Canada’s poster-boy is in the news again. Rob Ford “graduated” from a treatment center and is back on center-stage, larger than life (literally). Like most people fresh out of rehab he is full of quick clichés, intended to cast blame and potentially excuse his past behaviour. Don’t get me wrong, I am truly hopeful that this will help him sort out his life but the inconvenient truth is that such efforts rarely produce lasting change without ongoing counseling and accountability. Ford claims that he will see a professional “for the rest of my life” but based on past behaviours this seems unlikely. I am not seeking to be fatalistic, I just happen to have worked at an amazing Addictions Services Centre for years and have watched a few thousand people work through their own addiction issues.

Quitting addiction is tough. It can literally rewire your brain chemistry while damaging your frontal cortex of the brain:
“Fortunately, the brain also has a built-in override system, the frontal cortex. This is the part of the brain that makes a person moral, humane, social and altruistic – in a word, civilized. But the frontal cortex needs regular nurturing. If it’s long-silenced because of abused circuitry, if a person becomes a devotee of the pleasure-pathway, then the civilizing circuits decay.” (from the above article)

You can begin to see the problems. One of the greatest misconceptions about addiction is that anyone can just stop, once and for all. Another is that by quitting your drug of choice you have solved the problem. I remember vividly meeting a pharmacist who was dipping into the opiates at work and mandated to get help. He came to me and proudly announced that he was “no longer addicted”. I asked him why his lips were so puffy. It looked like a Botox appointment gone wrong. He admitted that he had taken to chewing sunflower seeds when he felt cravings. He was eating approximately 5 bags of spits a day. You can see this all the time. One person stops using heroin and instead smokes cannabis from morning til night. Technically they have stopped using, well you can see where I am going with this. Others engage in high-risk behaviours, or masturbate 8 times/day, or play World of Warcraft incessantly. While these are good harm-reduction strategies they do not address the problem.

Stopping addiction is difficult. We are tempted to address the symptom (the drug or habit) while ignoring the root causes. Most people initially begin overusing substances because they are self-medicating their life. Six months into recovery they wonder why they are still craving. It may be that they are craving their medicine. We have taken away the one medication that seemed to work and replaced it with… nothing.

Another misconception that people often have is that certain substances or activities, marijuana for example, are not “addictive”. This is a woeful misunderstanding of the deeper dynamics of addiction. Addiction is not really about alcohol or drugs. You can be addicted to shoes, or porn, or The Real Housewives of Vancouver, if that floats your boat. Addiction is primarily about what happens on a chemical and neurological level. Some people are addicted to dopamine, not drugs. Anything can be addictive because it’s not about the thing, it’s about the response on a chemical level. Certain drugs are, however, “more addictive” than others. Many people report that the very first time they used cocaine they couldn’t get enough. Anyone who has ever struggled with cocaine addiction can tell you that they were addicted to “more”. For some of us there is never enough cocaine. Those same people may feel bloated after two pints of beer and have no difficulty stopping. Put a line of coke in front of them, conversely, and watch them drool.

This is the problem with complete abstinence-based programs. They cherry-pick which chemicals are “bad” while allowing adherents to drink 40 cups of coffee a day and smoke 3 packs of smokes. They do not understand the devious and subtle nature of addiction. Most clinicians agree that substituting one drug for another is an effective harm-reduction strategy. That is why it is important to address ones addictive tendency, not just the crack problem. Addicts often cycle in and out of addictions – Tylenol 1’s or 3’s, Methadone, sleep aids, orgasms, overdoing it at the gym or church, etc. They are taught to deal with the drug, but not their broken life and propensity to make poor choices, again and again. That is why addiction groups strongly advise against romantic engagements for the first year of recovery. Addicts like substituting one addiction for another. Certain addictions are socially acceptable, though still very harmful.

There is also a pervading idea in the world of recovery that addiction must always be attached to abstinence… forever. I can still remember an 18 year old I spoke with who had just been to a recovery event and learned that, in spite of his addiction to pills and his disdain for overdrinking, he must abstain from alcohol for the rest of his life. For the rest of his life. He had no issues with alcohol at all but he was despondent that because of an issue with Oxycontin he would now be condemned to teetotalling the rest of his days. The thought was overwhelming. We talked.

While it may seem that I am disagreeing with myself at some junction I would like to point out the meta-narrative once again. Addiction is about excess in areas we cannot seem to control and which do something to us on a neurological and chemical level to ruin our lives or cause us to act in ways we are not proud of. There is no substantive proof that an adolescent who struggles with opiates will have difficulty with drinking. Some will yell that it is all the same, as I have seemed to indicate. It is, and it isn’t. Many who struggle seems to become addicted to everything. Others do not. I can give dozens of examples of people who are alcoholics who can take prescription medication with no ill effects. Many people who have difficulty with prescription abuse have absolutely no desire to drink to excess. While it is tempting to paint everyone with the same brush, this simply does not hold up in the real world.

Another misconception about addiction is about methodology. AA groups believe in what is called “the disease model”. Rob Ford was obviously at a program that was 12-step based. This philosophy believes that addiction is a terminal disease and there is no escape from it’s clutches. It is important to note that not all addiction research supports this belief (I can just imagine how many emails I am going to get accusing me of slamming AA). I love Alcoholics Anonymous and believe that it can be an effective model for sobriety. Unlike AA fanatics, however, I do not believe that this is the only road to Mecca. I believe is pragmatism – whatever works for you. Methodologies are not sacred but some are better than others.

If you or someone you know is struggling with addiction on any level get help. I cannot express enough how profoundly destructive this life can be. Addiction may, in fact, be the 21st Century plague. Recovery takes an incredible amount of humility, accountability, and hope. Talk to someone. Finding out the real story behind this important struggle may just save a life. Love someone enough to be honest, even if that someone is you.

Things can change. I wish Mr. Ford all the best.