A reader writes:

I see the same manic temperament with Charlie Sheen that I did with my brother - a now-deceased addict who suffered from bipolar disorder. I tried to go along and joke about Sheen's interviews and his pronouncements - he really is articulate - but I just can't. He's sick. He's an addict. He badly needs treatment, not amoral media outlets using him to fill airspace.

Another writes:

I am a long-time reader of your blog and enjoy your sharp and insightful commentary.  However, as a psychiatrist specializing in substance abuse for the last ten years, I have to call bullshit on your post about Charlie Sheen. 

You wrote:  "People do drugs for a reason. That reason is often intense pleasure to which they become addicted."  What you're missing here is the distinction between recreational use, drug abuse, and drug dependence.  The reason people do drugs changes depending on what their relationship to the drug is.  A recreational user is attracted to the pleasure that a particular molecule gives them.  A cocaine dependent person - undoubtedly Sheen meets the criteria - has become tolerant of most of the euphoric effects of cocaine.  Hence the suitcase full of cocaine Sheen was recently described ingesting, a superhuman dose that would kill a person who hasn't built up physiologic tolerance.  Typically, cocaine dependent people are motivated to continue using not for pleasure, but just to feel normal.  They become unable to cope with mounting emotional, professional, and financial consequences of their use, and this in turn becomes a motivation to use more drugs to make the problem go away in the short term. 

Cocaine is a particularly ruthless drug and the minority of users who find themselves dependent are in a truly horrific and treatment-resistant place.  Your links go further and virtually make Sheen into some kind of counterculture hero.  I think he's a hollowed-out shell who should be at the top of everyone's celebrity dead pool.

I think that exaggerates the point of my post. Sheen is not a hero in any respect. But he has been able to put the perspective of the addict into the public square in ways that few PSAs do.

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