Rehab for alcoholics and rehab for drug addiction are the two most popular search engines requests on google for the treatment of substance use disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders 5th edition published in 2013. The expressions “alcoholic”, “drug addict” and “addiction”, have no clinical meaning or significance in the diagnosis and treatment of substance use and related disorders according to the DSM-5. The word “alcoholic” is only used within the context of the community mutual aid self-help group Alcoholics Anonymous. The word “addict” is only used within the context of the community mutual aid self-help group Narcotics Anonymous. No one is diagnosed “alcoholic” or “addicted” to substances or behaviours and is instead diagnosed as either having a mild, moderate or serve condition based on the prevalence and severity of eleven different individual diagnostic criteria used to identify and treat these mental health disorders.
For good or bad, we can thank the media, popular culture, and mutual aid self-help groups (AA) for the proliferation of words and expressions that confuse the general public whilst simultaneously undermining evidence-based practice. There is nothing inherently wrong with seeking out help for imaginary illnesses; however, it can have unintended consequences if this process is not quickly re-defined and aligned towards genuine professional help. A structural engineer knows full well if the foundation of any building is off by the smallest of margins, it can have devastating consequences during the mid-to final stages of completion. Likewise, if people seek out imaginary illnesses and diagnoses, not unnaturally, they may find themselves on the receiving end of imaginary treatments or remedies.
The word addiction itself can often have a positive connotation in advertising and marketing. Subway often promote their cookies as addictive; people who use the gym too much are referred to as ‘gym junkies’, and special admiration is reserved for people who cannot take a day off work because they suffer from ‘workaholism’.
This is far removed from its original Latin word, “Addictus”, meaning to be enslaved to a person you owe a debt to. This notion of being a slave to another person is much closer to how many people might describe their relationship to substances and behaviours they feel powerless to control or manage. For many people their addiction is a form of pain management, treating underlying trauma, physical pain and a vast array of conscious and unconscious psychological and developmental problems.
In no other area of healthcare is the definition, diagnosis and treatment so diverse, inconsistent, controversial and misunderstood. Substance use and behavioural disorder are not spiritual diseases and are not considered biological diseases in any medical manual. Whilst the brain-reward circuitry can change over time through addiction to substances and behaviours this in itself has no relationship to what is commonly referred to as the disease of addiction. There is no such thing as the disease of addiction outside of a 12-step model (AA) for the treatment of addiction.
No Rehab For "Alcoholics" Or "Drug Addicts"!
America is a deeply religious country and this unhealthy alliance between science, addiction treatment, belief in God or a Higher Power, unfortunately, has devastating consequences for many people trying to access genuine evidence-based help and support. According to Doctor Marc Lewis, referring to addiction as a disease is, “apart from being scientifically baseless, the disease model undermines hope, fails to end stigma and doesn’t always get addicts the help they need”. Alcoholics Anonymous and Narcotics Anonymous provide support for many people seeking peer support within the community. They are ‘Not For Profit’, free of charge organisations that have no relationship with professional support, rehabs or medical treatment. In countries like the United States Of America where Government-funded treatment services are inadequate and massively underfunded, free of charge community mutual aid groups like AA play a significant role in supporting people in recovery. This factor combined with high levels of belief in Judeo-Christian philosophies within the American population makes Alcoholics Anonymous a key part of the American design for addiction treatment.
However, the rest of the world which is not so influenced by American culture and values rely more heavily on scientifically proven evidence-based practice. Many Private Rehabs charging 30, 50, 100 thousand dollars upwards for the treatment of substance use disorder do little more than drive their clients to the “FREE” service offered by Alcoholics Anonymous and Narcotics Anonymous. Most Private Rehabs are owned, operated and serviced by members of Alcoholics Anonymous and Narcotics Anonymous, so not unnaturally they want to support their clients in receiving the same treatment they received. The problem is these programs are free and available to anyone at any time. Many Private rehabs blame their clients for not staying clean and sober because they would not believe or surrender to God or a Higher Power, believe in a fictitious spiritual disease and or have not completed AA’s Step Work thoroughly enough. If these circumstances were not so serious it would be comical.