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In this excerpt from The Biology of Desire, neuroscientist and former U of T professor Marc Lewis combines case studies and science to argue against the disease model of treating addiction.
Background: I have worked in the alcohol and drug field for over 25 years in a number of roles in a variety of services, government, and non government community not for profit. I have a family history of both addiction and recovery.
It is interesting to read everyone's views so far. The number of treatment models are varied and at times contentious, with various camps sometimes at odds regarding the best treatment approach. My experience has been that harm minimisation, underpinning a pragmatic public health stance is the most humane basis upon which various treatment models can springboard.
In my experience, a one size fits all approach is the least helpful. A variety of evidenced based treatments are available and with comprehensive assessment and treatment matching many lives have improved, not only for the substance user but for the many people within their circle who can be severly affected by the often destructive behaviours of people in active addiction.
The number of options for people in Australia can range from free needle and syringe programs, pharmacotherapy, outpatient couselling, 12 step programs, long term residential treatment based on the community as method treatment model, brief intervention, MTAR programs etc. The main idea being that for different people, at different times, there are choices.
And as someone quite rightly pointed out- not having treatment is an option too. Sometimes that comes with serious consequences, sometimes not.
There are some people who will mention poverty, neglect, abuse and poor education as factors in addiction, and that may well be, However, over the years I have met many, many people who have struggled with addiction who have had every opportunity in life. I think money can make it easier for a person to hide substance use issues.
I think getting lost in the whys of addiction can sometimes be detrimental to moving forward with the hows of recovery.
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I’m sure you’re right. Caring for people, the way you do, you have a bird’s eye perspective. My own view, from a lower and therefore more maze-like standpoint, essentially backs up what you’re saying. For me though, and for people in the same position as me, who’ve had to write off people that’ve become junkies, the exceedingly remote possibility of some miraculous recovery has vanished.
As callous as that is, and as statistically wrong as it must be — as pejorative as the term ‘junkie’ must sound — cutting ties is a self-preservation skill that often does not come easily. A very different outlook than your better, more compassionate, more fundamentally sound view.
I can make out a bright glimmer of truth in what you’ve said about the key pathway to addiction being self-medication. With the people I’ve known, as far as I know, the root cause seems to’ve been self-medicating for untreated psychological disorders. Vicious family cycles of abuse, too. Like you say, the income prospects for your average junkie sneak thief with, say, late-onset schizophrenia, are not great. The better they’re doing, the more worrisome that is.
Like any other rat in the maze, my view toward junkies is probably common, even though I didn’t have to cut off several close family members the way others have. Unable and unwilling to keep company with junkies, having run out of alternate approaches and well
out past the first few ultimata, it began to seem to me that it wasn’t so much that I was abandoning anyone to their fate. Rather, it seemed as though they face their own judgement. Not their judgement in the sense that they make their own decisions. Judgement
in the sense that their choices make their consequences. It wouldn’t be me passing judgement. It would be entirely of their own making, nothing at all to do with me. Which was, to my mind at the time, likely to be as stern for the addictors as the addicted.
In my own particular Tennessee Williams drama, the primary addictor was the youngest in a chain of those. A family line of addictors, that reached back through generations of, of all things, doctors and nurses. Got the impression that a surprisingly high number of the
functional junkies in the world keep themselves that way by hiding in the medical profession. Yet another facet of self-medication, then. And vicious family cycles.
Not everyone can be saved
Triage. It is in place for a reason.
Not everyone WANTS to be saved.