Why 'Tough' Treatment Doesn't Help Drug Addicts
July 11, 2016 11:43 AM   Subscribe

Maia Szalavitz [mefi's own maias] talks about her new book, Unbroken Brain: A Revolutionary New Way of Understanding Addiction on Fresh Air with Terry Gross (transcript) - "We have this idea that if we are just cruel enough and mean enough and tough enough to people with addiction, that they will suddenly wake up and stop, and that is not the case."
posted by kliuless (55 comments total) 71 users marked this as a favorite
 
Calling out white privilege at 13m clearly. Nicely done.
posted by odinsdream at 12:01 PM on July 11, 2016 [2 favorites]


[paraphrasing]
TG: Why do you think you didn't have a harsher sentence?
MS: {6 minute explanation of systemic racism}
TG: So at some point, you knew you had a problem...

...wow, Terry. Wow.
posted by odinsdream at 12:10 PM on July 11, 2016 [10 favorites]


I haven't listened yet but I'm familiar with this book. I agree with the premise completely; I remember when I was a clerk in a senior center in the Tenderloin, (skid row in SF) and I worked with substance abuse counselors who worked with folks that had many decades of substance abuse to overcome. There was a meeting on different styles of intervention, mainly harm reduction vs. the 12 step style. The AA 12 step model is what most of the counselors were used to since they were recovered addicts themselves. I remember when the tough love thing came up and they insisted you have to let people hit 'rock bottom' before they 'decide' (intentional scare quote) to recover. And I asked, "But if they're already homeless in the Tenderloin, what exactly is "rock bottom"? Aren't they already there?" and the harm reduction advocate basically said "Exactly". Because what's the next step down, death?

In a doc on heroin addiction, one addict said the drug took a part of you with it, that you were consistently being diminished, and this seems to be the scenario with extended mental illness, that your ability to bounce back just diminishes over time. In my experience I have found that to be true; you may have more tools at your disposal but your brain has taken a cumulative beating. I can see how addicts are just increasingly hopeless and go to the only comfort they know, and perhaps it's a form of passive suicide.
posted by GospelofWesleyWillis at 12:11 PM on July 11, 2016 [24 favorites]


Its hard for me to not want to see some punitive response to breaking the laws regarding illegal substance use / dependence / purchase and sales. I realize that's a weird kind of visceral morality that is totally unrealistic in public policy. I can't plumb the reasons why I still harbor vestiges of such views. After listening to that interview it is so clear that not only is the balance of evidence heavily weighted toward treatment as opposed to punishment, but quite frankly the view that I described earlier is untenable and immoral.

Treatment, treatment, treatment ... and love too.
posted by Charles_Swan at 12:14 PM on July 11, 2016 [11 favorites]


Its hard for me to not want to see some punitive response to breaking the laws regarding illegal substance use

We made those laws up, though. Mostly to punish poor, brown people for having the temerity to experience happiness while being poor and brown.
posted by mhoye at 12:21 PM on July 11, 2016 [36 favorites]


Charles, I think that's a common attitude. At least you recognize the problems with it; a lot of people think jail is the answer, even some of the substance abuse counselors I worked with did say that jail was what made them stop, and maybe that was the basis of fear that propelled them toward recovery. But it doesn't seem to be the case for a lot of people who just continue the spiral down as the penal system only gives them more reasons to hate themselves and hate life and want to go numb.
posted by GospelofWesleyWillis at 12:23 PM on July 11, 2016 [3 favorites]


not to dominate the conversation, but I'm not always sure it's the pursuit of happiness here that dogs chronic users. I think it's the pursuit of annihilating pain and hopelessness.
posted by GospelofWesleyWillis at 12:25 PM on July 11, 2016 [36 favorites]


I think the book that has influenced my thinking most is Dr. Mate's In The Realm of Hungry Ghosts. His clientele, who were poor and of color and hard core addicts, were almost uniformly trauma survivors, whose addictions were rooted in that trauma. To add cruel societal treatment to that is something of an atrocity.

I realize it is hard for many of us who have been fortunate to accept that it is only that good fortune which differs us from others, and that it is not a special entitlement we have earned. But it is about time we started approaching addiction and its prevention with love, not punishment.
posted by bearwife at 12:29 PM on July 11, 2016 [34 favorites]


"And we have this idea that if we just are cruel enough and mean enough and tough enough to people with addiction that they will suddenly wake up and stop. And that is not the case. Addiction is actually defined by the DSM and by the National Institute on Drug Abuse as compulsive behavior that continues despite negative consequences. That's the definition of addiction. So therefore, if punishment, which is just another word for negative consequences, worked to fight addiction, addiction actually wouldn't exist.

And so we just have this thing so wrong. Addiction is a problem with learning from punishment, and we expect punishment to fix it. There's something deeply wrong with that."
posted by storybored at 12:35 PM on July 11, 2016 [34 favorites]


Maia did such a great job in this interview. Terry Gross: ew.
posted by odinsdream at 12:38 PM on July 11, 2016 [1 favorite]


> Maia did such a great job in this interview. Terry Gross: ew.

Oh, come on. Yes, I get annoyed with Terry too, my wife and I frequently groan and tell her to shut up, but she's still one of the best around; I'll bet if you asked Maia, or any of the great people Terry interviews, they'd say they were thrilled to have an interviewer who was intelligent and asked meaningful questions and had actually read the book/seen the movie/heard the album. Do you have any idea how shitty most interviews are? Let's not let the perfect be the enemy of good interviewing.
posted by languagehat at 1:08 PM on July 11, 2016 [42 favorites]


I've been recommending her book to everyone I know. Very worth reading. I also like Mate's book and think this is better. Maia is the best writer around on substance use and drug policy.
posted by gingerbeer at 1:11 PM on July 11, 2016 [1 favorite]


languagehat: I'm not even sure what you want out of this exchange. I hope you're having a good day.
posted by odinsdream at 1:16 PM on July 11, 2016 [5 favorites]


languagehat: I'm not even sure what you want out of this exchange
It seems clear enough to me that he wants to defend Terry Gross from your charges of "ew"
posted by thelonius at 1:22 PM on July 11, 2016 [9 favorites]


> It seems clear enough to me that he wants to defend Terry Gross from your charges of "ew"

It seemed pretty clear to me too, but thelonius explained it well. Are you having a good day? If not, I hope it improves.
posted by languagehat at 1:26 PM on July 11, 2016 [1 favorite]


I don't really have a lot to say on why I didn't particularly like Terry's end of this. Hence my trite, single-word review. You're welcome to memail me about it or contact me some other way if you wanna like, talk about Terry Gross. That's fine. It seems like it would be a derail here.
posted by odinsdream at 1:32 PM on July 11, 2016


Maia did such a great job in this interview. Terry Gross: ew.

Yes, I get annoyed with Terry too, my wife and I frequently groan and tell her to shut up,

Sounds like you two are in some sort of nonparallel agreement.
posted by Etrigan at 1:33 PM on July 11, 2016 [3 favorites]


I hate to derail a perfectly good thread on harm reduction but this is where I have to part ways with languagehat: Gross is a bad interviewer. Full stop. She has an amazing platform in Fresh Air but she's just not good. She often makes factually incorrect statement about her subjects or rambles off about her own uninteresting opinions or observations.

But back to the topic at hand, didn't the UK trial simply giving addicts heroin laced cigarettes decades ago? Just two weeks ago a safe injection site advocate in Toronto was found dead in an alley of overdose. It's so frustrating that I think there are really simple solutions to part of this problem.

Its hard for me to not want to see some punitive response to breaking the laws regarding illegal substance use / dependence / purchase and sales.

Drug use has a natural disincentive but most people aren't necessarily aware of it and dealers of course have no disincentive if they're not users. Drug use isn't great for any user as far as I can tell. But I think your urge is to find a way to disincent people further from trying it and to definitely disincent people from making money off addicts. And I think the easiest way to do that is to decriminalize addiction.
posted by GuyZero at 1:38 PM on July 11, 2016 [2 favorites]


[Maybe less with the opinion poll on Gross's interviewing skills and more on the literally anything else in the post, folks.]
posted by cortex (staff) at 1:39 PM on July 11, 2016 [20 favorites]


Why 'Tough' Treatment Doesn't Help Drug Addicts

The response to 'Why' is mostly anecdotal assertions.

On the other hand, "'Tough' Treatment Doesn't Help Drug Addicts" is empirical and I hope is broadly understood and accepted sooner than later. It really depends on the New Calvinists and how they capture media.
posted by j_curiouser at 1:48 PM on July 11, 2016 [2 favorites]


the (political) problem with harm reduction and "trauma" is that you don't have to be an addict to experience "rock bottom" and most of the people who experience the trauma of growing up at rock bottom don't become addicts. but addicts are in the nexus of squeakiest wheel and moral panic and that drives a huge industry of advocates.

the bottom line is that in a liberal society, which is organized by the moral choices of it's members, addicts get a pass for having a shit situation and there's no contradiction between charity for the unfortunate and "hard choices" for everyone else.

here's an example. young addict in my town starts breaking into houses with his girlfriend. I chase them out of my kid's mom's house when we stop by to pick something up in the middle of the day. turns out he hit a whole row of good hearted liberal minded homeowners. he gets sent to drug court, gets a diversion into treatment. gets to write an op-ed in the local paper about his sorry whiny addict self. gets interviewed on npr, etc. now, why are all these people interested in promoting this kid out all the young men with shit situations in my town?

"hard choices" don't work for anyone, not just addicts. But the fact that addicts have an out from the whole sick moral order we live in, "harm reduction" for them actually reinforces hard choices for the rest of us.
posted by ennui.bz at 2:18 PM on July 11, 2016


"don't mess with white powders"

"in the sort of hippie psychedelic community, there was this saying that - don't mess with white powders - that as long as you stick to marijuana and psychedelics, you're not likely to really get in horrible trouble with drugs, which is good harm reduction advice to this day"

This is very true. The majority of people who mess with white powders do not destroy their lives, but when someone does destroy their life with drugs it is generally the white powders. (Even chronic MDMA use can be a problem. Heron, speed, and coke are the real dangers, though.)
posted by poe at 2:19 PM on July 11, 2016 [4 favorites]


now, why are all these people interested in promoting this kid out all the young men with shit situations in my town?

This is basically the "it's unfair to help these people because other people have crap they deal with too" argument. And the problem of course is that argument can be used as an excuse to never help anybody, ever. Of course fewer people should be in shit situations, but you have to start shoveling somewhere.
posted by zachlipton at 2:39 PM on July 11, 2016 [16 favorites]


I listened to this podcast this morning and really enjoyed it - had no idea Maia is MeFi's own. Very cool. Like Charles_Swan, I also have some conflicting emotions on how to handle addicts who break the law, and this podcast forced me to think about those emotions more deeply, which I appreciate. I recently read this article on harm reduction in Canada, which I really liked as well. Seems like such a small and easy way to improve the quality of life for one of the most marginalized populations.

(And Terri Gross is great in my book. Not perfect, but who is? )
posted by widdershins at 3:03 PM on July 11, 2016 [1 favorite]


Chuck Dederich wept.
posted by Chitownfats at 3:25 PM on July 11, 2016 [1 favorite]


addicts get a pass for having a shit situation

addicts have an out..."harm reduction" for them actually reinforces hard choices for the rest of us.


what the fuck planet do you live on? you might be thinking of 'upper middle class liberals', or 'investment bankers'. you are not discussing addicts.
posted by j_curiouser at 3:45 PM on July 11, 2016 [10 favorites]


why are all these people interested in promoting this kid out all the young men with shit situations in my town?

I presume because he had a story that could be sold, and he was lucky enough to have the ability to sell it/people interested in helping him sell it.

But the fact that addicts have an out from the whole sick moral order we live in, "harm reduction" for them actually reinforces hard choices for the rest of us.

Did he revert to robbing houses or something? Because if a petty criminal successfully re-invented himself as a writer it would appear that harm has been reduced?

I'm not really sure what your point is except that you want to suspend your acknowledgement that the

whole sick moral order we live in

is bullshit for a minute to complain that someone tried to steal shit from you? Yeah man, that sucks.
posted by atoxyl at 3:55 PM on July 11, 2016 [7 favorites]


To those of you who have a visceral response of wanting to see addicts punished: do you also feel that way about alcoholics?
posted by Anne Neville at 4:05 PM on July 11, 2016 [6 favorites]


I read "Chasing the Scream: The First and Last Days of the War on Drugs" last year. Very interesting read. It really reframed how I think about drugs, and why we combat them, and how. I remember the author had been involved in some sort of scandal about his writing, so he was very meticulous to document everything. I had known that the War on Some Drugs was racist, but I hadn't known how much that was simply the point.
posted by Ambient Echo at 4:07 PM on July 11, 2016 [1 favorite]


I should add, not only very interesting, but damned infuriating, too. So much hatred and waste of human life in service of racism and awfulness.
posted by Ambient Echo at 4:08 PM on July 11, 2016 [1 favorite]


I think the trauma component is important - and i think it should be an additional catagory in its list of types of people. It changes how addiction is processed in some pretty important ways in my opinion, especially based on severe childhood trauma.

But love and respect do tons to heal traumatic experiences so she covers that in an non direct way.

I'm pro harm reduction, and I agree 100% that 12 step support group belong outside of treatment. There are so so many valuable things that can be done inside treatment, but the staff can watch peer led groups and call it a day charge thousands of dollars for it is absolutely maddening.

And yes get rid of maximums MAT drugs!
posted by AlexiaSky at 5:10 PM on July 11, 2016 [1 favorite]


I've had the...interesting experience of watching a close relative survive heroin addiction for close to two decades now. With an intermission in the middle where a brain tumour was discovered and the removal of which lead to some intellectual difficulties for him.

In the past two decades he has gone from stealing from his family, repeatedly, and selling to others including younger members of the family, to the methadone program. He has stuck with it the past three years, as his father (he lives with his parents) got sicker. Last time I saw him he had taken a motorcycle with a destroyed engine and refurbished it and repaired it (he explained the intricacies of the engine to me but all I retained was 'a piston smashed through the engine because they did a thing to make it more powerful'). He helps his mother with care for the house and his father, he cares for his daughter part time. He still has brain damage, and emotional difficulties (my daughter said "he needs to learn to take a breath before he speaks I think") but harm?

So minimised. He isn't stealing, he isn't dealing, he is actively becoming part of the household again and part of the community. He is 'giving back' and 'participating'. Yes, it took years. No, he was no violent. Yes he did steal and did time for it too. But if you'd just written him off with 'tough love' and jail time, you'd have increased his trauma and you would have halved his mother's support network. You'd have left a bike to rot for want of the expertise in his mangled head that takes a little longer to get through, a little more time to filter down.

It's been nice having him back to something like normal. It took a long time, it took patience, it took decent infrastructure finally making its way to his town, it took a lot of things. But he is getting better and it wasn't harshness that got him there, it was him being needed as part of his family and community and having something to do when the trauma hits, that isn't the bliss of drugs.
posted by geek anachronism at 5:23 PM on July 11, 2016 [22 favorites]


If I was emperor, I'd make harm reduction the center of society. It works so much better than the punitive model, and it is cheaper and more humane to boot.

I'm glad this book is getting the attention and I hope it reaches policy makers.
posted by Dip Flash at 6:09 PM on July 11, 2016 [6 favorites]


I think the book that has influenced my thinking most is Dr. Mate's In The Realm of Hungry Ghosts. His clientele, who were poor and of color and hard core addicts, were almost uniformly trauma survivors, whose addictions were rooted in that trauma.

My addictions were undoubtedly rooted in trauma, and I'm white with a middle class background. I have been very lucky to have the resources I needed to work through these issues. There is a lot of denial when it comes to trauma- I had years of weekly therapy sessions before uncovering my own PTSD and acknowledging the abuse in my history, and this was many years after quitting drinking. When you're struggling to survive and don't have access to mental health resources, it seems like such a difficult battle that it's not surprising people don't find their way out.

We do nothing but further traumatize people who are stuck in this cycle by putting them in jail for possession or sales and by withholding access to harm reduction treatment and basic necessities to provide stability. At some point, when the moralistic arguments fail to deliver the morality of compassion and empathy, and in practice result in more death and suffering, those arguments become justifications for Calvinistic punishment, no matter how ineffective it is. It's surely as strong a form of self-delusion and denial as the lies I told myself for decades before I could recognize that I was abused.
posted by krinklyfig at 6:25 PM on July 11, 2016 [4 favorites]


the (political) problem with harm reduction and "trauma" is that you don't have to be an addict to experience "rock bottom" and most of the people who experience the trauma of growing up at rock bottom don't become addicts.

Yes, and those people probably don't need treatment, not in any sort of immediate sense. They are lucky. It's not the case that they are better people simply because they didn't become addicts. I could tell you many stories about growing up in an abusive household, where the lack of addiction didn't mean lack of abuse or a sense of empathy. Those who become addicts are almost always self-medicating. Working through those issues takes a lot of time and effort, and resources.

My dad's side of the family is riddled with abuse, trauma and addiction. Some family members did not develop PTSD from abuse, and for the most part they do not struggle with addiction. Some of us - myself included - did develop PTSD from abuse and addiction problems. Why? Roll of the dice.

One of my nieces (mom's side) is addicted to meth, and after several years of stability as a single parent has disappeared and abandoned her children, which happened after CPS removed them from her home due to indications of abuse. She was also abused by my sister's ex husband, her father - now my sister, her mom, has custody of the kids. I'm very grateful that our family has been compassionate in how we deal with this. Her kids have some healing and challenges ahead, but nobody sees my niece as a horrible person. Her choices have caused a lot of pain, but it would do us no good to think of her as if she deserved to suffer. She is always welcome to come back, of course with limits as to custody, because her kids need stability and caring, as does she. I think we've all accepted that our best efforts might not be enough to bring her back. It's been a couple years since she left.


here's an example. young addict in my town starts breaking into houses with his girlfriend. I chase them out of my kid's mom's house when we stop by to pick something up in the middle of the day. turns out he hit a whole row of good hearted liberal minded homeowners. he gets sent to drug court, gets a diversion into treatment. gets to write an op-ed in the local paper about his sorry whiny addict self. gets interviewed on npr, etc. now, why are all these people interested in promoting this kid out all the young men with shit situations in my town?

First, I have a big problem with news media's unceasing desire to search for heroic arcs with a redemption narrative. Life is almost never that neat and clear cut, and is far more often messy, with choices that are at best ethically dubious. In the same sense, there is no way to tease out an accurate narrative that sums up these choices as those of the undeserving, a "whiny addict." This isn't about stories with heroes and villains.

That aside, personalizing every story of addiction as bad behavior doesn't help in delivering policy. There is no need to see individual behavior as an indication of an individual's worth when we're trying to help solve social problems, rather than retreat into moralistic arguments about who deserves help. The real value of 12 step programs and other spiritual paths (because that's what it is) is that the responsibility for the choices of an addict is still the addict's (any good therapist will also say the same, and a 12 step spiritual path isn't necessary for healing, but it does help some people work through this process).

An alcoholic who destroys his marriage and becomes estranged from his own children while drinking still has to live with the outcome of his choices when sober, meaning he may not find those he has hurt are ready to accept him in their lives again. There is no free pass. Working through forgiveness (or the lack of it) from those who were affected is an important step in healing from years of internalized shame, regardless of the specific path to healing. Sometimes you don't get reconciliation, and that's not anyone else's fault- you have to find a way to take on your own self-care. But without healing, the risk of relapse into the addiction cycle (as opposed to maintenance) is much bigger. Harm reduction allows for this process to begin without stigmatizing the addict, the substance or the addiction to it. This helps an addict establish stability and support networks.

Any legal issues are still the responsibility of an addict, including sentences for criminal acts against others, and even possession charges, fair or not. The mistake is in thinking that punishment and scorn is what addicts inherently deserve, rather than compassion and treatment. You don't have to forgive someone who hurt you, as that is your own choice. But to heap scorn and punishment on addicts as a society, in terms of social stigma, mental and physical health, social services, and within our criminal justice system, only makes things worse for everyone.
posted by krinklyfig at 7:47 PM on July 11, 2016 [9 favorites]


Is it just scorn and punishment though? What an addict may perceive as "punishment" may actually be the very necessary removal of them from situations where they continue to harm others (such as violence against spouses).

I see no contradiction in being compassionate, while also acknowledging that people have free will and are responsible for their choices. Trauma is ABSOLUTELY a bitch to get past, but at the same time, if you are nearly fifty and still making the same bad choices that have consequences (and cause trauma) to others, there isn't a lot of insight that can be expected to happen. Perhaps the resources would be better served preventing the next generation from repeating the cycle instead of financing yet another stay in rehab. Yes, it is callous, but if families/societies have limited resources they need to focus on what the best ROI is.

My experience is mostly with Meth, which is such a destructive drug, especially if drug-induced psychosis presents itself. Drugs like heroin seem so quaint next to it.
posted by saucysault at 10:07 PM on July 11, 2016 [3 favorites]


What an addict may perceive as "punishment" may actually be the very necessary removal of them from situations where they continue to harm others (such as violence against spouses).

one option is, charge them for committing violence against spouses, not for being addicted.

if you are nearly fifty and still making the same bad choices...there isn't a lot of insight that can be expected to happen.

keep the faith
posted by j_curiouser at 10:20 PM on July 11, 2016 [3 favorites]


Is it just scorn and punishment though? What an addict may perceive as "punishment" may actually be the very necessary removal of them from situations where they continue to harm others (such as violence against spouses).

The only way to deal with these kinds of problems in a healthy way is to take care of yourself first. That may mean someone else can't be part of your life, if their choices are destructive to your well being. It's often very hard to maintain healthy boundaries, but if you don't you end up in co-dependency. It's easier said than done, but it's not really compassionate to enable someone else's harmful behavior.

As for meth, it's not the same beast as opioid/heroin addiction, which results in physical dependency and withdrawals, as does alcohol (eventually). Meth addiction treatment doesn't really need maintenance doses for recovery, or physical detox. For some people, it does seem to be a long term addiction. But meth relapses to me look a lot like alcoholic relapses. They both tear up people's physical health and lives, and some people never escape. It's hard to be functional as a meth addict for too long, though. People get to the self-destructive phase pretty quickly.
posted by krinklyfig at 10:37 PM on July 11, 2016 [1 favorite]


At some point we lost the hippie model of free love and drugs and traded it for the harm reduction model. Our system has very cleverly moved the Overton window on the drug war up.

I know what people are going to say. The hippies used psychedelics for spiritual experiences, that's different than these hard drugs. I've got a copy of the Electric Kool-aid Acid Test that stands to differ.

The punitive or incarceration model is definitely much worse, but we are trading the worse for the meh, and frankly other countries haven't made that concession. We're losing that part of the left.
posted by formless at 11:42 PM on July 11, 2016


Very interesting interview - thanks to kliuless for posting, and not least to maias for writing the book and telling the story.
I really wish all drugs could be decriminalized, so we could get rid of the dealers and all of the whole drug industry.

In my family, there is a long history of addiction (my great-grandmother did some sort of opioids, I don't remember the details), and I am not at all accepting about drugs or tolerant. But I do feel criminalization is the wrong approach.

This made a lot of sense from my personal experience:
So there is one pathway where children are oversensitive and overstimulated and very anxious and really kind of nervous. And these kids are looking for a way to calm down and a way to feel safe and a way to connect. There is another pathway where people are understimulated and they feel almost like nothing feels like anything. They feel very disconnected or very numb. And those kids are looking for excitement and stimulation and to feel more.

And then the third path, which is kind of the most interesting, is where you sort of swing back and forth between the two. Sometimes, you're understimulated. Sometimes, you're overstimulated. But all three of them have in common that there is that a dysregulation of the ability to control emotion and sensation.


I can recognize all of those patterns in different family members - and the first one in myself, though I haven't tried drugs. With this basic observation, it also seems much clearer what is needed is love and care. But maybe sometimes, the addict has just burnt too many bridges, and though I find the 12-step programs sick in themselves, for some, it's probably the only place they can find a semblance of the love they need.
posted by mumimor at 1:26 AM on July 12, 2016 [2 favorites]


I've got a copy of the Electric Kool-aid Acid Test that stands to differ.


I think only in the sense that the "hippies" (God, I hate that word and I were one!) were knowingly seeking transcendence while our contemporary addicts often don't even know what they're fleeing. If you have any other takeaway from Wolfe's book, well, I would argue that you are cynically misreading. On the other hand, I am so inured now to how thoroughly us 60's kids can be so vilified nowadays even by people who wish they had been there that it is getting pretty close to me not even caring anymore. A Vote for Barry (Goldwater, not President O) is a Vote for Fun!
posted by Chitownfats at 3:22 AM on July 12, 2016 [2 favorites]


One thing that was not mentioned at all is that 12 step programs didn't send out invitations to all of these treatment centers, asking them to please send 20 detoxing, confused, lost, barely clean/sober people to overrun the 12 step mtg with "My therapist said this." and "My counselor said that."

They come in by the van-load -- ppl call them "druggie-buggys" -- and no one comes in with them, no one gives them a clue as to what is going on. Groups often get buried, the strengths of the groups pounded to nothing, not (always) by ill-will on the part of any of the ppl from treatment centers but just by their numbers.

Basically, the mtg is just a part of their day -- "Okay, Arts and Crafts from 4:00-5:30, then eat dinner, and then get into the van to go to the mtg." -- whereas to the members of the group, who are there because they *do* benefit from 12 step mtgs, this mass of ppl can be a huge distraction.

If there are five or six ppl with real animosity toward what 12 step is, imagine how happy they are being forced to go, imagine the joy they bring to the mtgs.

As Szalavitz drove home again and again, 12 step isn't for everyone. It is extremely effective for many, just like size 9 shoes fit a large number of ppl but would destroy other ppls feet, just like some ppl like hats and others hate them, wouldn't wear one on a bet.

The onus is definitely *not* on 12 step -- quite frankly, it's lazy, hazy thinking on the part of those who run those treatment centers. Not saying that Szalavitz says that the onus is on the groups, just that this piece wasn't ever brought clear.
posted by dancestoblue at 6:44 AM on July 12, 2016 [3 favorites]


I know a lot of people who've suffered with various addictive disorders or substance abuse over the years who may in fact be "hopeless cases," in the sense that those issues will always potentially be there to cause them trouble. But a good number of them do manage and are fine, productive, and relatively healthy by self-medicating with marijuana. For a number of years, I was able to effectively manage and avoid any more serious and harmful addictions by using weed from time to time, during periods of heavy life stress, to cope and make it easier to sleep despite anxiety. It also had the advantage of being a drug you could binge on without any real risk of overdose or accidental self-poisoning. But to try to minimize the potential exposure to legal risk to my family of occasionally keeping an illegal substance on hand, I started using what was then sold legally at convenience stores around my house as a synthetic THC--only it turns out those synthetic THC formulas carried a potential for true, physical addiction. So I wasted almost three years of my life becoming a true addict for the first and only time in my life (not counting nicotine and a brief stretch of binge drinking just out of college).

Growing up with a heroin addict mom (I was most likely a heroin baby myself), I always knew a little more about addiction than my peers and knew that the distinction between physically addictive substances and psychologically addictive ones could be crucial, and in the past, I was always cautious enough to do my research and make sure to avoid drugs with any potential for physical addiction. So the synthetic THC shit (so-called "spice") really screwed me. But I was able to ween myself off spice, with the help of an intervention from some friends and using weed again for a while as a proxy. I really think Willie Nelson and others are right: there's a huge potential for marijuana to be an effective tool in helping chronic addicts and people with genetic tendencies toward addiction in safely managing those disorders. But to so many, marijuana use is itself morally offensive, even though it's demonstrably less dangerous and harmful to long term health than popular and socially approved intoxicants like alcohol and slot machines.
posted by saulgoodman at 7:16 AM on July 12, 2016 [1 favorite]


Ugh, "wean."
posted by saulgoodman at 7:45 AM on July 12, 2016


In addition to advocating for science-based treatment instead of puritanical punishment, it's important to consider wider structural issues that lead to addiction: people self-medicate with drugs or alcohol in shitty societies because of stress and boredom and isolation and lack of community. Our shitty society is great at providing large doses all four of those things on many of its people, especially the poor.
posted by tgan at 8:59 AM on July 12, 2016 [2 favorites]


A few years ago, I observed a class on using motivational interviewing as a method of harm reduction. The class was made up of substance abuse treatment and mental health professionals. It surprised me how many people actually got ~mad~ at the idea that a relapsing addict would not get punished, but helped back on to the path. Seriously angry, and shouting about "they have to have consequences!" I'm always amazed at the punitive instinct in non-addicts. The "tough love" idea has a powerful hold on us.

It's not just the traumatized or numb who self-medicate - it's very often found in people with mental illness and developmental disabilities. There's a whole line of therapy for "dual disorder" treatment. Should we toss those folks into jail? If they're brown and/or poor, we do. We sure do.
posted by corvikate at 9:11 AM on July 12, 2016 [1 favorite]


I appreciated this interview. I don't struggle with drug use but I struggled with an eating disorder and alcohol for several years. People do a strikingly similar judgey thing w/ eating disorders as they do drug abuse, in that they focus waaaaaay too much on the substance and moralizing the use of it. Only drugs are illegal and can land you in jail. Food, however, is everywhere, you can't avoid and has its own complicated set of social stigmas. I feel a sort of kinship with people who struggle with other types of addiction -- and I've found a lot of people who come to ED support groups have some kind of history with alcohol or substance abuse.

Some people describe EDs as a "process addiction" and I find that to be quite accurate for myself. It starts as a more explicit emotional coping mechanism and then over time you feel like you need it to go on. After I ate I would be seized with so much anxiety my hands would shake and I couldn't think clearly until I had thrown up. And early on, after purging I'd feel so clear-headed and at peace and in control. With time neither eating nor purging felt good anymore but I still felt like I had to do it and it's so difficult to stop when it becomes automatic. Didn't matter that I know it's bad for me or eventually kill me, or how terrible I felt all the time. I liked how bad it felt sometimes too because it perpetuated how I felt about myself (very poorly). People shaming me (mother, who is from third world poverty, telling me about how little she had to eat and I should be grateful) just made me feel more guilty and engage in behaviors more. The idea of trying to force recovery through punitive measures is so crazy to me. It was a great deal of support and love that helped me realize I was worth recovery. It was shame, social alienation, trauma and violence that got me involved in the first place.
posted by mmmleaf at 9:19 AM on July 12, 2016 [4 favorites]


I wish the interview had focused more on the "learning disorder" model of addiction that the author was promoting. My brother is currently in a jail/rehab program that seems strongly based on the 12-step model and when he is released he's going to have to attend a Christian 12-step program whose website tagline says it "It is based on the actual words of Jesus rather than psychological theory." Now, I have no problem with spirituality being one facet of recovery, but I am totally appalled that he's not being given any other secular, evidence-based tools to help change his maladaptive coping behavior.
posted by megancita at 10:48 AM on July 12, 2016 [6 favorites]


Glad to see this posted here; I heard most of it the other day in my car. I considered sending maias a MeMail saying I thought she did a great job and that MeFi is fortunate to have her as a member who regularly shares her expertise with us. I never got around to it, so I'll just say it here instead.
posted by TedW at 12:16 PM on July 12, 2016 [2 favorites]


Interesting discussion here. Of course it is true that not everyone who has experienced trauma is going to be addicted to drugs or alcohol. But I think one of the most interesting things about Dr. Mate's book (again, In the Realm of Hungry Ghosts) is that he points out that addictive behavior is a common response to trauma, although we don't always identify the behavior as problematic. He uses himself as an example -- he is a Hungarian Jew, born in that country when Jews were being deported and starved and shot, and he definitely experienced trauma from that as an infant. He starts his book admitting he looks down on the addicts he treats, but then he begins to realize as the book moves along that he has his own obsessive addiction to collecting classical music. We may not lock people up for that, but Mate makes it very plain that is the only thing that distinguishes his obsessive shopping for and hoarding of his music collection from the behavior of hard core addicts. He also points out that this kind of addictive behavior is common in our society and promoted by business interests.

I have learned it is a lot wiser to look for our commonalities when we see people with traumatic backgrounds who are engaging in repetitive, self destructive behavior, whatever it may be. There are indeed some bad, bad people in the world, who I think need to be locked away, but a heck of a lot of people in the criminal justice system, particularly the addict population, respond well to and in my opinion deserve a much kinder and more supportive response from the rest of us. There but for the grace of God and all that.
posted by bearwife at 2:09 PM on July 12, 2016 [10 favorites]


Regarding being 50 and making the same bad choices, I can only think about the relentlessness of compulsion and addiction and that choice is a subjective, slippery concept in that context. Also I think when you're 50 and you have a lifetime of wreckage, how hard it must be to have hope that you can even build a future. Like, what does your resume look like? Do you have one? Who will hire you? That sort of thing. I think you have to be lucky to have a damn good social service support like supportive housing that will give you job training and work experience and what not.

You have to wonder how many addicts would have turned out differently had they access to decent therapeutic care at a younger age, if they had resources at key points. I'm middle to lower middle class and I've had pretty damn good resources due to my city's infrastructure, but even I have battled hopelessness when it comes to getting over my mental illness. When you're battling yourself on top of challenging circumstances, it is really hard not to just cave in to anesthesia and passive suicide. That's what I think a lot of addiction probably is; that's why you see people who have hit rock bottom but can't dig themselves out of that hole. They have untreated mental health issues, like PTSD, and they just don't have the internal resources to meet the challenges of poverty and racism and all of the practical challenges those bring- getting a job, decent housing in an area that isn't crime ravaged (which makes your PTSD even worse), getting a decent education and so on.

In order to 'delay gratification', as they say in psych parlance, and pass that drug by you have to have some concept of a decent future that is within reach that makes your going through withdrawls worthwhile. But what if that decent future seems unreachable, especially from where you are now? Then what? What becomes of your sense of "choice"? Do you just say "fuck it?" I'm not judging here, I'm just thinking out loud, because for myself, had I been dealt a rougher hand, I would highly likely say "Fuck it" regardless of how easy it seems to work through addiction from my current vantage point.
posted by GospelofWesleyWillis at 7:58 PM on July 12, 2016 [5 favorites]


I'd also add that I think a lot of traumatized, abused people grew up being told they were worthless, that they deserve abuse. If you've gotten that message (I did to some degree at times, and it colors my thinking) then you have a strong template of chronic self-doubt that you are not even worth the 'good life', that a shitty life is your destiny because you were born into it and that's all you'll ever be. I think this message is in some parenting and outside in society's judgements.

One snotty smug young coworker of mine said "I don't care about homeless people, they brought it on themselves". I reminded her that some of them have mental illness and can't help it. "Well, good riddance" or words to that effect. This attitude is everywhere, even in friends I've had. How can you feel worthy of rejoining (or joining for the first time) a functioning society when you get the message that you are shit and that people just wish you'd go away?
posted by GospelofWesleyWillis at 8:04 PM on July 12, 2016 [4 favorites]




Thanks so much for posting this and I'm happy to answer any questions about the learning disorder stuff. If you happen to be in London today, I'm being interviewed by Johann Hari at Volte Face at 7:00. Memail me if you want further info (you should just be able to find via google, though).
posted by Maias at 5:17 AM on July 14, 2016 [6 favorites]


thanks for sharing on treatments about drug addicts... It will be helpful for my younger brother...
posted by smithamit at 1:58 PM on July 18, 2016


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