The disease model of addiction emerged more than half a century ago as an enlightened and compassionate alternative to the judgmental view that addicts are morally deficient. The Hazelden–Betty Ford foundation described the plight of addicts in the bad old days before Hazelden’s founders “invented modern addictions treatment.”
Imagine for a moment that it is 1949, and that someone you love is alcoholic. As you struggle with this fact, you quickly learn about three prospects for this person’s future: One is commitment to a locked ward in a mental hospital, sharing facilities with people diagnosed as schizophrenic. Another is that alcoholism will lead to crime, which could mean years in prison. And third is a slow sinking into poverty and helplessness — perhaps life on “skid row.” In all three cases, your loved one’s condition will be denied, ignored, or denounced as evidence of moral weakness.
Sadly, in the 65 years since the “invention” of “modern addictions treatment,” the bad old days have gotten worse. Many more people are in prison for drug-related offenses, and the schizophrenics have to share facilities with them. Also, an increasing number of people who suffer from problematic drug use are homeless.
If “modern addictions treatment” is supposed to be nonjudgmental, how did it come to pass that so many certified addictions counselors (CACs) colluded with the criminal justice system in the war against people who use drugs? I witnessed pioneering CACs pitch their treatment programs to criminal justice officials in the 1980s and 90s. They sincerely believed they were saving lives, doing the right thing.
Most addictions counselors believe that addiction is a progressive disease, with dire consequences unless it is treated. Denial is a symptom of the disease. Abstinence is essential for treatment, which is based on the 12-steps. Every patient who participates in treatment, works the 12-steps, and attends meetings will experience recovery. Failure to recover is indicative of the patient’s denial, and/or failure to adequately follow the treatment regimen. Those beliefs blind addictions counselors to the ways in which they disregard and deny the reality of other people’s lives. Addictions counselors are largely unaware of the conflicting interests and ideologies that shape the service they provide to people who are forced into treatment by the criminal justice system.
Denial is a useful concept. We humans rationalize and justify behavior that satisfies our pressing, immediate wants, even though our choices may hurt others, and ultimately hurt ourselves. That’s the way we are. We blind ourselves to inconvenient truths, and deny them.
By proclaiming denial to be a symptom a disease, addictions counselors were able to justify forcing vulnerable people into treatment, even when the “patients” claimed that they did not have the disease. Some of the pioneering CACs actually asked researchers to develop diagnostic procedures that would not miss a single dependent person, no matter how many nondependent people were erroneously put into treatment.
By proclaiming denial to be a symptom of their disease, addictions counselors twisted a useful concept into ammunition for the war against people who use drugs. Maybe the counselors’ denial of their personal interests enabled them to collude with the criminal justice system, and thereby disregard the reality of vulnerable people’s lives.