When I determined to become a nicotine addict at age 14, it was more work than pleasure, involving months of nausea, dizziness and disgust. But I was motivated: Smoking was “cool” amongst the neurotic aesthetes I naively admired.
I succeeded, and smoked a pack a day for years. Eventually—urged by shame rather than callow romanticism—I quit cold turkey without skipping a functional beat. Once again, motivation was all. I’m therefore skeptical of those who “can’t” quit their nicotine addiction.
For greater perspective on motivation, consider Mao Tse-tung’s appalling approach to China’s then-20 million opium addicts: Dealers and addicts who refused to stop using were summarily executed. Drug addiction diminished dramatically.
Inelegant as it was, Mao’s “solution” demonstrates that context and motivated self-control—voluntary or coerced—are everything in taming addiction.
Other examples—like many heroin-addicted U. S. soldiers home from Vietnam who, once safe and motivated, simply stopped using without difficulty, or coke-snorting New York socialites in the ‘80s who casually abandoned their habit when the introduction of crack stripped cocaine of its social cachet—bear out the same premise.
Intervention can vanquish dependence, if addicts acknowledge the reality of their degradation, withdraw from its enabling environment and submit to proven rehab measures. Countless recovered addicts lead productive and self-respecting lives, largely thanks to residential therapeutic communities, whose pioneer-days, male-oriented, tough-love approach has matured into a nuanced spectrum of personalized, age-and gender-specific formats.
Unfortunately, the addict’s traditional route to earned self-esteem through conformity to social norms, a natural aspiration upon which such therapeutic programs depend for their effectiveness, presently finds itself at odds with the mood of moral relativism that dominates our culture. A penchant for romancing identity-group victimhood amongst our liberal elites draws influential ideologues in the public health field to the determinism and moral inertia pervading the disease model of addiction.
Addiction, disease-model proponents say—well, like any illness, it can happen to anyone, so there’s neither moral agency attached to becoming addicted, nor shame attached to the squalid behaviours addiction entails. Addicts know better, but since they benefit materially from this canard, most of them play along.
Disease-model guru Gabor Mate, staff doctor at a Vancouver Downtown Eastside homeless hotel, and author of In the Realm of Hungry Ghosts: Close Encounters with Addiction, articulates the disease model’s tendency to launder, even to quasi-spiritualize addiction: “At heart I am no different than my patients” and “Forget tough love. Love is enough.” In assuaging addicts’ potentially useful sense of shame and discouraging social judgment, the disease model implicitly encourages addicts to accept their “identity” in perpetuity.
And there’s the ideological rub. We “judgmentalists”—recovered addicts, therapeutic community professionals and civilians with true compassion for addicts—feel that such aspiration-averse fatalism does a cruel disservice to innumerable candidates for redemption.
When translated into public policy, the disease model results in a waste of public funds.
In addict-dense Vancouver, where the disease model flourishes amongst policy mandarins, free (illegality-exempted) heroin and legal heroin clones are being injected into addicts at an alleged cost of $7,500 per addict per year. Proponents of the plan claim that’s a bargain beside the $50,000 a year addicts cost the health care and criminal justice system.
Compare that investment to residential rehabilitation, at up to $70,000 per bed annually, each bed serving two and a half addicts per year. After eight years, every bed’s clean “graduates” will have saved government a million dollars.
About 1,200 significantly dependent drug addicts annually volunteer for treatment delivered by Montrealbased Portage, Canada’s foremost practitioner of the therapeutic-community approach to rehabilitation.
Internationally studied, Portage treats the severely afflicted in society in multiple facilities across Canada. Many of its staff are passionately committed ex-addicts. For years Portage has been systematically under-estimating its success rate at about 50%.
But just-released results of a study by Portage researchers reveal a far more validating picture. The report, Summary of a longitudinal outcome study of addicted male and female adults and adolescents between 2003 and 2008, details findings from research conducted at Lac Echo, Portage’s Laurentian facility.
The study’s 122 adolescents and 230 adults were followed at six-, 12-and 18-month intervals after program participation. Both adolescent and adult programs yielded enduring success, even amongst those who did not complete the program: Eighteen months after leaving the centre, the study cohorts’s hallucinogen, amphetamine and cocaine use had decreased by a stunning 85% overall.
Sidebar results, with significant implications for reduced burdens on the public purse, were equally impressive. Hospitalizations and contact with the justice system decreased by 86.8% and 92% respectively, while full-time employment increased by 55%.
The report concludes: “When comparing the social and financial cost to society of this clientele, if left untreated, with the contribution these clients are capable of making as a result of treatment, the dramatic impact of Portage becomes evident … The savings in dollars are very significant, the savings in human terms immeasurable.”
We find ourselves at a pivotal crossroads in addiction awareness. Once a correctional issue that flew under mainstream society’s radar, addiction has rightly evolved as both a public and an individual health concern, with increased funding now tantalizingly available for treatment, but often attached to counter-productive ideological strings.
Attention only to public health—the theory-informed illness model—means fewer dollars for rehab beds and programs to restore individual lives.
We must stop selling short addicts’ ability to transcend their enslavement and reclaim their portion of the human estate as autonomous beings who have earned their self-esteem. Funding should support the evidence-based therapeutic-community model, which over time has proven it offers greater returns to afflicted individuals, their families and society at large.
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