What Really Caused The Death Of David Carr?

The premature death of David Carr is deeply tragic for many reasons. Among them are that 1) it was preventable and 2) many other Americans (approximately 400,000 each year) die of the same disorder. In the hours following his unexpected death, online news reports focused on its cause. My sense was that some apprehension existed that this might have been yet another overdose by a celebrity who was known to have struggled with addiction. Rather quickly, the announcement was made that the cause of death was lung cancer.

While this was technically accurate, I would argue that the actual cause of death was, in fact, drug addiction. More specifically it was an addiction to tobacco, which David Carr continued to use and is probably the most common cause of death of recovering addicts. An Institute of Medicine study comparing the addictive potential of drugs ranked tobacco at the top, well ahead of heroin and cocaine. What disturbs me is that three groups that could mitigate the damage done by this deadly substance fail to do so.

One group is the 12- Step recovery community. In a 2008 interview with Leonard Lopate, David Carr understandably does not identify himself explicitly as being a member of a 12-Step program. He does, however, use language that suggests his familiarity with those fellowships. As an addiction psychiatrist, one of my primary goals for my patients is the successful transition into community recovery support groups, such as Alcoholics Anonymous and Narcotics Anonymous.

As much as I admire those organizations, I get angry when my patients are told by AA or NA members that attempting to give up tobacco in early recovery was likely to jeopardize their recovery. The lack of evidence supporting this view does not keep them from their confident assurances. Too often, deferring this issue means that it is addressed too late or never.

The second group is the health insurance community, which paradoxically spends enormous sums of money for treating the consequences of tobacco use, but refuses to pay for the treatment of tobacco addiction itself. Not long ago, they even refused to pay for medication that had been shown to be helpful in treating this disorder.

The third group is the federal government. Most of the medical research funds dedicated to tobacco are allocated to the National Cancer Institute, not the National Institute of Drug Abuse, which has expertise in addiction.

Recovery from this addiction, as with other addictions, is quite feasible, especially when properly treated. The Mayo Clinic, for example, has one of the few dedicated tobacco addiction treatment programs in the country and has impressive success despite limited continuing care.  The problem is that such much-needed programs are few and far between.

When a celebrity addict succumbs to his or her disease, I, like other addiction specialists, am often contacted by the media for interviews about addiction. I am writing this piece because I do not expect to be contacted about David Carr, despite the fact that tobacco kills about half of its users. Although tobacco does this so certainly, the pace is so slow that it escapes mention, and we are left thinking that cancer, or some other medical condition such as heart disease, is where the money and attention should go.

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