Response to Johann Hari’s TED Talk on Addiction

This is a guest blog post from Doug Chaudron:

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British journalist Johann Hari recently gave a TED talk, provocatively titled “Everything you think you know about addiction is wrong.” See the 15-minute talk, and find Hari’s biography, at http://tinyurl.com/o5kp779.

Some key points made by Mr. Hari in his talk include these: Current approaches to treatment don’t seem to work well; taking “addictive” drugs doesn’t always result in addiction; rats given appealing alternatives to drug use rarely become drug users; creating social connectedness and opportunities might work better than punishing addicts.

The speech is quite engaging, and for me depressing. The depressing part is that the research (e.g., Alexander’s Rat Park) and the conceptual alternatives he discusses have been well known in the addictions business for decades. So, there is nothing new here, and it’s depressing to learn that the speaker, and TED Talks organizers, thought that this was news. It’s not news at all. At the time of my retirement from Toronto’s Centre for Addiction and Mental Health, in 1999, Rat Park and related conceptual alternatives had been discussed for about 20 years.

Equally, even more, depressing is that the concepts have not “penetrated” the addiction-treatment industry. For an equal number of decades, research has shown that: shorter treatment is as effective as, or more effective than, longer treatment; outpatient treatment is as effective as, or more effective than, inpatient treatment; treatment by modestly-trained counselors is as effective as, or more effective than, treatment by heavily-trained experts; and brief interventions are as effective as, or more effective than, extensive and intensive interventions. But the treatment industry continues to prescribe long-term, intensive, inpatient treatment delivered by highly-trained experts.

I therefore wish that Mr. Hari would stop worrying about finding a new understanding of addiction (at which he has not succeeded), and instead worry about why the best information is not being used. As it turns out, there has been research on this issue. Of course there is the inertia of ideology, but research also leads to the discovery that the less-effective forms of treatment involve the making of more MONEY by their providers than the proven alternatives. Surprise, surprise…