Since we live in a sea of shared meanings for words we have to accept that there is something called ‘addiction’. One problem is that the word comes loaded with negative implications. It is put out in the cold by mental health services, left to itself in ‘addiction services’. In reality though, a person identified with having an addiction is experiencing the most frighteningly awful mental and emotional agony. This agony is amongst the most pervasive woes in our society. But you’ll usually hear ‘experts’ say thigs like, ‘Addiction sometimes causes mental disorders’. Which is as daft as saying something like, ‘Schizophrenia may lead to mental disorders’.
addiction does find its own sections in medical manuals, though it’s often dressed up with phrases such as ‘alcohol dependence syndrome’. These medical manuals are headed by the psychiatrists bible, the Diagnostic and Statistical Manual. (DSM). This has gone through many versions. We’re currently at DSM 5 (revised). Each new version has added hundreds of ‘new’ psychiatric illnesses. It’s put together by a team of psychiatrists who agree that these ‘disorders’ exist, and describe how to spot them. You may think you’re shy but if you check the manual you’ll discover that really you’re suffering from quite a list of disorders such as ‘social anxiety disorder’. If you are gay and checked for disorders up to 1973 versions of the manual you will find that homosexuality is categorically defined as a mental disorder, one of many such from a range of sexual ‘perversions’.
In practice, there are psychiatrists who specialise in ‘addiction’, along with many therapists (especially if you can afford them). As for treatment and diagnosis, you’re likely to get three different suggestions from three different psychiatrists. Treatment and diagnoses vary widely too across different countries and cultures. The chances are not good that you will meet up with a wise, kind psychiatrist who will treat you as a human being rather than treating you as something broken to be fixed with medications. In any case, the effect of the Tory government’s 2010 onwards policies around ‘addiction’ have seen both a savage cut in services and a cut in specialist doctors.
Commissioners (the people who dish out money for services) demand results, evidence of successful ‘outcomes’ within limited time frames. The whole tendency of mental health support to be characterised by cost analysis, quantifiable ‘recovery rates’, effectiveness and productivity means that a person becomes a unit on a conveyor belt. Many excellent charities and other third sector organisations have closed after losing funding because they could not meet the rigid requirements of evaluation. So, for instance, whereas anybody with the slightest understanding of human suffering knows that some people will need years of support including attention to social needs such as housing, each unit in the current model is expected to ‘get well’ in six weeks.
If you’re lucky and can survive the waiting list you may get a short course of cognitive behavioural therapy for anything from suicidal despair to mild depression. CBT is greatly over-hyped. It is very helpful for many people but utterly inappropriate for others. Similarly, medications such as ‘anti-depressants’ work no better than sugar pills for half the people prescribed (and that’s a lot of people). Even worse, despite years of denial from Big Pharma and psychiatrists, it can no longer be hidden that withdrawal from these medications can be devastating – and GPs are not yet aware enough of these dreadful withdrawal effects. Again, for some people medication helps (anti-depressants seem to be good for people with severe depression, not for the majority who suffer mild to moderate depression).
Given that commonly presented mental and emotional distress is diagnosed with one of the many types of depression and/or anxiety and treated with the conveyor belt approach of pills and/or talking therapy such as CBT (and there are 500 other talking therapies around as well as CBT), may we ask what has become of the unique individual, their unique feelings and expressed needs, their very humanity?
If this is the case for ‘respectable’ illnesses such as depression and anxiety, what hope for those seeking help with dirty ‘addiction’? What universal, abstract boxes do people find themselves put into? In the case of gambling, only 3% of those in need of support receive help although the NHS gambling clinics in England are a welcome development. Probably it is true that for the majority of people who are sad, traumatised, despairing, broken, maybe just totally flat and merely surviving, informal human support is best. Those with similar experiences (but never, never identical experiences) are, as throughout history, the greatest source of encouragement, support and hope. Groups like 12-steps and SMART Recovery, recovery cafes, groups for men or women suffering various mental and emotional distress, all of these work more than pills and experts for most people because they are community which means com-unity which means with unity which means all for one and one for all. You won’t find this in a syringe, a bottle, a bookies. Or a waiting room.
If you are seeking help, don’t exclude doctors but be aware of their limitations (which is not their fault of course) in terms of the above, and the tremendous pressures to wheel them in and get them out as fast as possible. You may have the good fortune to have a doctor who really does have the human factor and who somehow against tremendous odds finds time to share with you their common humanity. Some doctors will reach for the prescription pad perhaps too quickly; the best will often only prescribe pills as the very last resort, and support you to find much healthier ways to tackle distress than ingesting drugs. Like so much in life it’s down to luck. Many of us have had the good fortune to encounter a doctor, a teacher, a priest, just a human being, who has changed our life for the better.
Seek humanity first and foremost. But don’t forget the hugely supportive services that can address aspects of life that need support. Citizens Advice is an excellent place to start for many people. If you’re not comfortable in one GA or AA group find another. If you are a woman who doesn’t feel attracted to what tend to be male dominated groups go online and find others in your position – or start your own group. Doing something like starting your own group can be empowering for those who feel powerless. Avoid any service or group or individual that seems cocksure of itself as the only path to heaven. Avoid those who are constantly congratulating their own excellence, boasting about themselves. Look for those who are tentative, those who use words like ‘perhaps’, ‘maybe’ or ‘possibly’. Nobody can sell you a perfect future, and those who pretend they can are no better than snake oil merchants.
You may find yourself one day sitting next to somebody very different than you. Much older or younger, a different gender, a Christian or Muslim or atheist, a criminal or a vicar. Somebody whose life, like yours, is totally unique, and whose character and inner experiences of woes and joys is so different than yours. That person may become your best friend. For whatever our differences we share a common core of humanity. You or they are not ‘addicts’: you are a vital spirit who may have lost sight of that because, for now, you and they and we suffer from what, for convenience only, we call addiction.