Sir, – In his defensive response (June 22nd) to Lara Marlowe’s critical comments on American approaches to the rehabilitation of addicts, JC Durbin presents an image of scientific and policy consensus which is inaccurate.
Addiction therapists, whatever their professional background or geographic location, continue to subscribe to varying models of addiction: one obvious difference being between those who view addiction as disease and those who view addiction as choice.
There is absolutely no evidence to indicate that therapists who see addiction as choice have poorer outcomes than those who subscribe to the disease model; neither is it fair to suggest that those who consider addiction a choice spend their time telling clients to “pull themselves together”. Recent research, which explored treatment providers’ beliefs about disease and choice models, has indicated that “for-profit” treatment providers are more likely to subscribe to disease models than those working in the public health sector.
The suggestion that the World Health Organisation (WHO) is unequivocally supportive of the addiction as disease model is untrue. For instance, WHO abandoned its support for the disease concept of alcoholism during the 1970s and for almost 40 years now has promoted an evidence-based, public health model – which sees alcohol control policies as the primary means of problem prevention, and which sees treatment and rehabilitation as playing a rather modest role in reducing the total burden of alcohol-related problems within society.
Mr Durbin’s claim that addiction counsellors in this country go through the same accreditation process as other medical professionals is wrong; no statutory system for the accreditation and registration of addiction counsellors exists here.
Whether addiction is “epidemic” here, as Mr Durbin claims, is debatable, but I disagree entirely with his suggestion that what we need here is more of America’s “rehab culture”. We would, in my opinion, serve addicts and the country as a whole best by organising existing treatment and rehabilitation services in a more coherent way, not by creating more services and certainly not by importing any more dubious American models of practice in this complex field. – Yours, etc,