There is no way I will regret writing this post!
Anyway, Helen Rittelmeyer has a provocative piece called “The Language of Addiction Takes Over,” which makes a bunch of great points despite an underlying framework I think may be wrong. Some of the great points: “The religious novel is in eclipse, but the recovery memoir has never been more popular. Recovering addicts show up in high-brow shows like Enlightened, middle-brow shows like The West Wing, and low-brow shows like Prison Break, almost always portrayed sympathetically. … The irony is that the aspects of AA that seem to resonate with them are the things they hate about organized religion: the admission of powerlessness, the submission to authority, skepticism about the value of thinking for yourself, the rote repetition of phrases that to an outsider seem vapid, sentimental, or silly.”
But the underlying framework seems to be that “addiction” and addiction-recovery are contemporary constructs which are reducible to underlying unmet religious needs. Addiction is really sin after all. Rittelmeyer comes across as fighting back against the position of e.g. Maia Szalavitz that addiction isn’t really a moral or spiritual issue at all but basically a matter for psychiatry and medicine. (Here’s a good basic article from her.) And I don’t want to go all, “Girls, girls! You’re both pretty!”, but I think things are more complex than either of their perspectives, largely because different people have such different addictions.
These differences aren’t, or aren’t solely, about which substance you use. I’ve related most to an album about crystal meth and a book about liquor and coke. But at the moment–and I’ve been sober for not quite 15 months, so all of this is of course subject to change as I, you know, grow up–I think some people’s addictions are much more like disease than like sin, and vice versa. There are biological, emotional/psychological/psychiatric, moral, and spiritual components to it, and some people’s addictions will have a lot more of one element than another. (I don’t think “moral” and “spiritual” approaches to addiction recovery are necessarily all that similar–moral approaches tend to emphasize willpower while spiritual ones tend to denigrate it, just to take one example.) Therefore if the only addiction treatment you get is religion, it’ll do badly with people whose addictions have major biological and psychological components and who need to work on that stuff before/alongside personal surrender to a higher power. And if the only addiction treatment you get is psychiatric, it will often ignore the existential hunger and need for God’s mercy and guidance which tons of addicts have reported as a major component of our problem.
The twelve steps can be an open doorway to God, not a replacement for Him. One of Helen’s commenters points this out from personal experience, and it’s also a big part of memoirs like Mary Karr’s Lit and David Carr’s Night of the Gun. But also, psychiatry and medicine can open some doors as well. Cognitive behavioral therapy doesn’t need to be perceived as a threat to faith or a cheesy modern replacement for faith, and neither does methadone treatment or Suboxone, for example.
The end of Helen’s piece seems to position religion (bracketing all the battles about whether that’s a helpful concept or just another modern-era Potemkin village) as fighting a two-front war against twelve-steppery on the one hand and psychiatry and medicine on the other. I think she’s responding to some genuine weirdnesses in the “addiction” concept: If it’s a sin, how come there’s medication for it? If it’s a disease, how come one of the most reliable treatments is prayer and reform of life? But rejecting some aspects of addiction in order to reduce it to other aspects will always hurt the people whose addictions are most heavily caused by the suppressed or rejected aspects.
On the specific question of regulating rehab and other treatments… I think the more you read about addiction treatment the more sympathetic you are to the calls for regulation, or at least that’s how it’s worked for me. There’s such a strong history of humiliation and punishment being used as “treatment,” even when people are told that they’re being treated for a disease. There are obvious reasons to be wary of the state judging spiritual and emotional needs, and addiction–like mental illness–is a place where spiritual, emotional, biological and psychological needs seem to intertwine really tightly for a lot of people. But that doesn’t mean nobody should license or regulate psychiatrists and mental hospitals, you know?
Anyway, that’s where my thinking is right now. As I’ve said, all of this is subject to change, and certainly Szalavitz has thought and studied much more about this than I have. I’m also not sure I’ve expressed myself very well here, so I may post more later–you guys should definitely write in if you think I’m haring off in the wrong direction or missing something. Like I said, Helen’s piece is very much worth your time especially as cultural criticism, even though I don’t know that I agree with its underlying theology of addiction.