Today at Sober College, the treatment center where I work, a colleague picked up a copy of Jonathan Hari’s book Chasing the Scream.
After a few of us who had read the book began to talk about the merits and the criticisms of Hari’s work, we were all prompted to sit at my associate’s computer and watch Hari’s TED talk. For those of you who haven’t seen it, here it is:
All of us in that office– mental health and addiction professionals with many years of experience – got very excited talking about the importance of Hari’s message. Namely, Hari asserts that social isolation and a lack of human connection are the true causes of addiction. He states that helping those struggling with addiction find re-connection into the world and authentic connection with other people is the way to health and wellbeing.
Hari’s message is powerful, and there is a lot of truth in what he says. Although he’s been criticized by some – The New York Times wrote that Hari could not be seen as a serious journalist, and others have said that Hari’s calling for the legalization of all drugs could be very dangerous – the points that he makes ring true for many of us who work in the addiction field and who have personal experiences with addiction and substance abuse.
My issue with Hari is that, although his story is compelling, it’s not the whole story. Like many researchers and journalists wanting to make a name for themselves, Hari reacts full throttle against the agreed upon research of the day seemingly for the sake of being provocative and selling some books. Hari basically throws out the disease model of addiction, stating that social isolation is the One True Reason why people become addicted and have trouble with drugs and alcohol. Yes, there is validity in the assertion that social isolation often leads to and exacerbates substance abuse. However, it is equally true that many people are genetically predisposed to develop substance use disorders, and many people with full lives and families and friends cannot stop drinking and drugging without the help of abstinence-based programs.
Hari gives the example that many people are given strong opiates when they are injured either in hospital settings or through outpatient prescriptions, and that those people don’t always automatically become addicted to opiates. He claims that the only people who would really become addicted and have a problem are those who are without social support or authentic human connections in their lives. Unfortunately, this is not an accurate assessment. As an addiction therapist for many years, I have seen numerous cases of people who did, in fact, become addicted to opiates after being prescribed said opiates for an injury – people with full lives, families, jobs and hobbies.
I’m not trying to make the case that Hari is wrong and the disease model is right. The important take-away is that both viewpoints are valid and that addiction comes in many shapes and sizes. I agree full-heartedly with Hari that we should pay attention to the amazing job Portugal has done to help their citizens by decriminalizing drug use and pumping public funds into social re-connection and vocational programs for addicts. Bravo to Portugal, and bravo to Hari for bringing our attention to the amazing work they are doing.
But we can’t throw the baby out with the bath water. The disease model of addiction is valid and important. And for many people struggling with addiction, all the re-connection exercises in the world will not allow them to be able to use and drink without getting into trouble, because they have a biological issue that makes it impossible for them to have a healthy relationship with drugs and alcohol. We need to pull together as care providers and realize that addiction is complicated and varied and that the answers are complex and individual. Yes, we need to decriminalize drug use and learn from Portugal. Yes, we have to put our resources into helping recovering addicts find reconnection to the world and to other people. And yes, we have to treat addiction as a complex, brain-based disease with genetic predispositions for which we do not yet have a cure.
I would merely say that people who have “full lives and jobs/careers” are not necessarily either connected OR satisfied by what they “have”. I say that as I recognized that I might be heading for problems after being prescribed medication that made me feel “happy”. I went into therapy, because from the outside (and even from my own inside) it didn’t “make sense” that I felt something missing or that I was somehow DISsatisfied, despite apparent success. I’m not saying there might not be some who have a greater predisposition to addiction, or particular addictions, but I think there is something to the point that congruence (between inner values, goals and drives) and outer manifestations of “success” or “connectedness” are important considerations.
Much of what people “know” about life and picture as “success” (happiness being equated with same) is NOT knowledge acquired through real learning and exploration, it’s merely the exposures and expectations we’ve had. I do agree that addiction is complex, but my opinion (based in exposure to programs) is that providing a (treatment) model that is often just as rigid and inflexible as a person’s original misconceptions about life, what success is and so on, does as much a disservice to the person and their potential. Just my two or five cents worth.
Excellent response which echoes my professional concerns with his hypothesis. Thanks for taking the time to outline this.