Last week, Toronto mayor Rob Ford admitted to smoking crack following confirmation that police had obtained a video proving the allegation. A few days later, Mr. Ford hoped to minimize the consequences of using an illegal substance by attributing it to being “extremely inebriated.” And so the Toronto media circus continues:
If you were paying attention to the video, you might also notice that reporters were equally split on what Mr. Ford should do; some calling for him to step down while others were asking him to get help. It seems that reporters, like the rest of society, are split over whether Mr. Ford should be punished or treated. Is Mr. Ford responsible for his actions or does his addiction excuse him from responsibility?
What Our Clients Say About Responsibility
Many believe that, yes, addicts* are responsible, including addicts themselves. For example, we received this e-mail about the Mayor Ford controversy from an SCHC alumni living in New England:
” You can’t make this stuff up! I didn’t want to rib any of my Canadian friends for this – Lord knows we have enough to be embarrassed about with governance in the States. But really!!?! He’s caught on film smoking crack – after repeated denials – and when he finally admits his error his reason for expecting leniency is that he was in a drunken stupor at the time and didn’t know what he was doing? I am not laughing. This is no laughing matter. What does Ontario’s constitution provide for evicting an official who lacks the decency and shame to leave when he should… but won’t? This makes me sad. I hope somebody manages to do the right thing.”
Research** conducted at our facility shows that many of our current clients also agree with this statement, even though they were also actively drinking or drugging only a few short weeks ago. Yes, clients feel a lot of shame about the impact of their addiction on friends and family, but most tell us they still want to take responsibility for their actions.
Admittedly, this feedback from our clients was a surprise. After all, many people that work in treatment simply assume addicts would prefer to believe they are not responsible. It seems logical that attributing problems such as lack of work, marital strife, and poor physical health to a disease would ease the burden of their addiction. That’s what many treatment professionals like about the disease model of addiction. However, our clients tell us that this absence of personal responsibility is one of the biggest problems with the disease model.
Our Evolving Understanding of Addiction: From Character Defect to Disease
So why, one could ask, is there a disconnect between how addicts and the treatment industry perceive personal responsibility? To answer this question, we need to see how the disease theory came to be in the first place. On page 178 of his book, Slaying the Dragon: The History of Addiction Treatment and Recovery in America, addiction expert William L. White shows that addiction as a disease was a necessary step in helping advance the treatment of addiction:
“Between 1930 and 1955 a radical redefinition of the nature of alcohol problems in America was forged. Credit or blame (depending on one’s perspective) for this change is regularly attributed to what has been called the “modern alcoholism movement…It shifted America’s construction of alcohol-related problems from a religious and moral knowledge base to a secular one. It transformed the alcoholic from a morally deformed perpetrator of harm to a sick person worthy of sympathy and support. Within the American mind, it moved this diseased alcoholic from Skid Row into our own neighbourhoods and our own families. The movement declared that this disease was treatable.”
I would agree that the redefinition of addiction as a disease instead of a character defect helped ‘professionalize’ addiction treatment. It is also obvious that the disease model has helped bring medical expertise and government funding to the field. However, based on testimonials of our clients who have previously attended 12-step treatment, staff at these programs may say that addiction is a disease but their interactions with clients show otherwise.
For example, when I attend conferences with 12-step therapists I still hear them describe their clients as ‘liars, cheats, and thieves’ in denial and not to be trusted.*** Many treatment centres continue ‘hot-seat’ tactics where non-compliant clients are subjected to verbal abuse by their peers. There’s also the trump card used by treatment centres with so many non-compliant clients – early discharge. We should know, because when SCHC followed the disease model of addiction, we were doing the same thing.
Responsibility as a Place to Stand
“Responsibility means authorship. To be aware of responsibility is to be aware of creating one’s own self, destiny, life predicament, and, if such be the case, one’s own suffering.” - Irvin Yalom, author and existential psychiatrist
Nowadays, when clients at Sunshine Coast Health Center hear about taking personal responsibility, it’s not about whether they are to blame for, or in denial about, their problems. Blame and labelling some as ‘in denial’ only feeds into their sense of shame. There’s another way to define personal responsibility: a place to stand where you, ultimately, are in the driver seat of your own life.
Clients Are Not the Cause of Everything in Their Lives
At Sunshine Coast Health Center, we spend a lot of time with clients discussing spiritual principles, particularly humility. Along those same lines, we remind clients that they are not the cause of everything in their lives as if they are some sort of all-powerful god. So when we say responsible for everything in your life it means a declaration, not a fact. On the flip side, when clients take responsibility for their recovery it doesn’t mean taking on some sort of heavy burden, that they should be criticized when life isn’t working.
When You Are Being Responsible You Give Up the Right to Be a Victim
One of the more uncomfortable aspects of being personally responsible for your recovery is that you give up the right to assign cause to the circumstances, or to others. In other words, clients at Sunshine Coast Health Center learn that being responsible means giving up the right to be a victim.
Mayor Ford needs to take responsibility for his addiction. Not so he can be punished for any wrongdoing, but because it’s the best thing he can do to get himself back on track. Should he step aside while he gets treatment? That’s a decision better left to Toronto-elected officials.
(*) Note: the term ‘addict’ here is used as shorthand to describe an individual who is addicted to drugs or alcohol. The term is not meant to imply any judgment on the individual with an addiction.
(**) Note: for more information see Geoff Thompson’s article, “Addicts Take Personal Responsibility for Their Drug Use.”
(***) Note: For an example of this attitude look no further than a recent Toronto Star article on Rob Ford: “In [treatment], he will be called to account by others who know the game, the con, the emotional immaturity that is inherent to the ailment, the monumental selfishness that goes with the territory.”
Much of the philosophy outlined in this article is based on the following:
Erhard et al. (2013). Introductory Reading For Being a Leader and The Effective Exercise of Leadership: An Ontological/Phenomenological Model. pp. 43-44. San Francisco, CA: Landmark Worldwide LLC.
Wong, P. T. (2001). Freedom, Responsibility and Justice: the Cornerstones of the Good Life.
Frankl, V. (1986). The doctor and the soul: From psychotherapy to logotherapy. New York: Second Vintage Books.
Great Courseshas a wonderful audiotape series on the subject of existential responsibility: No Excuses: Existentialism and the Meaning of Life by Robert C. Solomon, Ph.D. Dr. Solomon is quoted from the series as saying, “Existentialism, unlike that of many more obscure and academic philosophical movements, is about as simple as can be. It is that every one of us, as an individual, is responsible—responsible for what we do, responsible for who we are, responsible for the way we face and deal with the world, responsible, ultimately, for the way the world is.”