Despite decades of research showing the harmfulness of coercive rehab for addiction, these abusive, tough-love programs refuse to go away.
On Wednesday, TIME.com reported on the phenomenon of “blood cashews,” nuts produced for export in Vietnamese drug-rehabilitation programs where addicts are forced to perform “labor therapy,” such as sewing clothes, making bricks or, most commonly, shelling cashews.
Last Sunday, the New York Timesdescribed Russia’s harsh new treatment camps, where addicts are locked up for as long as a month in “quarantine rooms” to endure withdrawal.
And last week a lawsuit was refiled against a Utah-based school for teens with drug or behavioral problems, with 350 former students alleging that the school engaged in abusive disciplinary tactics like locking students in outdoor dog cages overnight.
Yet, to date, there has been no evidence that the use of forced labor, public humiliation or generally brutal confrontation has ever been effective in rehabilitating people with drug problems — or any other kind of problem, for that matter. What’s more, when tough-love approaches are compared directly with kinder treatment alternatives for addiction, the studies find that compassionate strategies win by a large margin.
It was only recently that I realized the word “sober” had been so thoroughly co-opted by 12-Step recovery — it’s so tightly packed with implications — that it can’t be used normally. In AA, “not drunk” is the last thing they mean when they talk about sobriety. What they mean is: spiritually awakened, humble, abstinent from all mind-altering substances, working a good program, whatever. If the term “sobriety” weren’t so loaded, the term “dry drunk” would be irrelevant. So, how do AA’s call themselves sober and continue to smoke?
I just want to say right off that this is not a rant against smoking. It’s a rant against the paradox and silliness that enjoys a place at the forefront of addiction treatment. I’m not being judgey about smoking; I’m speaking from personal experience.
It is a plain fact that cigarettes are mind, mood, and life altering. Smokers have to factor smoking into every activity they want to pursue, and some will bow out of things they’d genuinely like to do (spend time with family, travel, old age, etc) in order to smoke. The habit drives people to betray themselves in countless ways. Still, AA’s have argued that cigarettes don’t alter one’s ability to function. That’s nonsense. Of course it does. When you smoke, you can’t just do whatever you want to do without figuring out how to accommodate cigarettes. Stopping whatever you’re doing to stand outside in the rain and pollute yourself several times a day sets a really low standard for functional. Continue reading AA Members Who Smoke Are Not Sober
Here’s how they do rehab in Russia:
YEKATERINBURG, Russia — The treatment center does not handcuff addicts to their beds anymore. But caged together on double-decker bunks with no way out, they have no choice but to endure the agonies of withdrawal, the first step in a harsh, coercive approach to drug treatment that has gained wide support in Russia.
“We know we are skirting the edge of the law,” said Sergei Shipachev, a staff member at the center, which is run by a private group called City Without Drugs. “We lock people up, but mostly we have a written request from their family. The police couldn’t do this, because it’s against the law.”
A thick silence fills the little room crammed with tall metal beds, obscuring the fact that there are 37 men lying shoulder to shoulder, each lost in a personal world of misery.
Outside the chamber, known as the quarantine room, 60 men who have emerged — after as long as a month with only bread and water or gruel — work at menial jobs, lift weights or cook in a regimen of continued isolation from the world that staff members said usually takes a year.
“To put someone in handcuffs, it calms them psychologically,” Mr. Shipachev said as he paged through photographs of men shackled to their beds or to each other. “Now, it’s the old-timers who calm the new ones. A guy shouts, ‘I’m going to die now!’ and everyone just laughs at him, because they’ve been there themselves. It would be much worse for him if he was alone. The best thing is to just go to sleep.”
Sometimes when we hash through the disease model of alcoholism, I’ll get this vaguely conceived fantasy about dropping alcoholics off on a deserted island where there is no possibility of indulging their addiction and they have to focus all their attention on their very survival: building shelter, finding food, skinny dipping with Christopher Atkins. They might go nuts for a few days, trying to ferment mangoes and smoke seaweed, but their pressing concerns and priorities will shift pretty quickly. I think this Russian style “rehab does you!” treatment is demented and horrifying because it offers nothing but debasement and dehumanization. Those conditions seem to mirror addiction itself.
What I find interesting, though, is that these people are actually going with the deserted island idea — except with more concentration camp and less quality of life. At the bottom of this approach, though, is the idea that beating an addiction is as simple as just knocking it off. Critics say that this approach doesn’t address all the complexities of addiction and doesn’t provide any aftercare. I am curious to know how a year of forced abstinence and dehumanizing conditions compares to a year of trying to have a spiritual awakening through the 12 Steps. It seems that they don’t consider 12 Step to be a realistic option:
Is it wrong to rescue a drowning person by pulling their hair?” asked Yevgeny Malenkin, a founder of City Without Drugs, summing up the public view. “If people say it is cruel and inhumane, let them teach us how to do it otherwise.
A recent article explains why Russians tend to resist 12 Step treatment, saying that it has to do with AA’s foreignness, its Protestant roots, and the fact that it thrives on donations. The article doesn’t mention 12 Step success rates, but it seems to me that a country so desperately in search of a solution to addiction that they are chaining people to beds would be well beyond quibbling about cultural purity. I’d like to see 12 Step efficacy rates compared to Russia’s own soul-crushing alternative.
Who Falls to Addiction, and Who Is Unscathed?
Here is what a NY Times writer has to say:
Singer Amy Winehouse’s fame and infamy have now been forever linked to one word: rehab. She is only one of many recent high-profile cases in which attempts at rehabilitation from substance abuse failed. Amidst strange public outbursts earlier this year, actor Charlie Sheen asserted that it was not rehab, but rather he, himself, that had been his secret weapon against abusing cocaine and booze.
Grief is about all I got, but I know that a lot of people in the world are taking the opportunity of Amy Winehouse’s death to say all kinds of things about addiction and rehab.
Maia Szalavitz has a thoughtful, introspective piece in her Healthand column, which ends with these thoughts:
Only if an alternative method of reaching that state can be achieved is recovery possible. For me, that came in learning that my belief in my own unlovability was a delusion and that my pain could be reduced by sharing it. Unfortunately, you can’t forcibly teach this. Even if Winehouse hadn’t said “no, no, no” to many rehabs, no therapy would be able to reach her if she couldn’t first come to believe that her intolerable pain could end without self-medication.
And that’s why rehabs that use coercive tactics are often so counter-productive and why trying to force abstinence can backfire. We know that the British system of addiction care offers more access to “harm reduction” programs that don’t require abstinence — but we don’t know whether Winehouse was offered this approach, what the circumstances of her death were and whether anything could have prevented it.
And here’s and excerpt from Stanton Peele’s Winehouse post:
So, was Amy’s dislike for rehab the cause of her death? Not only an addict, Ms. Winehouse was too stupid or too much in denial, in this view, to recognize rehab or a 12-step group would be her salvation.
Except Ms. Winehouse had been in rehab any number of times. In fact, she had just gotten out. According to the BBC: “She had recently finished a course of alcohol rehabilitation in London and at the time was under strict instructions not to drink.”
Which reminds us that overdose deaths are much more likely after individuals leave institutions such as prisons or hospitals. They then return to accustomed levels of consumption of a substance after having lost their tolerance for it.
Hyacinth requested a dedicated thread to discuss the subject and the public response to. So, here you go…
Is this good news or bad news? Mixed blessing? War?
There is an age-old debate over alcoholism: is the problem in the sufferer’s head — something that can be overcome through willpower, spirituality or talk therapy, perhaps — or is it a physical disease, one that needs continuing medical treatment in much the same way as, say, diabetes or epilepsy?
Increasingly, the medical establishment is putting its weight behind the latter diagnosis. In the latest evidence, 10 medical schools have just introduced the first-ever accredited residency programs in addiction medicine, where doctors who have completed medical school and a primary residency will be able to spend a year studying the relationship between addiction and brain chemistry.
“This is a first step toward bringing recognition, respectability and rigor to addiction medicine,” said David Withers, who oversees the new residency program at the Marworth Alcohol and Chemical Dependency Treatment Center in Waverly, Pa.
(h/t soberbychoice. Thank you!)
Around here, when we criticize the practice of sending kids to AA or other 12 Step programs, we usually focus on either the inappropriateness of sending kids to the same rooms where judges are sending grown up addicts and predators or on the unconscionable abusiveness of teaching people in their teens that they have an incurable progressive lifelong disease over which they’re powerless. In his article “Teens, The Brain, and 12 Step Recovery,” Thomas Greaney offers a few more reasons 12 Step programs are not a good fit for young people. First, he points out that the average age of an AA member is 48. Second, he says that the immature brain development prevents kids from processing drunkalogs as warnings — instead, they see these cautionary tales as more as a challenge. Third, he says that kids have a hard time “grasping the spiritual underpinnings 12 Step philosophy” and the notion of “powerlessness.
Greaney offers a re-vision of the 12 Steps that I really appreciate. It replaces powerlessness with accountability and personal agency; replaces original sin with original worthiness and value; and replaces divine intervention with intention: Continue reading 12 Step Recovery Is Wrong for Teens
Please go read Steven Slate’s piece on the new documentary about the “troubled teen” industry, created by survivors of the Straight, Inc. nightmare. He makes the connection between what some might consider a sort of isolated issue and draws a very clear line to the addiction recovery movement whose psychotic mythologies influence our culture so profoundly.
Here’s Steven Slate’s article. It is essential reading. When you’re done, please friend it:
I wanted to also point out that one of the creators of Surviving Straight, Inc. started a website that we linked to in the blogroll. Troubled Teen Industry is a powerful resource and a compelling read.
[UPDATED]: I guess Steven and I were writing posts for ST at the same time, and I just happened to hit “post” before he did! Sorry, Steven… I scooped you on your own story.
Steven Slate says:
As of now, distribution plans for the movie are up in the air, and they’re submitting it to festivals. One thing that may help is making noise about it on the net, and showing that there’s demand for it. I don’t know the best way to do that, but here’s where to start:
The film’s website: http://www.survivingstraightincthemovie.com/
Troubled Teen Industry: http://www.troubledteenindustry.com/
Reddit Troubled Teens: http://www.reddit.com/r/troubledteens
I can’t stress how much these people have put themselves on the line by making this film and appearing in it. Along the way, one of the filmmakers even received a message ominously taped to his door which read “You won’t survive Straight Inc.” I’d hate to see their efforts go to waste. I don’t know the best way to support them, so I’m just starting by spreading these links around and talking about the movie with the means I have at my disposal. Many of the abusive methods of Straight Inc are still in use in Therapeutic Communities all over the place, and this stuff needs to be stopped.