A few reflections on the treatment of drug and alcohol addiction (DAA) in women, by Juan Gutiérrez, psychologist
The general context: science, morality and treatment
Helping people who have a drug problem is not easy. Not only because of the inherent difficulty of these cases, but also and above all because the health community has not found a solution that deals with the underlying cause of the problem and, through the application of knowledge, creates the conditions necessary to find the path to establish a standard procedure for treatment.
We must be serious about this. There are theories from various perspectives which claim to outline the truth about the causes of DAA. Calling it a bio-psycho-social disease is a convenient catch-all solution that blames multiple factors because of an inability to pinpoint one.
Geneticists and epigeneticists seek to convince us about theories of “predisposition” and, using the map of neural connections (the Human Connectome Project), attempt to establish the theory that the biology of an addict’s neural pathway is distorted because of his or her compulsion and desire to use drugs (the reward pathway).
Addicts suffer from genetic diseases and/ or diseases of the Central Nervous System and have abnormalities anywhere from their genes to their medulla. These considerations (they claim) allow them to say that drug addicts are “ill” without uncovering the cause. Nevertheless, these theoretical propositions continue to be part of scientific research.
We need to be extremely wary about jumping on the bandwagon when it comes to scientific knowledge. Once this has become part of our common vocabulary and thinking, anyone could be labelled as “ill” in a derogatory manner. The same occurred in the past with the terms “leper” or “hysteric” with very real consequences. Telling a drug addict that s/he will be ill for life is a huge mistake from the perspective of knowledge as well as with regards to treatment.
One such comment made by a professional can in fact lead to a behaviour becoming an established feature of an addict’s life, making the problem harder, rather than easier, to solve. This can be seen in another area of community psychiatry in the use of diagnosis (informing the family of a diagnosis of schizophrenia changes for ever the way in which they treat that person).
It was in the 19th century that Claude Bernard introduced to medicine the practice of using laboratory experimentation to establish cures or treatments (before this they merrily dispensed theriac and other such concoctions).
The requirement to use scientific knowledge which finally replaced the Academy of Humanities for doctors, arose from a parting of the ways within scientific discourse in human and concrete terms. It naturally sought to go far beyond medical treatments.
It sought to isolate the moral dimension, the construction of a morality ineffective in alleviating or solving anything, whether it be a symptom or a geometrical physics problem, which was unrelated to the morality of the participants, their concept of Justice, Truth, Destiny, Good and Evil.
It was this that caused Nietzsche to say that God is dead.
It is to say that for Modernity the traditional moral subjectivity which comes from Christian Platonism no longer applies (that there are super-earthly beings that are perfect and eternal, which decide our lives and of which our material world is merely a valueless shadow) and that those who continued thinking in this way after the birth of scientific discourse were, at least, cowards.
In relation to the treatment of addiction, can we dispense with the ideas of destiny, good and evil, wrong and right, justice and injustice? Do we have proof derived from experimental investigations in a laboratory which allow us to dispense with these ideas in treatment and to substitute them with standardised procedures?
The standard process for vaccinating breastfeeding mothers and diets to control insulin for pre-diabetes are examples of the use of modern concepts in treating patients and which, without reference to traditional morality, are effective because they are the result of experimentation; displacing the individual symptom and restoring function, which has been the aim of medicine since Hippocrates.
There are however, diseases that we continue to characterise as unsavoury and immoral and punish with procedures rooted in the Christian ethos (eminently teleological but without the need to be Kantian).
I do not of course think that drug addiction does not cause suffering and an infinite number of problems such as physical deterioration and social isolation, but I try to focus on the treatments that we use:
Are they not an ambiguous mixture of the results of experimentation and social control guided by traditional ideas of morality (good, evil, justice and destiny)?
Do these treatments for drug and alcohol addiction reflect the symptom or notions of destiny and traditional sin?
If we consider the Spanish word RECAIDA, meaning relapse or literally “another fall,” we find connotations of Catholic morality; the notions of heaven and hell, good and evil, the sin of bodily passions, merited punishment, redemption through humility; revealing the remains of an ancient code of ethics within contemporary psychology.
And we are in every way running the risk of becoming a community that is at once secular and ecclesiastic.
The female subject: the new social contract between the individual and civilization regarding the body and pleasure
We take the broad view without any real attempt to seek to isolate any one argument.
We do this without considering the subject of the “war on drugs” nor thinking about its unsavoury origin (with all probability from when the Roman empire converted to Christianity and prohibited “pagan” traditions as heretic and linked to the cult of Satanism).
We look at the issue of femininity and gender from the following angle: What does it mean to be a woman? In my experience there are answers in the standardised treatments that we use.
Hypermodernity or late modernism has brought with it a recapitulation of some of the concepts of traditional morality which we thought had been extinguished by a new ethic of pleasure: a woman is not an inanimate object, for every human: take pleasure whenever you can because life is short (but for this to work you need to lead a well-ordered life).
Here we have a dangerous polarisation: all diversity must be normalised (woman, madness, childhood, delinquency) each different pleasure must fall within the reasonable parameters of a neoliberal society and so you can enjoy whatever you want. A new social contract.
In the face of these new cultural norms, the transformation of the monogamous patriarchal family bears witness to a new form of regulation of social power between the sexes where a woman demands equal treatment and her right to pleasure, just as man has had for at least two millennia (if not more).
Demands are being made for the alteration of the heteronormative pairing, not in the sense of diminishing male power but to give the equivalent to the female, as if she were male.
This does not reduce the rates of femicide or rape. It creates poorer conditions for confronting them.
It is not insignificant that in our contemporary capitalist society (secondary or tertiary thanks to the internet) the majority of economic exchanges are related to drugs (legal or illegal), the pornographic industry and the sale of arms. The goal of pleasure is our law of barbarity.
Within this context, residential treatments take the form of a return to premodern traditional ethics, above all for women.
They must be, first of all attentive mothers, clean, well-behaved, abstinent, controlled by pharmaceuticals (because their reward pathway in the Central Nervous System is abnormal) and any relapse, absence of personal hygiene or aggressive behaviour is punished or, as they say, is “addressed”. The last word speaks for itself.
The danger of this is not that the teams who work as treatment operators believe that they are better people, healthy, disciplined and always right (surely they don’t exhibit themselves the good behaviours and control that they demand from their patients).
I want to highlight another problem.
The ravages of pleasure evident in the histories of modern women are severe but rarely considered in moralising treatments which apply universal, standardised procedures based on ethical pronouncements of how to be a woman.
Current treatment of drug and alcohol addiction seems to be a distillation of industrial-scale ambition with regulated procedures and a catholic moral intension to control.
Amongst intellectuals, femininity has been a great mystery, however at a stroke of a pen the employees of therapeutic communities have the response: capable housewives, workers, attentive, abstinent, and if possible, heterosexual.
Nobody wants to discuss the profound sadomasochism behind drug abuse which echoes traditional male authoritarianism, or of the lone body full of the lethal pleasure of self-absorbed consumption, a drug-induced surrender to psychosis, the impact of the ravages of early sexual experiences, of the woman who loves another and hides it from herself.
These cases tend to be couched within a pseudo-hygienic language and glossed over with CBT.
Let us not forget that the cause has not been found and when it comes to these subjects there is still nobody who has all the answers.
Juan Gutiérrez, Psychologist, Dianova San Bernardo Therapeutic Community