America’s Addiction Treatment Trap

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America’s Addiction Treatment Trap

By Stanton Peele 12/01/15

If we think that we can treat away addiction, we are mistaken. For proof, see Chris Christie’s viral video.

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America’s Addiction Treatment Trap
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What do politicians of all ideological stripes agree on? More addiction treatment. Led by Chris Christie’s viral description of the fatal impact of addiction for his mother and a law school colleague, politicians from both parties have jumped on the bandwagon of more treatment—meaning residential and disease-based, and—often—coerced treatment.

Before delving into Christie’s video and proposals, we should note that the United States is already by far the world leader in addiction treatment—specifically, residential rehabs. Consider this map of treatment centers in Florida. How much more residential treatment will be required to quell our addictive problems? Do you think other advanced Western countries have this density of residential addiction treatment centers? Canada, Britain, Germany, France, Italy, Sweden, Australia?

We seem to need more because, actually, our addiction rates are increasing, both in rural areas (President Obama visited West Virginia, an addiction hub, to announce the federal government’s treatment initiative), while Baltimore is reckoned to be the heroin capital of the U.S. Meanwhile, New England communities are beset by opioid deaths. New Hampshirites regard heroin addiction as their number one problem, and presidential candidates campaign there with promises of evermore treatment.

One more thing to note before turning to Christie’s viral video—opioid deaths, along with the heroin epidemic—begin with painkillers. Not only are most deaths related to painkillers, but the standard heroin addiction narrative is that a person became addicted to a painkiller, like OxyContin, and then moved on to heroin because it was cheaper and easier to obtain, given restrictions placed on painkillers. Of course, given that opioid painkillers have been around for a century (oxycodone was synthesized in 1916), why do we have our current epidemic? Is it because we don’t have enough addiction treatment programs?

Now we can turn to the Christie video (which was recorded in New Hampshire).

Speaking of his mother, a life-long smoker, Christie relates, “She tried everything she could to quit: she had the gum, the patches, hypnosis.” When she got cancer at age 71, of course, she was treated for it. But, Christie claims that when it comes to heroin or cocaine or alcohol, people condemn treatment. Christie claims people say “addicts got what they deserved.” (Then who is in all of those treatment centers?)

Christie proceeded in his video to describe a fellow student at law school who became addicted to Percocet after an injury. He never took heroin. Nonetheless, his wife kicked him out of the house. She asked Christie and other friends to perform an intervention, which Christie did. “This began a 10-year odyssey of him being in-and-out of rehab. . .He was a drug addict, and he couldn’t get help, and now he’s dead. So we need to start treating people, not jailing them.”  

Do you see the contradiction? Both the cases of addiction that Christie described sought and received treatment repeatedly, almost continuously. Neither went to jail. If anyone disapproved of them, I’m afraid, it was the model wife who kicked the law school colleague out of the house. These are cases of the limitations of treatment, descriptions of how it can’t, or very often doesn’t, succeed. The video could accurately be titled, “How our treatment for addiction is failing, and why we need to try something else.”

Highlighting the current addiction epidemic, writers (here in the New York Times) invariably describe the rising death rate among white Americans ages 45-54: “Opiate addiction is on the rise in the United States. Death rates, partly stemming from substance abuse, are increasing among middle-age white Americans.” The point, of course, is that they are dying of untreated addiction.

This Times article proposes coerced treatment. It leaves out that the group of Americans whose death rate is increasing is limited to those who don’t attend college. These Americans are committing suicide more often and are suffering more general health and drug and alcohol-related problems and fatalities. Is the solution for the rise in deaths among this group of tens of millions of Americans that we should get more of them into addiction treatment, while in fact many of them can’t afford even basic health care?

Social Forces Determine Addiction Patterns

In fact, this group exemplifies how social forces determine addiction patterns, creating people who are then treatment candidates. Here is how Times columnist Paul Krugman, a Nobel Prize-winning economist, views this same problem, in a piece titled, “Despair, American Style”: this group of “middle-aged whites have lost the narrative of their lives. That is, their economic setbacks have hit hard because they expected better. Or to put it a bit differently, we’re looking at people who were raised to believe in the American Dream, and are coping badly with its failure to come true.” Will more addiction treatment cure this?

Krugman’s solution is instead more social programs to assist people to improve their education levels, provide them with health care, and enable them to find a secure place in American society. Yet improving these factors is exactly what our focus on addiction treatment distracts us from, as it did the writers of the Times article on the heroin epidemic.

In the 1980s, in the name of the War on Drugs, the U.S. began investing heavily in addiction treatment, diverting funding from education, housing, and basic health care. Keith Humphreys (who joined me as one of The Fix’s ten most important addiction experts) depicted this movement in a classic paper*. Instead of helping addictive problems for these non-privileged, middle-aged Americans, this surge in treatment has made their lives worse!

Treatment is simply not a remedy for social problems. It reaches too few people (and then mainly the well-off like Christie's mother and friend), too few people succeed at it for any length of time (that is, relapse is the rule), and too many newly addicted people are being created all the time for treatment to impact the overall prevalence of addiction in society. Rather, treatment is the American solution for its own invention—The American Disease—the title of David Musto's 1973 book on the origins of narcotic addiction in the U.S. That Musto described a phenomenon 40 years ago dating back to the beginning of the 20th century, and that we are still lamenting the expanding phenomenon of addiction and calling for more treatment, shows just how ineffectual our entire treatment enterprise, and the logic that underlies it, is.

Only a strong social fabric, one formed of good communities, with health care (not simply for addiction) and other social resources to assist people can reverse our addiction epidemic. And, to put it simply, that ain't going to happen in these United States.

Christie Disavows Changing Drug Laws

While Christie wants addicts to be treated, he adamantly opposes drug decriminalization and plans to attack pot legalization as president. Christie wants users to be jailed! This follows from his commitment to the disease model idea of addiction progression, which is not a modern medical discovery. It traces back both to Alcoholics Anonymous and to the 19th century Temperance Movement, where anyone who samples a substance (in the temperance case alcohol) is led down the garden path to total ruin and perdition (jail, an institution, or a grave). 

Christie has opposed marijuana legalization at every turn in New Jersey: "Every bit of objective data tells us that it's a gateway drug to other drugs. And it is not an excuse in our society to say that alcohol is legal so why not make marijuana legal. … Well … why not make heroin legal? Why not make cocaine legal?” In fact, believers in the disease theory, like the governor of Massachusetts, Charlie Baker, want to force addicts (or is that users?) into treatment, since, as his motto states, “Addiction is not a choice; it is a disease.”

Yet Baker and Christie claim to be acting in order to remove the stigma of drug use and addiction! They are, in fact, expanding and deepening the stigma of both.

* “From the community mental health movement to the war on drugs: A study in the definition of social problems,” American Psychologist, 48, 892-901, 1993.

Stanton Peele, Ph.D., J.D., is the author (with Ilse Thompson) of Recover! Stop Thinking Like an Addict. His Life Process Program is available online. His book Addiction-Proof Your Child is a model for the emerging area of harm reduction in addiction prevention. Stanton has been innovating in the addiction field since writing Love and Addiction with Archie Brodsky. He has published 12 books, and has won career awards from the Rutgers Center of Alcohol Studies and Drug Policy Alliance.

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