How to cure an addict: compassion or tough love?

We have just observed National Addictions Awareness Week in Canada. Everybody — informed or otherwise — has an opinion on addiction and how to treat it, so the subject never fails to generate animated public debate.

The literature on addiction is voluminous. Any amateur researcher trying to get a handle on the constant outpouring of medical, governmental and ideologically-tuned advocacy literature (both for and against legalization of drugs) will find it a daunting and confusing business. I have tried, so I know.

In the end it’s pretty simple. Everyone agrees addiction takes a terrible human and societal toll. It’s what to do about it that polarizes us. Opinion invariably drifts toward one of two basic camps, depending on one’s view of human nature.

According to the Tough Love (TL) school, human beings are endowed with moral agency and can control their choices. In this view, however painful the circumstances driving the flight into the oblivion drugs provide, nobody is beyond redemption if he chooses — and even if he doesn’t choose, but is forced into – long-term community-based rehabilitative therapy.

According to the Romantic school, summed up in the philosophy of Harm Reduction (HR), addiction is a chronic disease, like rheumatoid arthritis, that befalls victims. The best we can hope to do, from this perspective, is palliate the misery and mitigate the spread of disease and crime, while enabling the addiction’s perpetuation more hygenically.

For the ultimate Romantic approach, read Gabor Maté’s 2008 book, In the Realm of Hungry Ghosts. Dr. Maté, a sainted icon of the drug legalization movement, ministers full time to hard-core substance abusers. An admittedly neurotic personality with multiple manias and a hunger for both celebrity and vicarious suffering, the spiritually restless doctor found his bliss in his identification with the inhabitants of the Portland hotel, home to Vancouver’s most unregenerate human wreckage (“I saw the cockroaches and fell in love”).

Maté sees all of humanity as more or less addicted to something. For himself it is classical CDs; Conrad Black is “addicted to status”; and perhaps you are addicted to chocolate cake. Oh yes, and that emaciated parody of a human being lying spaced out in his own vomit is addicted to a “substance.” It’s all one, you see. And therefore: “Addiction can never be understood if looked at through the lens of moralism and judgment.”

After wading through Maté’s hagiography of junkiedom, you may, as I did, yearn for nothing so much as a heavy dose of moralism and judgment, not to mention assurance you are not an addict, even if, like me, you tend to buy a lot of books you may never read. You will find compelling abundance of both moralism and judgment in the Emmy-award winning TV series about addiction, Intervention. I have no use for reality shows in general, but this one I’m addic — er, I really like.

At the end of every Intervention segment, the addict — of alcohol, cocaine, heroin, gambling, oxycontin, you name it — is surprised with an intervention by his loved ones, facilitated by one of three plain-spoken ex-addicts.

You would not believe the tears that flow on this show, or the outpouring of love — real, passionately felt, unconditional — the parents and siblings and friends feel for the addict, love the addict accepts as an entitlement or shrugs off with indifference.

Unlike the co-suffering, romanticizing Maté, the ex-addict facilitators are pragmatic, cool, been-there-done-that realists. They are unmoved by the addict’s narcissism, self-pity and grievance-collecting.

The format of the intervention capping the addict’s documented downward spiral is invariable: The addict is seated in the midst of those whose lives he or she is ruining. Up to now they have been enabling the addict out of helplessly protective love.

The intervention begins with family members reading their own texts, enumerating the enabling behaviours they will no longer endorse (money, free accommodation, etc.), all ending with, “Will you accept this gift [of 90-day community rehabilitation therapy]?”

Usually the addict breaks down, as each of the addict’s victims makes clear the devastating scope of addiction’s consequences on others, especially children. They accept the rehabilitation, with varying degrees of gratitude or reluctance. Some succeed at it; some don’t.

The dramatic televised difference between the addicts in the grip of their grotesque enslavement and their mature acceptance of responsibility for their lives 60 days later is remarkable and inspiring.

In a nutshell: HR thinks shaming and blaming addicts is cruel and unfair. TL thinks shaming and blaming addicts is the only way to open their eyes wide enough to their own selfishness and degradation to push them into recovery. Read the “compassionate” Maté book, then see the “tough” Intervention, and then tell me: Which would you choose for someone you love?

Barbara Kay is a columnist for Canada’s National Post. She writes and lives in Montreal.


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