Thursday, February 19, 2009

Addiction Treatment

Once you recognize that you or someone you care about has an addiction—be it to drugs, alcohol, pornography, shopping or any other destructive habit or attitude—what's the treatment for it? In short, there isn't any.

Addiction treatment is a huge industry ranging from smoking cessation patches to expensive residential rehab programs to educational classes designed to teach addicts or potential addicts the dangers of drugs. Nearly all of it is ineffective by any statistical measure. Lots of programs can provide short term relief—if nothing else by separating the addict from his source of drugs—but in the long term, most programs are no more successful than a placebo in preventing relapse. Even when a program can statistically prove success, the results are so marginal that they hardly justify the huge cost.

Addiction treatment, of any kind, is a fraud. It simply doesn't work.

You can wear a Nicoderm™ patch to stop smoking or take methadone to get off heroin, and they seem to work at first, but then how do you get off methadone or Nicoderm? So much of what is called "treatment" is like that: just substituting one addiction for another.

This grim assessment may seem to be at odds with the many ex-addicts who claim that Alcoholics Anonymous or some other treatment system saved their life. They honestly believe this, but that doesn't mean it's true.

You could test the hypothesis by assigning addicts randomly to one of two different groups: Alcoholics Anonymous and some other "placebo" social group, like a hiking club, with no treatment component. In that case, research seems to show that there would be no substantial difference in relapse rates, and some people in the second group would claim that the hiking club saved their life!

The people who praise AA are the ones who succeeded, who already made the commitment to change and who would have latched onto any program available to them. AA may seem to be the cure, but really it came from within.

The only real cure for addiction is the addict getting so beaten up by the bad effects of his behavior that he makes his own decision to change. No outside "program" can do that for him. In fact, the availability of treatment may only serve to give the addict one more excuse not to quit: "I have a disease; someone else has to fix me."

Addiction is a philosophical disease as much as a chemical one. It's the natural consequence of fatalism. The central issue is a self-fulfilling prophesy: If you think you can kick the habit and decide to do it, then you will. If you don't think you can do it and choose not to, then you won't. It seems like a simple little switch in the brain that could go either way, but people become emotionally invested in fatalism, and those investments are the main barrier to change, not the chemistry per se.

If I decide to take control of my life now, then I have to accept that all those stupid things I did in the past were my own damn fault, not someone else's. People aren't comfortable with that kind of regret, so they resist changing their philosophy.

No outside force can make you more responsible for your own actions. Other than the molding of childhood and the hard lessons of experience, self-responsibility is simply unteachable. There are, however, plenty of ways to make people feel less responsible for their own actions, and one of them is offering cures from the outside.

All forms of addiction treatment send a philosophically defective message: "We will rescue you." Given such assurance, the addict has no reason to exert his own control. That's fundamentally why treatment doesn't work.

What does work? As a friend or family member, your options are limited. One route is to completely remove the addict from the environment in which the addiction takes place. If you take a child out of the home of addicts and place him in a home with no culture of drug abuse, you are likely to change his own propensity for addiction. Unfortunately, this really only works with children, since adults tend to carry their addictive philosophy with them and will reconstruct new addictions to replace the old ones. If you move your spouse to a new city to try to get him away from a bad crowd, it means you are treating him as a child and are giving him a free pass to act like one.

The only other thing you can do is withdraw your protection for the addict, so he experiences the effects of his behavior as directly as possible. If he gets falling-down drunk, then he needs to fall down, with no one there to catch him. If painful consequences happen to him enough times, he might change or he might not, but it usually offers better odds than any treatment program.

The barriers you encounter in this second option may be inside you as much him. Are you willing to let your spouse or family member fall? What will happen to your investments together? The key problem may be your own addiction to enabling his addiction. "I must rescue him," you tell yourself. "I have no choice."

As soon as you say, "I have no choice," you're doomed. There are always options, just not pleasant ones. Escaping from addiction always involves pain, but so does not escaping. If you choose less pain overall, then you will take whatever unpleasant actions are necessary now to achieve a better long-term outcome.

If you believe you "have no choice," then you're an addict yourself!

Also see: addiction, caffeine.

Also see Kilroy Café #22: "Words Don't Work"

Also see my comments on an L.A. Times article: Shaming Johns (another dubious "scared straight" program).


  1. You have stated in this rant over and over that treatment attempts to tell an addict that it will fix them. You obviously have been misinformed about treatment. Treatment does not say "you have a disease, we will fix you". Instead, it says, "You have a disease, we will tell you how to keep it in remission, you have to fix you". AA and NA success rates are between 15-40 %, but success is hard to define. Do we say that success is only abstinence for X amount of time? what if someone uses one time in the last ten that considered failure? the disease of addiction is much like live with it well if you have the knowledge that you have to take care of yourself to survive.

    It seems to me like you have had a bad personal experience with treatment...or someone in your family has. thats sad for you or them and I'm sorry to hear it. But before you sound off you might want to research what you are talking about.

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