Success of Anti-Addiction Drugs Threaten Conventional Treatment Philosophies
CNN carried a story yesterday regarding the rising controversy over a new crop of anti-addiction drugs, which are proving surprisingly effective. You might well wonder why treatments that help people break destructive additions would be controversial at all. But that’s because you may not understand the deep investment many people have in treatment philosophies as comprehensive worldviews.
Take the “critics” summary in the article: “Critics: Drug therapy does not address behavioral aspects of addiction.” Seems like a bit of a straw man: are doctors of really ignorant of the behavioral and psychological aspects of addition? I doubt it. But read farther down the article and you find out who these critics are and what really concerns them.
Despite studies showing effectiveness, established rehab programs have been slow to adopt the use of medication. At Hazelden in Minneapolis, Minnesota, a small proportion of patients receive anti-addiction drugs, but medical director Dr. Kevin Clark says the traditional model — based on intensive therapy and the 12 steps popularized by Alcoholics Anonymous — is still best. “It is a disease of the brain, but it’s a multifaceted disease. It has a spiritual component, a behavioral component to it,” says Clark. “Our experience tells us that having the network of support and recovery is what really makes the difference.”
John Schwarzlose, executive director of the Betty Ford Center, echoes that but takes a more stringent approach. No patients at Betty Ford receive anti-addiction drugs as part of treatment, although a handful of long-time addicts may be referred to a prescribing physician once their stay is over. “Where we battle with [the National Institute on Alcoholism and Alcohol Abuse] is when they say we have trials of a new drug, and then proclaim this is a treatment for alcoholism,” says Schwarzlose. “They’re smart people, but they’re missing how complex this disease is.”
Again, I sincerely doubt the people celebrating these drugs really deny that networks of support are important. It’s that “spiritual component” that’s really at issue. And that’s because, despite only middling success in actually getting people off drugs and alcohol, many conventional treatment programs often have a not-coincidentally religious fervor about the supremacy of their methods, not simply for treating addictions, but transforming people. AA, for instance, developed it’s entire theology of choice, control, and the lack of it back in the 30s, long before there was solid research on addiction and recovery, and hasn’t changed much in the intervening years. And while ostensibly non-denominational, AA’s program is littered with assumptions about spiritual intercession and even some scoffing at the rationalist and skeptical. The famous “Big Book” even threatens non-believers with the risk relapse and death: as subversive and disturbing of an evangelical tool as I’ve ever encountered.
“To one who feels he is an atheist or agnostic such an experience seems impossible, but to continue as he is means disaster … To be doomed to an alcoholic death or to live on a spiritual basis are not always easy alternatives to face.” (page 44)
I don’t mean to be too harsh on programs like AA, which certainly have helped some people find a structure and solution that works for them. And the implied theism hasn’t necessarily been a turn-off or a barrier to non-believers trying to work the steps towards recovery. But especially when people feel passionately wedded to a particular worldview or methodology, it’s always worth asking whether the theology has become more important than the original goal: fighting addiction. Indeed, I say only “fighting” addiction because many of these philosophies insist that there is such thing as ending an addiction, ever.
Which is precisely why the possibility that the chemical underpinnings of addiction could be ended must seem so threatening. If addiction is ultimately about building harmful habits and chemical triggers in the brain, and these urges can be broken by a simple pill, all the elaborate stories about choice and will and the need to surrender to a higher power come into question. Those stories may or may not be important in their own right, but it’s not hard to see why the possibility of a mere medical solution could potentially undermine them.
Of course, we make choices all the time to limit the range of possible options: indeed, many recovery programs teach patients to re-arrange their lifestyles such that they don’t come into contact triggers: people and situations that might tempt them to drink. But is that really so different from choosing to take a drug which then prevents the brain from ever fully feeling that temptation in the first place?
In both cases, we’re talking about the seeming paradox of making a choice that then helps to restrain our own choices later on: a seeming oddity perhaps, but also a daily reality. And there’s really only paradox here if you buy into the idea that we’re perfectly rational beings: that our brains aren’t simply disembodied spirits calling down the shots. If you accept instead that we’re a morass of gerry-rigged drives and instincts and habits, it’s not surprising at all to find that we can rewire and remake ourselves.