In Response to New York Times Op-Ed “Can Shame Be Useful? – Jan 23, 2016
“Never let lack of knowledge keep you from speaking with authority.” That was the first thought that came to mind after reading the NY Times op-ed, “Can Shame Be Useful?” (Jan 23, 2016).
I am a recovering alcoholic and addict with over 25 years of continuous sobriety. I am CEO of an ambulatory care facility specializing in the treatment of drug addiction and a bestselling author on recovery. I know addiction and what it takes to recover. Shame has NO PLACE in the treatment of addiction. In the op-ed the authors state; “Certainly, as a psychiatrist and psychologist, respectively, we have observed the corrosive effects of shame on patients with conditions over which they have scant control, especially those with schizophrenia and bipolar disorder. And like most people, we consider it unethical, cruel and clinically pointless to disparage or judge people whose disorders — severe mental illness, cancer — are largely or entirely impossible to modify by the sheer force of will. But addiction is different.” Really? When I read this, I understand that ignorance runs deep. You can’t “will away” addiction any more than you can “will away” any other disease.
Judging from their language, these authors believe it’s ethical to be cruel, judge, criticize and disparage addicts. They seem to suggest that shaming or disrespecting an addict could be part of a treatment plan. They must be big fans of the Rockefeller laws that used incarceration instead of treatment for addicts. The results of that experiment worked out well. Today we have more addicts than ever before, our jails and hospitals are pushed to the breaking point and a devastating opiate and heroin epidemic is sweeping the country.
News Flash – addicts don’t need your help in feeling shame! They already feel shame. It is shame, guilt and remorse that keep them on the downward spiral of addiction. They need clinical treatment. They need inspiration. Carl Jung said it takes “a vital spiritual experience” to break addiction. That is the definition of inspiration.
The argument that addiction does not have biological causes contradicts the facts. Numerous studies from the world’s top researchers, including those at The American Society of Addiction Medicine, have shown a direct link between genetics and a predisposition for addiction. Other studies have clearly shown that addiction is an inherited disease. Just as cancer, heart disease, and other progressive treatable diseases. Addiction runs in families. Researchers have been studying large families to learn what genes lead to addictive behavior. By comparing the gene sequence of family members who are addicts and those who have not become addicts, they are able to make distinctions as to what genes the addicted people share. Studies show that if a parent had an addiction problem, his/her children are eight times more likely to have an addiction. Studies of 861 identical twins and 653 fraternal twins show that when one identical twin was an addict, the other twin had a high probability of being an addict. Studies also showed that when one fraternal twin had an addiction the other was not affected in the same way. The study concluded that addiction is 50-60 percent genetic and these results have been reproduced numerous times. If someone inherited a gene that produced autism, should we try to shame that person into doing better?
Addiction is a complex DISEASE. Genetics is only one risk factor. Environment is the second part of the equation. But this is true of many diseases such as high blood pressure, heart disease or the example used by the psychiatrist and psychologist, cancer. Many diseases such as cancer are a combination of interaction between genes and the environment. Heart disease, high blood pressure and diabetes are not different from addiction, often they are preventable and survivable through better choices. Would these doctors think it is appropriate to shame a woman with breast cancer as part of her treatment?
In the 1930s, Dr. Robert Silkworth AA’s medical benefactor wrote “We believe, and so suggested a few years ago, that the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class and never occurs in the average temperate drinker.” Today science has caught up with the observation Silkworth made so long ago. Addicts are physically different from non-addicts. He called it an “allergy.” I have a friend who is allergic to peanuts. If he eats a peanut, he goes into anaphylaxis shock and can die. Does that mean he should be shamed? The difference between him and an addict is that he does not experience the phenomenon of craving that addicts experience when they take mind-altering substances for the first time. It is well documented that alcohol and drug addiction rewires the brain. My friend did not know he was allergic to peanuts until he tried one. This is the same way many addicts find out they have the “allergy.” They innocently try alcohol or drugs at a party or with friends and they get hooked the first time. Or they have an injury and are prescribed an opiate and the craving begins.
I have interviewed and helped thousands of drug addicts and alcoholics both active and in recovery and shame is a leading factor in both postponing treatment and causing relapse. Shaming has no place in modern medicine. Medical detox, followed by a quality clinical treatment regimen that includes physical, spiritual and emotional counseling, is what is required to achieve long-term recovery.