(:)(:)(:)(:)(:) for Unbroken Brain by Maia Szalavitz (Understanding the snout-based rating system). There are people who think 12-step programs are the only way to treat addiction and then there are people who hate 12-step programs and never the twain shall meet, except in this book. Before she rehabilitated herself and became a journalist, Maia Szalavitz dropped out of Columbia University due to drug addiction, was convicted of drug dealing and remanded to crappy residential treatment.The book is part memoir, part investigative journalism into the worst and best of 12 steps, residential treatment and the harm reduction model of treatment. Maia is clear that 12-step programs saved her life. And Maia is clear that abuse and harm is done in the name of treatment by almost exclusively relying on 12-step programs and “spiritual solutions” as well placing full responsibility on the addict for recovery from what is called a disease.
My most important take away from the book is this: while 12-step groups provide free, structured, self-led support and a spiritual solution that can be a key component of recovery from addiction, they also have some cultural biases and downsides that don’t help every addict hence may not be appropriate for a medical setting.
Honestly I could write a whole book about the questions this book raises (and only partially answers):
- If addiction is a disease, and not a moral failing, why does 12-step culture use so much shame and blame as a technique for getting people to stop?
- If addiction is a spiritual problem with a spiritual solution, how is it also a disease?
- Since doctors and medicine virtually provided no hope for treatment of addiction prior to 12 step, why should we trust them now?
- Follow-up to that question, how has medicine evolved in its treatment of addiction?
- If psychological components of addiction treatment, such as Cognitive Behavioral Therapy (CBT), use thought examination techniques popularized by 12-step groups, why should anyone pay a therapist when they can get it for free?
- How is it ethical for residential treatment centers to charge you or insurance companies a whole lot of money just to send you to free 12 step groups?
- Does it make sense for a medical model to refer you to a “spiritual solution” for what appears to be a disease?
- If addiction IS a disease AND has a spiritual solution, then why is there not a spiritual solution for other diseases?
- Follow up to that questions, and why aren’t medical centers referring you to spiritual solutions for those?
- Are there some personality types that respond better to the radical responsibility model of 12 steps than others?
- How can it be that it is “not my fault” that I’m an addict and “only I can solve it” by doing “my work”?
I think this is going to have to be a multi-part series because I have so many thoughts on every one of these questions. Stay tuned…