Wednesday, February 5, 2014

Learned Powerlessness

I'm cautious about commenting on this, especially as it's a touchy issue.  Still, so many are using the death of an actor by narcotic misadventure as a platform for expressing a great deal of bosh concerning addiction and drug policy, I thought it might be interesting to mention the latest perspective on treatment.  This is so new that it will take the Episcopal Church another twenty years to recognize it.

Of course, by then, treatment professionals will have moved to the next level.

[An aside: I'm fatigued by people who have started talking about the "heroin epidemic" in the United States over the last couple of days.  As a former urban rector who has done his share of funerals for those who have O.D.'d on drugs, this is not a new problem at all.  Pardon the radicalism, but what is new is that the latest victim was a wealthy, white man who was beloved by the media class; so now we're allowed to notice a problem.  I'm very sorry that that's what it takes, but so be it.]

We have been informed by most professionals that addiction is a disease. Certainly, given the success of most disease-oriented programs, this is a sound approach. However, it has been noticed that the label "disease" has convinced many addicts that theirs is a hopeless case with little or no chance of true recovery.  The thinking is that since there is no cure for addiction, sooner or later it will kill you. Thus, treatment theory becomes another rationalization for chronic drug use.  Of late, this has been increasingly frustrating to the professionals.

A number of therapists and treatment specialists are advancing a new way to address the paradox of "addiction as disease".  The latest theory is that those combating addiction can fall into a state of learned powerlessness; scientific evidence and analysis appears to show that the natural arc is for the most addicts to "mature" out of the disorder.  Learned powerlessness does not permit this maturity to occur.

This is based on a 1962[!] study entitled "Maturing Out of Narcotic Addiction" from which this telling quotation is written:

The difference between those who mature out of addiction and those who do not may also mirror the difference between addicts who struggle to abandon addiction and may develop some insight, and those who decide that they are 'hooked,' make no effort to abandon addiction, and give in to what they regard as inevitable."

More studies made subsequent to that initial study may be found in this 2012 document.  The end result is that contemporary treatment programs are beginning to seek to avoid learned powerlessness and are likely to bring some evolution to the "addiction as disease" narrative. As there is a lot of money being made through traditional treatment programs, I imagine this will not be an easy change.

[A disclaimer: Addiction treatment is not my field; I'm just noting a discernible change in medical and societal regard for it.  My main interest in any of this, I guess, is a desire never to have to officiate at the funeral of an overdose victim again.]