Addiction and recovery: time for progressive strategies?
Mural artwork by Smokey D. in Vancouver’s Downtown Eastside. Smokey lost his friend to a fentanyl overdose in 2017 and began painting murals depicting fentanyl overdose tragedies.
Canada is clearly in the middle of a severe addiction crisis. What is presently lacking is a coherent approach to what can be done to prevent so many of us from dying. In 2018, for example, a reported 4,588 people died from opioid overdoses in Canada.
Even though there are varied reasons why so many people die from addictions, predominant addiction and treatment models have, until recently, remained entrenched in approaches coming out of the 1930s.
Early psychological experiments designed to study addiction commonly used a caged rat that had the choice of drinking regular water or drug-laced water. In example after example, the rat chose the drugged water; often, it would die after becoming “hooked” on drugs. Based on these experiments, Western society and their varying drug legislation focused on the notion that drugs were “bad” and had to be stopped. This led to continued drug prohibition with severe criminal sanctions for users and sellers. Strict policing and corrections were seen as part of the (failed) “war on drugs.”
Approaches based on recovery from addiction were based on similar notions. The work of 12 step-based recovery organizations is well known. Alcoholics Anonymous (AA), and other programs based on it, such as Narcotics Anonymous and Cocaine Anonymous, were started in the US in the early to mid 1930s. Their goal is total abstinence for members, who are taught that recovery can begin once the drink or drug is put down. AA and the other fellowships have their advantages: membership is free, friendships and support can be easily built, and role-modelling can be very supportive. In addition, membership and successes can be celebrated, and the recovering individual can obtain some sense of pride and satisfaction in a job well done and in success at recovery.
The potential problem with the 12-step approach is in the general philosophy of the “problem and the solution.” A quote from ‘The Big Book’, a seminal text written by William G. Wilson, one of the founders of Alcoholics Anonymous, reads: “I need to concentrate not so much on what needs to be changed in the world as on what needs to be changed in me and in my attitudes.”
This small quote is significant, as it is often repeated in celebratory meetings when a recovering person reaches a milestone, such as a year of sobriety. The recovering person is taught that it is not society—or class exploitation or alienation or oppression—but rather their own adaptation to society that needs to change for their recovery to be successful.
Is there an alternative to the war on drugs? Is there a new way to stay clean?
Newer rat studies have challenged the earlier ones. The problem with a rat in a cage that has two choices of beverage is that the rat doesn’t have much choice or freedom. The latest studies, documented by Johann Hari in his 2015 book Chasing the Scream: The First and Last Days of the War on Drugs, are referred to as “Rat Park”, and provide the rats with an opportunity to have a whole room to live in. The rat can choose to eat cheese, dig tunnels, interact with other rats, hide on its own, and so on. Rat Park also includes the water tube and the drugged water tube; but no rat has become dependent on the drug water. The rats all drink the drugs, and maybe even come back for another helping, but the big difference is that none of them developed a debilitating addiction.
Are there approaches to recovery that take “Rat Park” into consideration?
For many years, Portugal had one of the worst drug problems in Europe. Several years ago, a decision was made to legalize all drugs, and money from enforcement and corrections was redirected to drug treatment and rehabilitation. Today, drug use in Portugal has declined significantly. Drug users can now get the help they need, if they want it, to thrive and move away from negativity in their lives.
Another important development in Canada and the US is the current effort to prosecute large pharmaceutical companies that have irresponsibly promoted medicines such as OxyContin, resulting in harm and death for many vulnerable people.
The harm reduction approach has many adherents. Instead of having people die from addictions, governments can provide services like safe injection sites, needle exchanges, HIV and Hepatitis screening. Harm reduction is person-centred, based on the notion that we can reduce the harm drugs can do so long as we put our fellow human first.
While many people find that 12-step recovery or “Rational Recovery” programs work for them, we need to develop a more progressive strategy for addiction and recovery. Such a strategy needs to be user-specific and based on notions of empowerment, love and care for drug users, whether they choose to abstain or not (or not yet).
Most importantly, substance abuse care needs to be based on theories of social transformation and assistance to overcome experiences of alienation at the heart of capitalist society.
Brian Major works as a Peer Support Specialist in a community mental health agency. He holds an M.A. in sociology.
A different version of this article originally appeared in People’s Voice.