As a society, we generally have pretty strong opinions – and even stronger emotions – regarding people who suffer with addictions. Take a casual survey, and you’re likely to find viewpoints that range from fearful, resentful and hopeless to downright cruel, vicious and hateful. Ironically, some of the people who hold these views are among the finest people you could ever meet. My father-in-law, for example, was a wonderful man, whom my wife, my children and I miss terribly – may he rest in peace. But he would sum up his view of people with addictions by saying, “Once an addict, always an addict.” And for that reason, he always advised my wife, from the time she was a young girl, to never have anything to do with “those people.” My wife and I have a very dear and close family friend who is a brilliant and talented engineer – and a truly kind and loving person. Yet, when she speaks of people with drug addictions, she is fond of saying (only partly in jest), “Just put them all on an island somewhere, blow up the island, and put them out of their misery! There’s nothing else you can really do for those people!”
Now that I’m approaching my 20th year of working with people with addictions, I understand why people think this way, even as I know how horribly wrong and misinformed they are. An important reason for the attitudes of hopeless negativity towards people with addictions is the regrettable history we have in this country of failing to provide effective, evidence-based treatment for them. At this point in history, we have a very good idea what works and what doesn’t. Yet we often persist in offering addicted people what doesn’t work, because we’re unwilling to invest the time, energy or resources to provide what several decades of voluminous research tells us is effective.
Here’s an example of how this happens. We send someone with a drug or alcohol addiction to a 28-day treatment program, even though more than 40 years of research into addiction treatment tells us that most people need at least 3 months in treatment in order to achieve any meaningful and lasting recovery (and many people need substantially longer than that). Quite predictably, the addicted person goes right back to drinking or using drugs, perhaps just a few days after being discharged from his 28-day program. We then look at this situation, shake our heads in disgust, and conclude that the addicted person can’t or doesn’t want to recover. Therefore, some of us further conclude, he must be hopeless and should be “put out of his misery.” Or we conclude that addiction treatment, in general, doesn’t work and is a waste of time. Often, we draw both conclusions at the same time, which gives us every reason to throw up our hands and resign ourselves to the idea that “once an addict, always an addict.” Time to load ‘em up on a plane and fly ‘em to that deserted island, right? Anyone have any dynamite?
Pretty ridiculous, isn’t it?
Imagine if we doctors treated people with chest pain from an oncoming heart attack simply by saying, literally, “Take two aspirin, and call me in the morning.” After all, we know that aspirin has been proven to be part of an effective prevention regimen for many people with coronary heart disease. But suppose we did little more than that. We would at least be doing part of what is known to be effective. I suspect we’d have an astronomically high rate of “treatment failures” and an alarmingly high rate – much higher than it is already – of people dying prematurely from heart attacks. We might even conclude, as a society, that treatment of heart disease and prevention of heart attacks is an ineffective waste of time. Perhaps we should make room on that island for all those Americans who suffer from heart disease.
Think of what an outrageous public health disaster that would be, especially when you consider that we know better!
I submit to you that the way we have treated people with addictions – and the way many of us regard them – is just that outrageous. And it’s every bit as disastrous for our collective public health – especially when you consider that we know better!
Dr. Steve