By Richard J. Loebl, LCSW, BCD
For hundreds of years addiction to alcohol or drugs was considered by most people to be a moral failing or a sin against God. By the 20th century, the medical model of addiction was established by the American Medical Association, and endorsed by psychologists, social workers, counselors, and Alcoholics Anonymous. Attitudes began to shift, and many people today believe that addiction is a disease (although many others still judge addicts as morally or spiritually corrupt).
In his fascinating and controversial new book Chasing the Scream: The First and Last Days of the War on Drugs, Johann Hari argues that “…almost everything we have been told about addiction is wrong…” (An article based on his book can be found online at https://www.huffingtonpost.com/johann-hari/the-real-cause-of-addicti_b_6506936.html.) The author describes the misguided and failed War on Drugs, and he makes a compelling case for supporting a new model of addiction. He concludes that alcohol and drug addiction is an adaptation to socially impoverished circumstances, not a disease, and certainly not a problem of morality. The drugs have addictive qualities, but the drugs do not cause addiction.
Mr. Hari bases many of his conclusions on the work of Dr. Bruce Alexander, a psychology professor, research scientist, and author. Dr. Alexander conducted studies that show how addiction is a social problem – not a disease or moral disorder. His research has been validated by other scientific studies. In these experiments, animals were confined in environments where they were socially isolated from other animals, and deprived of their normal, healthy surroundings. These animals developed an addiction when they had a choice between 2 containers of water: one laced with opiates or stimulants, and another vessel with normal, untainted water. When the very same animals are moved to normal, social environments, they prefer the water that does not contain drugs. And the same results occur with human beings in a variety of real life circumstances (such as returning war veterans and post-surgical patients who are prescribed opiates for pain).
There is ample evidence now to conclude that the medical model of treatment, based on the addictive qualities of drugs themselves, is short sighted and ineffective. The implications for effective alcohol and drug treatment are quite clear, and should include:
o Warm and welcoming treatment environments.
Treatment facilities for alcohol and drug clients are often bleak, colorless and uncomfortable. These settings often result in negative emotional reactions in patients and may even contribute to relapse.
o Caring and compassionate counseling staff.
Counselors and therapists in addiction and rehab programs are often over-controlling and confrontational, with a tendency to “pathologize” clients (that is, they often view the clients as “sick” and treat them from a position of superiority and judgment). Alcoholics and drug addicts who are rigidly controlled, demeaned and criticized for their behavior only feel worse about themselves, and will receive little benefit from treatment.
o Social and emotional connection.
The vast majority of addicts have suffered rejection, alienation and trauma in their lives (including childhood neglect, abandonment and abuse). Treatment programs and counselors will only be effective when they address these emotional wounds, and help their clients connect to their feelings in a healthy manner. Clients must be treated with respect and open, non-judgmental acceptance. Social and relationship skills need to be taught by counselors and reinforced by organized program activities.
o Secure housing and subsidized employment.
A majority of clients in residential or inpatient alcohol and drug rehabilitation programs, and many others in intensive outpatient programs have limited resources or ability to live independently. Hari visited countries like Portugal, where drugs have been decriminalized, and funds from their failed war on drugs were redirected to housing and jobs for addicts. In countries like Portugal and Great Britain, addiction has fallen by as much as 50%.
Alcoholics and drug addicts can and do recover, often with the support of other addicts in programs like Alcoholics Anonymous and Narcotics Anonymous. The debate about the medical model and the disease concept of addiction is likely to continue for a very long time. We need to learn from programs and countries with impressive records of success. This success is based on compassionate care, concern, and love – not on control, judgment and punishment. And as Mr. Hari reminds us, we also need to “…talk about social recovery – how we all recover, together, from the sickness of isolation that is sinking on us like a thick fog.”