the Insti­tute on Urban Health Research — to ana­lyze the behavior of indi­vid­uals who struggle with sub­stance abuse.

Wine­house acknowl­edged her refusal to seek help for drug addic­tion in the Grammy Award-​​winning song “Rehab.” In gen­eral, why do some people refuse treat­ment for sub­stance abuse? How can family and friends help a loved one suf­fering from drug addic­tion get the proper care?
It is quite common for people who are addicted to drugs or alcohol to be in denial about their problem. There are many rea­sons why people who need treat­ment refuse it, including an inac­cu­rate per­cep­tion that they can quit any time or that they can simply “con­trol” their use. Others fear the pow­erful impact of phys­ical with­drawal. For many, addic­tion serves as a self-​​medication for over­whelming emo­tions stem­ming from trauma, so let­ting go of this coping mech­a­nism evokes fear. Others may fear legal con­se­quences and stigma of addiction.

Family and friends can play an impor­tant role in helping someone with an addic­tion dis­order rec­og­nize his or her problem. But often, loved ones don’t know what to do and may also be in denial until the problem is quite severe. Expressing con­cern and pro­viding clear mes­sages about the neg­a­tive con­se­quences of a person’s drug use and related behav­iors is very impor­tant. Family and friends can also seek guid­ance through self-​​help pro­grams or coun­seling with an addic­tion spe­cialist to find out if they might be enabling sub­stance abuse, and to sort out strate­gies for inter­acting with loved ones suf­fering from addiction.

Why does fame so often lead to self-​​destructive behavior, such as sub­stance abuse?
It is not clear if fame dis­pro­por­tion­ately leads to self-​​destructive behav­iors com­pared to what we see in the gen­eral pop­u­la­tion. But having celebrity status and such great sudden finan­cial resources at a young age may con­tribute to the problem. Adding to this are demanding sched­ules, pres­sures to pro­duce, high expec­ta­tions and, in some sec­tors of the enter­tain­ment industry, nor­ma­tive use of alcohol and drugs. For younger people, among whom sub­stance use is highest in the gen­eral pop­u­la­tion, these fac­tors, com­bined with others — such as a per­sonal pro­file of risk taking and sen­sa­tion seeking, psy­cho­log­ical trauma, mental health prob­lems, or family his­tory or genetic vul­ner­a­bility to sub­stance abuse — can be a dan­gerous combination.

Winehouse’s ex-​​husband report­edly intro­duced the pop star to heroin and crack cocaine. How impor­tant is it for a drug addict to sur­round her­self with pos­i­tive role models who rein­force healthful behavior?
It is not uncommon for women who become addicted to ini­tiate drug use through a male partner. Having pos­i­tive role models, part­ners and friends is impor­tant because our loved ones and those in our social net­works are extremely influ­en­tial in our behav­iors, including binge drinking, drug use, overeating or living a seden­tary lifestyle. For a person recov­ering from addic­tion dis­or­ders, it is essen­tial to avoid indi­vid­uals who are active drug users, as well as places and sit­u­a­tions asso­ci­ated with such use. These are par­tic­u­larly dan­gerous to those in recovery since they can trigger crav­ings and lead to relapse.