Canada Drug Rehab

By Geoff Thompson, MA, CCC
Program Director
Sunshine Coast Health Center

We can learn a lot about addiction and recovery from our current fare of drug prevention programs.

Here are some statistics: According to a 2007 published survey by the Government of Canada, most Canadian youth, aged 15 to 24, reported that they used illicit drugs. Only 39.7% said they have never used, 38% said they used only cannabis, and 23.7% said they used an illicit drug other than cannabis. Almost all youth reported using alcohol, and 82.9% in the last 12 months. Of past year drinkers, 13.8% reported getting drunk weekly and 40.6% at least monthly. (By the way, if there is such a thing as a ‘gateway drug’, then these numbers tell us that it’s alcohol.)

To combat these numbers, communities, schools, and parents spend a lot of energy trying to keep youth away from drugs and alcohol. Most prevention programs are simply local efforts, which have no basis in psychology research or practice. But both the US and Canadian governments tell us that many programs have been studied and have “scientific evidence” that they work. These programs generally use some basic psychology principles to help people learn how to say no, how to deal with peer pressure, how to deal with stress, how to deal with anxiety and depression, and so on.

The key to all these programs is that they point out that drugs are a poor way to deal with what makes us uncomfortable in life. And there are lots of things that make us uncomfortable. Booze is great if you’re going to a dance. It helps you get over shyness. Being intoxicated is a great way of dealing with boredom. Getting high is a great way of dealing with loneliness.

The problem with using drugs for this kind of uncomfortableness is that they can backfire. Having to rely on drugs every time you go dancing, for instance—and having to use more as time goes on because of tolerance—can lead to disaster.

Pointing out the risks involved seems entirely reasonable. But here’s the problem: Regardless of what program designers and governments tell us, top-of-the-line research has shown that our current prevention programs don’t work very well.

It’s important to remember that Bill W., the driving force behind the development of the 12 steps, also understood the benefits of using. He said that intoxication is a substitute for satisfying the urge for wholeness and connection with God. In 1943 at the Shrine Auditorium in LA he told the audience that the alcoholic was a person who was looking for religion in a bottle. But, of course, seeking fulfillment through intoxication always backfires, leading to great suffering.

In this article we’ll explore prevention programs to see why they are not very successful. Knowing this can help you understand the power of drugs and what you or your loved one will likely have to do to recovery from addiction.

Part One — Our Current Approach to Prevention: “Drugs are bad”

Drug prevention programs operate according to the principle that “Drugs are bad, so don’t use them.” Typically, they tell us that using drugs will inevitably cause any number of problems. Studies of the effects of drugs on the brain, physical deterioration of the body, lost jobs, depleted finances, broken families, risk of arrest and incarceration, and so on are marshaled up to convince people to abstain. And many programs invite recovering addicts to tell their story to young people about how drugs destroyed their lives.

It all seems like a good way to keep young people away from drugs. Unfortunately, this approach doesn’t work very well.

Many big-shot researchers have studied the “evidence” of programs that claim to be successful — the ones that the US and Canadian governments have said were scientifically proven to be effective. The researchers discovered that the “evidence” was not very good.

For example, four of the most famous prevention programs are Strengthening Families, Life Skills Training, Project ALERT, and DARE. Researchers examining the evidence for Strengthening Families and Life Skills Training wrote: “Far from supporting the evaluators’ claims concerning the rigour of the findings and their generalisability and public health significance, the results were very fragile, of little practical significance and quite possibly analysis-dependent.” What this means is that the so-called “evidence” that the program worked did not meet basic research standards. Other researchers studied the evidence behind Project ALERT and DARE and found that these programs were of little or no value.

Part Two — Problems with the “Drugs are Bad” Approach

It seems so reasonable to try to stop people from using drugs by telling them all the dangers. And the dangers are not little: lost families, major health problems, lost jobs, mucking up the brain chemistry. And there is the real possibility of death.

But there are a growing number of experts in the field, who are showing why this “drugs are bad” approach is not very effective in preventing drug use. Here are some of their reasons:

1) Prohibition doesn’t work — The idea that drugs are bad is based on, as one researcher said, “the persistence of prohibition as an ideological force.” What this means is that trying to scare people into abstaining is based on ideas of the prohibition movement that helped make drinking illegal in the United States in 1920 and in Canada in 1918. You probably know that prohibition did not work. It was based on a moral stance and not on any scientific understanding of human nature.

2) People don’t believe the message — Surveys of school kids exposed to the “drugs are bad” message have shown that they don’t believe it. They know kids who have used crystal methamphetamine and who didn’t end up in the emergency ward of the hospital. They know kids who use substances and are straight-A students. They know athletes who smoke marijuana. They know kids who get drunk at parties, and the most they seem to be affected is a hangover the next day.

3) Kids like to take risks — One of the pleasures of teenagers is to take risks, including doing things that are illegal (small things, mainly). There’s an excitement involved. A drug prevention program that displays illegal drugs is likely to inspire more curiosity than fear. Interestingly, when addicted famous people talked to kids about drugs, the kids usually thought they could do drugs and then clean up — just as these celebrities did. (By the way, when researchers discovered this, they stopped asking famous people to talk to kids about drugs.)

These are just a few examples; there are many more. But they show that perhaps our current drug prevention programs are wrong-headed.

Part Three — New Research on Prevention

A handful of researchers, knowing that current prevention programs do not work very well, have said that we need to re-think the logic that we use to try to prevent drug use.

Most of these researchers are in England, but a growing number are in Canada and the United States. For example, British researchers have been studying why young people in Britain use ecstasy and ketamine. They have discovered that many young people find positive benefits from intoxication.

The idea that intoxication has rewards is not new. The great psychologist and philosopher William James (the guy who impressed Bill W. so much) was convinced that being drunk or stoned helped the user connect with the universe, find insight into perplexing problems, and generally feel more energized and alive. And, of course, some of the great addict-writers, such as Thomas De Quincey, Samuel Taylor Coleridge, William S. Burroughs, Eugene O’Neill, and Jack Kerouac said more or less the same thing.

Young people we’ve studied have told us that using ecstasy and ketamine at dance clubs has helped them connect with others in a positive way. They even tell us that they have found long-term benefits of being more empathic (the ability to appreciate what others are feeling).

The second thing they tell us is that intoxication allows them to connect with something greater than they are. In previous articles I’ve talked about how people can feel a sense of belonging while under the influence. Researchers in the United States have studied 18 to 24 year olds who experience the benefit of ecstasy as “transforming the everyday.” The researchers concluded that ecstasy highlights “the extraordinary or transcendental nature of the experience.”

Part Four — Drug Prevention has to Account for the Benefits of Drugs

Modern drug researchers have come up with a “new” idea. As one researcher put it, “Research has failed to explore a significant and integral feature of drug use, primarily the reasons why people use and the benefits they receive.”

People use because they find some rewards for getting intoxicated. Researchers have concluded that we need to understand these benefits if wide are to design drug prevention programs that work. In fact, one researcher has pointed out the obvious: The reason why our current drug prevention programs don’t work is precisely because the benefits that users tell us they get from being intoxicated make them resistant to programs that are based on the approach that “drugs are bad.”

Here are some of the rewards that users have told us about substances: (1) “Alcohol is great for dealing with shyness,” (2) “ecstasy can make you feel closer to others,” and (3) “heroin makes everything okay even when my world is falling apart.” Young users of dextromethorphan tell us that it aids in creating a trans-personal experience. This trans-personal experience means that that intoxication moves the user beyond paying attention to himself and puts him in a state that is beyond time and space.

So, this is good information for you to know as part of how to stay away from drugs and alcohol. If the benefits of intoxication are this feeling of community and this trans-personal experience, then it makes sense that you will have to figure out how to find a sense of belonging and how to finding something in life that makes you feel alive.

This is, of course, the entire purpose of the 12-step program. And it is one of the main themes of addiction treatment at Sunshine Coast Health Center.

By Geoff Thompson - MA, CCC 
Program Director

Lots of addiction experts believe that one of the greatest barriers to recovery is that clients have internalized the stigma of addiction. Basically, this means that clients think of themselves as ‘failures’ or ‘diseased’ or ‘irresponsible’ or having ‘defective character traits’ or a ‘defective personality’, and so on.

It’s not surprising that they think of themselves like this. Watch any real-life cop show, and you will see most of those arrested are addicts. And pretty stupid ones at that. The impression is that all addicts are criminals. Watch Oprah or the afternoon talk shows, and you will hear the ‘experts’ condemning the addict as incapable of making decisions, an immoral person, and so on. Watch just about any movie, and you will hear that addicts are either the cause of human suffering or that those in recovery are only one drink away from catastrophe.

Governments sponsor prevention programs that tell young people to “just say no,” as if the addiction were no more than a simple choice. The typical message is that a “poor choice” to use drugs leads inevitably to disaster. Almost all treatment programs claim that drugs leave users incapable of reasonable thinking, which is why they tell clients what to think and what to do. A counsellor on the Intervention television show said that he felt his work with a client was successful because the client “learned that he couldn’t trust himself.” Documentaries regularly show addicts as irresponsible mothers, fathers, and partners. In several BC communities, local politicians routinely blame addicts as the main cause of suffering in their communities.

As if all this weren’t enough, popular opinion has raised the power of drugs to almost magical levels. Newspapers and television tell us that just using a drug a couple of times will plunge the user into the abyss.

Experts have noticed that this sort of exaggeration is a real detriment to recovery because those struggling to get off the drugs often believe what they hear. Two of the more famous experts are Stanton Peele and Steven Hayes. Peele tells us that these messages actually increase the drug problem because they are “one-sided propaganda” and do not match what we know from research, which is that most people in our society use drugs and yet go on to live good lives. Hayes developed a treatment program specifically to help addicts overcome the stigma of their addiction, which he considers one of the greatest barriers to recovery.

What do Peele and Hayes know? Here are some interesting studies. Researchers studied those convicted with a DUI, who were ordered to attend the Victim Impact Panel (VIP), sponsored by Mothers Against Drunk Driving (MADD). It turns out that attending VIP actually increased the chances that the person would later be charged with another DUI. The reason was that VIP increased the stigma felt by participants, which led them to drink more. The most popular drug prevention program, Drug Awareness Resistance Education (DARE), is based on the stigma. Research has shown that not only does DARE not work, but that with some kids it actually increases drug use. And studies comparing recovering addicts with those recovering from cancer and other illnesses have shown that the stigma of addiction significantly decreases successful outcomes for the addicts. In BC, we know that at least two-thirds of those with mental health or addiction symptoms do not seek help because of the stigma attached to addiction: they fear losing their kids, being denied health insurance, losing jobs, losing their driver’s licence, etc.

So what can be done about all this? In this blog article, we’ll try to figure out how people with addictions can self-assess whether they have internalized the stigma (bought into the popular opinion) and, if so, what can be done to get rid of it.

Internalizing the stigma of addiction? Part I

Steven Hayes begins his therapy for addicts by asking them to complete an inventory to see how addiction has affected their lives. He then talks with them about what they were thinking and feeling as they completed the questionnaire.

Inevitably, his clients say that they felt badly about all the money they had spent, the relationships that were destroyed, the jobs lost, and so on. They have made sense of their addiction by assuming what the popular media and politicians say is true: they are failures, losers, and defectives. Hayes argues that these beliefs inhibit their recovery. Even though they may pay lip-service to the idea that addiction is a health issue, the more powerful thought is ‘…but I must be a defective person because I became an addict’.

At Sunshine Coast Health Center when we listen to the stories of clients, we hear a catalogue of embarrassment and shame. This is particularly evident in the week before Family Program—it’s almost a guarantee that there will be more chaos during this week than other weeks, which is the a common sign that clients feel stressed. Clients keep secret their worries: What will my family tell the counsellors? Will I get caught in a lie? Do I have to plan to keep certain family members away? What’s going to happen to me when I sit in with my family Sunday afternoon?

And the big one—Will the counsellor explain to the family that the things I did in active addiction were not really me?

These feelings and thoughts are typical of those who have internalized the stigma of addiction. For them, it’s very tough to break away from the popular idea that addicts are defective.

Internalizing the stigma of addiction? Part II

Here are five public statements that describe addiction: 

• Canadian Human Rights Act, Part I, Section 25: “disability means any previous or existing mental or physical disability and includes disfigurement and any previous or existing dependence on alcohol or a drug” (1985)

• Canadian Society of Addiction Medicine (CSAM): “Addiction…[is] a primary, chronic disease…. Like other chronic diseases, it can be progressive, relapsing and fatal” (1999)

• Nora Volkow, head of the National Institute of Drug Abuse (NIDA): “…addiction is a chronic brain disease” (2007)

• Bill W: Alcoholism is a “spiritual” condition (1939)

• Psychologist Paul Wong: “Addiction is a response to living a life that lacks personal meaning” (2005)

So, we have descriptions from very reputable sources, who tell us that addiction is a health problem or a response to a meaningless, monotonous, and boring life. When we think about someone suffering a medical condition or having a need to find meaning, we generally don’t jump to the conclusion that the person is weak or has a flawed personality or is making some conscious choice about having or not having the condition. Would you consider Terry Fox as having a flawed personality because he suffered from a medical disability? Would you condemn Anne Rice or KD Lang as being irresponsible because they searched for a meaningful life?

Tips for overcoming the stigma of addiction

Almost everyone has an addiction has, consciously or unconsciously, internalized the stigma. And overcoming this is tough.

The late US senator, Harold Hughes, lamented that addicts face the same stigma that those with mental health issues used to have to put up with. Today, the public understands that depression or bipolar disorder, etc, are not choices—that there is a neurobiological vulnerability to mental health struggles. But this is not yet true for addiction: so many people still tar the addict as irresponsible and immoral.

Here are three tips to overcome the stigma.

Tip One: Remember that science has confirmed that not everyone can become an addict. It seems that addicts have a neurobiological vulnerability to addiction. Neuroscientist James Kalat put it this way: “Addiction isn’t in the drug, it’s in the person.” The famous addict-writer William S. Burroughs stated the obvious: “No one ever wants to be an addict.”

Tip Two: When you think you need to defend yourself against others, stop. Addiction neuroscientist Carlton Erickson recounts the story of a person who wrote on a reply card to an invitation to hear Betty Ford talk at a fundraiser for alcohol research: “I’ll never give a penny to help those d**n drunks.” There’s not much anyone can say to such a person. And your job in recovery is not to change these people.

Tip Three: Be conscious of the language you use to describe yourself. You have probably used descriptions of yourself that are based on the stigma: I’m a drug fiend, a drunk, etc. In fact, one of the reasons why 12-step programs are offensive to some is because they believe that saying, “Hi, my name is Harry, and I’m an addict” reduces them to a label. (This is not the intention of AA/NA, by the way.) We would never expect a patient at a hospital to introduce himself as “Hi, my name is Sue, and I’m cardiomyopathy.”

Overcoming the stigma of addiction: Self-determination

At Sunshine Coast clients often hear the statement, “You are the author of your life.”

A good example of this concept is the actress Drew Barrymore. At 13, Barrymore was called, quite publicly, “the youngest drug addict in America.” ‘Experts’ pointed out that she grew up with a family of addicts and thus was at the mercy of the addict’s genetics. They pointed out that she was doomed unless she started to listen to experts. Imagine what the young teen must have thought of herself, having all these ‘experts’ declare publicly that she was defective, powerless over addiction, and at the mercy of her genetics (Actually, we know; she wrote an autobiography, Little Girl Lost.)

As Drew grew into adulthood, she gave up the drugs. Experts, such as Stanton Peele, point out that the young woman refused to reduce her life to the label ‘addict’. She refused to believe the experts when they equated her life with addiction. She refused to identify herself with the stigma.

What if Drew actually bought into the pronouncements from Dr. Phil and the others? It is very likely that she would have never achieved the success she has today. It’s difficult to imagine a successful person who believes they are defective, cannot make good decisions, cannot trust themselves, etc.

Addiction neuroscientist Carleton Erickson also reminds us that many people “have a desire to hold drug users accountable for their actions. Individuals who may have been emotionally, physically, or financially affected by other people’s drinking and drugging may be loath to ‘let them off’ by saying they couldn’t help it.”

At Sunshine Coast, we remind clients that their job is not to change negative people; that’s their job because they are the authors of their lives.

By Geoff Thompson - MA, CCC

William R. Miller, a world-renowned addiction expert, told us in 2006, “Addiction is not well understood.”

Miller’s comment seems almost bizarre considering all the money and effort invested in cleaning up and preventing addictions. According to the most comprehensive study in Canada, the annual per capita cost of dealing with addiction in this country was $725 in 2002 (this includes enforcement). This works out to $18.9 billion for a single year. One US government study put the 2005 cost in the US at $276 billion. The same figures are true for other Western nations. A 2008 study from PricewaterhouseCoopers, for instance, concluded that each UK addict cost British taxpayers $1.4 million.

The annual budget for the National Institute on Drug Abuse, a US government research agency, is $500 million. And that’s just one of dozens of private and public outfits. Results of thousands of studies are published in more than three-dozen English-language scholarly journals dedicated to the subject. Dozens of major conferences are held each year offering the latest theory and practice. Universities offer courses on addictions, and many grant advanced degrees in it.

The US and Canada spend staggering sums every year on prevention programs (though Canadian figures are difficult to collate). The most famous is Drug Awareness and Resistance Education (DARE), which the US government subsidizes with a $1 billion. Treatment for addictions comes with an even bigger price tag. Alicia Busch of Harvard University’s addiction research program estimates 600,000 treatment slots for drug addicts (not including alcoholics) in the US. If we rely on the US government’s studies of the cost per person for treatment, this puts the annual treatment budget into the tens of billions.

Given all this time and money, can Miller’s comment be accurate? If we don’t really understand addiction, then what are we doing in all those prevention and treatment programs?

Sadly, Miller is right. And he is just one of many experts who have admitted publicly that we’re still trying to figure out who these alcoholics and drug addicts are and what motivates them to begin and keep using, even though they know what will happen.

One example of our confusion is the effort to prevent addiction. According to a 2006 report from the US General Accountability Office (GAO, the US government’s watchdog), the most widespread drug prevention program in schools, DARE, isn’t worth the money. Health Canada came to the same conclusion in 2001. Also, according to the GAO, the US President’s 2006 $1.2 billion ad campaign to prevent kids from using drugs was not merely ineffective but actually made drugs more appealing for some teenagers. Scholarly studies of another prevention program, the Victim Impact Panel (VIP) of Mothers Against Drunk Driving, showed that attendance at VIP actually increases the chance that someone convicted of DUI will get another DUI. 

Treatment providers seem equally baffled. Studies of mainstream programs have shown that the average program helps only one in four clients stay abstinent for some period of time up to a year—after that, it’s all downhill. Studies at the four-year mark found only 7 percent still clean and sober; at seven years, 5 percent.

Many claim that the answer to addiction is the twelve-step program developed by Alcoholics Anonymous. As powerful as this program is, independent researchers and AA’s own internal surveys confirm that the program does not seem to have any enduring appeal for the vast majority of alcoholics.

The public generally assumes that professionals know what they are doing—that is, until the problem hits home. That’s what happened to Robert Shapiro, the famous lawyer. Shapiro’s son died from a drug overdose 18 months after completing treatment. Questioning what had happened, Shapiro began investigating. On the October 21, 2005, edition of the television show, Larry King Live, he reported “the most successful program in the world [has] a 12 percent success. He also mentioned the old joke: “[P]eople who go into rehab for 28 days…will relapse on the 29th day.”

So what’s going on? Should we just wave a white flag and surrender to this terrible thing called addiction? Far from it. Shapiro’s investigations convinced him that addiction was a lot more complicated than he had been led to believe, but it also gave him hope. We’ve learned a great deal after 40 years of study. We now know, for instance, that certain approaches to prevention and treatment are effective, even if much of what is currently practiced doesn’t seem to work that well.

In future articles I’ll describe what the experts and the addicts tell us about what it means to be addicted and what it means to find recovery. It’s a fascinating discussion, and one that tells us as much about ourselves as it does about those with addictions.

About the Author

Geoff Thompson, MA, is the Program Director at Sunshine Coast Health Center, a private addiction treatment facility for adult men. His book, A Long Night’s Journey into Day, explores Eugene O’Neill’s life to uncover the truth of addiction and recovery.