“The opposite of addiction is not sobriety. The opposite of addiction is connection.”
- Johann Hari, Chasing the Scream
Ideas about how to treat addiction are so widespread that it seems almost impossible to imagine alternatives. Endless films, TV shows, and news coverage have led us to believe that if someone is addicted to drugs, the only solution is for them to stop, cold turkey.
However, treatment needs to move beyond just sobriety. Here’s why:
Sobriety has been the only option and it’s not working. The vast majority of rehab and addiction treatment programs available today use an Alcoholics Anonymous (AA), or 12-step model, with sobriety as their ultimate goal. Opting for sobriety is an effective and life-saving option for many people. However, it does not work for everyone. Despite the dominance of the AA model, its success rates (measured by its own standards) are quite low. A 2014 survey of AA membership found that 27% of those surveyed remained sober less than one year. LA Times cites an 8-12% sobriety rate after the first year. Meanwhile, drug overdose is the leading cause of injury death in the United States, surpassing even motor vehicle crashes. It’s clear that the field of addiction treatment needs to change.
Meet people where they are and reduce harm. For those struggling with addiction, the substance serves as an important mechanism to cope with the challenges they face around them. Renegotiating one’s use to this substance takes time, deep internal struggle, and often involves making mistakes. Yet, many rehab programs view relapsing as a sign of failure or even as grounds to kick someone out of treatment, rather than the natural course of treatment. Instead, treatment should understand that people are trying their best, even when it’s most challenging. It should support people with compassion as they go on their journey to change their substance use.
Moderation is a viable option--in fact, most people do it. Globally, most people moderate their use with some substances and abstain from others. Even people struggling with problematic substance use have limits about how or when they use. For example, maybe they don’t use when they need to show up for an appointment or when they are around children. This shows that, with a mental shift, other ways of dealing with the substance are possible. If someone has an unhealthy relationship to, for example, alcohol, why couldn’t one goal be to develop a healthy relationship to it? Why should a glass of wine with a meal be considered a relapse?
Renegotiating substance use on a person’s own terms allows them to go deeper. There is strong consensus in the psychological, psychiatric and addiction research world that addiction and substance abuse most often occurs as a coping strategy with underlying trauma or other major stressors. (See sources below.) Solely encouraging someone to shift their behavior just scratches the surface. Shifting treatment to the person rather than the substance allows them to address the issue at the root. For example, for someone dealing with alcoholism, experimenting with moderation (in a supportive environment and with a clear plan) can allow them to better understand what purpose the substance serves in their life. They can address any issues that arise when in contact with alcohol and start to explore a different relationship to this substance. In the end, they may decide that abstinence makes the most sense for them after all. Yet, because of this deeper process, the outcome is richer and longer lasting.
When people steer the course of their own treatment, outcomes last. Addiction often arises for people in response feeling a lack of control over their life circumstances. Treatment that imposes a particular outcome or practices “tough love” sometimes only reinforces this feeling of lack of control. A person may comply with sobriety in the short term, but find that it doesn’t stick. By contrast, when people have a say the course of their treatment, they are often clearer about what they want and value. This tends to lead to deeper and more sustainable change.
When we stop narrowly focusing on the substance, possibilities multiply. Shifting the focus away from just the substance opens up a multitude of conversations about the person’s life. What are the person’s fears, desires, dreams? What is their relationship to community, to work, to sexuality? The conversation becomes less about just a substance, and more about the person. It allows them to connect or reconnect with their purpose in life and begin to live with a greater sense of meaning.
The Business of Recovery. Directed by Adam Finberg. USA: 2015.
Hari, Johann. Chasing the Scream: The First and Last Days of the War On Drugs. First U.S. edition. New York, New York: Bloomsbury, 2015. Watch Hari’s TED talk.
Maté, Gabor, M.D. In the Realm of Hungry Ghosts: Close Encounters with Addiction. Toronto: Knopf Canada, 2008. Watch Dr. Maté’s TED talk.