Despite their limitations, preconceptions, and borderline exploitation, the various recent television reality shows about addiction do shine a bright and dramatic light on two dark, secretive, debilitating and very destructive mental disorders: Substance Abuse and Substance Dependence. Like many, but especially as a clinical and forensic psychologist with almost thirty-five years of dealing with such tragic tales, I still find it simultaneously fascinating and painful to watch shows like Intervention and Celebrity Rehab with "Dr. Drew" Pinsky. I suspect I am not unlike other ambivalent viewers who stop channel-surfing long enough to gawk at the emotional equivalent of a human car wreck. Despite being disturbed, horrified and racked with voyeuristic guilt, we just can't quit watching. Still, part of what makes such programming so compelling is our compassion for the suffering souls we see struggling literally for their lives. And our conscious or unconscious identification with their struggle. In some ways, addiction is an extreme example of an existential challenge we all wrestle with every day: accepting reality as it is. One obvious dynamic of addictive behavior (be it alcohol, licit or illicit drugs, sex, food, internet or television) that I hope viewers are made more aware of by such so-called reality programs is the powerful connection between addiction and the compulsive desire to alter, avoid, deny and escape reality. In this sense, these "reality" shows are, at their best, indeed about learning to confront rather than retreat from reality.
For those who haven't seen or heard of these shows, Intervention dramatically depicts what happens to addicts prior to entering treatment and demonstrates what it takes to get them there. Denial and other chronic behaviors designed to avoid or escape reality are starkly revealed in the addicts predictable and powerful resistance to entering treatment. Celebrity Rehab documents the goings on in an in-patient addiction treatment program catering to so-called celebrities, including the likes of Mackenzie Philips (daughter of musician John Philips), basketball star Dennis Rodman, former Guns 'n Roses drummer Steven Adler, actor Tom Sizemore, and other lesser known or infamous individuals like ex-madam Heidi Fleiss, Rodney King, former teen beauty queen Kari Ann Peniche, and porno performer Mary Carey. The program is supervised by television personality and now celebrity physician "Dr. Drew" Pinsky, M.D., a board certified internist specializing in "addiction medicine": a medical specialty tending (not unlike AA) to conceptualize and treat addictive behavior as a "disease." Dr. Pinsky is a physician, but, to my knowledge, not a psychiatrist, psychologist or trained psychotherapist. And it shows. Still, Dr. Pinsky's heart is clearly in the right place. He is a caring and compassionate physician committed to helping his patients heal. But his lack of psychological sophistication leads to making sometimes cringe-worthy, laughable, dubious and dangerous decisions in his treatment of his difficult and demanding "celebrity" clientele. Unfortunately, "Dr. Drew's" compassion and caring often overcome his ability to be paternally firm and consistent when setting limits for his patients, some of whom act like (and indeed, emotionally are) spoiled, petulant children who won't be told no. Or angry adolescents rebelling against external discipline and authority. Frequently, "Dr. Drew" and his staff make excuses for the residents' bad behavior, blaming it on withdrawal, medication or, more generally, their "disease." This is a serious mistake. It tends to permissively collude in the patient's chronic denial of reality and responsibility. Personal responsibility, a fundamental part of accepting reality and adulthood, is habitually avoided by addicts. And this bad habit must be broken if recovery and sobriety is to succeed.
Of course chronic intoxication and withdrawal from drugs influence one's feelings, perceptions, judgment and actions. But does that make the person not responsible or accountable for his or her conduct? Under California law, for example, the courts specifically exclude intoxication and addiction in and of itself from the legal criteria for a plea of Not Guilty by Reason of Insanity, which would stipulate that the defendant was not legally responsible for his or her actions due to their state of mind at the time the crime (or crimes) were committed. There is considerable wisdom in this statute. Existentially speaking, there are always choices available to someone even in the throes of addiction, whether it be alcohol, drug or sex addiction. And it is crucial to his or her psychotherapeutic treatment that full responsibility be taken for those typically self-destructive choices. Such choices start with the self-defeating decision to either continue to feed the addiction or, more constructively, to seek assistance of the sort offered by Twelve Step groups or Dr. Pinsky's Pasadena Recovery Center and so many others like it. The addict may not have the power to say "no" to the substance or behavior yet. But they do have the power to say "yes" to getting help, a point made quite clear by Intervention.
The fact is that addiction, by definition, is a psychiatric, psychological or mental disorder first, and a biological or physiological illness second. The recovery movement and "Dr. Drew's" own dogmatic conceptualization of addiction as a primarily biologically-based disease, is a significant part of the problem he and others have in effectively treating such patients. Addiction, be it to alcohol, cannabis, sex or porno, is not a biological disease like diabetes or leukemia. Patients may, in some cases, inherit a genetic, temperamental predisposition to the tendencies that make one susceptible to addiction. But that is not what makes them an addict. More than anything else, addiction is about denial of reality. It is, like depression, nonetheless a debilitating and potentially deadly psychiatric syndrome. People do suffer and die from addiction. And that these patients are severely ill, especially in the advanced stages of addiction and during withdrawal, cannot be denied. But that does not make addiction a biological "disease" per se. For, as AA has long rightly recognized thanks to psychiatrist Carl Jung's influence on its founder, alcoholism and other addictions are at least as much sicknesses of the soul, psyche or spirit as of the physical body and brain.
