We Don't Treat Brains, We Treat People

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When drugs carry and express important meanings for the user, the thought of giving the drug up or cutting back may be experienced as a threat to one’s psychic survival and capacity to function in the world. Trying to get someone to relinquish substance use without helping the person understand the role it served, and providing him with unique alternative coping strategies jointly discovered in treatment, is a recipe for failure. Unless the user has identified its meanings and discovered new healthier solutions, attempts to stop using will be met by understandable resistance. Psychotherapy is an essential ingredient in the treatment process. As the meanings and functions of the drug use are clarified it becomes possible to explore alternative less harmful routes of expression or satisfaction. Harm reduction strategies that minimize the risks associated with active substance use may be vital to the user’s health and safety. Some include using clean syringes, switching to safer substances and routes of administration, reducing amounts and intensity of use, not using alone, being attentive to general healthcare and nutrition. The harm reduction principles of meeting people where they are even if they are not ready, willing or able to embrace abstinence, and of accepting all positive changes in substance use as successes, allows users to begin the therapeutic process wherever they are in terms of their motivational stage and goals.  This enables a collaborative exploration of the psychobiosocial variables that contribute to the addictive behavior. As the variables are identified it now becomes possible to bring together biological, psychological and social interventions to address them. Ignoring the powerful personal motives for using will subvert well-meaning efforts to support positive change.

Social Collusion with Addictive Dissociation

Might our culture’s tendency to neglect or ignore the multiple meanings of addictive behavior actually collude with and reinforce it? If addictive behavior expresses meaningful aspects of the self that the user disowns, might the cultural ignorance of the disowned meaning support the disowning of meaning in the user?  The relatively greater national emphasis on punishing and incarcerating drug users and sellers and trying to get drugs off the street, an absurd and impossible fantasy, rather than emphasizing treatment and education reflects this ignoring of the meaning dimension. The “drug war”, against heroin in the 60s and 70s, crack in the 80s, crystal meth in the 90s, focused on the drug rather than the question of why are so many people drawn to these potentially devastating substances and other risky activities? I believe that in the minds and writings of addiction as brain disease advocates, their model does not preclude meaning but without an equally loud and clear proclamation that addictive behavior is meaningful activity, the brain disease statements can be interpreted to mean addictive behavior is a purely biological phenomenon that can be treated by purely biological methods: abstinence and medications.

So let’s remember that people use substances initially and throughout their using careers for multiple meaningful reasons that must be understood and respected so that they can be brought into treatment in ways that make new solutions and modes of expression possible. This renders substance use less appealing and vital to the user and supports an integrative treatment approach that addresses all aspects of the person involved with problematic substance use.

Andrew Tatarsky, PhD is the author of Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems. He is the Founder of The Center for Optimal Living, an addiction treatment center in NYC, and the Chairman of the Board of Moderation Management. He can be emailed at tatarskycenterforoptimalliving@gmail.com