Addiction, Treatment and Recovery

Good news … and other news … in the ongoing struggle to definitively define addiction to alcohol and/or other drugs as a disease, a disease that responds well to comprehensive professional treatment.

In March, the Geneva-based World Health Organization issued an authoritative report – its first ever – citing an explosion of advances in neuroscience to conclude that substance abuse is as much a disorder of the brain as any other neurological or psychiatric disorder.

Substance dependence, says the report, is caused by biological, genetic, cultural and environmental factors. The report summarizes new knowledge on how psychoactive substances are able to mimic the effects of naturally occurring or endogenous neurotransmitters. It urges increasing awareness of the complex nature of these problems and the biological processes underlying drug dependence.

Finally, the WHO report advocates effective prevention and treatment approaches.

Ironically, the same week that the WHO report was released, a splashy feature appeared on Forbes.com headlined, “The Most Luxurious Places to Dry Out.”

“While some people may opt for a more self-abnegating path to sobriety,” the story breathlessly declared, “others might choose to fight their demons with the help of gourmet meals and daily massages.”

Funny. If it weren’t so sad.

“Today, more and more treatment facilities resemble upscale resorts, complete with beach-side settings, fitness centers, tennis courts, fine dining (sans wine list, of course) and a list of fitness activities which could rival a luxury spa.”

Funny. If it weren’t so sad.

It’s interesting, the stigma that we in the treatment field have long fought is that alcoholics and persons addicted to other drugs are “skid-row bums” – or just a step away from becoming “skid-row bums.” The new stigma is of super-affluent alcoholics/addicts who can “fitness spa” their way to sobriety.

The simple fact, of course, is that treatment ain’t easy. It’s hard, hard work – and maintaining sobriety is hard, hard work. What a cruel hoax it is to pretend that treatment is anything other than a rigorous challenge.

Many of the “luxurious places to dry out” listed in the Forbes story are in Malibu, California. According to a recent article in the Los Angeles Times, there are now 16 “rehab centers” in that small community of 13,000, most of them “chic spots” charging $30,000 or more per month.

The director of one of the facilities – who has received no formal training in treating alcoholics and addicts – takes a swipe at places like the Betty Ford Center which have what the article calls “a more Spartan approach, making patients clean bathrooms and wash dishes as part of their therapy.”

“Why should we punish someone for being an alcoholic by turning them into a cleaning person,” the facility director asks.

Of course we don’t ask patients to clean toilets or wash dishes! But we do ask our patients to keep their rooms tidy and make their beds. It’s called accepting responsibility.

How should those of us who operate addiction hospitals respond to what appears to be the growing “spa” approach to treatment? Grin and bear it? Wage a public information campaign against them? Or just keep doing what we’re doing, recognizing that coping with this disease is a difficult, one-step-at-a-time challenge for both our professional staff and our patients.

As WHO’s assistant director-general says, “Substance dependence is a chronic and often relapsing disorder. While we do not know to what extent it is curable, we do know that recovery is possible through a number of effective interventions.”

I submit that getting “deep” massages, riding horses, sailing yachts, playing tennis, eating epicurean meals prepared by private chefs, do not represent “effective interventions.” They are not the route to effective, long-term sobriety for most alcoholics/addicts.

Would that it were that easy.

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