Exporting the disease

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Lise Reckee brings a Scandinavian perspective to the debate about the 12-step model

I am writing in support of Stanton Peele’s exceptional wisdom and freedom In rejecting the punish­ment/treatment dichotomy (DDN, April, page 8). Strange as it may seem to English speakers, Stanton Peele´s views on addiction and recovery are not under debate in Scandinavia. Frankly it can be quite confusing to understand the fuss and the controversy so openly expressed in the US and UK.

Long ago when living in Denmark, I used heroin – extensively and often combined with other drugs. I almost died from it. Methadone was available from the general practitioner, who prescribed it to me for almost 15 years – even though no one ever labelled my condition as a disease, or told me what I had was a chronic condition. My physician simply followed the Hippocratic oath, prescribing an opioid and consoling and soothing me. This was not a common attitude among all Danish physicians, but every general practitioner was allowed to decide for themselves whether they wanted to treat addicts or not. No counselling was offered, nor any demands of me changing my lifestyle.

We looked at opiate addictions as bad habits that you were supposed to outgrow. And it may be a surprise for the Americans, but many – including me – did outgrow their addiction. Sadly this was not reflected in scientific reports, as the Danes never really took the issue of ‘recovery’ that seriously. On the other hand, what you would call harm reduction measures were from early on introduced and maintained in Denmark.

Many Danes, once seriously addicted to drugs, are in good job positions today, as we grew up as was expected. This was not a road followed by all of those addicted to drugs, and some were left behind, like everywhere else. Often this was because they were denied the prescription of methadone or other opioids. The Danish perspective changed in the 1990s, when the 12-step movement started to colonise Scandinavia through private entrepreneurs in the form of professional addicts opening private treatment institutions. They claimed that the Danish treatment model had proved to be a failure and pointed out the missing communities of recovering addicts as proof.

At the time I was enrolled at university finishing my masters degree in psychology, and had left my drug and methadone taking days long behind me. Actually I rarely thought or spoke about drugs, but with the fuss in the media from the new ‘recovering addicts’, I became curious and went to a newly established 12-step meeting. There for the first time ever, I learned that I had a chronic disease, and that relapse was to be expected. I did not know the word relapse, and I had certainly never thought of having one. But after a few meetings I started waking up in the middle of the night with panic attacks and the phrase ‘relapse’ on my mind. What if I woke up experiencing an uncontrolled relapse? I reconsidered my desire to attend 12-step meetings because, furthermore, I was told that my ability to control my drinking alcohol proved I did not have ‘the disease’. Not having a deadly disease has given me freedom to do whatever I like for the rest of my life, including using recreational drugs, drinking alcohol, using pain medications for serious pains, hanging out with whomever I like and pursuing a carrier of my own free choice.

The ‘traditional’ view on addiction and recovery is still alive and well in Scandinavia, where most people and many social workers still see drug addiction as a passing phase in life that you can and should outgrow. However, we now struggle with the two disease models imported from the US. The NIDA model embraced mostly by Norwegian physicians results in patients receiving methadone or buprenorphine, and they are told that their medical treatment is permanent – that they will never be able to quit. Some patients have objected and filed cases against the health authorities protesting that they have been denied detox or tapering of their medications, with some even being coerced into taking huge doses of methadone they do not want.

Non-judgmental treatment in Denmark was available in many forms from the ’60s, even though the Danes had no working concept of ‘disease’, but rather defined treatment in the context of social customs or prescribing opioids as a kind of traditional maintenance. Neither concept of ‘addiction as disease’ (AA’s or Nora Volkow’s) has improved treatment quality or rates of success, which have been documented by the national addiction research centre. On the contrary, the disease models have introduced a range of troublesome concepts including the chronic and incurable addict. Harm reduction does NOT depend on a disease theory – quite the opposite, in most cases.

Lise Reckee is a Danish social worker/addiction counsellor, now working in Norway