Have We Failed Lindsay & Charlie?

I know, I know.  This is not the question that is most on peoples’ minds when it comes to Lindsay Lohan and Charlie Sheen’s well-publicized drug and legal problems.  Instead, the media, their fans, and probably their friends and family too, are more likely to be stewing about how these two gifted but troubled people have failed them – time and time again.  However, as a clinical psychologist with specialties in both addictions and motivational interventions, I have to wonder if this group of people, as well as the addiction and legal professionals, have done enough or have we all failed Lindsay and Charlie in some ways?  This may be especially relevant given that Charlie has begun to reach out to Lindsay with advice, misdirected as it is, about how to deal with some of her problems (http://widget.newsinc.com/fullplayerwvars.html?wid=2172&cid=1252&spid=23327799&freewheel=90075&sitesection=azcentralarticle_ent).

Society may have failed Lindsay & Charlie…

Society (which includes media, fans and people at large, including Lindsay and Charlie’s friends and family) may have failed them because, by and large, it still fails to acknowledge addiction as a disease, which it clearly is based on all of the available science (science that has been conducted in the same rigorous manner as has the science on cancer and other medical problems).  Acknowledging it as a disease leads us to treat the addicted person far differently and better than if we continue to view it as a moral failing or as completely willful bad behavior.  The research also tells us that the more understanding we are of what the affected person is going through, the better their recovery rates.  The main reason for society’s refusal to accept addiction as a disease, I believe, is that many believe that such acceptance would necessarily require that we exonerate all of the addicted person’s bad behavior.  But that’s simply not the case.  Blame and responsibility are separate issues.  Despite not being fully to blame for their addictions (while an oversimplification, it’s part biology, part behavior), they do have full responsibility for doing something about it.  Just like someone who has hypertension, who may have bad genes, and thus is only partly to blame for his condition (the rest of the blame may be attributable to bad choices like creating a stressful home and work environment, failing to exercise regularly or take prescribed medications), he is still fully responsible for getting and sticking to the best treatment available.  So, if we acknowledge addiction as a disease, we will feel and express far more sympathy and compassion for the afflicted (which allows us to be much more effective motivators of change), and at the same time, maintain our expectations that they do what’s best to address their problems.  But what if the best treatment is hard to find?

Addiction professionals may have failed Lindsay & Charlie…

Addiction treatment research, which as mentioned above is conducted in as scientifically sound a manner as research evaluating treatments for other medical diseases, clearly shows that a number of specific evidence-based approaches (e.g., motivational interviewing, cognitive-behavioral therapy, a variety of safe medications to curb cravings and drug/alcohol use, and motivational family interventions) are highly effective (see http://www.drugabuse.gov/PODAT/Principles.html and this New York Times article on motivational interventions at http://www.nytimes.com/2009/08/06/fashion/06intervention.html?_r=1&src=tptw).  Despite this, however, the addiction treatment community at large (which is usually separate from the research world) often does not offer these effective treatments (not even the high-priced ones) and thus may have failed Lindsay and Charlie.  So, when it comes to treatment for an addiction, money may not buy you the best.  This also means that the treatment community may not have taught Lindsay and Charlie’s family members the most effective way to  talk to them about their addictions, which, by the way, is very different from the way you might think would be an effective way to talk to an addicted person.  The reasons for the discrepancy between what science tells us is effective and what treatment providers in the community actually do are many fold and not the topic for this post.  Instead, I think it would be very helpful for all who are concerned about Lindsay and Charlie to ask the tough question: Have they received scientifically-supported treatments or have the professionals failed them too?

The legal system may have failed Lindsay & Charlie…

While I have never been an attorney, judge or probation officer, I do know from the science, as well as from my years of consulting for departments of probation, that when court-ordered conditions are used in conjunction with good addictions treatment, as well as with specialized probation procedures, probationers such as Lindsay and Charlie do far better than when treatment and legal sanctions are not integrated in an evidence-based way.  What the research shows us is that while mandated rehab gets people into treatment, it does not necessarily keep them in it or keep them engaged (i.e., participating and using the good skills they’re learned).  External motivation (i.e., pressure from the court or family) to enter treatment does not last very long.  After it’s gone, the treatment community and the probation officers would do very well to learn and use motivational strategies to harness the patient’s internal motivation – their own, well-defined and deeply personal reasons for change.  While you may want to argue this point, it is clear to me and many other addiction and legal professionals that we cannot expect people like Lindsay and Charlie to change simply because of increasingly serious court conditions.  If the legal system has this mistaken expectation, then it would be relying on a very limited, external source of motivation and ignoring the far more effective, personal incentives for recovery, and then it too may have failed Lindsay and Charlie.

The Bottom Line

So, is the bottom line, “Poor Lindsay and Charlie?”  No.  The bottom line is that while we hold off on blaming (not a helpful way to motivate people who are having a hard time changing) and keep up our expectations of personal responsibility, we should also (and always) look at how we too may have failed and how to reverse course.  This is the only way we, the media, the friends and families, the treaters and the courts will finally provide people like Lindsay and Charlie the things that truly work.

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