The Heart of Addiction

How psychology drives addictive behavior.

Hidden Moralizing About Addiction

Don't put up with being insulted.

People moralize about addiction all the time. They say that folks suffering with addictions are weak, selfish, pleasure-seeking, stupid and on and on. This kind of nonsense is easy to spot. But some moralizing is more subtle. Here are two examples of hidden moralizing that I've gathered from comments made in response to our book "The Sober Truth," which examines the flawed science behind 12-step treatment.

1. "If you aren't doing well in 12-step programs, it's because you haven't worked at it hard enough. You haven't followed the suggestions. You haven't done the steps." People who say these things probably mean well. They have a belief that if you just followed the program, you'd be well. After all, it worked for them. This is the reasoning in the AA slogan: "It works if you work it." However, the slogan is completely untrue, as we showed in our book (12-step programs have a 5-10% success rate, which cannot be attributed to the idea that 90% don't work hard). Saying that people who don't benefit because they're not working hard enough is unconscionable.

Anyone trained in psychotherapy knows that when people don't seem to be "working" at treatment, whether it is psychotherapy or any other therapeutic effort, there are important reasons for that -- reasons that themselves should be explored and understood. These can range from just feeling uncomfortable revealing oneself to strangers, or shame about what brings you to the treatment, to more serious issues. Anxiety about being open with anyone -- stranger or not -- terror about being attacked or abused, fear of exposing hidden parts of oneself, and many other concerns may underlie an apparent lack of motivation. Professionals are trained to be attuned to these deeper factors. Untrained people naturally jump to the conclusion that if you aren't "trying," you're lazy or uncaring.

2. A corollary myth is: "If you haven't walked the walk then you can't criticize." When this is said of people who are critical of 12-step programs, it is a version of the notion that if you don't have the problem yourself, then you can neither understand it nor treat it (a foolish and dangerous idea in itself; imagine seeking treatment for depression only from people who are depressed). But the hidden moralizing arises when this idea is directed at people who have spent a lot of time trying to use the steps without benefit, and as a result are critical of them. These people are sometimes told they don't deserve to criticize because they didn't really "walk the walk." Why? Well, if they had really walked the walk, they would have been helped!

If you suffer with an addiction and haven't been helped by any given approach, try something else. The very poor success rate of 12-step programs tells us that we must be actively seeking other approaches, including harm reduction programs such as HAMS, LifeRing and Smart Recovery, or—for people who are inclined to be introspective about themselves—the approach I described in my first two books, "The Heart of Addiction" and "Breaking Addiction." You might also want to see a professional who can help you work out what makes you fearful or anxious about engaging in treatment. But don't let anybody tell you that the problem is that you just need to work harder. And don't let anyone tell you that you don't have the right to criticize a flawed approach.

Lance Dodes, M.D., is an assistant clinical professor of psychiatry at Harvard Medical School.

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