A famous Eugene O’Neill play enacted with Debra Winger at APA’s convention spurred
discussion of ways psychologists can combat the stigma surrounding substance abuse.
BY BRIDGET MURRAY LAW
After Eugene O’Neill wrote the play “Long Day’s Journey Into Night,” he sealed it in wax and instructed his publisher not to publish it until 20 years after his death.
It was a play, he said, “of old sorrow, written in tears and
blood.” Over four-and-a-half hours, it portrays the fictional
Tyrone family’s disintegration at the hands of addiction, which
mirrors what happened in O’Neill’s own family. His mother
was dependent on morphine, while he, his father and his two
brothers struggled with alcoholism, the disease that eventually
killed his older brother.
O’Neill’s shame about his family’s troubles ran so deep that
he couldn’t stand to see the play performed during his lifetime.
He died in 1953, and was posthumously awarded the Pulitzer
Prize for the play in 1957.
More than 50 years later, at APA’s 2011 Annual Convention, a
cast of actors and an audience of psychologists used the play to
examine the issue of addiction-related stigma head on. As part
of the Addiction Performance Project, a National Institute on
Drug Abuse–sponsored continuing-education program, Oscar-nominated actor Debra Winger led a cast in a dramatic reading
of part of the play. Through a series of these performances
across the country, they hope to raise health-care professionals’
awareness of addiction in their patients.
Winger, her husband Arliss Howard, and two other actors
performed the play’s third act, in which the Tyrone men
confront Mary Tyrone, the matriarch, about her relapse into
morphine use. In turn, Mary — played by Winger — rails
against her husband’s and sons’ drinking.
In a discussion following the performance, panelists noted
how the scene portrays patterns of denial, blame, anger and
bitterness that are typical in families affected by addiction.
Certainly there are positive reinforcing effects of the drugs —
pleasure and relaxation, for example — but there also negative
reinforcing effects, said NIDA Acting Deputy Director David
Shurtleff, PhD. “Family members take it not just to feel better
but to escape pain, which then affects parts of the brain related
to coping, emotional regulation and judgment. So this makes
the family dysfunctional in relation to each other, and they
escape into the drug even more to cope. It’s a vicious cycle.”
And addiction often goes untreated, he continued. Nearly
23 million Americans struggle with alcohol and drug problems,
but only 2 million receive treatment.
at the Yale University School of Medicine, echoed Shurtleff’s
comments. “The addiction keeps family members stuck and
angry and unable to deal with each other,” said Carroll, who is
principal investigator of the New England Consortium of the
NIDA Clinical Trials Network.
Part of what fuels the stigma is people’s reluctance to openly
discuss addiction, said Carroll. “Why is it so hard to talk about
addiction?” she said. “The family in this play was always talking
around it ... I see the same patterns in my psychotherapy tapes
— brushing over it, dancing around it.”
In response, fellow panelist Carlo DiClemente, PhD, a
psychology professor at the University of Maryland, Baltimore
County, noted that facing addiction is uncomfortable and that,
at times, watching the play made him want to leave the room.
So how do psychologists stay in the room, cutting through
the stigma and treating the addiction? DiClemente and other
panelists and audience members suggested that they:
• Ask patients directly about past and present alcohol and
drug use and about substance-abuse issues in their families.
• Draw patients out on addiction issues by asking follow-up
• Choose less stigmatizing words, such as “person with
addiction or alcohol problems,” rather than addicts or
alcoholics. “Stigma itself is a stigmatizing word,” said one
• Work on empathizing with people with addiction
problems and withholding judgment. “We psychologists are
guilty of stigmatizing our own colleagues who have struggled
with these disorders,” said DiClemente.
• Understand that relapse is part of this disease, just like it
is part of any chronic disease.
• Teach patients with addiction problems alternative
coping and social-interaction strategies. “This is where
psychology and cognitive-behavioral therapy can play a great
role,” said Shurtleff, “not just in treating the individual addict
but in helping them come back into the family and society,
helping to restructure and bring back that family unit.” n
Bridget Murray Law is a writer in Silver Spring, Md.
To learn more about the Addiction Performance Project’s work
to provide continuing education on addiction to health-care
professionals, visit www.nida.nih.gov/nidamed/APP/.