The dos and don’ts of helping a drug addict recover | Maia Szalavitz | Big Think

There are people who are trying to promote brain surgery for addiction using electrical stimulation of that area, and it doesn't work any better than methadone. And that's not to say that methadone isn't the most useful drug we currently have, but it does not involve invasive surgery! And I should say methadone and buprenorphine, the opioid agonists, are the best treatments that we have for opioid addiction.

And what they do is two things: the first thing is they cut the death rate by 50 percent, which happens whether you continue using on top or not. So that's like pure harm reduction, and that's wonderful. If we can keep you alive long enough that you stabilize your life, that is a lot better than having you die. The other thing that they do is they allow people (who are ready) to stabilize their lives.

So you couldn't tell right now if I was on a maintenance treatment or not because basically once you get a tolerance to these drugs, you are not high or impaired, and you can drive and you can work and you can love and you can do all of these things. But we don't understand; we think, “oh you’ve just substituted one addiction for another.” No, what you've done is you've substituted compulsive behavior despite negative consequences, and now you just have a physical dependence.

And that's not a real problem as long as you have a safe and legal supply. Well, I think the most important place to start is that addiction is a learning disorder; it's not a sign that you're a bad person. And if you want to have a safe and addiction-free, or at least lower level addiction workplace or school, you want people to feel included and comfortable and safe, and you don't want this to be an adversarial thing.

The research shows that the best way to get people help is through compassion and empathy and support, and absolutely NOT tough love. There may be situations in which an employer has to fire somebody because their performance has just degraded so much that there's no other option, but they shouldn't think, “I’m doing them a favor by firing them, because that will make them hit bottom and it will help them.” Sometimes that happens, but sometimes they just go on to a life of homelessness and then die.

So you can't assume that creating extra-negative consequences is actually going to help a person with addiction. What you want to do is ally yourself with them, and presuming this is an employee that you want to keep, help them realize that this is not a sin. “I am not trying to control you. What I want to do is for you to be at your best; at work, at home. And you're not being at your best right now, so what can we do to help?”

Well, I think the important way to start that conversation is to first not assume that a problem that you think might be drugs is drugs. The person could be having any number of mental illnesses; the person could be having, you know, there's a million things that could look like—oh, you think they have a drug problem—and there's something else going on.

So if you approach the person with respect and not assuming that you're going to find a drug thing; obviously, in some situations, it's completely obvious, but in most situations, it isn't. And so the best way I think is to say, “I’ve noticed XYZ. I'm worried about you. I'm concerned about you. I want to make sure that I can help you.”

So it comes from a place of not like, “I caught you!” you know, because there's so much advice that is just like, “Well, threaten to fire them if they don't change, and drug test them immediately,” and all of this kind of stuff, which destroys trust. So, that's not to say that if somebody is doing something dangerous or clearly inappropriate, that that behavior doesn't need to be addressed, but it is to say that you can approach somebody in a confrontational, degrading, and sort of high-powered manner or you can approach them as an equal human being deserving of respect.

And if you do the latter, you will have much better results. And I have to say it's almost never going to be easy because people, whether they...