On Accepting Addicts Where They Are

Simon and James are brothers who’ve done virtually everything together, including drugs. They have even entered rehab together three times, though three times they’ve failed. Although the Missourian brothers were raised in the church by a deeply religious family, they fell into substance abuse at the ages of 17 and 19. Their family had little understanding of the kinds of places and people their sons eventually chose to surround themselves with once the drugs had taken over, and from their perspective, drugs were about sin and the rejection of God.

It was true that neither Simon nor James still felt that swelling, heart-warming feeling of connection and unity with God they’d come to know as children. From a very young age, they’d happily attended Bible camp and James had even been a youth leader. But neither had done anything so clear-cut as rejecting their faith, and they both carried a great deal of shame and guilt surrounding their heroin use.

The reality that recovery was difficult for them was not surprising to any of the clinicians they’d met in treatment. Even people who come from religious backgrounds can become addicts. And even people with close family connections can become addicts. But, sadly, most of the people who struggle with severe addiction will fail to respond successfully to recovery in the long term. This does not mean there is no hope, but it does challenge us—those of us who work with addicts, and those of us who love and care about someone who is addicted—to accept them where they are.

The Uncomfortable Truth About Addiction

Dr. Gabor Maté, a Canadian physician, author and addiction expert, has written extensively about the experience of those who work with people suffering severe addiction. In his often confessional narratives, he combines a deep compassion for the addict experience with hard truths about the reality of relapse. In his 2008 book, In the Realm of Hungry Ghosts: Close Encounters with Addiction, Maté wrote: “We may (and do) hope that people can be liberated from the demons that haunt them and work to encourage them in that direction, but we don’t fantasize that such psychological exorcism can be forced on anyone. The uncomfortable truth is that most of our clients will remain addicts who are on the wrong side of the law as it now stands.”

Sadly, the prospect of total recovery for severe addiction is low. It is believed that somewhere between 60 percent and 90 percent of people who enter rehab for drug and alcohol addiction will relapse within the first year. The success rate goes up in each consecutive year after relapse, however, and there are many who successfully complete treatment—either the first or the fifth time—never to use again.

Addiction Is Not About Willpower

If addiction were simply about willpower, the relapse rates would not be so high. The expertise of clinicians and the quality of treatment modalities available today are unprecedented. As any addict will tell you, no one would willingly choose to be an addict. The consequences are too devastating. We must keep in mind that addiction is about anesthetizing underlying emotional pain. As Maté explains, “The first question—always—is not ‘Why the addiction?’ but ‘Why the pain?’ ”

Every one of us, addict or not, can empathize with emotional pain; it is simply part of the human experience. We don’t all choose drugs or alcohol to escape, but most of us choose something—TV, brownies, a relationship. The more able we are to see ourselves in the addict’s shoes, the more accepting we will be—not of the addictive behaviors but of the person who struggles with them. And this kind of acceptance is believed to be a shaping force for those who do go on to succeed.

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