Pinsky started watching the Showtime limited series with a skeptical eye, but now refers people to its depiction of how addiction works.

Dr. Drew Pinsky was ready to hate on “Patrick Melrose” as yet another Hollywood production that gets addiction wrong. But the former “Loveline” host, and board certified addictionologist, then watched the Showtime series — and came away pleasantly surprised.

“The first episode I thought, ‘Well, pretty good! That is pretty much how heroin is,'” Pinsky told IndieWire. “And as I got more and more into it, I went, ‘Oh my God, this is a literary study of the condition of alcoholism and addiction in a very interesting, historical context.'”

Pinsky said he felt that the auspices behind the production, including David Nicholls, who adapted the series of novels by Edward St. Aubyn, “knew what they were writing about… I was going in expecting to be critical, and show people how it really works, and walked away having been enriched and wanting to refer people to it if they want to understand how it does work.”

In particular, Pinsky said he felt “Patrick Melrose” was timely “in the setting now of Anthony Bourdain’s case. I’ve been recommending people to it because he was a heroin addict who drank. ‘Patrick Melrose’ is one of the consequences of heroin addicts who drink. It always goes bad. It goes bad in a lot of different ways, Patrick Melrose was one way, Anthony appears to have been another. But it always goes bad. If you’re a heroin addict and you try to use.”

Over the years on his various TV, radio and podcast programs, Pinsky has been clear that there “is no such thing as ‘was a heroin addict’ or ‘had heroin addiction and now can drink.’ Now you can drink for the time being, but while you are drinking, and you continue a relationship with fill in the blank substance, your life is in danger. Your relationships, everything is in danger. That’s the way it works.”

Pinsky said he can now use “Patrick Melrose” as a place to refer people in the culture who want an accurate idea of addiction and how it works. He recently wrote an essay for Showtime on how the series got it right; he shared his thoughts below.

Ollie Upton / Showtime

“Patrick Melrose” is a frantically accurate exploration of the addict mind tormented by trauma, magnificently brought to life by Benedict Cumberbatch. At its core, it is a story that has a timeless quality with echoes of Cervantes. It is story about the shifting tectonic plates of history as one societal power structure gives way to something new. The pursuits and mores of the old guard seem as empty as the long empty halls upon which the camera frequently rests. And nowhere is the emptiness starker than in the interpersonal lives of this aristocracy. These living carcasses of this self-righteous elite act out their empathic failure upon their children, leaving the next generation addicted, dysregulated, and unable to form stable relationships. Patrick Melrose’s most charitable assessment of his childhood and his family of origin is that at best it held a “Kafka-esque charm.” That is, indeed, about the most generous assessment one could render of a childhood terrorized by a mustache-twirling psychopath of a father who physically, emotionally and sexually abused him, and an alcoholic mother who at her best engaged him in the thick sappy emotional excesses of covert sexual abuse, and at her worst failed to protect her son from her husband, and frankly abandoned him. Childhood trauma is the rocket fuel for addictive pathology, and this fundamental truth is laid bare in Patrick Melrose. Add to this enchanting recipe the genetic potential for alcoholism, which he inherited from his mother, and you have a perfect formula for the creation of an opiate addict. The principle experience of childhood traumas is the phenomenon of dissociation, vividly described by Patrick in his childhood as the desire to put himself inside the Gecko lizard he happened to see on the wall as his father was raping him. Fundamentally, Patrick is trying to contend with experiences that shatter the young brain’s upper regulatory limits, inducing a state of shutdown. In that state, the individual literally disconnects from the body and may experience itself as hovering above, blacked out, or as in Patrick’s case, over there, inside the lizard body and out of his own. In Patrick’s unfortunate childhood, this was only part of the chronic cruelty that he experienced at the hands of his father, who described his “love of medicine” having begun with putting a bullet in the head of one of his colleagues who had developed rabies while out boar hunting. These awful experiences essentially guarantee an adolescence and young adulthood marked by emotional dysregulation and misery. If the viewer wishes to know what goes on in the mind of a drug addict, she need only watch episode 1. In desperation to escape the pain and emptiness, Patrick turned to what was available to him to survive – and that was drugs. Often addicts with trauma histories will say that for the first time in their lives they felt relief when they found their way to an opiate. Certainly, this was the case with Patrick. But this is still not the disease of addiction; this is merely the process that leads to trying and using substances in many cases. The disease of addiction is the biological disorder that is triggered once the drugs are used for a period of time. The disease then results in a complete usurpation of the brain’s motivational system. The voice in Patrick’s head as he struggles mightily to stay sober is the voice of his disease. The distortions of thought, perception and motivation lead to the repeated choice to use. For me, the series brought to light a phenomenon that addicts often describe to me when they contemplate suicide. Sure, Patrick’s withdrawal included suicidal ideation, as is often the case, but as a viewer I experienced a vivification of something more subtle and pernicious. Suicide in the setting of severe addiction may not so much be a desire to kill oneself but rather a desperate attempt to kill the “addict self.“ The addict voice in Patrick’s head helped me understand and empathize more vividly this struggle. The director (Edward Berger) very correctly portrayed the rooms of mutual aid as Patrick would have experienced them. He was not ready to give up drugs. These people in the 12-step community were different from him as far as he was concerned and so very “Californian.” And, like every addict, he believed he could make it on his own and used his disdain for ”those” people, whether in the mutual aid society or the fading British aristocracy, to remain aloof and disconnected. By doing so, he will never fully confront the effects of his childhood experiences and he leaves the door open to using. While I wish the rooms of mutual aid, where so many miracles occur every day, was not portrayed as such a dour affair, that of course is my own bias as a treating professional.

With every severe addict who manages to white-knuckle his way to abstinence, there is always something that will incite drug seeking. Patrick learns the hard way, as many must, that alcohol is very much a drug and will do quite nicely as his substance of choice. All the while, his alcoholism escalates and the devastating effects on his relationships accumulate; he minimizes the significance of his relationship with alcohol, after all it’s not heroin, it’s not Quaaludes, it’s not speed! The viewer must attend closely to the hints at the transformative power of recovery that spill through Patrick’s life. Johnny is struggling to stay sober. He is new to sobriety and as a result he may not always be the best source of advice for Patrick. He models for Patrick the need for fellowship and the utility of mutual aid, but he is new to the process. At one point Johnny suggests a romantic partner might help Patrick stay on course. In fact, romantic relationships are probably one of the most frequent reason addicts go out. This is one of the reasons there is an axiom, no new relationship in the first year of sobriety. Chili, on the other hand, appears miraculously in Patrick’s life. Chili in his disease was a seemingly psychotic end-state addict who shows up transformed, a musician performing at an aristocrat’s birthday party. Patrick is in disbelief; this simply cannot be the same person. I, myself, have not infrequently come across recovering addicts years later that I had given up on. It is like seeing a ghost come to life. The transformations can be astonishing. Chili for one brief moment is not so much Prodigal Son but the potential for Patrick to find faith; faith in resurrection, faith that sobriety is possible, faith that the most lost can be found. But a thriving recovery is not without great risk, Chili reminds us, by reporting that his wife had overdosed and succumbed to her addiction. Rather than riding through the countryside tilting at windmills, Patrick’s quixotic quest crosses an interior landscape. He is left wandering about the ghastly prison of his childhood, his body reliving the traumas of the past as though they were occurring today. The dragons with which he must joust are not merely windmills but human monsters. We see hints that Patrick begins to see his father for what he is and he can imagine standing up to him. Mommy and daddy no doubt had their own traumas. Patrick’s own children are the beneficiaries of this intergenerational curse. Certainly, nowhere near as cruel as Patrick’s experience, but his children will struggle as the witness to addiction, alcoholism, broken families and domestic abuse. While the series portrays this and so much more about this condition accurately, I do not want to give the impression that trauma and sexual abuse is a requisite history for the development of addiction. In our current epidemic, many opiate addicts come from stable home environments but may get exposed to opiates in a medical setting. The liberal prescribing habits of American physicians for the last 15-20 years created many an addict who might not otherwise have fallen victim.

I would invite every viewer to join me in abject condemnation of any parents, so called, who breaches the fundamental responsibility of adulthood. Big people take care of little people; we must live up to that trust.

Drew Pinsky, M.D., is a fellow with the American College of Physicians and a board certified addictionologist. For more on Dr. Drew please visit DrDrew.com.

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