Robin Williams, I hardly knew you

Robin Williams

During the last day or so many people have related personal stories about how Robin Williams touched their lives. Whether their anecdote comes from a movie, performance, interview or personal encounter, people have voiced their disbelief that such a carefree and mirthful human being could commit suicide. He rarely let his demons be known and, when he did, he made a joke about it or moved on quickly to less serious subjects.

But, for those of us in the mental health and substance abuse fields, those demons are very real and omnipresent. We see them in ourselves and in others. We never really know when the deep dark thoughts will take hold and the path to obliteration will set in. There are warning signs, of course, but the false alarms are many. At a certain point we become a little numb and a little less observant. We let our guard down. Complete and utter despair makes its entrance. There appears to be no way out. Self-annihilation appears in the guise of sweet relief. You know the rest.

I traveled in the same circles as Robin Williams did before he was famous in the mid 1970’s when he was performing in places like the Holy City Zoo and The Palms in San Francisco. I never knew him personally; he was among the many people I encountered in passing during the height of the disco era. He went on to become a celebrity and I took a circuitous path to academia. I heard about him from time to time in the media and in movies and on TV. I developed more interest in him as a person when he began to talk about his recovery from substance use. Our worlds began to look a little alike. I was in recovery myself and working with people with substance use and mental health problems. He was a well-known person who gave others hope when he talked about his struggle, even if fleetingly. When I would go on a run in San Francisco we sometimes nodded as we passed each other at Crissy Field. He was one of us. We were all doing what we had to do to contribute in whatever way we could to make up for our past sins.

Robin Williams death by suicide has taught me two things that I learn over and over again every time a thing like this happens. The first is that, no matter how many times you relapse, if you use this as a learning process, you can get clean and sober again. There is no “model” recovery and relapse is the rule rather than the exception. For anyone to hold themselves to an arbitrary standard can lead to a sense of inadequacy which can fuel the spiral downward into depression.

Secondly, always make sure there are at least two people (two in case one person is unavailable for some reason or another) that you can be absolutely truthful with and who you know will not judge you. Find these people through trial and error and, when you do, cultivate these relationships like there’s no tomorrow. These people will be invaluable to you when you are too ashamed to admit to others that you have descended into your own personal hell.

Unfortunately, Robin Williams’ celebrity didn’t protect him from the extreme emotional states that depression and substance abuse can bring on. He was well-loved and respected yet, it seems, this did not ensure his sense of well-being. It is a testament to his talent and generosity of spirit that his suicide affects many of us so deeply. On some level we feel that if only he could truly know how we felt about him he might now still be with us…

Drugs of choice: San Francisco Bay Area

turrellpurplephoto (2)

Recently the San Jose Mercury News reported that drug use has increasingly become a problem in the technology industry. High expectations have led to the adrenaline fueled culture which leaves its workers vulnerable to the temptations of licit and illicit drugs. Specifically, the article documents a rise in the use of uppers and downers to enable workers to maintain their productivity. These drugs include oxycodone, heroin, adderall and provigil. Methamphetamine and cocaine are not mentioned in the article but, from my experience in the field, these drugs are also part of the equation. The simple fact is that, particularly for young middle class professionals, when the doctor stops writing prescriptions you can turn to the streets for cheaper and just as effective options and, since many of these Silicon Valley professionals live in and commute from San Francisco, the drug market is in the city.

Given what the article presents I am given to ask, what exactly is the Bay Area experiencing in terms of drug and alcohol problems? Alice Gleghorn with the Department of Public Health in San Francisco put out a revised report in November of 2013 entitled Drug Abuse Patterns and Trends in the San Francisco Bay Area, California: June 2013. The report includes findings from the San Francisco Metropolitan Area which includes San Francisco, Marin, Alameda, Contra Costa and San Mateo. I will pull out a few statistics and findings from the report for the 2012 reporting period. While these numbers tell us about the problems associated with the use of substances, they can also help us to begin to understand patterns of drug and alcohol use in general.

Drug Seizures

Drugs most often seized in order of frequency as reported by the National Forensic Laboratory Information System (NFLIS)

1. Methamphetamine
2. Marijuana
3. Cocaine
4. Heroin
9. MDMA (Ecstasy)

Also, of note, various opiate, sedative hypnotic, and stimulant pharmaceuticals were seized by the DEA and these accounted for 10.6% of all drugs seized. These drugs included oxycodone, hydrocodone, alprazolam (xanax), clonazepam (klonopin), buprenorphine, and amphetamine.

Emergency Department Visits

Some findings from Emergency Department visits as reported by the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network (DAWN) were:

  • With the exception of methadone, many of these same pharmaceutical drugs individually showed significant long- and shorter-term increases in nonfatal emergency department (ED) visits in 2011 as compared with 2004, 2009, or 2010 (methadone-related visits decreased by 17 percent from 2009 to 2011).
  • Alcohol, cocaine, heroin, methamphetamine, gamma hydroxybutyrate (GHB), and lysergic acid diethylamide (LSD) also showed similar ED visit decreases during the same time comparisons.
  • Marijuana rates rose 146 percent from 2004 to 2011, slowing to a 40-percent increase between 2009 and 2011.

Treatment Admissions

Individuals entering treatment represent those who have transitioned from use to problematic use of substances. The most frequent primary drugs of abuse for this population as reported by the California Department of Health Care Services using the CalOMS (California Outcome Monitoring System) system were:

1. Alcohol (particularly among males over 35)
2. Methamphetamine
3. Heroin
4. Cocaine
5. Marijuana
6. Prescription drugs

Primary route of administration

  • Smoking for methamphetamine, cocaine and marijuana
  • Injection for heroin and methamphetamine
  • Orally for prescription drugs
  • Inhalation infrequently for heroin, methamphetamine and cocaine

Overdose deaths

As reported by the Drug Abuse Warning Network (DAWN) Medical Examiner Report drug-related deaths were due, in order of frequency, to:

1. Heroin
2. Cocaine
3. Alcohol
4. Stimulants
5. Benzodiazepines

Field reports found “bath salts” (substituted cathinones) and cocaine present in some drug-involved deaths.

Additional Findings

  • Heroin price and purity has continued to decrease to $1.40 per milligram of pure heroin with purity only at 3.9 percent on average in samples.
  • Laboratory analysis of a drug sold as “gunpowder heroin” revealed that this drug contained primarily heroin, lidocaine, codeine and morphine.
  • AIDS (acquired immunodeficiency syndrome) incidence and mortality have dropped to baseline levels, with approximately 18 percent of cases including injection drug use as a transmission factor.

In conclusion

This is the first in a series of posts that will provide a snapshot of what the experts are finding from their data collection and analysis efforts. Some aspects of drug and alcohol problems inevitably fall under their radar, however. I will continue to explore these elements so we can get the smaller and bigger pictures, that is, how this affects us personally and how this affects our community. Please feel free to contribute to the discussion; I welcome your observations and feedback.

May, P. & Somerville, H (2014, July, 25). Use of illicit drugs becomes part of Silicon Valley’s work culture. San Jose Mercury News. Retrieved from

Alice A. Gleghorn, Ph.D. (June 2013, Revised November 2013). Drug abuse and trends in the San Francisco Bay Area, California: June 2013. Retrieved from National Institute of Health (NIH) Community Epidemiology Workgroup.