Acceptance is the answer. As someone who has been through his fair share of rehabs and Alcoholics Anonymous meetings, that is an axiom that I am sure Charlie Sheen is well acquainted with and, based on his history of addiction denialism and his recent behavior in the wake of his public announcement of HIV status, it is one he steadfastly refuses to acknowledge. On a very special two-part episode of The Dr. Oz Show earlier this week, Sheen invited the (not so) good doctor to his home and showed up for an taped interview in studio to demonstrate the ways in which he had turned over a new leaf and begun to tackle his HIV with a newfound, sober resolve. What ended up happening, as one might reasonably expect, is that Sheen's appearance did the exact opposite of what the actor desired, painting him as an unstable, delusional individual who was risking his life chasing curative windmills instead of following his antiretroviral treatment regimen.
It is impossible to have a discussion about Charlie Sheen's management of his HIV without first discussing his issues around substance abuse and, more importantly, mental health. Sheen's travails around his myriad addictions, which run from alcohol and cocaine to gambling and sex, are one of the worst kept secrets in Hollywood and it shouldn't come as a surprise to anyone that the actor told Dr. Oz that he was once again newly clean and sober. Sheen reports that he hasn't used drugs since in about 5 months and that he quit drinking the day after going on the Today Show and revealing his HIV diagnosis in an interview with Matt Lauer, which, if true, would mean he has a little under 2 months of simultaneous sobriety and clean time. Given his history of chronic relapse and his lack of a sober support system or recovery program, it's hard to be too confident in Sheen's continued sobriety, but it is encouraging nonetheless and, regardless, it isn't necessarily an impediment to him suppressing the HIV in his body. Studies have shown that, as HIV medications have gotten more readily available and easier to take with fewer side effects, the number of people in active addiction who were able to take their meds regularly has skyrocketed, going from 19.3% in 1996 to 65.9% in 2009 according to one study.
However, Sheen's mental health status is a different story. In the special, he admits to Dr. Oz that he as been labeled and diagnosed as being bipolar before by several people (he won't say specifically by who, but it's safe to assume psychiatric professionals were among them), but that he refuses to identify himself as such or to take any medications for it, saying he doesn't want to, "turn into some Seroqueled zombie." For those who are unfamiliar with it Seroquel is a anti-psychotic medication that is FDA approved to treat schizophrenia, depression and bipolar disorder. It is a pretty heavy duty medication with a host of pretty dreadful side effects, the most common of which are increased fatigue, sedation, dizziness, cotton mouth and an increased appetite. It's certainly understandable why Mr. Sheen wouldn't want to take Seroquel or any drug that has those sorts of side effects, but his failure to treat his bipolar disorder has, in all likelihood, led him to make decisions regarding his HIV treatment that are potentially fatal.
The big "bombshell" of Dr. Oz's special came when Sheen admits to the film crew following him around that he had stopped taking his HIV medications. "I feel like there's this mantra, 'Stay on your meds, stay on your meds, stay on your meds'" Sheen says to the camera in an SUV after receiving some acupuncture therapy. "As I was leaving, Michelle (Sheen's acupuncturist) said 'you look very healthy ... you look very present, very clear.' And I told her, 'well, I'm not on my meds.' I've been off my meds for about a week now and I always feel great. And yeah, am I risking my life? Sure. So what ... I told my mom on day one that the disease picked the wrong guy if it wanted to stay alive."
Later on in the episode, Sheen reveals that he had begun seeing a Dr. Samir Chachoa in Mexico, who was using alternative therapies to not only treat his HIV, but cure him from having it using treatments that were patented over 2 decades ago and which have been either discredited or ignored by the international medical community. When Dr. Oz managed to reach him via telephone, Dr. Chachoa told him rather matter-of-factly that, in order to convince Charlie of the efficacy of his treatments, he, "drew some blood from him (Sheen) and I injected myself with it and I said, 'Charlie if I don't know what I'm doing, then we're both in trouble right now, aren't we?'" After recounting the story to his studio audience, Dr. Oz called Dr. Chachoa's behavior, "pretty inappropriate", a statement that might be the early frontrunner for the largest understatement of 2016.
While Sheen was in the studio, Dr. Oz also had the actor read an excerpt from something he had sent him that was half poem, half program pitch and which outlined an idea for a TV show he had called Chasing The Cure. In it, Sheen wrote that in this show, "We'll go through the medical front lines, the alternative back rooms, and at times, the radically unsafe and uncharted catacombs and warrens that have been labeled or deemed as 'godless voodoo' or 'unapproved junk science'." Essentially, Sheen is saying that he wants to put his life on the line to find HIV treatment's Holy Grail when perfectly good antiretroviral treatments already exist. He truly believes that, because of his fame, because of his brilliance and because of his intrepid nature, he can find a cure to HIV where all of humanity and science has failed previously.
This sort of detachment from reality and sense of exceptionality are some of the hallmarks of both someone who is in denial and someone experiencing a manic episode. To a sane individual, the idea that any one person could either, through biologic superiority or unbridled tenacity, be better equipped to combat HIV and/or find a cure is ridiculous, especially when there are already scientifically proven treatments on the market that can render the virus suppressed within the body. But to someone who is in denial or actively manic, that idea can sound perfectly reasonable.
It may sound like I'm harping on the mental health aspect of this -- and to a certain extent I am -- but it's only because I feel as if it's one of the more overlooked parts of medication adherence and because I have personal experience with it as well. While I am not HIV positive myself, I am in recovery from addiction and alcoholism, I have been on medication for bipolar disorder for almost my entire adult life and I have done case management work with numerous clients who had been diagnosed with various mental illnesses. I know what it's like to have side effects from the medication you take have negative impacts your life and I also know that those side effects are the price I must be willing to take if I want to live a productive, satisfying life. I can't say with any certainty what Charlie Sheen's medication adherence and sobriety will look like if he continues to leave his mental health untreated, but I know from experience, both lived and observed, that his odds are not great.