Wednesday, March 9, 2011

In Defense of Charlie Sheen

By Andrew Tatarsky, PhD

Charlie Sheen has been making outrageous-sounding claims about his treatment for substance
abuse that fly in the face of conventional wisdom. But is he wrong?

On NBC’s Today Show, Mr. Sheen declared that he has cured himself of his addiction. On CNN’s Piers Morgan Tonight, Mr. Sheen went further saying, "I don't believe myself to be an addict. I think that I just ignore or smash or finally dismiss a model that I think is rooted in vintage balderdash.”

He has also rejected Alcoholics Anonymous, the icon whose principles dominate addiction treatment in this country, calling AA’s approach “fiction” and pointing to its "5% success rate." After 22 years of addiction treatment, Sheen turned to self-help at what he called the”Sober Lodge”-- his own home.

"I close my eyes and make it so with the power of my mind,,’ he told a reporter. Is he delusional, setting himself up for a big relapse?

Mr. Sheen has had a long history of problematic substance use and related difficulties. Many of his public statements seem deliberately in-your-face. I have never met and evaluated Mr. Sheen and it would be irresponsible to comment on how true his statements about addiction and change are for him. But regardless of what you think about Mr. Sheen's provocative and sometimes destructive words, behavior and lifestyle choices, he is correct in challenging the prevailing wisdom about drug and alcohol addiction and its treatment.

A growing number of addiction treatment specialists and researchers agree with Mr. Sheen on two points: the traditional disease concept of addiction and the related "abstinence-only" ideology are not in line with contemporary thinking about addictive behavior and its treatment.

Many practitioners no longer believe that total abstinence is the only way to deal with drug and alcohol problems. Yet this extreme position has been the prevailing view since Emil Jellinek postulated a disease model for addiction treatment in 1946, basing his findings on a survey taken by Alcoholics Anonymous of its members. At the time, the disease model was a significant improvement from the previous prevailing view—that people with drug and alcohol problems were moral degenerates. For a great many people, the disease approach has been very helpful in countering the shame that can accompany serious substance use problems.

But this one size-fits-all treatment ignores the personal and social complexity related to problem drug and alcohol use and can actually set people up for failure. In fact, people can emerge from severe substance use problems with a variety of outcomes. They may drink or use drugs in moderation or not at all. They might abstain from drug use but drink occasionally. They may reach this new way of being without any treatment at all.

Charlie Sheen is correct about this: AA fails far more often than it helps, and may actually subvert other treatments that would be more effective. In a 2009 survey, The National Institute on Drug Abuse estimated 22.5 million persons (8.9 percent of the population aged 12 or older) were classified with substance dependence or abuse in the past year. Of these only 2.6 million (1.0 percent of persons or 11.2 percent of those who needed treatment) received treatment at a specialty facility. Typically, only 15-35 % of patients complete treatment and even smaller numbers actually maintain abstinence when they do complete. A major study in 1996 by the National Institute on Alcoholism and Alcohol Abuse (NIAAA) found that 70 percent of people who received treatment for alcohol dependence returned to drinking “alcoholically,” and the remaining 30%--the success stories—were split equally between abstainers and people who had “cured themselves”and drank in moderation

Despite their limitations, A.A.type programs clearly do work-- and have been lifesaving-- for many people. But the data suggests they don’t work for everyone, not even for most people. There is strong evidence that suggests that the best predictor of success is a good fit between the patient’s goals, needs and strengths and the treatment approach and provider. Many people with severe substance use problems benefit from non-abstinence, non-12-step approaches such as Motivational Interviewing, Cognitive-Behavioral Therapy, Harm Reduction Psychotherapy with the emphasis on therapeutic alliance and Psychodynamic Therapy. There are also many self-empowering groups with abstinence and moderation goals in addition to AA that have been around for a long time and have many dedicated, successful members. Listed in order of longevity they include Women for Sobriety (founded 1976), Secular Organizations for Sobriety, Moderation Management (founded 1994), SMART Recovery and LifeRing Secular Recovery (founded 1999).

Mr. Sheen may or may not be one of those that can sustain his positive change without treatment. But he like millions of others with mild to very severe substance use problems should never be told that there is only one path to healing, growth and positive change.

Mr. Sheen’s substance use problems may reflect difficulties with anger, defiance of other’s attempts to control him, grandiosity and omnipotence, attempts to manage the stresses and strains of celebrity and many other possible meanings that only he and a good therapist can ever really know.

Andrew Tatarsky is a clinical psychologist, Author of Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems; Founding Board Member and Past President, Division on Addiction, New York State Psychological Association; Chair of the Board, Moderation Management Network, Inc.

1 comment:

lillian_anastos said...

This was a great article. You are a visionary among th herd.

Lili Anastos