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What You Really Don't Know About Recovery

Once an addict, always an addict. Hitting bottom. Tough love. These are only myths about beating addiction. Why can't we handle the truth?

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The head-in-sand theory of addiction photo via

By Maia Szalavitz

06/04/12

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We all think we “know” a lot about addiction. Recovering people, especially, believe that they have particular insight—but even those who have never set foot in a 12-step meeting or found themselves struggling to resist the call of the crack pipe are persuaded of their knowledge of drugs and addiction. After all, almost every American kid is subjected to drug education in secondary school, and pop culture is rife with portrayals of addicts and (fewer) sober folks.

From The Days of Wine and Roses to DARE to Dr. Drew’s Celebrity Rehab—and in routine media coverage—fundamental assertions about addiction are made daily, and go unchecked, simply because they are so common as to seem beyond doubt.

Unfortunately, most of what we think we “know” is slightly incorrect or based more on myth than on fact or completely divorced from reality. But because we think we already “know” what we need to know, the myths and misconceptions are continually repeated.

Consider two of the most common:

1. “Once an addict, always an addict.” This statement resonates with people in 12-step recovery, where the problem is generally experienced as a chronic, relapsing disorder. However, research that follows heavy drinkers and drug users over time finds that a majority of people who, at some point, met the criteria used to define addiction no longer do so later in life—and that most have recovered without attending meetings or treatment.

Even more contrary to “in the rooms” beliefs, many of these people resolved their problem through moderation rather than abstinence. For example, some former heroin addicts drink alcohol without risk of becoming drunks; others smoke marijuana from time to time.

Most of what we think we “know” is slightly incorrect or based more on myth than on fact or completely divorced from reality.

While this contradiction of the “once an addict…” truism might be answered by saying that people who recover on their own—without treatment or through moderation—weren’t “real addicts” in the first place, unfortunately, the course of any particular person’s addiction and recovery is entirely unpredictable. Some people who seem “farthest gone” turn around completely without help, while others whose problem seems less severe never get better. Although greater severity of addiction is linked with reduced ability to successfully moderate, the correlation is far from absolute.

What’s at stake here is more significant than just proving conventional wisdom wrong. The recovery industry continues to promote “one size fits all” approaches to addiction treatment based on “facts” that aren’t supported by the evidence and that don’t represent the full range of people suffering from substance problems. And since most of the so-called experts and advocates who embrace this false assumption do not suspect that their fundamental ideas about addiction are problematic, it’s really hard to promote change.

2. “Hitting bottom.” Similarly, many people believe that recovery is only possible once an addict reaches a serious low, an unprecedented level of self-destruction. A staple of 12-step meeting shares, stories emphasizing “bottoming out” as the catalyst for quitting do in fact reflect the perception many people have of their experience. However, like the idea that “real addicts” can never moderate or quit without treatment, the concept of the “bottom” can only be defined retrospectively, however hellish it can be to actually live through these lows.

If I reach a low point, quit for several years and then relapse, I develop a “new” bottom when I return to recovery—canceling out the prior story. If I’m a chronic relapser hitting “bottoms with trap doors,” the notion that recovery starts at a low point becomes somewhat ludicrous because my lowest low might no longer be connected to any definable starting point of a real recovery. A lasting recovery may well begin in earnest when my drinking and its consequences are nowhere near their nadir.

Indeed, the data on recovery reveal that many people don’t actually quit when their problem is at its worst because intense stress itself is a strong predictor of ongoing addiction and relapse. Hope and a sense of possibility—in other words, moments of renewal rather than fear—bring change at least as often, and possibly more frequently.

But sadly, the myth that by making the lives of addicts tougher we can push them to “hit bottom” pervades much of our treatment and drug policy. Since the assumption that addicts need tough love is so widespread in popular culture that we never examine its validity, we persist in treating addicts harshly—from cutting them out of our lives to locking them up in prison—while justifying this harshness as “help.”

There is no lack of proof that the result of tough love is often harm rather than help. Kurt Cobain committed suicide after being confronted about his addiction in an intervention; Terry McGovern, daughter of the former vice-president, died drunk in a snow bank after her parents pulled away from her. Yet we tend to ignore the possibility of such negative outcomes. We think we “know” that toughness works because we are continually exposed to the claim that it does, when, in fact, studies show that gentler approaches that don’t risk pushing people into more extreme behavior have been shown to be more effective at getting people help. 

(This is not to say, of course, that there aren’t times when distancing yourself from an addicted loved one is necessary for your own sanity or for the safety of vulnerable family members—just to say that no one can predict whether this will harm or help the addict.)

These prevailing but outmoded notions about addiction and recovery proliferate because people are only rarely informed that their unexamined assumptions aren’t based on sound data. Nonspecialist reporters covering addiction simply recapitulate the myths, not even realizing that the conventional wisdom they embody has been refuted. And since everyone thinks they know about addiction, the media has no reason even to consider using specialist reporters. Every now and then we get a “counterintuitive” or “debunking” story—and then go back to ignoring the data.

The problem is further complicated by the fact that people whose personal recovery is based on a particular view are often resistant to other perspectives for fear that recognizing the complexity will lead to relapse. For example, if you acknowledge that some people recover by moderation, you might be tempted to try it—even though you’ve never succeeded at it yourself. These fears are understandable, but they are antithetical to effective addiction policy and reporting. You have to be able to leave your own issues out of it.

There is no lack of proof that the result of tough love is often harm rather than help. 

This puts me in the strange position of advocating against my own experience as a source of expertise. But the reality is that simply recovering from addiction via one path doesn’t make me an expert—any more than beating cancer by one form of chemotherapy does. No one would listen to me if I advocated chemo only because that was what “worked for me” when I had cancer because we know that being a successful patient doesn’t make me a doctor.

With addiction, however, because self-help is such an important part of recovery for so many, we lose track of this truth. We privilege personal experience. Because the science often seems to contradict our stories, we lose sight of truths that capture the success of larger populations.

The solution is not to ignore personal experience or dismiss it as a possible source of knowledge. If we want to create effective treatments and drug policies, however, we need to put our stories in the context of the data and always question our assumptions. As many people in recovery know, the first step to solving a problem is realizing that you have one.

Maia Szalavitz is a columnist at The Fix. She is also a health reporter at Time magazine online, and co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010), and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006). 

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