I am heartened to hear Andrew Tatarsky addressing the role of language in the recovery community. In this post, Dr. Tatarsky describes how a colleague of his made a comment about the “addict” and that “untruths… come with the territory.” The comment disturbed him enough that he was inspired to write this post on his Facebook Page.
~ Len Van Nostrand, M.A., CCP
On a professional list, a colleague made a comment about the “addict” and that “untruths…come with the territory”. It was quite disturbing and inspired me to write the following. I invite others to share their thoughts about this issue with our community.
I would ask us all to be careful with use of the term (socially constructed) “addict” (like leper) and the common presumption that “untruths…come(s) with the territory with addiction”.
Do “they” lie more than other groups of people? Do we have data on this? If they do, is it because they are “addicts” or because they live in a stigmatizing and criminalizing culture that tends to promote punitive responses to the “addict” and, as a result, many of these people have experienced trauma repeatedly simply because they use or misuse substances.
There is a commonly accepted addiction/recovery narrative that addiction is a chronic, permanent, progressive “disease” and that all “addicts” share many of the same features associated with this “disease”, lying being one among many devaluing, de-humanizing, stigmatizing presumptions.
This narrative is embedded in our culture, promoted implicitly and explicitly in the popular discourse and lives in our dominant approaches to treatment and overemphasis on criminal justice approaches to “addiction”.
We, including me, have all grown up imprinted with this narrative and it lives in each of us in what I call social countertransference to people who use and misuse drugs. We may inadvertently view people with substance use disorders through this lens and contribute to the social construction of the “addict” through projective identification and self-fulfilling prophecy. One way this might go…we think the “addict can’t be trusted, we treat “the addict” like then can’t be trusted, the “addict” feels misunderstood, mistreated, hurt, angry and despairing and can’t trust us for good reason so the “addict” lies to us, understandably. Then we say, “you see, the “addict” lies”.
I have been writing and presenting on the scientific revolution that we are in the midst of regarding what we call addiction and its treatment. The old disease model does not support the data of how people develop substance use problems, the wide variations between people with substance use disorders and the multiple pathways to healing, growth and positive change, “recovery”. It also has given rise to a dominant treatment approach that has been an abysmal failure at attracting, retaining and facilitating positive change in this group of people and, I might add, our current overdose crisis!
The disease model locates this complex, multiply determined “addictive” experience at worst in the relationship between the toxic agent (drug) and one’s vulnerable biology. In fact, problematic substance use is always a reflection of complex interactions between the drug, biology, relationship dynamics, individual psychology, learning, social, cultural and political context and more that are unique to each person. This “psychbiosocial” model better explains the data and suggests to me the need for a new more sophisticated approach to helping that is more consistent with our approaches to treating all other patient populations that I call integrative harm reduction psychotherapy (IHRP). IHRP draws on psychodynamc, relational, CBT, mindfulness and body oriented interventions in a harm reduction frame of meeting the person where the person is in their uniqueness. Simply, we need to radically personalize helping, develop collaborative empowering therapeutic alliances that enable us to clarify with our patients what blend of psychobiosocial factors needs to be addressed in treatment and what substance use goals and integration of therapeutic strategies will best serve the needs of each patient. We need to treat the person….like a person.
I could go on but…
Obviously, this is an issue I feel passion about and am extremely sensitive to and think all of us need to be very careful about our language and assumptions when thinking about, talking about and trying to be helpful to people with problematic relationships to substances and other risky behaviors. I invite you to share your thoughts and experiences with the community.
Len Van Nostrand, M.A., CCP
Certified Coach Practitioner