by Joshua Hoe
I have not read Maia Szalavitz’s book yet. Have I made that clear yet? I hope so.
I usually hate commenting on commentary, and I will read the book, but I wanted to make a few comments about the things she appears to be arguing about addiction.
I will apologize if I am misunderstanding her points after I read the book.
Is Addiction A Disease
According to Jesse Singal in Science of Us, Maia believes that addiction “should not be seen as a disease or a moral or personality shortcoming, but rather a learning disorder.”
I 100% agree that addiction becomes a disease because of a flawed coping process initiated originally because of trauma and later because of triggers that remind us again of that original trauma.
But, I do not agree that explains the process entirely. At first, addiction starts because of a learning disorder (if that is an easier way to explain it) but later it creates a pattern in the brain that has effects that experts consider at least similar to that of a chronic disease.
It is a broken brain, but because neural pathways can be retrained, it is not a permanently broken brain.
Maia herself mentioned this in a recent Huffington Post article:
“From my perspective, addiction is clearly a health and medical problem — no different from depression or attention deficit/ hyperactivity disorder (ADHD), both of which are influenced by biological, social, cultural and developmental factors. However, in America, the D-word in the context of addiction has come to mean something much different from the word “disease” used for any other condition — something that unfortunately is more moral than medical.”
So, okay, addiction is a disease and starts from following a mistaken learning pattern.
Why Don’t People Accept Addicted People As Having A Disease
So Maia argues (in the Huffington Post piece) that people don’t accept that addiction is a disease because (and I am paraphrasing here):
A) We have laws against using the substances and many of the behaviors that addicts engage in (in other words, people have been told forever that using drugs is wrong).
B) The widespread adoption of the AA 12-Step Model (that suggests that people need to ‘bottom-out’ to recover – more about that later).
I agree with A 100% and agree 100% with the spirit of B but have always believed that this is a slight misinterpretation of AA doctrine.
In particular, Ms. Szalavitz says:
“Do psychiatrists suggest that people with depression must to take “a searching and fearless moral inventory”? Do any other patients routinely get told by the medical professionals that their problem involves ‘defects of character'”
A fair point.
But psychiatrists do suggest that people who struggle with addiction take “searching and fearless moral inventories” as well as many other kinds of extensive histories. I know, I have been in many psychology offices giving answers to many inventories.
And there is a reason most Western approaches to therapy have all involved actively “talking” about our problems (therapy, confession, 12-steps etc.).
I certainly do not, and have never, agreed with the “defects of character” language found in 12 step literature either. But, I have always attributed it more to the time period that it was written in and less to it having a more concrete and ongoing meaning.
But, there could be a larger meaning here. What the 12-Step literature is probably talking about here is original sin (more than it is talking about addiction or acting-out per se). The literature talks about “defects of characters” because human beings are inherently flawed (born into sin). In other words, the literature is not singling out addicts as evil people it is a means of connecting addicted people to a common humanity (the commonality of sin).
Of course, it is totally fair to criticize the Christian roots at the core of the 12-step message. Not everyone is Christian and not everyone believes that the nature of Man is sin. But that is where the “defects of character” part of the doctrine might come from.
She is certainly right that part of the problem is that people see 12 Step Programs as “treatment” instead of as a support group. I have consistently argued it is a good idea to have a therapist, a support group, and a spiritual support group (as they all deal with different problems).
Therapy is a way of investigating the causes and traumas that are at the base of your problems while a 12 Step group is a training program for interpersonal intimacy (created for people who are bad at being emotionally intimate).
Oh, and a spiritual support group helps your relationship with God.
No matter what we disagree about. I suspect we would likely agree that the answer is to stop criminalizing addiction and start including more science in our treatment schemes (although support groups are extremely important too).
Rock Bottom + Maia Szalavitz
One area I agree with Ms. Szalavitz entirely is that we should NEVER be teaching that people need to reach rock-bottom before they recover.
I could go around and around on if 12 Step programs endorse that rock bottom is a pre-requisite for recovery (I do not think the literature is unequivocal on this point).
However, nothing, in my humble opinion, has done more damage to recovering addicts than the notion that people should be pushed down the metaphorical stairs before recovery is possible.
Most of the torture perpetrated by the “tough love” forces started with the “rock-bottom” nonsense. These things allow people to feel like the more awful they are to addicts the more that they have “helped” them. It gives people a moral shield to treat people horribly.
Worse yet, there is no evidence at all that it is true. Oh, and even if it were true, there is always a new bottom. Maybe we could, with all of our medical knowledge and technology, find a better way than giving people license to just be even more awful to addicts every time that they relapse.
Not awful enough? Must not be rock bottom. Hit the addict even harder. Losing your family not enough, try poverty. Losing your house not enough, try prison. And as the addict is destroyed, everyone pats each other on the backs.
It reminds one more of leeching than science and more of torture than it does of compassion.
Oh, one other thing, making things awful for addicts almost always is engaging in what triggers more acting out. It works as a trigger, until (maybe) it doesn’t? That is a stupid and awful treatment plan.
*** Note: Someone mentioned on Twitter that I had made claims about 12 step literature as definitive. I made an edit to clear this up, this blog is about my thoughts and opinions, I have no insider knowledge or claim to “knowing” the “true” interpretation fo 12-step literature.” I also have no claim to speak for AA. ****
What do you think of Ms. Szalavitz arguments? What about mine? Let me know what you think, leave a comment!