Addiction and Pity

This is post 2 of 3 in a series on how we talk about addiction.

Last week’s post discussed the judgments and generalizations we are all familiar with. Today we turn to pity. Pity toward people with addictions may seem like an improvement over condemnation, but when translated into practice—as in policy and treatment—it usually produces the same results.  

How does pity show up in discussions about substance use or addiction?

·       Labeling someone else’s experiences as “suffering,” as in “suffering from substance use disorder”

·       Not acknowledging that people use substances for pleasure, or

·       Interpreting substance use strictly as a means of coping or self-medicating

·       Assuming that all people with addictions would quit if they could

·       Discussing what someone “needs” (determined by outside authorities) rather than what they want (which they can easily tell you themselves)

Deployments of pity like the above are popular in policy discussions because they make the speaker sound humane and appeal to the audience’s empathy. They are popular in the treatment industry because they cast treatment providers as rescuers who bring relief to the desperate and sick. One contingency, however, to whom it will never appeal: drug user advocates and peer harm reductionists. And if a narrative about any issue alienates some of the most active and engaged people on the scene, something is obviously wrong with that narrative. Not only is pity patronizing; assumptions like the above also directly contradict information that is freely available from drug users and others with lived experience.

People trying to increase access to substance use treatment often use arguments like those listed above. And we certainly do need increased access. But pity reveals itself when exactly the same arguments are used to force people into treatment rather than simply offering it to them. The same proponents named ealier—some policymakers, some providers—score points or make money by herding people into treatment they do not want. Overdose is common after forced treatment, and relapse nearly universal. This is why I do not call arguments like the above “compassion” or “humanity.” The recent executive order “Ending Crime and Disorder on America’s Streets” represents the next inhumane step in our existing policy approach to addiction. That approach, to be explicit, is assuming that people are incompetent to make their own decisions and that they can be forced to change—or at least kept out of sight.

A slogan seems to be trending on social media lately: “Addiction is not a choice.” I understand the intent, similar to arguing that sexuality is not a choice, but many of my clients in substance use treatment would disagree. I once introduced to a treatment group the 12-step saying, “we are not responsible for our disease, but we are responsible for our recovery.” They objected; they felt they were responsible both for developing substance use problems and for dealing with them. Some clients even detailed the choices they made in progressing into addiction, to demonstrate how they indeed saw it as a choice—though maybe one they regretted. Does framing addiction as a choice make someone unworthy of resources, of care, or even of a place on the sidewalk? A lot of people think so, as my clients well know. I believe they owned their choices anyway because they would rather be deprived than pitied.

Coming up next: Addiction and Respectability

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