Grammy Award-winning pop singer Amy Winehouse, whose drug and alcohol abuse overshadowed her musical talent, was found dead last weekend at her London apartment. We asked Hortensia Amaro — professor and associate dean in the Bouvé College of Health Sciences and director of the Institute on Urban Health Research — to analyze the behavior of individuals who struggle with substance abuse.

Winehouse acknowledged her refusal to seek help for drug addiction in the Grammy Award-winning song “Rehab.” In general, why do some people refuse treatment for substance abuse? How can family and friends help a loved one suffering from drug addiction get the proper care?
It is quite common for people who are addicted to drugs or alcohol to be in denial about their problem. There are many reasons why people who need treatment refuse it, including an inaccurate perception that they can quit any time or that they can simply “control” their use. Others fear the powerful impact of physical withdrawal. For many, addiction serves as a self-medication for overwhelming emotions stemming from trauma, so letting go of this coping mechanism evokes fear. Others may fear legal consequences and stigma of addiction.

Family and friends can play an important role in helping someone with an addiction disorder recognize his or her problem. But often, loved ones don’t know what to do and may also be in denial until the problem is quite severe. Expressing concern and providing clear messages about the negative consequences of a person’s drug use and related behaviors is very important. Family and friends can also seek guidance through self-help programs or counseling with an addiction specialist to find out if they might be enabling substance abuse, and to sort out strategies for interacting with loved ones suffering from addiction.

Why does fame so often lead to self-destructive behavior, such as substance abuse?
It is not clear if fame disproportionately leads to self-destructive behaviors compared to what we see in the general population. But having celebrity status and such great sudden financial resources at a young age may contribute to the problem. Adding to this are demanding schedules, pressures to produce, high expectations and, in some sectors of the entertainment industry, normative use of alcohol and drugs. For younger people, among whom substance use is highest in the general population, these factors, combined with others — such as a personal profile of risk taking and sensation seeking, psychological trauma, mental health problems, or family history or genetic vulnerability to substance abuse — can be a dangerous combination.

Winehouse’s ex-husband reportedly introduced the pop star to heroin and crack cocaine. How important is it for a drug addict to surround herself with positive role models who reinforce healthful behavior?
It is not uncommon for women who become addicted to initiate drug use through a male partner. Having positive role models, partners and friends is important because our loved ones and those in our social networks are extremely influential in our behaviors, including binge drinking, drug use, overeating or living a sedentary lifestyle. For a person recovering from addiction disorders, it is essential to avoid individuals who are active drug users, as well as places and situations associated with such use. These are particularly dangerous to those in recovery since they can trigger cravings and lead to relapse.