Addiction 102

There is an old joke about the difference between a drunk and an alcoholic. A drunk doesn’t go to meetings.

We hear a lot about addicts “in recovery” and recovery programs. It’s partly grounded in the medical metaphor that addictions are illnesses, and that people gradually recover from addictions, but there is another layer of meaning. Recovery also implies spiritual change, and that version of recovery seems to have become a prevalent idea in popular culture. This version of the idea of recovery has been used as the foundation for programs aiming at recovery from real and fancied abuse, and programs of transformational change, healing and personal growth.
There is reason to believe that people can radically alter their behaviour under certain circumstances, for the right reasons and with the right support. The main example is the experience of religious conversion. There is a historical connection between religion and addictions treatment. In the 18th and 19th centuries, the early Methodists and other Evangelicals – emotionally oriented religious movements – were reasonably successful in recruiting alcoholics and changing their lives through religion. By most accounts, a sincere religious conversion can be effective in providing an addicted person with a different perception of his priorities, with new rewards, and a different sense of flow and satisfaction in his life. I am not sure if anyone followed converts and tried to find out if they relapsed into addiction later, especially after falling away from their churches.
In the 20th century, AA and other programs devoted to change through self-examination, spirituality, and devotion to the Program have evolved. AA was founded by a fundamentalist preacher, and it works as a kind of life-long religious exericise. By many accounts AA, NA and other 12 step programs, and other similiar support groups provide the same kinds of support and rewards for some people. Surrendering to a higher power can work when the decision is rewarded by the approval of the group, or if the insights lead to following a different routine that replaces the addictive behaviour with a less harmful, and equally rewarding behaviour. A couple of years ago I read a book called Cults: Faith, Healing and Coercion by Marc Galanter who is a psychiatrist, a co-author of the 1994 Textbook of Substance Abuse Treatment published by the American Psychiatric Press, and many other books and published papers on addiction. He also wrote a paper called “Zealous Self-Help Groups as Adjuncts to Psychiatric Treatment; A Study of Recovery, Inc.” American Journal of Psychiatry. Vol. 145, 1988, pp. 1248-1253 and other papers on group psychology and cults. He favours a network approach to addictions counselling.
Dr. Galanter’s cult book draws on his field work with AA groups. His assessment was that it was a relatively beneficial cult – he regarded it as the lesser harm. It works because people meet various emotional needs through participating in meetings and the social supports that cult participation provides. That’s probably the most sensible explanation for how 12 step programs works. Dr. Galanter’s study would imply that support groups and social supports, used consistently, can help in coping with addiction. Dr. Galanter and other pyschiatrists regard group therapy as the treatment of choice for addiction.
AA and the other senior 12 step programs caution their members against expecting permanent recovery. They teach that addiction is a permanent condition and they encourage people to keep working the Program. That seems to be prudent advice although reliable information on recovery and relapse seems to be scarce.
A variety of self-help and personal growth programs have grown up around the ideas of recovery and personal transformation. They seem to work by the manipulation of feelings through the influence of healers, therapists, and coaches, and through social dynamics. I am not aware of any clear evidence on how well self-help and personal growth programs work and how they compare to professionally facilitated support groups and 12 step groups.
Promoting and reinforcing a value system and lifestyle where the addiction is less rewarding is obviously a good idea. However the idea of transformational change is daunting, and to some extent, demeaning. Many of the advocates of transformational change are simply advocates for alternative value systems, and some of them are just kooky. They can be so focussed on promoting their own values that they miss the chances to work on simple harm reduction goals.


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