Submission: April 04, 2017; Published: April 07, 2017
*Corresponding author: Johann Hari, University of Scranton, Jefferson & Linden Streets Scranton, PA 18510, USA, Tel:570.815.7024 ; Email: email@example.com
How to cite this article: Susie A, Siobhan M, Sam C, Cayce W , Brian E B. Substance Use and Mental Health Treatment Retention among Young Adults. Glob J Add & Rehab Med. 2017; 1(3): 555564. DOI:10.19080/GJARM.2017.01.555565
Although I have never met him, I am an unabashed fan of Johann Hari. Last year, while preparing to teach a graduate school class in Addiction at my university, I ran across the June 2015 TED Talk by Hari titled, “Everything You Know about Addiction is wrong.” I was fascinated and after watching the 14 minute presentation, stunned, delighted, and frankly liberated. He uttered a phrase that sent me reeling: “The opposite of addiction is not sobriety; the opposite of addiction is connection.”
It is clear that Hari is speaking here not just of intimate human bonds of attachment and affection, although these are central to his argument. People are also connected to one another, to their society, to families, neighborhoods, organizations, to their nation, to a sense of meaning and purpose, to a higher calling and sense of how they “fit” in the world. A sense of connectedness is relational, motivating, and deeply spiritual. It is inherent in the ways we are built as social beings. All these meanings flashed in front of me as I heard that pregnant phrase, and it sent me on my own journey of revisioning addiction for myself, my clients, and my students. This new frame of reference liberated me to explore.
Let me take a step back and explain. I have been a professor of counseling and human services for over twenty-five years and throughout that time I have been privileged to know and work alongside some of the brightest lights in the field of Addiction Studies: Ernie Kurtz, William Miller, Stephanie Brown, William White, George Vaillant, Bruce Alexander, Tom McGovern, and many others. I have kept up-to-date with trends and changes in the literature and practice of counseling with addicts. I shared what I learned freely and continue to do so. But, this phrasing was so straightforward and apt that it left me breathless. In retrospect, it framed the insight that I had been waiting for.
And so, when less than a year later Hari’s book, Chasing the scream: The first and last days of the war on drugs Bloomsbury  made its appearance, I bought it quickly and gobbled it up. The book documents his journey into the depths of our Americanand global history with the war on drugs and tells, through the stories of seminal characters in that drama, a potent narrative of why the drug war has failed and how we might do better. It confirmed some of what I knew and taught me even more. Here was a journalist at the top of his craft reviewing and assessing the best information available. His interview subjects were well-chosen and the interviews themselves were revealing.
Throughout the TEDTalk and the book, Hari conveys some real affection for the main characters that challenge our own thinking about addiction. His portrait of Bruce K. Alexander, the Canadian research scientist who first designed Rat Park, is full of insight and suggests the gentility and erudition of the man. The description of Dr. Gabor Mate, physician to the “hungry ghosts” of Vancouver’s addicted underworld, makes a powerful case for the influence of trauma and childhood adversity on the development of addiction. His brief discussion of Professor Ronald Siegel’s career-long studies of buzzing cows, tripping bees, and loco horses, and the ubiquity of intoxication in the animal world, is delightful and inspiring .
I have spoken about these insights to any who would listen, including my students. I am currently writing a book, Tending Hungry Hearts: A Vital New Clue to Unlocking the Secrets of Addiction, which takes its inspiration from Hari and the many figures he describes. This has been a fruitful exploration for me and its benefits are not yet complete.
So, imagine my consternation, reading Andrew Dobbs’ essay, published in that same year in The Fix, “Four things Johann Hari gets wrong about addiction – Updated with a response from Hari.” Dobbs resides in Austin, Texas and describes himself as an “environmental organizer and active Austin citizen,” but at least on his twitter account he seems to be more of a blogger and polemicist. His website is full of critical postings about a number of people he deems to be less than authentic or undeserving, over-inflated or pompous. He clearly misunderstands Hari’s work, it seems to me, and rather than inviting a dialog chooses the easier and softer path of glib criticism .
His target in the essay I read in The Fix was Hari. As most
know, The Fix is one of the “world’s leading websites about
addiction and recovery.” It contains investigative interviews,
essays, lifestyle and cultural resources as well as blogs and letters
on sober living. Dobbs’ critique appeared on July 29, 2015 and
begins with the acerbic subtitle: “Outed as a lying plagiarist in
the UK, the disgraced journalist Johann Hari has remade himself
as an addiction expert. Or has he?” Clearly, the author views Hari
differently from me. More about that later.
Dobbs has four complaints about Hari’s work, although
reading his essay gives me the distinct impression that Dobbs
is commenting more about his own willful mis-reading of Hari’s
views. Dobbs seems to have pre-judged Hari — here’s where the
“lying plagiarist” bias becomes important — and reads Hari’s
work with a bee in his bonnet.
Dobbs accuses Hari of emphasizing “social isolation” as the
cause of addiction to the detriment of any biological or physical
impact from the drugs themselves. Dobbs makes his own point
of view clear when he states that “the determining factor [in
addiction] is almost certainly physical and/or genetic” and “not
merely a yearning for loving kindness that only a latte can fill.”
Ouch! This is at the same time an over-statement and a somewhat
Dobbs offers no evidence for his biologist model of addiction
and seems to have little understanding of the long historical
competition among models that offer up various culprits as the
cause of addiction (genes, allergies, personality, choices, disease,
vulnerabilities of various kinds, etc.). If one is so sure that
biology plays the determinative role, then nothing else is good
enough. In this way Dobbs repackages the tired, decades-long
battle among addiction models and takes the side of physicalist
views. Fine But, he also paints a straw man version of Hari that
is both misleading and unfair, as Hari’s response later points out.
Drawing distinctions is one thing. Painting (smearing?) with an
overly broad brush is quite another.
Throughout his various presentations Hari is at pains
to present a respectful and multi-causal view of addiction.
However, when championing a subjugated minority view like the
sociocultural one – social dislocation is a sociological concept –
he has chosen to present a “strong case” version, selecting social
dislocation, fragmentation of meaning, and connection as his
main protagonists. Warm latte indeed! The dominant majority
view – addiction as disease – needs to be challenged; this is
how science progresses with consideration given to new and
alternative data. Biological realities are clearly involved, but
other factors may be just as important. The reader will get none
of this from Dobbs, however. Biology is his strong man here .
Dobbs’ essay takes issue with Hari’s criticisms of
interventions from friends and family members, and in particular
references the popular “reality television” show Intervention.
Dobbs makes two points. First, addiction is a “disease,” hesays, which also infects the addicts’ loved ones and persists
through their “enabling” of the addict. Intervention, then, is a
procedure intended to help those closest to the addict liberate
themselves from the disease. If that requires threatening family
members’ connections to the addict, so that she or he goes to
treatment, so be it. Second, Dobbs derides Hari’s offer of deeper
companionship to the addict, as opposed to threatening, and
suggests that the offer sets people up for being manipulated by
the unscrupulous and selfish addicts in their lives.
This criticism presents a very pejorative view of the addict as
a manipulator with a disease who corrupts those around him or
her. (No word about how a biological disease infects others and
turns them into “enablers.”) This is also not a winning portrait
of the addict’s loved ones who enable sick behavior and need
protection from the addict’s machinations. This view comports
with the old style approach of traditional treatment — the addict
is “diseased” and family members are misguided “enablers” —
and may help to explain the low success rates and revolving
doors of old time treatment.
Even with all this, however, one could have fruitful debates
with many of these points, but clarification is essential. The
treatment literature is pretty clear that “confrontational”
interventions, like the ones that make good television, enjoy
very little real success. Family members are often unable or
unwilling to follow through with the intervention or with the
consequences; addicts go to treatment and then leave “against
medical advice;” addicts are so resentful at the tactics used that
they relapse soon after treatment finishes.
“Invitational” interventions, like the evidence-based ARISE®
program (A Relational Intervention Sequence for Engagement)
of Dr. Judith Landau are better. Everyone benefits when (a) family
members experience success with their efforts to help their
loved one, and (b) the addict goes to treatment and receives a
sufficient dose of medicine (recovery) to be confident of success.
The success rate of ARISE is often around 80% as opposed to the
17% figure of more tradition confrontational interventions.
Dobbs objects to the Hari rhetorical device that I found so
compelling, namely that “the opposite of addiction is connection.”
Dobbs rightly observes that the recovering community utilizes
the power of connection to facilitate recovery and inoculate
against addiction. I agree, and I would add that recovery groups
welcome and nurture addicts as a way to connect with them and
pave the way for healing, while the treatment industry often tells
families NOT to employ the very same strategy. The industry
often conveys that it can do a better job with addicts than friends
or family members. This is not only wrong-headed (who best to
provide an experience of connection?), it is ineffective. It’s a bit
Dobbs’ objection to Hari’s phrasing is that Hariplaces
addiction and connection on opposite poles. To me, it seems that
Hari views a lack of connection as predisposing to addiction and the restoration of connection as the way to recovery. If you are
a bit baffled here, you are not alone. I do not understand Dobbs’
Dobbs saves his major criticism for last, and it is a doozy. He
rehearses Hari’s ethical shortcomings as a journalist, pointing
out the incidences of plagiarism in his past and his use of
pseudonyms to discredit others in his profession. Dobbs then
goes on to assert that Hari has been insufficiently contrite for
these failings and has not utilized the rigorous honesty that is
needed for recovery. Hari is, then, in Dobbs’ estimation someone
whose work on addiction cannot be trusted; Dobbs has taken his
inventory. In addition, Dobbs believes that Hari is still trying to
“plagiarize” the insights of others, namely recovering people, by
claiming that isolation is the root of addiction and connection is
the way home. Even worse, Dobbs believes that Hari is “seeking
a return to journalism on the backs of people too marginalized to
protect themselves,” and reminds us that recovering people, like
Dobbs himself, value honesty above all else. While all this is a bit
self-serving and grandiose — does he really believe that all 23-
plus million of us in recovery are “too marginalized to protect”
ourselves? — It also flies in the face of the facts. Months before
Andrew Dobbs published his essay in The Fix, Hari had given an
extraordinary interview to Decca Aitkenhead that was published
in The Guardian (Jan 2, 2015) and is widely available online.
I do not wish to rehearse here the egregious nature of Hari’s
failings or speculate about the “defects of character” that might
have led to them. Hari himself did so in the interview. I do wish to
point out, however, the honesty and authenticity that permeate
his remarks. First, Hari is at pains to separate his failings from
his own drug use (Provigil). He does not take the convenient out
of blaming his own struggle with addiction for his shortcomings.
He claims his failures straightforwardly and takes responsibility.
A quote might suffice:
“Look... I can talk to you about why what happened in my
life happened. But I just think that’s a way of trying to invite
sympathy, and that would be weaselly. If you tell a detailed
personal story about yourself, you’re inherently asking people to
sympathize with you, and actually I don’t think people should be
sympathetic to me. I’m ashamed of what I did. I did some things
that were really nasty and cruel.”
Toward the end of this long interview, Hari is asked about
the consequences he faced (loss of job, loss of profession) and
the disgrace he continues to endure. Hari makes it clear that
he believes the punishment fits the crime and that he does not
want to talk about the repercussions as a kind of “redemptive
fable.” Fair enough. But I see it differently. Frankly, I’m a sucker
for redemption stories. Hell, my own recovery story certainly fits
into that genre as I suspect do the stories of countless others.
What else is recovery but a story of redemption, writ large? I
can’t get enough of them. And Dobbs is correct: radical honesty
is an absolute requirement. Reading the Guardian interview, I
believe Hari has met that test. And besides, what he is saying
about addiction and recovery is so right that it’s hard to disagree
with. Of course, there will be quibbles about this and that. But
they don’t add up to a serious indictment of Hari’s work. I believe
his insights, and what he has learned during his journey into the
heart of the drug war, will stand the test of time.