Prince was a beloved, lauded musician who will be terribly missed. He was known for his great musical gifts and tremendous stage presence. And he was also known for being substance-free: it was commonly recognized that he did not allow drinking, smoking, or drug use by anyone in his home or work. And yet recent reports indicate it may well be the case that he fell prey to an overdose of addictive pain medication.

The premature loss of this great artist is all the more shocking and heartbreaking in hearing that the cause is one that might have been preventable. One might assume that greater finances and influence brings access to better care, better advice, and greater protection from preventable dangers. Yet, it seems that despite all his fame and fortune, Prince still somehow did not have access to what might have saved him.

It is difficult to understand how this could be true – shouldn’t someone like Prince have all possible access to cutting edge treatments to address whatever ails him? What could the obstacles be that block access to appropriate care for someone with his means? As a psychologist, I am always reticent to speculate about the personal details of someone not personally known to me, given the professional ethic of privacy and a deep respect for the significant individual variables so often at play that cannot be assumed. At the same time, being in the field of substance abuse treatment, these issues are so prevalent and problematic, that commentary on the problem in general feels important. It is also not so difficult to make some educated guesses about what may have gotten in the way, and it’s a terrible shame.

Shame and secrecy. No other ailments are associated with the level of shame and secrecy that surround problems of substance abuse. There is a heavy weight of blame around substance abuse, despite the fact that the vast majority of people who try or use alcohol/substances do not develop abuse or dependency. No one starts using a mood-altering substance with the intent to develop a dependency and yet society and the media treat this problem as though it were solely self-inflicted. This view may be changing as the use of prescribed pain medications has exacerbated, leading to inadvertent dependency. Perhaps there is more compassion for those in this camp – people who start off medicating legitimate pain with prescribed medication, but gradually slide into a physical dependency, the reins of which are not adequately held and supervised by medical professionals. And yet, those suffering from this entry to substance abuse problems are not exempt from the same terrible shame and secrecy. Prince was most likely not immune to the denigration, disparagement, and indictment that most people with substance use problems experience. These self-disparaging feelings may have been all the more mortifying for him holding such a strong stance publicly regarding mood-altering substance use. Going public, even just in sharing with friends, that he may have developed a problem would be all the more difficult.

Our society can be so condemning of these problems that people do not dare ask for the help they need, and problems worsen as a result. With overdose rates on the rise and more media attention to these issues, will the news of the many available options become more commonplace among consumers and practitioners alike? Anonymous 12-step meetings, for instance, are not the only available supports for problematic opiate use. Several medication options are also available: Suboxone, Vivtrol, and Methadone – all proven to save lives. We may never know if any of these were known to Prince or if medical doctors advised him in a way that included them in their assessment.

A documentary about Janis Joplin aired on PBS television recently, which detailed her amazing musical career, cut tragically short with her death by heroin overdose. It is striking that her death was over four decades ago when there were much fewer medications and psychological treatments of addiction problems available, and yet it appears that another great artist may have fallen prey to this tragedy, again without adequate medical treatment. It is depressing that in four decades and many advances in this field of treatment, that there has not been more progress in the use of those treatments, awareness of the options – including overdose prevention – and in the deep shame and secrecy that haunts those who struggle to cope. The lack of self-compassion, social compassion, and active use of existing scientific advances in treatment is sad and angering. And this state of affairs unnecessarily keeps life-saving treatments from the hands of those who most desperately need them.

Prince is sadly no longer with us to save, and this is a horrible tragedy. But there are many more people who can benefit from treatments now available. Let us hope that the obstacles of shame and secrecy can start to be left behind now, paving a way for people to access the variable methods of treatment – whether to prevent overdose with Narcan, decrease cravings with medications like Suboxone, increase motivation and skills for change with Motivational Interviewing and Cognitive Behavioral Therapy, or increasing social support such as with Anon programs – there is help available.