27 Sep Addiction Treatment: Tough Love or Torture?
The prevailing opinion in addiction treatment has long been that tough love is often necessary to get an addict to first admit to having a problem and then to beat a way to sobriety. By letting an addict hit rock bottom, the idea goes, he will finally be able to emerge from denial and ask for help. Underlying this foundation of many methods of addiction treatment is the belief that addicts are weak-willed, unable to help themselves, and morally inferior to the rest of us.
In recent decades, new ideas about how to best help addicts, especially those who abuse drugs or alcohol, have been developed by therapists, counselors, and other addiction specialists. These take a turn away from the idea of tough love and instead consider the idea of compassionate care and even harm reduction. Changing the traditional order is never easy, but proponents of showing kindness rather than toughness are working hard to do so. Unfortunately, in some places, the tough love treatment has been taken to extremes. Human Rights Watch (HRW), an international organization that works to protect and defend human rights around the world, issued a report showing that drug addiction treatment centers in Asia were actually torturing patients and forcing them to do hard labor, all in the name of a cure. The United Nations has called on these centers, which are found in Vietnam, China, Cambodia, Thailand, Laos, and Malaysia, to be closed, but that has not yet happened.
Many of the inmates locked up in these so-called treatment centers are homeless addicts who have been rounded up by police and forced into custody. Because of their addiction, these unfortunate people can be detained indefinitely with no right to a trial or to make an appeal. Children are often included in the centers and are confined with the adults, which leads to abuses.
Because the addicts provide a cheap or sometimes free source of labor, there is virtually no incentive to shut down these prisons. In Vietnam, many centers force addicts to work at the grueling job of husking and skinning cashews. The oil from the husk is caustic and causes burns on the hands. The dust from the skins causes respiratory problems, and the work goes on for between six and ten hours each day. According to eyewitness accounts, when the detainees refuse to work, they are beaten or sent to solitary confinement.
In the U.S., many still believe that tough love leads to successful addiction treatment, but the evidence does not support this. Researchers have found that such methods can create traumatic experiences that actually increase the chances of relapse. Although not as severe as the examples in Asia, there are treatment centers in the U.S. that take tough love to questionable levels. These include the ever-popular "boot camp" style of treatment, which is also used for fitness and weight loss. Some of these institutions for addiction have been found to include some form of forced labor, beatings, extreme exercise, and sleep and food deprivation.
After the circulation of an incriminating video, two police officers running a boot camp for troubled teens in California were investigated. In the video, the young people were forced to drink water until they threw it back up and were made to exercise excessively and past their abilities. All the while, the instructors were taunting and screaming at the teens. Similar programs exist across the country, and in general people believe that this sort of tough love, although not necessarily the extremes seen in the video, are helpful and keep kids from falling deeper into addiction.
The political response to the California incident has been to legislate regulation of these camps for troubled teens at the state level. There is no federal regulation of such treatment centers. California is not the only state in which tough love has turned into torture. Teens have actually died in these programs. These deaths number in the dozens and have occurred in Maryland, South Dakota, and Florida. In addition to the deaths, other abuse scandals have erupted.
The addiction prisons in Asia may represent an extreme example, but boot camps in the U.S. are hardly better. In Asia, the police take addicts off the streets and force them into treatment. In the U.S., entrance into these facilities is not terribly different. When addicts are arrested for drug offenses, they are often sentenced by the court to attend tough love treatment centers.
Until the general attitude about addiction and how best to treat it as a disease changes, these facilities will continue to exist behind a façade of helping people realize and defeat their weak natures.
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