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More Options Better Than No Options

If addiction problems are on the up (they may or may not be, perhaps we are just more aware of the many forms addictive behaviour can take), the silver lining might be that we finally acknowledge treatment must be, first and foremost, pragmatic. Hospitals, rehabs, 5-star hotels, sober companions…all welcome!

Addiction treatment used to be quite a dogmatic affair. Patients had to adapt to a particular model, or have no treatment. Forty years of research have taught us that every addicted individual is different and requires an individual treatment approach.

There are many distinct treatments for addiction that have proven effective (for alcohol this has been referred to as the “dodo bird effect” from Alice in Wonderland: all have won, so all shall win prizes). There are also many different ways of delivering those treatments. The skill lies in tailoring treatment to an individual’s needs and circumstances.

The group of the wealthy and powerful can be a particular challenge. These may be individuals who are so used to getting what they want, that they will struggle with having someone make decisions for them. However, this is often crucial. Addictive disorders can kill and addiction is, at its core, a disorder of motivation and choice. Thus, treatment must involve firm boundaries as well as a menu of treatment options. That is perhaps why group work and sober companions can play such an important part: it is harder to manipulate, or throw your toys out of your pram, when you are dealing with your peers.

Threading that fine line between choice and boundaries isn’t easy. It is easier, as we used to do twenty or thirty years ago, to take the dogmatic view and demand that the addicted person shape up to the treatment, rather than the other way around (some centres I have come across, particularly in the US, still do this). It is also easier to give the rich and powerful what they want, without really treating their addiction (Michael Jackson’s case comes to mind). But good addiction treatment, leading to long-term recovery, must balance scientific evidence, medicine, empathy, compassion and boundaries, whether the addicted individual is of the super-rich variety or not. That we are finally appreciating this, is something to be celebrated.


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