Was Nancy Reagan right? Can we “Just Say No”?
Powerlessness and victimology in substance abuse treatment
In the 1980s, Nancy Reagan’s “Just say no” slogan was making the rounds and amusing drug users worldwide. Although the first lady offered this approach as a way to keep young people from experimenting with drugs in the first place, she hit on something extremely important. Everyone who uses drugs—whether addicted or not—makes choices every day about whether to continue that behavior, and trying to convince people they are powerless is utterly counterproductive.
Twelve steppers might say that addicted people are powerless while they are under the influence of drugs and/or alcohol but are no longer powerless when they abstain, but that’s really not the case either. If complete powerlessness over the lure of the drug were true, alcoholics would take drinks from neighboring tables at a restaurant because they had no control. Dealers would be gunned down in the streets within minutes in order to prevent withdrawal. Everyone has some degree of self-control, and it’s downright silly to think otherwise.
People with addiction issues do not see the subtlety in the powerlessness argument; they see confirmation of their fear that addiction and its accompanying consequences will never end. People tend to believe it without question, and citizens, instructors, doctors, family members, and even government agencies are at least somewhat at fault for it.
I presented a workshop on this subject some time ago and started it with “If you were still in your addiction, and your drug of choice was right in front of you, ready to use, and I was holding a gun to your head telling you I’d shoot you if you put that drug into your body, could you hold yourself back?” The group dismissed the argument, calling it unrealistic, so I tried something else.
“Okay, say the police have just broken down your door and are about to arrest you, but there are some drugs in front of you, could you resist?”
This hidden equation exists in many behaviors—some large and some small--that we think about curtailing. Dieters calculate whether to cheat, and so do adulterers. Child molesters have control of their actions, too. In many cases, we as a people pretend that the ugliness of the behavior proves that it is compulsive. It's so ugly that we can't possibly be choosing it. We have bureaucratized “bad” behavior, and in doing so, we have given it roots. Religious beliefs and community evaluations have taken the place of our own judgment, and behaviors that are accepted and rationalized. “The devil made me do it” is an example of this kind of thinking. “My daddy did it, and they say it’s genetic.” “It’s a disease, and I can’t help myself."
We have become a society of weak-minded people, not because we ARE powerless, but because we BELIEVE we are powerless. It is self-fulfilling prophecy, and it hampers recovery. There's a big difference between not having a choice and believing one has no choice, but the results are the same.
When I first heard the “powerlessness” argument, I imagined a bottle running down the street, chasing after the defenseless drinker, throwing him to the ground, and forcing his mouth open. A heroin user discovers a hypodermic needle plunging itself into her flesh and watches it slink off. Cocaine powder wafts in on the wind and enters the nose of the unsuspecting man watching football. It's just not like that. We argue with ourselves, we justify and rationalize. We make a decision.
It seems fatuitous to me that we want to put the responsibility for addiction outside ourselves. Even our national drug policies make us out to be unwitting victims by cutting off supply, an impossible task. If people believe it is out of their hands, it becomes a self-fulfilling prophecy. It's important that we avoid abdicating personal responsibility for our actions; that burden is what gives us an opportunity for change. If we made a choice in doing it, we can also make a choice in not doing it. It's the very crux of empowerment.
Let me take this one step further. In psychology, strict behaviorists would say that the stimulus (whatever your triggers might be) causes the response (drinking or using drugs). The model was this: S (stimulus) leads to R (response), or SàR. In the late 20th century, cognitive psychologists revolutionized our understanding of learning, saying instead that the brain sees and interprets that stimulus, and the response is imbued with internal and environmental factors, and the model became S-->O-->R, where O is "organism." "Organism" is the contribution of the individual, the processing of information before the response.
This is simplified, obviously, but what I'm getting at is that powerlessness ignores that individual's contribution to learning, and instead relies on straight behaviorism, a framework which is now largely out of vogue in psychological research. A drink on a neighboring table remains undisturbed, and dealers can sell without being gunned down in the streets.
Our old approach to addiction is flawed, and our success rates provide ample evidence of that fact. We aim for 20% success and rarely get it. That's a crime! Good research is being done all the time now, and we will learn much from it someday, but we should also pay attention to what we have known for decades: Believing one can change is essential.
It is difficult to bring change to a task like ours. People are understandably uncomfortable with transitions, but change we must if we want to figure out how to overcome addictions more effectively.
¡Viva la Revolucion!
Check out this oldie but goodie: The Little Engine That Could
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