Resistance to the very things that will help us!
Learning right living isn’t always easy. Often we resist the very things that will help us live the very life that we long for. It has been our experience that gratitude is directly related to happiness.
We have an exercise we do which requires the individual to write a list of everything they are grateful for. After the list is completed we send each person out to find a small rock in nature. When everyone returns with their rock we explain that this rock will now represent everything they have to be grateful for.
Hold your Gratitude Rock in your hand and think about the people and things that you have in your life right now which you are grateful for. Think about the incredible experiences you’ve had as a result of having these special people and possessions in your life. When you do this on a consistent basis and start to associate the power of this experience and the feeling of gratitude with your Gratitude Rock, you are creating a very formidable base from which everything else will grow.
Now whenever you touch your Gratitude Rock, you will start to experience the same magnificent feeling of gratitude immediately and you will be reminded of all the wonderful things that you already have in your life. The people you love. The good times you’ve had with them. Whenever you find yourself overwhelmed by life’s daily stresses, all you need to do is to grab your Gratitude Rock and you will feel this positive energy and put yourself in the right state of mind immediately.
One young man, who was full of self doubt and lack of motivation decided to resist the lesson. He thought it was silly, he balked at the exercise thinking he was too cool for such a thing.
The next morning when asked where his rock was he laughed and said he didn’t need any rock. This didn’t sit well with the other Habilitat residents not to mention the staff. Later that evening he was asked again for his rock and again he balked.
It was decided that, like all the exercises at Habilitat, he would have to participate and there was no negotiating. At Habilitat you do what you are told or you can choose another place to reside.
This young man obviously needed this lesson since the power of gratitude was something he didn’t really understand. We decided to have him sit with his rock for a while. It took a few days before he gave in but eventually he got it. He surrendered his resistance and quickly started to focus on everything he was grateful for. From that day on he carried that rock in his pocket. In fact, nearly two years later while in a group we asked him where his rock was. He dug into his pocket and pulled it out and said “I am never without it!”
This may sound crazy but this lesson totally transformed this young mans attitude from bitter and resistant to change into a very humble and grateful human being. From that point on he cooperated, learned all he could and continued to grow into someone his children could be proud of.
The last we heard he still carried his rock with him each day. He moved on and now lives on another island where he helps him aging mother, raises his children and lives each day in gratitude for everything in his life!
We never know what lessons can transform our lives. Live your life seeking the lesson in everything. Resistance is only limiting you from being the person you want to be. It’s never too late to be that person you always wanted to be!
Every Addict has an Enabler
Throughout our history Habilitat has worked diligently to teach a lifestyle based on common sense and logic. Our philosophy is centered in “self-reliance” and “independence.”
Unfortunately too many families unwittingly contribute to the addict’s demise by enabling the addictive process. Some do it out of guilt, some out of love but most out of ignorance.
I have never met an addict that didn’t have an enabler. Whether it’s the rescuer mom, the understanding father, the guilty grandmother or even the state welfare system, we all have our benefactors.
We have a saying at Habilitat that continues to run true to this day. “The quickest way to take someone’s dignity is to do for them that which they are perfectly capable of doing for themselves.”
That being said, in this day and age, parents and families simple do too much for their loved ones. For those of us with a propensity toward addiction, it’s a recipe for disaster.
We have long understood that addiction is not the primary problem. In fact, Habilitat doesn’t subscribe to the common belief that addiction is a disease. If it is, where the hell did mine go? Because many of us old timers at Habilitat haven’t even thought about drugs in years! We believe that addiction is a symptom of a great many problems having to do with thinking.
If a person can learn a new way of thinking there is hope for a better life. We won’t say that Habilitat’s lifestyle is for everybody. It isn’t. We will say it can help anyone, addict or not. Yet it doesn’t help everyone. Why? Because not everyone is ready or willing to do what needs to be done to make the transformation from dependant and reliant to independent and self- reliant.
I have witnessed people come trough our rigorous program, make the changes in mentality and do their best to practice what they have worked so hard to learn…. Only to return to where there came from, the same environment, with the same toxic family dimensions, only to relive the same hell that brought them to us to begin with.
We do our best to inform families on the do’s and don’ts. Frankly many don’t want to hear it. They expect to send their kid to Habilitat and have us work our magic and then send the kid home… fixed! The problem is that they don’t ever stop to think about the contribution the family dynamic made to the whole addiction in the 1st place.
They want the kids to change but they are unwilling or unable to make the changes necessary to encourage long term success. Unfortunately the kids that return to the toxic setting are doomed to return to the same old Hell.
I can’t count how many times we have counseled parents, explaining that the less they do for the person the better off they will be. One woman in particular sent her son to Habilitat a few years ago. He was a tough case but we worked with him. He struggled through and eventually, after some 25+ months he got it. He started to realize that he was capable and he too could set goals and accomplish whatever he was willing to work for. We watched this kid grow up and become a man.
Upon his completion at Habilitat he moved out on his own. We helped him get a great job making very good money. He actually made more money that I did at the time! His family kept encouraging him to move back home. Eventually he did. Soon after mom and dad started doing too much for him… Mom, did his laundry, dad bought him a car, grandma helped too. Unwittingly, within months he was getting high again. He lost the job and was soon back to no good! He called us from Jail a few months ago asking where he went wrong.
I was so obvious to those who care to look. His family took his dignity without even so much as a second thought. You see, they didn’t believe what we told them about self reliance being directly related to self esteem. They just were not willing to listen. The kid is now in prison, He will be eligible for parole in 2018.
Another guy who comes to mind was a real role model at Habilitat. He adapted and thrived in our environment. When it came time to graduate we warned him….”don’t go home!” Unfortunately he and his family didn’t listen. Last year in September they buried him near their home on another island. He died in a car after drinking and driving. They called me to inform me about the tragedy and made it clear that they now believed we were right. Too late for him though!
Without struggle there is no progress. The determination to survive and make it on our own is a lesson which the value is without parallel. Take our advice… stop enabling the addict and give them the opportunity to do for themselves!
Jeff Nash
Recovered Addict
Facility Director
Habilitat, Inc
Addiction… Disease or Myth
I honestly don’t buy into the whole imbalanced brain thing. Perhaps we have the propensity toward addiction but then again what about those that have the propensity to shop or eat chocolate… Is that too an imbalanced brain?
Frankly I think the whole disease concept was created by the American medical establishment so that they could get 3rd party payment. There is a very frightening trend that has developed momentum in the past few decades. The new trend is for doctors to assign labels and prescribe drugs. The result… a whole generation of people who believe they have a mental disorder and have become dependant on script drugs.
I can’t count how many times we have people come in with these labels and have been brainwashed to believe they are Bi Polar, Manic Depressive or other similar labels. That is not to say that the individual doesn’t have the typical symptoms… just that labels and drugs are not usually the answer… these limiting beliefs make our work all the more challenging. We have to un-brainwash the individual and teach them to empower themselves.
I my opinion the medical establishment has done more to create a dependant society then anything else. There are billions spent on short term treatment for addiction with very little solid results.
I remember when I was doing the treatment thing. I have been through 14 programs and Habilitat 2X. One center I went to three separate times for a month stay each time. The doctors knew I needed something more substantial than what they were offering but they took me in each time… you think they treated me for free? Nope! 10K each time…. Meanwhile they knew it wouldn’t work… after all relapse is part of addiction right? WRONG! I was a billable commodity for them. Finally at the end of the 3rd treatment they suggested I might need a longer term program. They knew that from the 1st stay! But it won them another 20K to just let me go through the motions.
I have been labeled many things… Bipolar, Manic Depressive, Clinically Depressed, Anti Social, Incorrigible, and many others I don’t care to even remember. They prescribed me drugs, drugs and more drugs… lithium, librium, xanax, methadone, paxil, seraquil, valium, atavan, prozac and more… they said I had a chemical imbalance….
Of course I had a chemical imbalance… I was taking all those drugs along with Heroin, Cocaine, and Methamphetamine. That tends to confuse the natural order of the brain’s chemistry! But after a prolonged period of abstinence my brain did what brains do… it started to function normally again…. I hope anyway!
It took time… a long time… that’s why short term programs don’t get long term results… There is no short term solution to a long term problem… fact is that drugs create a long term problem with the brain… they alter the brain’s functions… at the time I couldn’t understand why, after a month off the stuff I still felt hopeless… “Anhedonia” look it up! It’s basically the inability to experience pleasure brought on, in the addicts case, by mixed up brain chemistry brought on by drugs. This condition can take months and months to overcome. Luckily in most cases it will go away… I have seen some people take up to 20 months to start to feel normal again, especially with Meth. If we “truly” knew how much it would mix us up we would probably never had tried the stuff to begin with. At least that’s my thought today! Back then no one could tell me anything…. But that’s a story for a different day!
I have never met a junkie that took his first hit with the intention of becoming a junkie. People start off because of peer pressure, to party and have fun like everyone else…. Some people just can’t stop after that. Their whole existence becomes tied to the finding, funding and using of the drugs. Most of us have a moment in our addiction where we ask ourselves “how the hell did this happen to me?”
“The person takes the drug, the drugs takes the drug, the drug takes the person!”
The road to recover has a lot to do with not using drugs. The road to life has more to do with taking charge of our own lives and finding new ways to deal with our problems. I get a kick out of people when they tell me “I’m in recovery too!” I almost always reply with “REALLY! I am RECOVERED!” The idea that we will always be in recovery is not a belief that I care to subscribe to. I always like to ask people when they plan on finishing their recovery. See, their belief that they will never be rid of their addiction keeps them focused on not using drugs… The main focus of that idea is “USING DRUGS.” We teach people to focus on life, creating opportunities, and doing what will create a better tomorrow for them and their families.
So, is addiction a disease? I think not. If so, where did mine go? If there is a disease I would say it is more of a disease of character… one of mediocrity, mass thinking, and lack of discipline. These things can be overcome with the right motivation. I know because I did it! For all those wonderful doctors who tried so hard to convince me that I had a label and needed their drugs…. Well, they were wrong! Every last one of them! With all the school and all their experience, they couldn’t help me. I had to help myself!
Ask any shrink if they think long term treatment works better for addictions and they will tell you “YES!” The fact is that there is no money in long term success just like there is no money in the cure for cancer etc…. Ok…ok… now you think I some kind of conspiracy theorist… Nope… treating addiction is big business and there are many people getting fat from the profits… Why? Because they are in the money business not the people business. Profitability is of the highest order. Show me a clinic that will treat someone for free, that is without any form of compensation…There might be a few good doers but the reality is that most people are in the business for the almighty dollar… Hence the idea that addiction is a disease. Show me a doctor that can get paid for treating addiction without the addiction being a disease… How about we make PMS a disease? Or overeating… hell that kills more people than addiction by far! Smoking? Why isn’t that a disease? It’s an addiction? If we follow the flawed logic that drugs kill people and they should be illegal and the people who do them should be locked up… what about the tobacco industry? Why is Budweiser sold on every corner but when I got busted with a $5 piece of crack I was sentenced to 10 years in prison. Don’t get me wrong… I’m not advocate for legalizing dope. Just that the system is full of double standards.
Habilitat and a few others like it seem to be the only organized efforts to treat the person not the addiction. We see it every day…. A person comes in thinking their addiction is the problem… take away the drugs and you have a person with many other issues, self-esteem, guilt, historical pain, abuse, neglect, lack of coping skills, anger issues, lack of confidence and many more… For any addict to recover fully these areas have to change otherwise the cycle will repeat itself. Addiction is a symptom of a serious set of problems that can’t and won’t be fixed with a label or a pill. Either way… it all comes down to choice… Showing people that they have a choice is where the efforts pay off!
Jeff Nash
Recovered Addict
Facility Director
Habilitat, Inc.
Lets Get Real Here…It’s a Right of Passage!
We encounter many things in our efforts to help people reclaim their lives after succumbing to addiction. Unfortunately there are so many misconceptions that many people just don’t really understand all the issues related to addiction and, more importantly, the recovery process. We often find that families have the idea that they will send their loved one off to rehab and they will come back healed!
First let get something straight… We don’t heal anyone! We never have and we never will. There is no magic cure. I wish there was because the world would be a better place and I would be a very rich man. Unfortunately, to date no one has found a magic pill that will cure addiction and they never will. Why not you ask? Because addiction is not so much an issue of drug use. In fact, the use of substances is merely a symptom of a combination of things.
“We CAN’T medicate ourselves out of a problem that we behaved ourselves into!”
Yes, that’s right…. That goes for anything. Americans seem to think that there is a pill for everything. Think about it! People spend years practicing a set of behaviors that lead to eventual unstable health (mental, emotional or otherwise.) To expect lasting change from a pill is simply a recipe for disaster. In order to change one must change the behaviors that created the situation. In most cases that requires a change of lifestyle.
So, now to the point of this rant!
Habilitat works very hard to prepare individuals for a productive lifestyle. The point of our organization is to empower people to become independent and self-reliant. Our philosophy is simple. Hard work and strong values make a person worthy of feeling good about their lives which eventually leads to a meaningful life one can be proud of.
Many people come to Habilitat unable to even look at themselves in the mirror without feeling deep self loathing. Our regimen guides people through those feelings are helps create a self identity that is strong, confident and ready to embrace the challenges of everyday life.
That confidence is built from one’s ability to overcome the numerous obstacles they face in our artificial imposed environment. When a person leaves Habilitat they feel good because they have accomplished things that they didn’t even know they were capable of.
See, addicts often possesses qualities that other people just don’t have. We usually have a unique “sixth sense” that we developed from life in the addictive process. Add to that the creativeness and tenacious will we had to get high and you have a person who has the ability to achieve great things. We just need direction. In fact, the very skills that we used to find, fund and chase the drug can be focused and directed to create a very interesting lifestyle. We have seen it over and over again.
Still we need to get real here. The reality is that only a little over 1/3 of people who enter Habilitat actually finish it. Why? Because it’s hard. Habilitat will work for anyone but it doesn’t work for everyone. Not everyone is willing to go through the programming to redirect those “dope fiend” qualities to become a “recovered addict.”
Of those that do finish Habilitat, about 54% never have issues with addiction of substances again. Obviously that means that 46% continue to use drugs after the Habilitat experience! The question is WHY!
There is no simple answer. Some come to Habilitat to avoid incarceration. Some to get their parents off their back. Some come because they are tired of the results of their addiction. Whatever the reason it always has to do with some for of pressure, street pressure, family pressure or legal pressure. Either way, 54% of the ones that finish Habilitat go out into the world and create a life for themselves, recovered from their addiction.
So for those who return to their addiction…. How and why does it happen? Those people in that 46% have some things in common. This is not always the case but it sure seems to be something to take note of. Here is what we have observed through the years.
• They return to the exact environment they came from.
• They don’t get to work as soon as they leave Habilitat.
• They move back in with enabling family.
• They immediately search for a romantic relationship.
• They get involved in an unhealthy relationship.
• They fail to secure employment and take the welfare handout.
• They choose to associate with old friends or family who are on drugs.
• They think its ok to drink alcohol since it is legal which leads to drug use.
There are probably more precursors to continued addiction. We have tried to identify the most common here. It seems that there are usually combinations of factors that contribute to the fall. That’s why we teach people to consider what is SAFE first.
We continue to work toward educating families so that their lack of knowledge will not end up contributing to the demise of our proud graduates. When someone leaves Habilitat as a graduate the have been conditioned, seasoned if you will, to use critical thinking to insure their safety. They are programmed to do things to the very best of their ability. They are hard workers and feel a new sense of independence and they will continue that as long as they continue to do the very things that brought them to that place.
Its not rocket science! In fact, its mostly common sense. Lets face it, common sense is not quite so common anymore!
You wouldn’t believe how many people we have seen go down the tubes after leaving Habilitat simply because the families wouldn’t allow the person to “Do For Themselves.”
We have come to believe that it is usually fueled by guilt and sometimes misguided love. Often times families want to make things easier by taking care of everything upon program completion. This is probably the 1st sign of impending disaster.
Lets take a better look at this… person comes to Habilitat because they can’t get their act together. They work hard and get to a point where they are not only capable but are actually doing what society expects and then some. Now they practice this for a while then when we feel they have a great chance of continued success we send them back into the world. The parents are so happy that they now want to celebrate by giving them everything and making things as easy as possible.
Take note here…
1st…They got better because we MADE them work their butts off and earn EVERYTHING!
2nd…Why the heck would we want to celebrate the fact that someone is doing what is expected anyway? What message does that send? People always ask why I don’t celebrate my sobriety date. Simple! I will not celebrate something that I should have been doing all along!
A very famous Fredrick Douglas once said “Without a struggle the can be no progress.”
Guys, trust us on this one… The struggles that one faces after Habilitat will define the individual’s future. The more you do to remove the struggle… the more you do to disable the very person you think you are helping. The struggles are a “right of passage” from dependent addict to independent adult, and outstanding member of our society.
You see, we spend an average of 2.5 years teaching people the survival skills needed to live a productive life without substances. That’s it… we teach the skills… It’s up to them to go out and use them. If you remove their ability to use those skills you remove their ability to survive (based on what we taught them.)
Now here is the lesson… The less you do for our graduates… the better their chances. PERIOD!
They are perfectly capable of doing everything on their own. We wouldn’t call them a graduate otherwise!
So PLEASE! Rethink your guilt, your motives. Consider what you do and why you do it. Is it helping or is it contributing to the eventual demise of someone who had a fighting chance… if only they could have been allowed to do it on their own!
I hope we haven’t offended anyone here. But if we did then I guess the message hit home! The fact is that this stuff is so common that it needs to be said. We take what we do here very seriously. It’s deadly serious in fact. See, we get phone calls from parents who say “I wish we would have listened!” For them it’s too late. On average we receive two or three calls a year from parents who didn’t listen and regret it only after its too late.
For those of you who want more info…. Read our founder’s book. Its called Journey to Hell and can be purchased on Amazon I think.
Aloha until the next time!
Habilitat’s 9 basic concepts
Aloha
We just wanted to share something with you as food for thought. Habilitat’s philosophy is based on 9 basic universal concepts that have remained unchanged for years. These concepts, we call the 9 basic concepts, are the core of the lifestyle we teach.
1. Honesty
2. Act as if
3. Sometimes its better to understand than to be understood
4. Intellectual trust
5. No free lunch
6. Nothing is constant but change
7. You get out what you put in
8. You can’t keep it unless you give it away
9. You are your bothers and sisters keeper
Take notice of the #1 concept. It sounds simple but really that one concept is the foundation to a better life. It’s also the toughest to practice, especially in a world that deception and manipulation seem to be the mainstay.
Stay tuned and we’ll explain them all soon!
Aloha,
Habilitat Family
Building better people not better prisons
A life saved
I just wanted to share a couple of thoughts with anyone at all who may be interested. Long before I came to Habilitat, when I was in the throes of my addiction, I would measure the state of my life each Christmas that passed and I would ask myself where I was on that day as compared with the year before. Every year, for over eight years straight, the bitter answer I had to accept was that my life only grew darker and darker. Each year I grew more and more despondent as I realized yet another year had gone by and I was even further down the deep well of misery I had put myself in. Every Christmas was filled with a profound sense of loneliness, sadness and despair. I would curse God for this affliction he gave me. I felt that I was destined to die a junkie. People have different functions in life: some are doctors, some are lawyers, some are teachers…some are drug addicts and they are destined to die as drug addicts. That was me. That was who I believed I was supposed to be. By the time I had endured my ninth year of addiction, I had already been through four short to medium-term residential treatment programs never achieving more than four days clean after any of them. I was convinced beyond any doubt whatsoever that I would never, ever have a life worth living. The only question was how much more suffering would I have to endure until my tortured life would finally be over.
The words of one particular staff member assigned to me at my second stint in treatment in Kansas still echo in my mind as if it were yesterday. Responding to my desire that I wanted to leave the program, she said to me very matter of factly, “you’re one of the addicts that dies from their addiction! I’ve seen people like you come and go and I’ve seen them end up dead. That’s the very sad reality of who you are and what your life has become. What are you going to do about it?” Well, within a few days of hearing those words I did indeed walk out against medical advice. Almost immediately, I then went through another six month program which I did complete but after which I stayed clean for those four days I referred to earlier. Then another program, six weeks this time which, I again completed even though I was using and clocking the drug tests to avoid detection while I was in there. Two weeks after that, I was admitted to an intensive care unit comatose after a massive heroin overdose. I stayed in that coma for more than three days. The doctors had told my parents while they were standing over my lifeless body that I may live or I may die, it was fifty-fifty. I did actually flat-line, twice, and was revived twice.
I’ve just written this prelude for one reason and one reason alone. To reach people who may be suffering the way I was and for them to not naively think that only they know what it’s like to live this kind of life. They need to understand the utter depth of despair and hopelessness I felt. It was absolute sheer agony. It was horrible and horrific. I know what it’s like to wake up every day and to wish to God that I didn’t! I know what it’s like to constantly imagine putting a bullet in my head and to actually be able to imagine the relief that might come with that. I know what it’s like to drive down the road and every tree, light post or bridge I drove past represented a possible end if I would just veer the steering wheel in that direction. It would be over…it would finally be over.
Well, here I am today, eight years removed from that life, healthy and incredibly happy, living a life full of hope, full of truth, full of meaningful relationships and brimming with fulfillment. Habilitat helped me to achieve all of this. I am convinced that if I never stepped foot in that facility I would be existing only as a memory in my tortured parent’s minds with only a headstone to commemorate my miserable life. To say I am eternally and infinitely indebted to Habilitat is a gross understatement. Habilitat remains to be probably the single most profound experience I have ever had. For people like me, Habilitat was my ONLY hope and I didn’t even know it at the time. It would take time and it would take work but the specter of hope would only grow as long as I fed it.
To live free of the handcuffs of drug addiction is remarkably easy once all the hard work is done. To get to that point I had to walk through some dark tunnels filled with mirrors showing me exactly who I was and what I had become. Once my conscience came back it was very hard to look at myself but I had no choice. I was tired of wanting to die. I was tired of being so hopeless and afraid. I was tired of being a source of agony for good people who had no choice in the decisions I made. The change took time and it needed to take time. I needed to confront different aspects of who I had become. I needed to continuously confront my self-doubts and I needed to wage the war between the different characters that now lived within me. I did finally make it through and the biggest surprise to me would be my realization of just how much I had changed and how much strength I had within me. I did have the power to make choices in my life and that I never, ever had to revisit my past again. So what is the ultimate answer, for me at least?
It’s as simple (and as difficult sometimes) as just doing the next right thing. Honesty is the basis of my mental and emotional health. Without secrets there is no conscience to bear guilt and so there is no guilt to promote negative self-esteem, and so there is no negative self-esteem to make the specter of getting high more alluring. I treat myself well, I treat others well, I make my word mean something, I don’t lie, I don’t cheat, I don’t steal and I treasure what I once lost but somehow was lucky to be entrusted again with. Very shortly after leaving Habilitat the most surprising and liberating thing of all was that I almost never, ever thought about getting high. As the years have gone by, those thoughts have faded far, far away. I feel an internal strength where I can say with the utmost conviction that I will never experience those days again. I will always remain a junkie though because my mind will never forget who I was for so many years. That person is still there within reach and just a handful of poor decisions away. I am not worried; I am not worried at all. I return to the place that gave me life every year and I will continue to return every year until my time on this earth is over. I may never know what my true purpose on this earth is but I DO know what it isn’t! I definitely was not made to be a junkie or to die a junkie…
Induction day: January 14 2002
Graduation day: May 17 2004
Another Note from a Proud Graduate
I know its been a while but I just had to drop in and say thanks for everything that you and Habilitat has done for me, yes I still run’um hard Hab. style always in search of some thing better for me and my family and the higher standards of living, I must say that the training that every one receives is a vital part of out every day living, and for myself thats what I choose.
I have been chosen for employee of the month and now employee of the quarter which in the Hospitality Industry is a huge honor and now just got promoted on Friday to head Engineer under my Chief. I was never a people person but because of the situations that I have been placed in there at Habilitat, forced me to step out of my comfort zone and now years later I am reaping the benefits.
I am working at a job that I love in an industry I never thought I would be successful at always learning more improving and challenging myself to do better, the one thing I need to keep in mind always is that I had the “Habilitat” training and that we are truly a step above the so called “Normal People” running circles around them in all aspects of life, I don’t share my past voluntarily but if and when asked I tell them how much of an asshole I was to my family and friends due to the drug abuse, how I did a little time in jail and that what they see in me now is a product of Habilitat, I gotta admit that going through the program was hard but now see that it was what I was lacking in life, simple direction, guidance and a different way of thinking.
There’s one thing that I constantly keep in front of me and will always be real is remembering where I came from, where I been and where I am at now July 25 2005 will be five years since I used drugs and for me is a huge accomplishment and some thing I am proud of once again Jeff thanks to you the staff and all my friends that I still keep in touch with cause we still pull raps lol! thats what friends are for right.. tell the guy’s sitting on the floor that at this point I would give anything to trade places with them dishpan, contract or corner I need a time out seriously… tell the family I said hi and if you git grads planning on coming up to Seattle send them my way see if we can put them to work.
Aloha
Addiction is a choice!
Addiction Is a Choice
By Jeffrey A. Schaler, Ph.D.
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Psychiatric Times October 2002 Vol. XIX Issue 10
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(Please see Counterpoint article by by John H. Halpern, M.D.)
Is addiction a disease, or is it a choice? To think clearly about this question, we need to make a sharp distinction between an activity and its results. Many activities that are not themselves diseases can cause diseases. And a foolish, self-destructive activity is not necessarily a disease.
With those two vital points in mind, we observe a person ingesting some substance: alcohol, nicotine, cocaine or heroin. We have to decide, not whether this pattern of consumption causes disease nor whether it is foolish and self-destructive, but rather whether it is something altogether distinct and separate: Is this pattern of drug consumption itself a disease?
Scientifically, the contention that addiction is a disease is empirically unsupported. Addiction is a behavior and thus clearly intended by the individual person. What is obvious to common sense has been corroborated by pertinent research for years (Table 1).
The person we call an addict always monitors their rate of consumption in relation to relevant circumstances. For example, even in the most desperate, chronic cases, alcoholics never drink all the alcohol they can. They plan ahead, carefully nursing themselves back from the last drinking binge while deliberately preparing for the next one. This is not to say that their conduct is wise, simply that they are in control of what they are doing. Not only is there no evidence that they cannot moderate their drinking, there is clear evidence that they do so, rationally responding to incentives devised by hospital researchers. Again, the evidence supporting this assertion has been known in the scientific community for years (Table 2).
My book Addiction Is a Choice was criticized in a recent review in a British scholarly journal of addiction studies because it states the obvious (Davidson, 2001). According to the reviewer, everyone in the addiction field now knows that addiction is a choice and not a disease, and I am, therefore, “violently pushing against a door which was opened decades ago.” I’m delighted to hear that addiction specialists in Britain are so enlightened and that there is no need for me to argue my case over there.
In the United States, we have not made so much progress. Why do some persist, in the face of all reason and all evidence, in pushing the disease model as the best explanation for addiction?
I conjecture that the answer lies in a fashionable conception of the relation between mind and body. There are several competing philosophical theories about that relation. Let us accept, for the sake of argument, the most extreme “materialist” theory: the psychophysical identity theory. Accordingly, every mental event corresponds to a physical event, because it is a physical event. The relation between mind and the relevant parts of the body is, therefore, like the relation between heat and molecular motion: They are precisely the same thing, observed in two different ways. As it happens, I find this view of the relation between mind and body very congenial.
However, I think it is often accompanied by a serious misunderstanding: the notion that when we find a parallel between physiological processes and mental or personality processes, the physiological process is what is really going on and the mental process is just a passive result of the physical process. What this overlooks is the reality of downward causation, the phenomenon in which an emergent property of a system can govern the position of elements within the system (Campbell, 1974; Sperry, 1969). Thus, the complex, symmetrical, six-pointed design of a snow crystal largely governs the position of each molecule of ice in that crystal.
Hence, there is no theoretical obstacle to acknowledging the fact that thoughts, desires, values and other mental phenomena can dominate bodily functions. Suppose that a man’s mother dies, and he undergoes the agonizing trauma we call unbearable grief. There is no doubt that if we examine this man’s bodily processes we will find many physical changes, among them changes in his blood and stomach chemistry. It would be clearly wrong to say that these bodily changes cause him to be grief-stricken. It would be less misleading to say that his being grief-stricken causes the bodily changes, but this is also not entirely accurate. His knowledge of his mother’s death (interacting with his prior beliefs and values) causes his grief, and his grief has blood-sugar and gastric concomitants, among many others.
There is no dispute that various substances cause physiological changes in the bodies of people who ingest them. There is also no dispute, in principle, that these physiological changes may themselves change with repeated doses, nor that these changes may be correlated with subjective mental states like reward or enjoyment.
I say “in principle” because I suspect that people sometimes tend to run away with these supposed correlations. For example, changes in dopamine levels have often been hypothesized as an integral part of the reward/reinforcement process. Yet research shows that dopamine in the nucleus accumbens does not mediate primary or unconditioned food reward in animals (Aberman and Salamone, 1999; Nowend et al., 2001; Salamone et al., 2001; Salamone et al., 1997). According to Salamone, the theory that drugs of abuse turn on a natural reward system is simplistic and inaccurate: “Dopamine in the nucleus accumbens plays a role in the self-administration of some drugs (i.e., stimulants), but certainly not all” (personal communication, Nov. 26, 2001).
Garris et al. (1999) reached similar conclusions: “Dopamine may therefore be a neural substrate for novelty or reward expectation rather than reward itself.” They concluded:
[T]here is no correlation between continual bar pressing during [intracranial self-stimulation] and increased dopaminergic neurotransmission in the nucleus accumbensåour results are consistent with evidence that the dopaminergic component is not associated with the hedonistic or ‘pleasure’ aspects of rewardåLikewise, the rewarding effects of cocaine do not require dopamine; mice lacking the gene for the dopamine transporter, a major target of cocaine, will self-administer cocaine. However, increased dopamine neurotransmission in the nucleus accumbens shell is seen when rats are transiently exposed to a new environment. The increase in extracellular dopamine quickly returns to normal levels and remains there during continued exploration of the new environmentådopamine release in the nucleus accumbens is related to novelty, predictability or some other aspects of the reward process, rather than to hedonism itself.
Perhaps, then, some people have been too ready to jump to conclusions about specific mechanisms. Be that as it may, chemical rewards have no power to compel–although this notion of compulsion may be a cherished part of clinicians’ folklore. I am rewarded every time I eat chocolate cake, but I often eschew this reward because I feel I ought to watch my weight.
Experience with addiction treatment must surely make us even more dubious about the theory that addiction is a disease. The most popular way of helping people manage their addictive behavior is Alcoholics Anonymous (AA) and its various 12-step offshoots. Many observers have recognized the essentially religious nature of AA. The U.S. courts are increasingly regarding AA as a religious activity. In United States v Seeger (1965), the U.S. Supreme Court stated that the test to be applied as to whether a belief is religious is to enquire whether that belief “occupies a place in the life of its possessor parallel to that filled by the orthodox belief in God” in religions more widely accepted in the United States. This requirement is met by members of AA and other secular programs that help people with addictive behaviors and encourage their members to turn their will and lives over to the care of a supreme being. What kind of disease is this for which the best available treatment is religion (Antze, 1987)? Clinical applications are based on explanations for why the behavior occurs. An activity based on a religious belief masquerading as a clinical form of treatment tells us something about what the activity really is–an ethical, not medical, problem in living.
What passes as clinical treatment for addiction is psychotherapy, which essentially consists of various forms of conversation or rhetoric (Szasz, 1988). One person, the therapist, tries to influence another person, the patient, to change their values and behavior. While the conversation called therapy can be helpful, most of the conversation that occurs in therapy based on the disease model is potentially harmful. This is because the therapist misleads the patient into believing something that is simply untrue–that addiction is a disease, and, therefore, addicts cannot control their behavior. Preaching this falsehood to patients may encourage them to abandon any attempt to take responsibility for their actions.
The treatment of drug effects, at the patient’s request, is well within the domain of medicine, what passes as evidence for the theory that addiction is a disease is merely clinical folklore.
Dr. Schaler teaches at American University’s School of Public Affairs in Washington, D.C., and at Johns Hopkins University in Baltimore. Addiction is a Choice (Open Court Publishers, 2000) is among his published works on addiction.
References
Aberman JE, Salamone JD (1999), Nucleus accumbens dopamine depletions make rats more sensitive to high ratio requirements but do not impair primary food reinforcement. Neuroscience 92(2):545-552.
Antze P (1987), Symbolic action in Alcoholics Anonymous. In: Constructive Drinking: Perspectives on Drink From Anthropology, Douglas M, ed. New York: Cambridge University Press, pp149-181.
Campbell DT (1974), ‘Downward causation’ in hierarchically organized biological systems. In: Studies in the Philosophy of Biology: Reduction and Related Problems, Ayala FJ, Dobzhansky T, eds. London: Macmillan.
Davidson R (2001), Conspiracy, cults and choices. Addiction Research & Theory 9(1):92-92 [book review].
Garris PA, Kilpatrick M, Bunin MA et al. (1999), Dissociation of dopamine release in the nucleus accumbens from intracranial self-stimulation. Nature 398(6722):67-69.
Nowend KL, Arizzi M, Carlson BB, Salamone JD (2001), D1 or D2 antago
nism in nucleus accumbens core or dorsomedial shell suppresses lever pressing for food but leads to compensatory increases in chow consumption. Pharmacol Biochem Behav 69(3-4):373-382.
Salamone JD, Cousins MS, Snyder BJ (1997), Behavioral functions of nucleus accumbens dopamine: empirical and conceptual problems with the anhedonia hypothesis. Neurosci Biobehav Rev 21(3):341-359.
Salamone JD, Wisniecki A, Carlson BB, Correa M (2001), Nucleus accumbens dopamine depletions make animals highly sensitive to high fixed ratio requirements but do not impair primary food reinforcement. Neuroscience 105(4):863-870.
Sperry W (1969), A modified concept of consciousness. Psychol Rev 76(6):532-536.
Szasz TS (1988), The Myth of Psychotherapy: Mental Healing as Religion, Rhetoric, and Repression. Syracuse, N.Y.: Syracuse University Press.
United States v Seeger, 980 US 163 (1965).
Just when we thought we’d seen it all
This morning I received a phone call from a psychologist who will remain anonymous. The call was in reference to a girl who was being released from prison soon to enter Habilitat for treatment.
While incarcerated this girl was being treated for depression and had a case open with a local clinic which evidently serves some of the people in the local jails. They were insisting that we allow their therapist to have access to her throughout her stay here. In other words they wanted to treat her with their therapist at our facility.
When we respectfully told them that wouldn’t be possible they became quite insistent that she was severely mentally ill and needed their brand of help. Now this obviously raised some red flags since we don’t do “severely mentally ill.” It’s out of our realm of expertise.
As we started to follow up it became apparent that their intense desire was only motivated by their inability to get their 3rd party payment for her… not a need to help her at the level she needs. In short, if she came to Habilitat and they were not allowed to continue with their therapy, they were not going to get paid.
The scary thing is that this girl was nearly denied entry to Habilitat because the other agency called us telling us that she had a severe mental illness. This whole incident scared the hell out of me. Why you ask? Well, it seems that our medical establishment is labeling people and making very serious compromises in integrity to ascertain contract funding for people who may or may not be “mentally Ill.”
Since when is an addict coming off dope, in an anhedonic state, considered severely mentally ill. More importantly, what self believe has this poor girl been sentenced to. Now she will come to us and we will have to undo all the bullshit that these damned so-called therapists have done to her belief system. Hey no problem. We are experts at that… but geez… has it really come to that?
Basically they seem to be calling someone crazy just so they can get another bite from the governmental handout. No wonder our country is broke. If you ask me these people should be run out of town. They even helped her to do the work to get into treatment but tried to ruin her chances when they realized they wouldn’t be invited to the party.
This is a sad state of affairs if you ask me. I had some choice words for them but I refrained since my not so “politically correct” mouth would have done nothing but tarnish our reputation. I am frankly tired of people who claim to be in the social services industry only doing what serves their paycheck…. In this business we have a responsibility to do what’s best for the people we serve… If that means we loose a payment then so be it. Make it up elsewhere… But don’t put the client out to the proverbial “mentally ill” pasture just to secure another buck or two. I am really starting to get fed up with all these people that call themselves doctors yet they only serve their own personal motives, MONEY.
What happened to matching client with level of care? These doctors seem to become more and more like prostitutes, willing to turn any trick to secure a few more greenbacks. In fact, I have more respect for the prostitutes. At least they are upfront about what they are selling.
These seedy psycho-want-to-be-academic-pencil-pushing-no-intelligence-having-pretend-social-service-working people suck you in when you are in need and all of a sudden you have gone from bad to worse. Now not only are you coming off a drug habit but now you are also hooked on psychotropics, labeled crazy and led to believe you are “SEVERELY ILL”
My advise to you, be careful! Just because someone has a clinic and calls themselves a doctor doesn’t mean that they know how to help you. Most of them don’t know how to treat addiction and none of them have ever cured single person of anything! Their fix is Labels and Drugs….
My advise to them…. Get the hell out of the people business. You are hurting people!
Update: the girl arrived. She is not mentally ill, nor is she even depressed today. She is happy as hell we got her out of prison though!
