Public Shaming In The Irish Times

An article appeared in The Irish Times last week about America’s obsession with rehab. I thought the piece was well done, and far more objective/unbiased than most such articles in mainstream publications. Most of the piece revolved around quotes from Adi Jaffe – a man who clearly represents the conventional view that addiction is a disease which should be medically treated. For good measure, an opposing voice was given some attention at the end of the piece – me.  But my opinions aren’t allowed in the mainstream, and any journalist who lets such ideas through will quickly be put in her place.  Of course a foolishly misguided disease propagandist (JC Durbin of Toranfield House) had to fire off an angry letter to the paper – which they printed.

I did write a point by point response, but it’s just too exhaustive to publish (plus these propagandists just don’t deserve to learn from my brilliance how to fix every one of their mistakes), so instead I’m gonna home in on the main message of and problem with the criticism.  Here goes:

Madam, – I was taken aback by Lara Marlowe’s column (“How US obsession with addiction has spawned a rehab industry”, June 18th)…

…I totally disagree with her premise that addiction, in all its guises, essentially comes down to choice.

This unfortunately common misperception only serves to make it even more difficult for those in addiction to ask for help – as if the stigma in this country of mental health problems and addiction wasn’t enough.

The problem is that the talking point in this last sentence (which I’ve seen a million times) is not a defense of the disease theory.  Instead, it’s an attempt to guilt people into dropping their very valid criticisms of the disease theory.

So let’s make sure we’re familiar with the talking point, because it ALWAYS comes up in every debate about addiction, here’s the most common version of it.

Top Diseaser Talking Point:  We should just accept that addiction is a disease so that people won’t feel ashamed or guilty and they can come forward to get help.

Now let’s look at all the fallacious assumptions contained in the talking point:

Assumption #1: People won’t get help for a problem unless that problem is labelled a disease.

Please.  When I was in high school I had a problem with getting my schoolwork done, I got help by going to a tutor. No one had to tell me I had a disease to get me to do that. What happened was the school told me I wouldn’t graduate unless I pulled perfect grades in my last semester. So, I got help.

Here’s another example: What about when addiction counselors realize that they’re doing absolutely no good for their clients, and indeed probably harming them with their nonsense? They probably go to some workshops or continuing education to learn new techniques. Must they be under the impression that their total lack of effectiveness is due to a disease in order to motivate them to get help? Well, maybe that’s not a good example.

Should I keep going on this ridiculous assumption?

At my lowest point, I personally refused to go to another treatment program because in my words “they’ll just tell me the same thing, and it won’t work, and I’ll stay sober while I’m there, but I’ll still want to get high when I get out.” My parents found someone who would tell me different – I got help from people who taught me that addiction was not a disease, and I finally solved my problem.

There is nothing about a problem being one of personal choices which then disqualifies it from the realm of things you can be helped with.  Furthermore, there is no demonstrable cultural pattern which shows that people are reluctant to seek assistance for a problem unless it has the status of a medical disease.  In fact, it is quite the opposite.  You should know that marketing 101 teaches you to sell products by convincing people that they’ve got a problem and that your product can solve it.  There is no such marketing law that says you need to convince people that their problem is specifically a disease in order to get them to act to solve it.  That’s an advancement that your kind added just so that you could keep out competition, and obtain government payment for your services.  Your whole talking point is completely absurd and your whole editorial should be dismissed based on this.

Assumption #2: People should not get help for problems of choice.

Really?  This is of course a twist on assumption #1.  Financial advisers, personal trainers, party planners, college advisors, all come to mind as those who help people with problems of choice. I could keep going with examples, but do I really need to?

Assumption #3: Declaring addiction a choice somehow imparts shame or stigma on people, and it’s an act of judgment.

Wrong.  Shame comes from beliefs about oneself. The belief that addiction is a choice says of the addicted person “you have the power to change” – the belief that addiction is a disease says “you can’t change, you never will change, you’ll never be able to control your behavior.” Which one of these beliefs do you think will result in more negative feelings about oneself? I think the disease theory is the harmful belief here.

Of course, some people might say that believing it’s a choice would cause you to be overwhelmed with guilt over all the bad choices you’ve made. I guess that’s a possibility. But what’s preferable – dealing with some guilt, learning from past mistakes, and working towards a brighter future of better choices – or gaining virtual absolution for your past mistakes with the disease theory, and looking forward to a life of struggle? Again, I think the disease theory leaves you worse off.

It’s not so clear cut whether guilt and shame will proceed directly from the belief that addiction is a choice. There needs to be accompanying beliefs for the shame to occur – that is we can’t lay the blame for shame and stigma simply on the concept of choice. Examples of these other sorts of beliefs would be:

1. Doing drugs is a sin against god
2. Using drugs or alcohol makes me a bad person
3. I must be perfect and never make any mistakes in life
4. I owe it to so-and-so to stay sober or I’m a bad son – father – husband – etc
5. Everyone thinks I’m bad because of my drug and alcohol use , and that’s awful

And so on. Just refer to Albert Ellis for the kind of beliefs that will cause massive guilt. “I have a choice” doesn’t seem like an awfulizing belief to me – and more importantly, it implies none of these other beliefs. That’s basic psychology right there.  But what do I know, I don’t run a treatment center for a fake disease.  Not only are you arguing dishonestly by attaching beliefs such as those I listed above to the simple belief that addiction is a choice – you’re also hurting people – because in the same way that people blindly follow the authority of the organizations which you cite later in the article, people will also blindly follow your words because of your position of authority.  Your entire commentary is incredibly irresponsible – as the CEO of a psychiatric treatment center you should be privy to at least some basic principles of psychology.  You are actively indoctrinating people with self-damning, awfulizing, shame inducing beliefs about addiction.  You’re teaching people that they should be experiencing debilitating shame over the idea that they have a choice over how to behave.  Go brush up on CBT and then write a public apology for your misguided public flogging and smear job you did on Lara Marlowe, and all of the damage you’re doing to people with substance use problems.  As far as current positions within the industry go, I’m probably a layman compared to you, yet I understand the basics of these issues far better than you.

Granted the original article wasn’t a detailed and footnoted argument against the disease, it was more of a mild questioning of whether the rehab culture is good or not – but this reader (who is no less than the CEO of a conventional rehab – and should be capable of quickly explaining some theory here) is now expressing genuine outrage at the fact that anyone would question the disease theory.  If it’s so true – please explain it!  Instead, all we get are classic appeals to authority:

What wasn’t mentioned in the article is that prevailing medical opinion here and internationally, including the opinion of the two largest and most well-funded governmental research bodies internationally on addiction – the (US) National Institute on Drug Addiction (www.nida.nih.gov) and the World Health Organisation (www.who.int) – is that addiction and substance dependence is a disease.

Wonderful.  But it doesn’t offer any sort of logic on what makes it a disease (hint: no such logic exists).

For good measure, here are some more examples of where the shame/stigma/not getting help talking point is reiterated throughout the angry letter:

Perpetuating this view also encourages many people close to those in addiction to mistakenly ask: why don’t they just pull themselves together and sort their lives out – like everybody else?

The fact is that they may want to sort their lives out, but can’t, and need professional help. In the article, Steven Slate is quoted saying “. . .the best way to overcome addiction is to find other things that make you happy.” I rest my case.

I haven’t said you can’t be helped in doing that, and I haven’t said you have to be helped in doing that either.  But that is what happens when people resolve their substance use problems, whether they get “treatment”, some other sort of help, or no help at all.

Turn The Tables

Later on in the piece, the author makes a remedial attempt to push the biopsychosocial model of addiction, and asserts that:

“…its [addictions] causes … include … family and the social environment.”

I can play your ridiculous shame-game too.

How dare you blame the friends and family of addicts for addiction? Now those people will feel guilt and shame because they’re causing addiction. Haven’t they suffered enough with a diseased loved one?  Now you have to hurt them by saying this?  We should never speak of “social environment” or family causing addiction again. We’ve already got enough shame and stigma in this world.

See how stupid you sound?

Yours, etc Steven Slate

P.S. If you ever wanna know how to really help people with these problems, let me know and I’ll teach you how to do it. It starts with not making their problem worse by creating an expectation of failure and an external locus of control.