Addictions and self – help Phoebus Zafiridis, Sotiris Lainas Editorial to the scientific journal Society and mental Health, v. 5. 2007 Original article was published in Greek. The epidemiological indices for addiction problems show a huge spread of the phenomenon in all modern western societies during the last decades. A review of the most valid studies on psycho-social problems and their expansion paths, places the dependence on psychoactive substances, both legal and illegal, but also the recent phenomena of nonpharmacological dependencies (internet, gambling, overconsumption, feeding problems) in a primary position.i ii The particularities of addiction problems, its fast expansion and its consequences on multiple levels, have resulted in sedulous studies of this phenomenon by the social and health sciences. The volume of the studies, in the last decades, on causes and ways of dealing with the problem of addiction is enormous. Particularly great is also the number and the multiplicity of the interventions implemented or being implemented in order to offer satisfying answers to the problem. However, despite the overwhelming volume of available information, the constantly growing financial resources and the doubtless increase of investment in the education of specialized staff, no convincing evidence exists to allow for optimistic expectations about the future limitation of addiction problems’ expansion and the improvement of therapy efficiency. On the other side, attempts with extraordinary results, like Synanon in the field of addiction and the program Soteria in the treatment of psychosis, were not adequately studied.iii

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This is due to the fact that the policies adopted by the contemporary western

states in order to deal with psychosocial problems are based on biological/nosological theories, even though their correctness has been questioned.v The paradoxical situation whereby non valid and ineffective theories prevail is interconnected with the broader

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W.H.O., (2001). Mental Health: New Perception, New Hope. Orford, J., (2001). Excessive Appetites: A Psychological View of Addictions. New York: John Wiley and Sons Ltd. iii Zafiridis, Ph., (in press). Pre-constructed Lies and Structural Flaws in the Nosological Model of Addiction iv Mosher, L., (2001). Treating Madness Without Hospitals: Soteria and its succesors. In: Schneider, K., Bugental, J. & Pierson J., (Eds), The Handbook of Humanistic Psychology (pp 389-402). Thousand Oaks, California: Sage v Peele, S. (1991). Diseasing of America. Boston: Houghton Mifflin Company. Ford, G. (1996). Existential model of promoting life change. Journal of Substance Abuse Treatment, 13 (2), pp. 151158. ii

tendency of the scientific research to explore the causes of psychosocial problems exclusively on grounds of individual, biological or psychosocial mechanisms. Yet, disconnecting these problems from the social, political and cultural context within which they are developed constitutes a clear ideological choice, with the “scientific neutrality” serving as an alibi for the spreading and forcing of views and theories selected by political criteria.vi vii viii ix This situation has left its distinctive print in the treatment of addiction, which, outof-context and trapped inside the nosological approach, leads to a monstrosity. During the past one hundred and fifty years we observe the phenomenon of a new pharmaceutical substance emerging with the intention to treat an addiction caused by a previous one. Based on this line of thinking, in 1898 and while the U.S.A. is already confronted with a serious problem with addicts of a series of substances, such as codeine, morphine and cocaine, Bayer medical industry introduces to the market a new promising drug named “heroin”, which, among others, is “indicated” for addiction treatment. The result is a sheer increase in the number of addicts. In the 1950’s, with the discovery of drugs for mental problems a new hope is born in health sciences: that their use will also fight effectively the problem of addiction. We have again a fruitless attempt. In the 1960’s, the first methadone programs begin with the prospect and hope for a definite solution to the problem of addiction from opiate substances. After a decade, Dole and Nyswander, the pioneers of these programs, recognize in their follow-up studies that the treatment of addiction is a much broader process than the simple provision of substitutes.x During the last decade, new opiate substitutes or competitors emerge, based on the reasoning of the pharmaceutical treatment of addiction. The problem remains and increases. The situation is quite similar in the field of non-pharmacological treatments. The upto-date known psychotherapeutic approaches, though helpful in our understanding of certain aspects of Addiction, have not managed to constitute effective suggestions for the

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Zafiridis, Ph. (1992). Drugs: Prohibition, legalization and …trainee wizards. Prosegisi Magazine Zafiridis, Ph., (in press). Pre-constructed Lies and Structural Flaws in the Nosological Model of Addiction viii Albee, G. W. (1998) Fifty years of clinical psychology, Selling our soul to the devil. Applied and Preventive Psychology, 7, 189-194. ix Sarason, S. B. (1981). An asocial psychology and a misdirected clinical psychology. American Psychologist, 36(8), 827 - 836. x Zafiridis, Ph. (1983). Drug addiction: Towards a Free Individual or a New Manipulation? The Methadone Problem. “Anti” Magazine vii

confrontation of the problem.

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What can be observed, is that even the most successful

professional therapeutic programs, do not offer satisfactory results over time.xiii A common axis among all these professional approaches is the incapacity to radically address the problem and the shift of focus from the treatment of its causes to the conservation, harm reduction and – at best - the treatment of the symptom of addiction. This shift, however, is accompanied by the constant augmentation of the problem and the continuous reduction in the effectiveness of the various therapeutic programs. However, apart from the failures, the review also demonstrates suggestions which have produced positive results. In the 1930’s, the first self-help groups of the Alcoholics Anonymous make their appearance. These groups, formed by people with an alcohol addiction problem, introduced a series of innovations in the field of addiction. The enrichment of therapy with the introduction of a spiritual aspect, the notion of mutual help and the mobilization of those directly involved lead the AA groups to a great development in a short period of time. At the end of the 1950’s, Charles Dederich, an ex member of the Alcoholics Anonymous, established in California the commune of Synanon, for drug addicts. This constituted a real breakthrough in the field of drug addiction, since it brought to light very important aspects of the problem and of the proposed ways for its confrontation.xiv Studying the parallel therapeutic attempts by the scientific community on one hand and the directly involved citizens which formed self-help groups on the other, the clear supremacy of the self-help approach is evident.xv xvi This supremacy is probably explained by the fact that self-help mobilizes the directly involved citizens towards undertaking the responsibility to face their problems within a context of collectivity and solidarity. It is exactly this feature of self-help which negates the currently observed passivity in the attitude of the citizens toward health issues. Besides, the fact that self-help groups are selfmanaged and function by their members and for their members, without the presence of

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Kooyman, M. (1993) The therapeutic community for addicts: intimacy, parent involvement and treatment success. Amsterdam/Lisse: Swets & Zeitlinger xii Yablonsky, L. (1994). The Therapeutic Community. New York: Gardner Press. xiii Simpson, D. (1986). 12 year follow up- outcomes of opioid addicts treated in therapeutic communities. In G. DeLeon & J. Ziegenfuss, (Eds.), Therapeutic communities for addictions. Illinois: C. Thomas. xiv See relative article in the present review xv Yates, R., Rawlings, B., (2001). Introduction. In: Yates, R., Rawlings, B., (Eds), Therapeutic Communities for the Treatment of Drug Users. London & Philadelphia: Jessica Kingsley Publishers. xvi Chapel, J. (1997). Alcoholics Anonymous and Narcotics Anonymous in Clinical Practice. In N. Miller, M. Gold & D. Smith (Eds). Manual of Therapeutics for Addictions. New York: Willey.

experts, self-help facilitates the sharing of personal experiences among the participants and the offer of mutual support of a unique quality. Furthermore, other causal mechanisms of Addiction are addressed by the building blocks of the self-help approach. For example, self-help groups or initiatives often address the needs for love, security, collectivity, human relationships, which are fundamental causes of addiction problems. The negation of passivity, the undertaking of responsibility by the directly involved –in contrast with the transfer of responsibility to omniscient experts- as well as the meeting of people who constitute communities of persons and not impersonal “cases” classified in some rigid diagnostic categories, are all determinants of the effectiveness of the self-help groups. Another positive outcome of self-help, least discussed in the scientific world is that the dynamics of the movement, which developed particularly in the last decades, exerted influence and still exerts influence on the discourse and practice of experts. The experience of these groups has influenced not only our knowledge of the problem of addiction, but also our understaind of the helping relationship as well. The spiritual aspect introduced in the therapy of addiction by the AA in 1935 and the following recognition of social pathology as a fundamental cause of addiction problems by the Synanon self-help organization, have altered our knowledge about the nature of addiction and have influenced the professional therapeutic attempts. The effective function of self-help has revoked in practice the traditional model for the provision of help and because of that, it has obliged us all to redefine our role as experts. In any case, self-help is not a panacea. It constitutes an autonomous practicexvii

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with its own ideology, which is also effective in treatment termsxix but not as an additional therapeutic instrument among many others for the problem. This perspective shifts the focus from a technical/instrumental mode of thinking to a broader ideological one. The ideas and principles inherent in the groups greatly exceed the debate on successful or not techniques and they wholly affect the philosophy of addressing addiction problems. Examples such as that of the A.A., the N.A. and Synanon oblige health sciences to distance themselves from their past arrogant stance towards citizens’ initiatives and to show a greater interest in them. Not, however, an “academic” interest in describing and supervising xvii

Bairaktaris, K. (1994). Mental health and social intervention, Athens: Alternative Publication (Enallaktikes Ekdosis) xviii Rappaport, J., (1993). Narrative Studies, Personal Stories, and Identity Transformation in the Mutual Help Context. Journal of Applied Behavioral Science, 29, 239-256. xix th Zafiridis, Ph. (1987). Basic principles of the function of a therapeutic community. 11 Panhellenic Congress of Psychiatry, Athens

these attempts, but rather an interest in cooperation, acquisition of knowledge and, in some cases, education. The phenomenon of addiction is one of the most unworkable problems at present. The contribution of self-help in the confrontation with the problem has been of particular significance. The ideological contributions and innovations of self-help initiatives in the field of addiction are manifold and multilevel. Within this framework, the present issue attempts to open up a discussion in Greece for self-help in addiction treatment, a discussion already intense at the international level.