This piece originally appeared in Vice.
Marc Lewis traveled the long, tenebrous road of opiate addiction, but he emerged out the rabbit hole a neuroscientist, science writer, and author. His best-selling memoir, Memoirs of an Addicted Brain, chronicled his descent into substance abuse, splicing the narrative with neuroscientific lessons about the brain’s reaction to each chemical. His latest literary endeavor, The Biology of Desire: Why Addiction Is Not a Disease, asserts labeling addiction a disease is not only specious, it’s downright harmful. VICE caught up with the University of Toronto Professor Emeritus, and current faculty member at Radboud University in Nijmegen, Netherlands, via Skype.
VICE: You’re critical of the rehab industry because, according to you, it pulls addicts in under the ruse of medical treatment. However, it offers little more than 12 steps and pep talks. You’ve called it a canard. Can you elaborate?
Marc Lewis: I don’t see it as an evil conspiracy, exactly, but it depends where you are. In the US, there are a lot of violations, a lot of improprieties. Treatment is inadequate. Opiate substitution doses are wrong; the period of time for getting off it is often wrong. Individual care is lacking. They have generic policies, which often don’t benefit people, and the medical care is a fairly small aspect of the program in general. Eighty to 90 percent of the program is dominated by 12-step methodology. You also throw in a whole bunch of group sessions, in which people are lectured on anything from how to stop making excuses to all sorts of hodgepodge rants. For some people, it can work, because they get them out of their environment and drugs, so they dry out. But it doesn’t work for long because they go back to their environments, and all the triggers are there. They don’t get the psychological skills addicts need to move on. What you do need is a number of skills: They have to self-regulate and be conscious in order to put their lives into perspective.
I’ve never been to rehab, so I don’t know much about the ways in which they treat patients. Do they claim their methods are predicated upon medicinal practices, and why do some rehab centers charge exorbitant sums of money for treatment?
That’s exactly the point. When you get to the upper end, $50,000 to $100,000 for a month, you’re basically paying for five-star luxury treatment. I know people who have done that and they’re getting gourmet meals, over a Pacific Ocean view, and foot massages. The nuts and bolts of treatment doesn’t cost that much. You’re also paying for the time, the doctors and other professionals. But a lot of people running rehabs are under-skilled, recovered addicts who got a crash course. They’re unregulated and unsupervised. It’s a big mess. If you don’t pay a large amount, there are state-run rehabs, but often there are waiting lists and other compromises that you need to go through. The waiting period itself can be a real problem because people are often willing to (get sober) within a small window. But that window closes, so timing is also important.
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