Maia Szalavitz on the toxic "cult" of tough love that's shaped addiction recovery for decades.
What do you get when you humiliate and impose powerlessness? A literal and figurative cult that can be deadly.
It’s actually amazing to consider how thoroughly our culture has been infused with the notion that recovery from addiction requires great suffering. And it’s not just the addict who must hit rock bottom, then run the gauntlet of psychic humiliations to atone (powerlessness, etc). Their loved ones must suffer too. In addition to watching their family member struggle, parents, siblings, and friends must mete out “tough love.” Giving the addict money, or a safe place to stay—it prolongs their disease and the truly compassionate act is to shut your door.
Addiction and drug policy journalist (and lone ray of light in the New York Times’ drug coverage) Maia Szalavitz recently wrote an article busting the myth of “co-dependency,” which posits that family members enable the addict when they help and support them.
We spoke with Szalavitz about the role of AA in shaping the recovery narrative, how the literal cult of Synanon, formed in response to concerns that AA was too lenient, has shaped recovery for decades, and alternative approaches to “tough love.” As it turns out, listening to someone in pain is better than screaming at them. The conversation has been edited for length and clarity.
Tana: Where does the idea that you have to let loved ones hit “rock bottom” before they can get better come from?
Maia: It’s a misinterpretation of the 12-step model. If you actually read AA literature, they talk very early on about the existence of alcoholics with, “two cars in the garage!” Meaning that they hadn’t lost everything. But there’s this idea that no one would want to take inventory, make amends, until they absolutely had to—until they hit rock bottom.
There are so many mythologies encapsulated in that. So what you see is this idea first of all that you must be driven by the lash because alcoholism and addiction is so much fun that if you weren't driven by a lash you’d keep living that way forever.
There's also the idea that to recover you have to go through an even greater ordeal than your addiction. Recovery must be challenging. It must be as tough as possible to get better. If you wanted to find a way to get people to avoid treatment, that would be it: “It’s going to be horrible, difficult, as hard as possible.” So then you get a great “success rate” for AA, because only the most motivated stick it out, while others drop out or seek alternatives. Then when they say, rehabs that use 12-step have an 80% success rate — well you’re talking about a population that self-selected to endure these methods. The real success rate is far closer to rates of recovery with no treatment at all.
Where does the idea of “tough love” come from? That relatives and friends must facilitate the “rock bottom” necessary to get people to endure the difficult work of recovery?
That comes from Al-Anon, the idea that relatives and friends form a “codependent” relationship with the addicted person and enable them to continue their behavior. And if they stop enabling, their loved one will recover.
It’s a major paradox: Al-Anon tells you that you didn’t cause the addiction and that you can’t control or cure it. At the same time, the program posits that you’re driving the loved one’s addiction by enabling. Both can’t be true.
People in Al-Anon will say, it’s not about helping the person with addiction get better, it’s to get relatives to recover from their own problems. And that’s not a bad thing! But it’s also difficult for families to keep it straight. “You can’t fix it! But stop enabling!”
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