Thursday, October 02, 2014
Although the analysis is somewhat deterministic, I
found an article by Maia Szalavitz titled "Most People With Addiction Simply Grow Out of It: Why Is This Widely Denied?" to be a vast improvement on the
conventional wisdom about substance abuse and recovery. Two points particularly
First, Szalavitz reveals a thinking error that lends credibility to one popular myth about addiction:
Why do so many people still see addiction as hopeless? One reason is a phenomenon known as "the clinician's error," which could also be known as the "journalist's error" because it is so frequently replicated in reporting on drugs. That is, journalists and rehabs tend to see the extremes: Given the expensive and often harsh nature of treatment, if you can quit on your own you probably will. And it will be hard for journalists or treatment providers to find you.Szalavitz is correct to question the pessimism, but does not really get away from the notion that addiction is a disease. That said, her article still offers useful information for those of us who disagree with that idea entirely.
Similarly, if your only knowledge of alcohol came from working in an ER on Saturday nights, you might start thinking that prohibition is a good idea. All you would see are overdoses, DTs, or car crash, rape or assault victims. You wouldn't be aware of the patients whose alcohol use wasn't causing problems. And so, although the overwhelming majority of alcohol users drink responsibly, your "clinical" picture of what the drug does would be distorted by the source of your sample of drinkers.
Treatment providers get a similarly skewed view of addicts: The people who keep coming back aren't typical--they're simply the ones who need the most help. Basing your concept of addiction only on people who chronically relapse creates an overly pessimistic picture. [links dropped]
Thus, the second thing that stands out about this article is what it has to say about the recovery process and how treatment might be improved:
To better understand recovery and how to teach it, then, we need to look to the strengths and tactics of people who quit without treatment--and not merely focus on clinical samples. Common threads in stories of recovery without treatment include finding a new passion (whether in work, hobbies, religion or a person), moving from a less structured environment like college into a more constraining one like 9 to 5 employment, and realizing that heavy use stands in the way of achieving important life goals. People who recover without treatment also tend not to see themselves as addicts, according to the research in this area.This discussion reminds me of Ayn Rand's discussion of the relationship between life and values, particularly the following:
While treatment can often support the principles of natural recovery, too often it does the opposite. For example, many programs interfere with healthy family and romantic relationships by isolating patients. Some threaten employment and education, suggesting or even requiring that people quit jobs or school to "focus on recovery," when doing so might do more harm than good. Others pay too much attention to getting people to take on an addict identity--rather than on harm related to drug use--when, in fact, looking at other facets of the self may be more helpful. [bold added]
The standard of value of the Objectivist ethics--the standard by which one judges what is good or evil--is man's life, or: that which is required for man's survival qua man.Of course, without volition, none of this is relevant to the problem at hand. That said, not only do some recovery stories give good evidence of the role of volition in changing a life-threatening habit, it is plain that recovery from addiction hinges on two things: (1) a realization on some level that the addiction stands in the way of some value (or at least something the individual considers a value), and (2) a decision to choose the threatened value over the addiction.
Since reason is man's basic means of survival, that which is proper to the life of a rational being is the good; that which negates, opposes or destroys it is the evil. [emphasis in original]