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CNN Presents

Addiction: Life on the Edge

Aired April 19, 2009 - 20:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

DR. SANJAY GUPTA, CNN CORRESPONDENT: Hello and welcome. I'm Dr. Sanjay Gupta. Just about ever major hospital in America has an addiction ward. And I've always been curious about the people who get treated there. What are their lives like? Completely overturned by a substance such as alcohol, painkillers, heroin. I hear crystal meth is one of the worst.

Twenty three million addicts right now, and, yes, your kids, our kids are at risk. For over a year now, I've been following several addicts. You know what they say. Once an addict, always an addict. When we started this whole thing, I didn't quite know what to expect. But we learned a lot together along the way.

Angela Puckett is a mom, but she used to be a party girl, big time. Hooked on painkillers and alcohol. Lucy Gross, she could be your daughter. Just 16, she finally screamed out for help in a way that would make any parent shudder. Walter Kent, well, he snapped a 40- year addiction by simply taking a pill.

Then there's Nic Sheff. Former honor student, amazing writer. Meth addict.

For me, as a doctor and a neuroscientist, I had questions. First of all, what exactly is addiction? Is it a disease of the brain, a weakness of character or is it both? It may surprise you, but smart, established scientists don't always agree on this. But the answer means everything. It changes how we approach addiction, certainly how we treat it. And for you at home, it probably changes how we perceive it.

NIC SHEFF, ADDICT: All of a sudden I'll remember to look up at the sky.

GUPTA: I caught up with Nic Sheff and his father in Boston. They had each written a book about the worst time of their lives.

DAVID SHEFF, NIC SHEFF'S FATHER: Once again, I called the police and the hospital emergency rooms asking if he's in jail or if there's been an accident. Each time I call, I brace myself for the unthinkable. I rehearse the conversation, the stolid, disembodied voice and the words, he's dead.

GUPTA: Nic's descent into addiction began in San Francisco, the beautiful city by the bay. But not for Nic. He calls it the poison city. Here he took his first drink when he was just 11. Enough liquor to puke and black out. A year later, his father found pot in a backpack. D. SHEFF: I was blown out of the -- blown away by it. We talked a lot about drugs and I had given him warnings and I felt that I would know. And I was so blindsided that when I found it, I was surprised and worried by the fact that he was smoking pot and also by the fact that I didn't know what was going on with him.

N. SHEFF: With pot, my tolerance got really high really quickly. And I think that's why I reached out to different drugs, the harder drugs.

GUPTA: Would you tell people that marijuana is a gateway drug, as you talked about?

N. SHEFF: I think that for someone who is in a lot of pain and is using a drug to mask that pain or try to heal that pain, then for that person, I think maybe it is a gateway drug, because eventually it is going to stop working. It's going to stop giving you that relief. And, you know, if you're relying on a drug to give you relief, eventually you'll start looking to something, yeah, stronger.

GUPTA: "I loved drugs," Nic writes in his memoir. "Crack, cocaine, ecstasy, heroin." And his favorite, crystal methamphetamine.

N. SHEFF: When I did crystal meth for the first time, it was like -- yeah, it was like the answer to my problems. It was like I felt strong and confident and just like a superstar or something. And it was a feeling, yeah, that I'd wanted my whole life.

GUPTA: For a long time, addicts and alcoholics were viewed as lacking morals or willpower. But many believe addiction is also a disease of the brain. An equal opportunity illness that cuts across gender, age, race and income. One thing we can stay for sure, the various drugs people take for pleasure do affect different parts of the brain.

Inside the brain, you can see it in three distinct ways. One is right here, the orbital frontal cortex. We normally use it for decision- making. We call it executive function. In an addict's brain, that's damaged. It's a physical difference and it leads to a loss of willpower.

Another key spot, the amygdala. It's further back, lower down, toward the center of the brain. The amygdala handles stress -- call it the dark side of addiction -- anxiety that can only be relieved by drugs and alcohol. This particular region in the addict's brain overreacts to stress. That brings on a powerful craving.

You've also have the nucleus accumbens. That's a name to remember. Nucleus accumbens. It's an important place where things like dopamine trigger a good feeling of reward. The centers in an addict's brain overreact to drugs or alcohol but they underreact to normal pleasure. The whole reward system is thrown off. In short, you're hooked.

These are all signs of a real physical brain condition. So with that in mind, the question becomes how exactly do you treat it, and what makes someone seek out help? For Nic Sheff, it took a vigilant and caring father, who could see that he was losing his son. For Angela Puckett, it took an overdose. ANGELA PUCKETT, ADDICT: That was a major awakening that something needed to change.

GUPTA: Her story is next. And later, what if you could stop addiction with a pill? That's how Walter Kent did it.

WALTER KENT, ADDICT: I can be next to people drinking with it and I don't have one ounce of an urge for a drink.

(COMMERCIAL BREAK)

UNIDENTIFIED MALE: Britney is now in rehab.

UNIDENTIFIED FEMALE: Kirsten Dunst has reportedly checked into rehab.

UNIDENTIFIED MALE: Eva Mendes has reportedly checked herself into rehab.

GUPTA: Celebrities entering rehab, the headlines are everywhere.

(MUSIC)

UNIDENTIFIED FEMALE: Earlier this week video was released showing the singer smoking something in a glass pipe.

UNIDENTIFIED MALE: Lindsay Lohan reportedly out of control and now definitely in rehab.

GUPTA: But far from the bright lights, thousands turn to rehab in desperation.

When we hear about rehab celebrity style, it looks something like this, a place called Promises.

According to news reports, this was the rehab of choice for Britney Spears, Lindsay Lohan, Ben Affleck, Charlie Sheen, Diana Ross, just to name a few. Stunning Malibu vistas, gourmet food, poolside lounging, even acupuncture.

What else could an addict want? The price tag, if you're wondering, $48,000 a month. But David Sack, who runs Promises, says it's worth it for those who can afford it.

DAVID SACK, PROMISES REHAB: For us, the amenities are not so much about creating a spa but about creating an environment where people feel worthwhile and where they can recover.

GUPTA: The thing is, most people don't have this option. Only about half of insurance plans cover residential treatment. And even when it is covered, the typical experience is a jolt of reality. Angela Puckett's addictions almost killed her.

PUCKETT: You know, I was always a party girl. My first real time of drinking to forget was when my husband and I were going through infertility treatments and we got all the way up to in vitro, we got pregnant on the first time, and then we had a miscarriage. That's when I really started drinking to drown things out.

GUPTA: Eventually Angela and her husband adopted a son. But here's the thing. She kept drinking. And sinking.

PUCKETT: So I was on Klonopin, Trazadone, Xanax, Vicodin. And a lot of alcohol. A lot of alcohol. And that's just what led to it, the last six months was the worst.

GUPTA: So how does an addict define worse? A near-fatal overdose which landed her in the ICU at St. John's Hospital outside St. Paul.

PUCKETT: Waking up in the ICU after an overdose and suicide attempt, that was a major awakening that something needed to change.

GUPTA: In a way, that's typical. Addicts don't get help until they hit rock bottom, until they run out of options. Two million Americans a year do turn to rehab. Angela Puckett was one of them. She checked into Hazelden, one of the world's largest nonprofit addiction treatment centers.

PUCKETT: The first day that I got here, I was -- I was scared. I didn't know what to expect. I didn't know what was going to happen. I didn't know what it was all about. I really wanted to come here to learn how to live sober and how to deal with my emotions and how -- how not to be a party girl. I'd always been, you know, the partier.

GUPTA: Dr. Kevin Clark is medical director at Hazelden near Minneapolis.

Who is your typical client or patient, if you will, here at Hazelden?

DR. KEVIN CLARK, HAZELDEN MEDICAL DIRECTOR: Well, we don't have a typical client. We certainly are able to facilitate the treatment of individuals who range from individuals who are homeless and unemployed to individuals who are CEOs of major corporations.

GUPTA: For Angela Puckett and everyone who comes here, this is the first stop, detox.

Not a lot of people get to see this particular area of the medical services unit, but this is where most patients end up the first couple of days here at Hazelden. The goal, to get them through that withdrawal period. And it can be tough. Their hearts start to race. They start to sweat. Oftentimes they get the shakes and it can be life threatening. Getting them through those first couple of days, that's absolutely the goal.

At any given time, approximately 160 addicts are being treated at Hazelden. For privacy reasons, we aren't showing any of them.

For 60 years, Hazelden's program has been built on the 12 steps, pioneered by Alcoholics Anonymous. Step one, admit you're powerless over your addiction. Steps two and three say turn your life over to a higher power.

PUCKETT: In a meeting was the very first time that I said, hi, my name is Angela, I'm an alcoholic and an addict. And it was the smallest voice I had ever heard come out of me.

CLARK: Right now we're heading through the living quarters. And this is where a lot of the treatment activities take place. There's a red chair over there that you can see. And the red chair is essentially the hot seat.

GUPTA: Do you get asked to sit in the red chair? What happens?

CLARK: Around the two-week period in treatment, an individual will have the chair placed in the middle of the room and the individual will sit in the chair and their peers will give them feedback, basically, on what they perceive the individual to be in terms of their strengths and their weaknesses with regards to their recovery.

GUPTA: That's fascinating. So they actually take this chair, put it in the middle of the room surrounded by all the other people that are undergoing ...

CLARK: That's exactly how it works.

GUPTA: And they're told how they're doing or how their recovery is going along?

CLARK: Yeah. Very direct, very honest, very focused feedback on what they see as their strengths and their weaknesses in recovery.

GUPTA: Sound like they could get kind of harsh.

And it can. But this is where the breakthrough happens. Sitting in a meeting like this, Angela Puckett had what she calls an epiphany.

PUCKETT: It was a midmorning group on the Lily unit. I remember the chair that I was sitting in and the sun was kind of coming in. And the meeting had wrapped. One of the things that I -- that really came clear was that if I hadn't gone through the infertility issues, I wouldn't have my son. And we are mother and son soul mates. He is my son. I thank God now. I thank God for the infertility issues.

GUPTA: Puckett was lucky. Not only did she have her son, she had very good insurance. And Hazelden is not cheap. The typical 28-day stay costs $26,000. At prices like that, or what Promises charges, we shake our heads, especially when we hear about addicts, usually the rich and famous, checking into rehab again and again and again.

And it's not just celebrities. When it comes to drinking, only about one in four people getting treatment is able to quit drinking completely for a full year afterward. David Sack of Promises in Malibu.

SACK: Whether it's a celebrity or a Joe Smith down the street from you, most serious medical disorders have high rates of relapse.

GUPTA: But the picture is not as bleak as you might think. Even people who don't abstain after treatment cut back their drinking by two-thirds. In other words, even if people pick up a drink again, it doesn't mean rehab is a total failure. One of the few rehabs to publish results, Hazelden says 44 to 47 percent of its clients relapse within a year. Nic Sheff relapsed after staying at this now closed Hazelden rehab in New York. It got us wondering, why do some people succeed when so many others fail?

If addiction is a disease of the brain, why don't you treat it like you would treat blood pressure, diabetes, heart disease, some of the things you were mentioning?

CLARK: Well, you're absolutely right, it is a disease of the brain. But what we know, it's a disease that has a spiritual component to it, a behavioral component to it. So we know that treating the whole person here at Hazelden is what has worked for us for over 60 years.

GUPTA: But it made me wonder, what if you could go cold turkey simply by taking a pill? Walter Kent says it saved his life.

KENT: Without it, I think my marriage would have been gone and I'd probably be dead right now.

GUPTA: That's later. Next, a teenager in trouble.

(COMMERCIAL BREAK)

GUPTA: You're looking at the pretty side of Gloucester, Massachusetts, known for its connection to the sea, its fishing industry. Nowadays, it's also known for drugs. Growing up here, Lucy Gross started smoking pot with friends. She was 12.

LUCY GROSS, ADDICT: Well, I was never really comfortable in my own skin. That was, I think, a big reason that I really liked drugs and alcohol, because it made me feel comfortable.

GUPTA: Even before the drugs, there were behavior issues. By sixth grade, Lucy was seeing the school counselor and behavioral specialist. In high school, Lucy began seeing a psychiatrist. She suffered from anxiety, was diagnosed with depression and put on medication. That's not unusual. Many adolescents with psychiatric issues have co- occurring drug problems.

L. GROSS: I was doing cocaine. I was taking painkillers, prescription painkillers. I was smoking pot. I was drinking a lot. I was doing a lot of pills, Adderall, Vicodin, Oxycontin.

GUPTA: As a parent, I was simply stunned at what she told me. Her parents had the same reaction. Tony, a commercial lobsterman and Abby, a journalist, suspected Lucy was in trouble. They just didn't realize how much. And then Lucy asked for help.

TONY GROSS, LUCY'S FATHER: In the form of a note on her door. It was don't come in unless you're going to get me treatment.

L. GROSS: I don't really know why I did that. I knew that I couldn't be at home and be OK. I knew that I needed something.

GUPTA: Tracking down an open bed in rehab was tough, but they found one at McLean Hospital, a psychiatric facility affiliated with Harvard Medical School. But that was just a 28-day program. It wasn't enough. And so Lucy went to Ironwood, a six-month residential facility in Maine for troubled teens.

L. GROSS: The full first day, I was just thinking, my parents will be back within a week. They're not going to make me stay here, like they'll read the letters that i'm sending them. I'll tell them how awful it is. They won't keep me here.

GUPTA: But as hard as it was, something was happening. Lucy was making progress. It came at a price. The month at McLean cost $24,000, with insurance covering all but $6,000. And ironwood cost nearly $54,000, all of it paid out-of-pocket.

But her parents' biggest concern was relapse. All the more likely if Lucy returned to her old school.

ABBY GROSS, LUCY'S MOTHER: For kids who are susceptible to go back into that environment and to stay clean and sober has just got to be incredibly difficult. I don't know. I don't know how they do it.

GUPTA: Lucy didn't have to. She attends North Shore Recovery High School in Beverly, Massachusetts. You won't see classes like this at most public high schools. Lucy calls it "group". Here she gets to talk about her struggles with drugs and alcohol.

L. GROSS: Sometimes I want to hang out with my old friends, and I think that's mostly because it's familiar to me.

What a difference it makes, because compared to normal high schools, there's such a higher, like, staying sober -- rate of staying sober here. And it's because we're all supportive and we're all going through the same thing.

GUPTA: Recovery high schools. They got their start 20 years ago outside Minneapolis. They're opening across the country. North Shore, in 2006, was the first on the East Coast. Today more than two dozen high schools and more than a dozen colleges belong to the association of recovery schools. Most follow the 12-step model of recovery. All of them offer state-certified diplomas.

Almost all of these schools are part of the public school system, so North Shore is free, paid for by the Massachusetts Department of Health and by the School District. A good deal. But there aren't nearly enough schools to meet the need.

As things stand now, more than 300,000 adolescents every year are in rehab. Think about that. And fewer than 2,000, less than one percent, end up in a place like this, a recovery high school.

For the lucky few, it's a safe haven. Here's North Shore principal, Michelle Lipinski.

UNIDENTIFIED FEMALE: Every student here will tell you when they walk down their public high schools, that they know where to get anything. They know where to get pills. They know where to get pot. They know where to get heroin. They know where to get ecstasy. They know the locker to go to.

GUPTA: At North Shore, students have to be clean and sober for at least 30 days before they're eligible to enroll. They sign a contract when they walk in. They can't use drugs. They can't be around known users or known drug houses.

UNIDENTIFIED FEMALE: Their contract says they have to go to three meetings a week. We do offer a couple meetings here after school. And they have to go to one other supportive place.

GUPTA: And, yes, random urine drug testing occurs at least once a week.

UNIDENTIFIED FEMALE: We have on-site observed drug testing through urine screens. Not that that's 100 percent foolproof. We all know that kids can get around that. But they talk about it. We have groups, and they're honest and they're open. And I've never seen more honesty in a high school in my entire life.

GUPTA: How do you measure success?

UNIDENTIFIED FEMALE: It's so funny because when I started this, I thought relapse, number of relapse was going to measure my success. I thought, the students clean and sober, that was going to be my measure of success. What I've come to really find out is that them keep fighting the fight.

GUPTA: There's 47 students here. But if this looks a little empty, it's because 12 were back in treatment, a testament to how fragile the road to recovery really is. Lucy has been on that road for over a year now. Optimistic about her success?

UNIDENTIFIED FEMALE: Optimistic but not without -- you know, people struggle. It's a struggle.

L. GROSS: I don't want to give up what I have now, most of all. I don't want to, like, backtrack when I've come so far. I don't want to give that up for anything.

GUPTA: Next, to hell and back.

N. SHEFF: When I did crystal meth for the first time, it was like the answer to my problems.

D. SHEFF: Where is Nic? I'll not accept the most likely answer that he's relapsed.

GUPTA: A tough conversation between father and son.

(COMMERCIAL BREAK)

(NEWSBREAK)

GUPTA: This isn't how most fathers and sons would ever hope to spend their time together, autographing memoirs about drug addiction. Each book, David Sheff and son's Nic's, a chronicle of addiction's painful and frightening toll on Nic and his family.

D. SHEFF: I keep trying to fathom what's happening not only to Nic but our lives for what's happening to him.

I think for parents we're hardwired in a way we don't want to see what's going on with our children because it's too scary. It's terrifying.

GUPTA: Was there a point, David, where you said, OK, now things are officially out of control?

D. SHEFF: I remained in denial as long as I could until I could no longer could be. That was when Nic disappeared for the first time.

GUPTA: At book readings across the country, David Sheff tells audiences he went through days and nights of terror, worrying, where was his son?

D. SHEFF: I called the police. And I called the hospital. And at one point, one of the police, someone at the police department told me, have you checked the morgue?

GUPTA: He knew his son needed help. Some kind of help. But that was easier said than done.

D. SHEFF: When he was under 18, I guess I could have just dragged him in and signed him in myself. But once he became 18, he had to walk in the door and sign the papers himself. And getting a child or getting anyone to seek treatment when they're using is not easy.

GUPTA: Nic finally made it home. Alive. But frail. And strung out on crystal meth. He was just 18 years old.

D. SHEFF: I mean, he looked like he'd been through hell. And I helped him get up and I got him into the car. And I said, Nic, you know, we have to get some help. And he said, I know.

GUPTA: His father looked for treatment centers. But it's awfully hard to pick a rehab.

D. SHEFF: I was told by some of the places I called exactly what I wanted to hear, bring your son here and we have a 97 percent success rate. And someplace else said they have a 67 - I didn't know what that meant.

GUPTA: And then one day he heard the truth.

D. SHEFF: Then I got on the phone a nurse at a hospital. They always ask you what's his drug of choice. When I said that it was crystal meth, the woman just sort of let out a sigh. She said the true number of people who stay sober when they get out of here for meth was in the single digits.

GUPTA: You can see why it's so hard in brain scans. These bright red spots, that's hyperactivity in a meth addict's brain in the region that feels cravings. It's out of control because the region that's supposed to keep it in check, well, that isn't working either.

See this blue spot here? That's low activity.

This is the key to higher brain function like decision-making. In the addict, this part of the brain is damaged. That leads to serious trouble with impulse control. And there's this vicious cycle. More drinking, more damage and even less impulse control.

EDYTHE LONDON, UCLA: When a person comes into recovery, their brain is not 100 percent. And we have pictures to prove that.

GUPTA: Professor Edythe London studies how addictions affect the brain.

LONDON: It's very important to realize that the individual needs time to adjust while some of these system stabilize and he can begin to make better decisions.

GUPTA: The Sheffs selected this historic hilltop recovery center in downtown San Francisco to treat their son. Introductions did not go well.

N. SHEFF: I said, you know, I'm Nic, and, you know, I don't really belong here.

D. SHEFF: I did have some very naive hope that I'd pick him up in 28 days and this nightmare would be over. I was naive. I didn't know.

GUPTA: After only three days sober, Nic relapsed. The family tried again. Another rehab. Nic stayed clean for a month.

N. SHEFF: You know, I'd always have this feeling of sort of insecurity and, I don't know, like there was this hole inside of me. And I was in a ton of pain. And I didn't know what else to do but keep using drugs.

GUPTA: Nic disappeared again, homeless, living on the streets. He survived on candy bars and garbage scraps. He slept in city parks or in his car. He hustled men for money to buy drugs.

N. SHEFF: Walk down to the beach?

GUPTA: After two more rehabs, Nic was doing better. Eighteen months sober and living in Los Angeles. He even had a job working at promises. The upscale rehab famous for treating celebrities.

N. SHEFF: I had been sober for a long time at one point, and really built back all my relationships. I ended up having a really bad situation happen with a girl, and I ended up driving back to San Francisco and relapsing.

GUPTA: Reporter: here, on this street corner, Nic says he paid $60 for a single gram of crystal meth. His book "Tweak" covers the next 642 days as he struggled to recover his sobriety.

N. SHEFF: I cooked up a bunch of heroin and go to pick out a bottle of white wine from the refrigerator. I'd take it up to the kitchen and poor a large glass for myself. I'm standing at the full length winnow looking out on the street below feeling powerful.

D. SHEFF: He could have died at any moment.

GUPTA: Is relapse part of recovery?

N. SHEFF: Yeah. I mean, I don't think it has to be.

GUPTA: How did you break the cycle?

N. SHEFF: I was at this last treatment center. For the first time they really forced me, in a way, to sit still and face myself and look inward. I was able to see that the person that is in my core is not this worthless, disgusting person, but is a person that is of value.

GUPTA: A person of value, but fragile, even today. When we met up with Nic in Los Angeles, he was working on another book, but still haunted by what he calls the ghosts of his past.

N. SHEFF: I'll be walking my dog or something and all of a sudden, I'll just remember something, you know, that either I had forgotten or I had blocked out completely. Those sort of ghost memories is what I live with every day.

GUPTA: When you decide not to use drugs now, is it because you don't want to go to a place that you fear? Or it's because you want to stay in a place that you're more optimistic about? What -- I mean, are you scared about it?

N. SHEFF: Yeah, I think that being just scared about it or something is not enough. I really love where my life is at now. And I feel like I want to hold on to that.

GUPTA: Remarkably, Nic tells me if a pill existed that could stop his cravings, taking it would not have made a difference.

N. SHEFF: That sort of hole inside of me was still there, and that self hatred. And i think that I would have ended up killing myself in one way or another.

GUPTA: Three weeks after this interview, some heartbreak.

N. SHEFF: I just left my girlfriend ...

GUPTA: He seemed to be taking it in stride.

N. SHEFF: I'd like to establish a life here, you know, with me and my dog and, you know, whatever friends I have and stuff and finish writing my next book and have them love it and want to publish it.

GUPTA: But just two days before my follow-up interview with Nic, a startling twist. He wouldn't be able to meet with me. He said he wasn't feeling in a very good place. I couldn't help but wonder, had Nic Sheff relapsed again?

(COMMERCIAL BREAK)

GUPTA: This is the last place you'd expect to find a recovering alcoholic.

KENT: This is one of my old favorite watering holes. This is the place I've still been coming to for like 20 years.

GUPTA: But this is where Walter Kent spends his Friday's, a bar called Goober's.

KENT: Now I can walk in here and I have no problems at all because I have no urge, no sensation at all for a drink. Let's go in.

GUPTA: Walter Kent is a giant of a man. But for most of his life, he couldn't find the strength to put down that bottle.

KENT: I was the type of person that the only time I drank was when I was alone or with somebody. Other than that, there was never a problem.

GUPTA: His first serious try at giving it up, a month in rehab. It was 30 years ago. There were other attempts to quit, too many to remember. But nothing worked.

KENT: I'd go into rehab for 30 days. I tried AA at nights. Nothing seemed to get rid of that urge. I couldn't get rid of the craving. And this is something that -- I guess it's like a drug addict. Once you get addicted to it, you can't shake it.

GUPTA: What does that craving feel like?

KENT: It's -- I would have to say something like maybe -- like a little kid wanting a piece of candy. You see it, you want the taste of it. You can smell it. You can be by yourself and you get the hint even of alcohol. Just the smell of it, you can -- oh, I can go for a drink, I need a drink. And even though you're not around one, you can actually sense that sensation.

GUPTA: But then in 2000, Walter Kent got an ultimatum from his wife, a woman he'd known since grammar school. She told Walter she'd had enough.

KENT: My wife said to me, Walt, you've got to do something because you're killing the marriage and you're killing yourself.

GUPTA: And so he tried again. He checked himself into an experimental program run by Brown University. This time he got counseling once a week and a daily pill. A medicine called naltrexone. About two months into it, Walter Kent suddenly noticed the world around him looked and felt different.

KENT: And I had just turned around and I said, this is really something for the first time in my life that I never had this sensation where I didn't want a drink. And this, to me, was like a godsend because of the fact that for someone who had to have a drink, now all of a sudden I don't need that -- I don't have that feeling anymore.

GUPTA: He hasn't had a drink in more than eight years. Even after his doctor stopped the medication. He's healthy, back at work, fixing up carburetors. And now he's part of a running debate. Is addiction an illness you can treat with a pill or a character flaw to be tackled with therapy and self-help?

We also have to consider ...

GUPTA: Dr. Bankole Johnson runs the psychiatry department at the University of Virginia. Is addiction a disease?

DR. BANKOLE JOHNSON, UNIVERSITY OF VIRGINIA: Addiction is a brain disease. Alcoholism, cocaine dependence, all of them are brain diseases. About 60 percent of alcoholism is biologically genetic.

GUPTA: Johnson studied a drug called topiramate which is sold as Topamax. He found that it cut down on drinking and made alcoholics less obsessed with alcohol. It seems to work on two levels. It makes people less impulsive and it blunts the pleasure, the excitement they get from drinking.

Now, Johnson is a consultant to the company that makes Topomax but says other drugs work as well including naltrexone. That's the one that helped Walter Kent. They're not addictive, either. But side effects, like a dry mouth, are minor.

But you think everyone who is an alcoholic should probably be treated with a medication?

JOHNSON: I think everyone who is an alcoholic should be treated with a medication, if they're willing to take it.

GUPTA: Despite the evidence, most fancy rehab centers use medication only rarely, if at all. The focus is much more on therapy.

CLARK: With the health care professional staff here at Hazelden, our experience tells us having that network of support in recovery is what really makes the difference.

GUPTA: More so than medication?

CLARK: More so than just medication, exactly.

GUPTA: And that's the conventional wisdom.

UNIDENTIFIED FEMALE: We do not use them at the Betty Ford Center.

UNIDENTIFIED MALE: I do want to disagree a little bit with Susan in this in that I think medications need to be on the table.

GUPTA: Dr. Mark Willenbring has been fighting this for year. It's part of the National Institute of Alcohol Abuse and Alcoholism, part of the National Institutes of Health.

DR. MARK WILLENBRING, NATIONAL INSTITUTES OF HEALTH: Most people are not ever told about the medications that are available for treating alcohol dependence. I think that's a crime.

GUPTA: Dr. Johnson agrees.

What grade would you give the way that we currently rehab addictions in this country?

JOHNSON: Let me put it this way. Rehab, in my view, in some cases, does not address the fundamental question of treating alcohol dependence. And it's been shown over and over again in research studies with different medications that effects of the medication over and above that of the psychotherapy. So it's a bit like having your hands -- one hand tied behind your back.

GUPTA: In Alcoholics Anonymous, they say that once an alcoholic, always an alcoholic. But sitting in Goober's with Walter Kent, I have to say it changed my view of what that means.

We're in a bar. There's alcohol everywhere.

KENT: Right, right.

GUPTA: What's going through your mind?

KENT: It gives me a chance to run into the guys I still see who drink, but I don't have to sit here with them and say, hey, do you -- like you want a drink or something? No, I don't. I'll have a soda. And I'm fine with it. Because when there's no urge, there's no craving, it doesn't bother me.

GUPTA: Walter Kent said he stayed sober, just like Angela Puckett, Lucy Gross and Nic Sheff. But with this disease, it's hard to know. Coming up, relapse.

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GUPTA: An adoptive mother, a high school teenager, a retiree, a writer, all of them addicts.

In addition to her sales job, Angela Puckett has a new part-time job, working weekends at a rehab. This fall, two milestones. Her son, Allen, started second grade as Angela entered her fourth year of recovery. But even today, the thought of using drugs and alcohol hasn't escaped her.

PUCKETT: Sometimes I get mad that I have this disease. But what's the big deal? So I get a buzz. It's gone. It's not going to stay forever and then I'm going to have all these consequences. I'm going to be hung over, disappointed in myself, disappointed family members. It's not worth it. It's just not worth it.

GUPTA: Lucy Gross also has a new job at a horse barn. An avid rider, she's been accepted to the equine studies program at the University of Massachusetts. Lucy has remained sober for more than 18 months.

L. GROSS: My worst day in recovery is better than my best day using. And I don't know, overall I'm doing really well. GUPTA: Walter Kent, too, remains sober.

KENT: And I have yet to go back to say I have an urge for a drink.

GUPTA: But what about Nic Sheff? He canceled the follow-up interview. It was all very mysterious.

We had heard that he relapsed. Finally, we tracked him down at this sober living home in Santa Monica, California. Hey.

N. SHEFF: Hey.

GUPTA: How you doing?

N. SHEFF: Good. Thanks for coming all the way over here.

GUPTA: In a remarkable four-page letter to CNN before my visit, Nic confirmed my suspicions. He'd been using. "I am isolated, alone, disgusted with everything and most especially myself. I am filled to overflowing with pain and torment and weight, he wrote."

He admitted to taking pills and smoking pot. He even wrote about getting high before speaking to a rehab. He said he started back on the drugs after an episode of mania, a condition sometimes experienced by people who are bipolar, as doctors have diagnosed Nic. He'd also broken up with his girlfriend.

N. SHEFF: I just felt like I needed relief so badly.

GUPTA: Nic writes that while looking for toothpaste in his mother's bathroom, he found something entirely more appealing, prescription drug bottles, Klonopin and Darvocet. He took one of each, he says, without even thinking twice.

N. SHEFF: Instantly, you know, I -- the craving was set off in me.

GUPTA: Nic spiraled downward. His fifth relapse.

N. SHEFF: It was like, well, I've already relapsed, so I might as well take these. Then once I was taking those, it was like, well, I might as well go get pot from this guy.

GUPTA: On the outside, he kept holding it together. The success story. But it was a lie.

You were actually high when you were going to the airport to fly to Washington to talk about ...

N. SHEFF: Yeah, I was. Well, I was -- I had -- yeah, I did -- that morning I smoked pot, yeah, before I went to talk to that -- to that boys' rehab about sobriety, yeah.

GUPTA: It's ironic.

N. SHEFF: And then I saw that -- it was like -- I mean, it was just so crazy how I went from zero to 60, you know, in a day and a half or something. So that was what really scared me.

GUPTA: But this time, before it got too bad, he sought help, checking into a seven-day group therapy program. When I met Nic this time, he was staying at a sober living house. He told me that he had been clean a little over 70 days.

Last time we talked about this whole idea that relapse may be a part of recovery. I got to say I was surprised to find you here, though.

N. SHEFF: Yeah. No, absolutely, man. I think I was doing -- well, I was doing really well externally. But, again, yeah, I didn't have any support really. And so I was just sort of trying to do it on my own and be really strong on my own. And if this process has taught me anything, it's that I really need to reach out to other people for help.

It's pretty cool ...

GUPTA: Pretty big.

N. SHEFF: Yeah, it's a nice -- I mean, super nice location and a nice space. And you share a room with somebody, which is nice and humbling.

GUPTA: In sober living, Nic was once again back in meetings, trying to follow the 12 steps of recovery.

N. SHEFF: I really struggle with it. I wish I didn't struggle with it, because I see it working for so many people and I'm very envious of people's ability to be sort of so swept up in it and have it help them so much.

GUPTA: We've met a lot of people who are addicts. Some of them are younger than you. Some of them are older. When you hear now -- you hear a story of someone who is an addict, do you immediately think of them as someone who has a disease that's going to need to be treated and cured? Do you think there's someone who has a lack of will?

N. SHEFF: I feel, yeah, that they have a disease, and that is the first thing that I think of. They're a sick person with a mental illness.

GUPTA: The first time Nic and I spoke, he told me if there was a perfect pill that could help him beat his addiction, he wouldn't take it.

How about today?

N. SHEFF: Yeah, I don't know why I said that. I would totally take it. I mean, I know that there are a lot of underlying issues that I have to deal with, but to take out the addiction piece would be just such a relief, I feel like. It would just allow me to not have to fight so hard to stay alive, really.

GUPTA: Nic Sheff remains sober. He says he's excited about the journey of recovery that still lies ahead.