Why Addictions Treatment Fails

The rates of success for contemporary addictions treatment are miserable. The vast majority of people who undergo it, whether at a treatment center or in the so-called recovery movement – AA, NA and their companion abbreviations – fail to improve (though if they keep trying, their chances of success increase). Those who enroll in a program do about as well as those who do not. Sometimes they do better. In any given attempt, most addicts who try to improve their situation do not achieve success. And within any given year, something like fifty thousand people in North America die of drug and alcohol use. This number does not include deaths from nicotine addiction, which claims the lives of half of all smokers, or from obesity (addiction to unhealthy eating), which will soon be the leading cause of preventable death in North America.

Addiction can be an intractable process. Now consider who succeeds. Sometimes, when I’m working with counselling students and supervisees who work with people on the street, I hear about the clients who, without any kind of treatment or professional intervention, simply stop abusing themselves. Before I closed my own clinical practice to focus on teaching and writing, I heard similar stories many times. I remember one particular tale, from a man who is now an addictions counsellor. He told me that he woke early one morning, thirsty for heroin, and found that he had misplaced his watch. Needing to know if it was late enough to go out for supplies, he turned on the television and checked the time on the ticker of the local news station.

But the ticker showed the date beside the time, and my client realized – suddenly, with a great shock – that four years had gone by since he last knew what year it was. He stopped using at that moment, the moment in which he reached behind the veil of the substance and saw his life disappearing like the wake behind a boat.

Sometimes people just turn a corner, and there is no way to predict or facilitate this. It’s something we talk about at the clinics: the mystery of it, of how suddenly a shift happens inside, as though a part of the self awakens after a long and inconvenient sleep. Recovery strategies don’t seem to play much of a role in this process, nor does empathy or emotional pressure or the exigencies of daily life. Nothing works but readiness, and that readiness is like sunshine: it comes, or it doesn’t.

The most successful treatment programs for addiction require clients to go through a long period of application, in which they are required to demonstrate their commitment to change. In such situations the rates of success are typically quite high; but this has less to do with the effectiveness of treatment than with the demonstrated readiness of clients.

Recovery from addiction is a psychological process, and is not solely – or even primarily – about discontinuing substance use. It does help, and is probably essential, to reduce or stop the use of addictive substances, but use is not all there is to addiction. At heart, addiction is a longing for the experience of being alive, for a felt sense – deep in the body, and in the spirit – of the fundamental vitality and vibrancy of the human condition.

The substance facilitates this vitality, distills it from the background noise and turbulence of daily life, ushers the user away from the quotidian and toward the experience of wonder.

Discovering vitality and vibrancy, and doing so without the facilitation of substance use, is the essence of healing.