Addiction: Truth and Myth

 I spent the first several years of my clinical career working in substance abuse treatment programs. On the front page of my website, I note this fact and state that I "frequently work with persons in recovery." If only this were actually true! What has happened over the years is that the people who've come to see me for my addictions treatment experience are mostly not in recovery. Most  have been people who are still abusing drugs and/or alcohol. But psychotherapy is not the best treatment for addictions, which is why I tried, in the language on my website, to suggest that I want to work with people who've already stopped using drugs/alcohol and are looking for relapse prevention and treatment for other emotional problems.

"Recovery" means that you have stopped abusing substances--you are now abstinent from the problematic substance and any other substance with a similar effect, and are engaged in a different lifestyle. What I have found consistently in the course of my career is that 90 percent of addicts/alcoholics need a 12-step program to remain in recovery. Sadly, most of the substance abusers who have come to my office, although they may verbally express an interest in going to a 12-step program, don't stick with it and thus they don't stop using drugs/alcohol.

Most abusers of alcohol and drugs who come to my office claim that they "know" they have a "problem." This may represent a change from the attitudes found before the 1970s. Before the 70s, most alcoholics and addicts lied about their problem and were frequently in denial about its severity.  Celebrities in the late 70s started to come out of the closet with their addiction problems. Now it's become socially acceptable to admit you have a problem with drugs or alcohol. But  most people who "admit" this fact still  don't really want to change.  This may not make sense to most people, not only because using drugs/alcohol in the face of death or other severe consequences doesn't seem logical, but also because the media promote the myth that people use drugs because they don't have access to treatment. Nothing could be further from the truth, as the 12-step program is free and available all over the country. In addition, most inpatient rehabs are desperately seeking patients and some have closed.

Why would someone continue to engage in addictive behaviors despite access to treatment? There are many possible reasons, some that are psychological and some that perhaps could be better described as philosophical or spiritual, depending on one's beliefs.

Some recovering addicts have told me that before they found the 12-step program, they simply thought that they were destined to be drug addicts--it was their identity and fate. When they heard, in 12-step meetings,  the stories of people like themselves who had completely changed their lives, they realized they were wrong.  They realized they could choose their fate. They also realized that they needed help from others to remain free of drugs and alcohol. This may seem paradoxical, but all humans need both a sense of autonomy and self-direction and also social support.

 People with intractable addictions--those who go to 12-step meetings but still don't arrest their addiction--may be people who are too narcissistic to accept their dependency on other people. This makes them unable to use the 12-step program. Others can be persons who just don't see a meaning in life. Ordinary activities that give others' lives meaning, such as the sense of pride in working for a living and doing a job well, mutual interpersonal relationships, and greater causes or beliefs, are meaningless to them. Without a sense of meaning in life, it's hard to see a reason to stop drinking or doing drugs.  All experienced substance abuse counselors know there is a percentage of the population who cannot be helped and who will not recover from addiction.

Initially in private practice, I thought I would screen out all active addicts, and instead insist that they first attend 12-step or an inpatient rehab, or both. I changed that position when I realized some of the addicts and alcoholics coming to my office had severe depression or anxiety that needed to be treated. I didn't think it was right to deny treatment to someone for one disorder because the person refused treatment for another. I can say that I did help some of these individuals, whose depression and anxiety did improve, even though they did not completely arrest their addiction(s). (The fact that these individuals did not stop using drugs or alcohol despite recovering from their anxiety and depression shows that a popular theory, the "self-medication theory," is wrong. The self-medication theory, believed by many psychotherapists, holds that drug and alcohol abusers are simply self-medicating depression and anxiety and will stop their behavior if they take medication and go to psychotherapy. If this were really true, addiction would not be the vast social problem that it is). Recently, I've come to realize that active alcoholics and addicts present liability concerns for my practice. Therefore, I've decided to go back to my original position of requiring that addicts/alcoholics be in recovery before I will agree to see them.