This post was originally published on August 5, 2016.
When it comes to addiction treatment programs, you don’t often hear the words “love,” “compassion” and “kindness” thrown around as some of the basic tools that are used. For recovering alcoholics like me, we’re more accustomed to receiving tough love or diamond-sharp truths that cut to the quick. Author Maia Szalavitz, in a recent NPR feature, argues that most treatment methods are as useless as they are ordinary. “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,” Szalavitz said. Conventional hard-nosed treatment, she claims, does way more harm than good. So-called “harm reduction” programs don’t simply question a lot of standard thinking about addiction treatment—they may be the best ways for providing positive, effective roads to recovery.
The Best Solutions Don’t Always Have 12 Steps
In her latest book Unbroken Brain, Szalavitz questions why more treatment programs don’t “treat people with addiction like human beings.” In the NPR piece, she levels most of her criticism at 12-step programs. “My issue with 12-step programs is that 80 percent of addiction treatment in this country consists primarily of indoctrinating people into 12-step programs, and no other medical care in the United States is like that,” the author said. Part of the problem rests in 12-step programs like AA failing to see their place as support groups, and overestimating their importance in recovery.
Szalavitz contends therapeutic approaches are just as effective as any 12-step program out there. In fact, many experts agree with Szalavitz’s argument. An essay in Psychology Today claims that AA is simply cognitive behavioral therapy (CBT) in disguise. CBT is a popular form of psychotherapy where a person and their therapist talk through the person’s thoughts, feelings and actions. The goal is to re-wire the person’s thinking so that they can make healthier decisions in life. And when it comes down to it, changing how addicts think and act through talking about it is largely what AA is all about. In the Psychology Today piece, Dr. Clifford Lazarus noted that “[AA] is a very behaviorally oriented process. For example, one of the core recommendations that AA makes is to change people, places, and things. In other words, to change one’s routines, repertoires, and actions.”
Still, methods like CBT don’t involve spiritualism or morality. “They have none of the issues around surrendering to a higher power, or prayer or confession,” Szalavitz points out. “The only treatment in medicine that involves prayer, restitution and confession is for addiction. That fact makes people think that addiction is a sin, rather than a medical problem.” Because of this, she believes, AA does a disservice by making addicts and alcoholics feel like they’ve committed shameful sins. It becomes less a professional issue than a matter of personal care. 12-step programs only serve to bolster stigmas around addiction rather than bolstering addicts’ attitudes about recovery.
Maintaining A Path to “Normal”
Opioid addiction remains a national epidemic that’s killed four times as many Americans since 1999, according to the CDC. Methods like “maintenance therapy” offer addicts a chance to live relatively normal lives by taking regular doses of opioids such as methadone or buprenorphine. Harm reduction programs like this spark a lot of controversy. “People taking methadone feel stigmatized,” a buprenorphine provider told The Huffington Post. “There is a pervasive idea that abstinence is the only answer to addiction even though we know it doesn’t always work.” Still, critics of maintenance therapy argue that addicts are simply swapping out one addiction for another, which is neither getting to the heart of the problem nor qualifying as genuine recovery.
Not so fast, Szalavitz told NPR.
By taking these drugs in regular, controlled doses, addicts can function without living in fear of another relapse. “The way people with addiction experience intoxication is that they take more and more and more, they take it irregularly, [and]the dosing pattern is completely different,” the author said. Maintenance therapy helps drive up opioid tolerance and, therefore, keeps addicts free and clear of opioid-related problems. Szalavitz also claims that the number of addicts in maintenance who overdose is a staggering “50 to 70 percent lower than…people who are using other methods of treatment, and that includes all of the abstinence treatments.” It’s a sobering statistic that’s hard to argue with.
All You Need Is Love
Szalavitz believes that being “kind and supportive and empathetic” is really all it takes to get users past their addictions. She cites data that indicates the effectiveness of providing clean needles and safe injecting spaces to drug users. But the real evidence isn’t really found through number-crunching. It’s everywhere you look in the recovery community, she told NPR: “If tough love was the answer, and the idea was you shouldn’t enable addiction, if that theory was correct, those things should all prolong addiction, and the exact opposite is true.”
The author is convinced that, through the kindness and compassion of others, addicts find recovery—and re-discover themselves along the way. It’s a belief that’s equal parts simple and profound. “When you’re an active drug user, when you are injecting, everybody crosses the street to avoid you. And here you’re just seen as a person who deserves to live, and you deserve a chance,” Szalavitz said. “And it’s that that gives people hope. And it’s that that shortens the period of addiction.” By treating a person with kindness rather than treating a problem with dispassion, recovery programs would go a long way toward healing both the head and the heart.