Author Maia Szalavitz says that 12-step programs and “Tough Love” may do more harm than good – and she should know what she’s talking about after having been a cocaine and heroin addict from the age of 17 until she was 23. As a journalist, she has since spent a great deal of time researching the topic, and her findings may come as a surprise to the traditionalist who feel that 12 step programs are the only way to go and that being “mean” to addicts will help them quit. Szalavitz say that harm reduction is the way to go. Addicts should be treated decently rather than being punished.
12-step programs have value, but…
Szalavitz says that 12-step programs can provide much-needed support for recovering addicts, but she says that they are too rigid, requiring prayer, confession and surrender to a higher power that not all addicts would identify with. Cognitive Behavioral Therapy, she feels, is a more scientific approach, and research has found it to be among the approaches to addiction treatment that show good results.
Her primary criticism of 12-step programs is that they seem to regard addiction as a moral issue rather than a medical problem. She does not see 12-step programs as having any real basis in science and feels that they should be regarded as “self-help” programs rather than hard addiction treatments. However, most addiction treatment in the US currently centers on 12-step programs, and she believes that this is why addiction treatment is often unsuccessful.
People need to understand maintenance treatment better
Another concern that Szalavitz has, is that many people fail to understand that maintenance treatments really are a safer way to come off drugs. She explains that although the drugs given to recovering addicts are opioids, they are administered at doses that don’t make the patient feel intoxicated. The primary benefit is that if the patient then relapses, the chances of an overdose fatality are reduced, whereas they are heightened by complete abstinence.
Maintenance treatment allows addicts to become used to living without the high, and when they have been relapse free for long enough to be sure they can withstand temptation, they can off the maintenance treatment too. However, she acknowledges that the approach is considered controversial as many see it as replacing one addiction with another, related addiction.
Replacing “tough love” with harm reduction
Szalavitz also notes that the negative public opinion towards safe injecting spaces where clinicians provide addicts with clean needles is skewed. She says that research shows that providing safer environments saves lives, and doesn’t prolong addiction. “Tough Love” theory, she says, would imply that providing safety would be “enabling” behaviour and would therefore prolong addiction, but according to the facts, this is not the case.
She says that the dignity with which patients at such sites are treated gives them a greater sense of self-worth – an essential ingredient if they are to recover in the future. “It gives them hope,” she says.
Doctors agree with Szalavitz
In a column published in the Huffington Post, Dr Peter Ferentzy’s views are strikingly similar to those of Szalavitz. He likens quitting an addiction to any other behavioural change. If you are a bad-tempered person, and resolve to be gentler, slowly reducing the frequency of your outbursts, most people would see you as making progress, but this is not the case with addiction. You could even end up in jail. Dr Ferentzy says that it’s time people stopped imposing their own “preachy” attitudes on addicts. If maintenance works for them, they should be allowed to practice it under medical supervision.
Dr. Gabor Mate of the controversial safe injection site in Vancouver is vocal on the need for such facilities. A bid to close the site down was thwarted by the government which found that the facility was saving lives. The doctor says that the facility does not enable behaviour that addicts wouldn’t indulge in anyway, but that it at least ensures they won’t kill themselves or contract serious diseases from dirty needles. The site doesn’t treat addiction, but it could help addicts to survive for long enough to ultimately do so.
He says that there are many motivations for addiction, and none of them are positive. If hitting “rock bottom” healed addiction, he says there would be no slum drug addicts. Positivity, he feels, and an opportunity to be treated with dignity provides a far better motivation for quitting than “tough love” ever could.
Leading experts in the field of addiction say that there is always a root-cause for the addiction – it is a symptom of some malaise rather than existing as a disorder that is independent of outside influences. “Kind love” rather than “Tough love” is far more effective in helping people to escape the negative cycle of addiction.