Viewpoint: Why Tough-Love Rehab Won’t Die

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Despite decades of research showing the harmfulness of coercive rehab for addiction, these abusive, tough-love programs refuse to go away.

On Wednesday, reported on the phenomenon of “blood cashews,” nuts produced for export in Vietnamese drug-rehabilitation programs where addicts are forced to perform “labor therapy,” such as sewing clothes, making bricks or, most commonly, shelling cashews.

Last Sunday, the New York Times described Russia’s harsh new treatment camps, where addicts are locked up for as long as a month in “quarantine rooms” to endure withdrawal.

And last week a lawsuit was refiled against a Utah-based school for teens with drug or behavioral problems, with 350 former students alleging that the school engaged in abusive disciplinary tactics like locking students in outdoor dog cages overnight.

Yet, to date, there has been no evidence that the use of forced labor, public humiliation or generally brutal confrontation has ever been effective in rehabilitating people with drug problems — or any other kind of problem, for that matter. What’s more, when tough-love approaches are compared directly with kinder treatment alternatives for addiction, the studies find that compassionate strategies win by a large margin.

So why does the whip-’em-into-shape approach continue to get re-invented around the world? Three main factors typically foster support for harsh rehab, and each is important to understand if societies ever hope to rehabilitate addiction treatment and turn it into something that works.

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The first is economic: genuine medical treatment, which requires the participation of qualified professionals and, often, the use of medications, is costly and is therefore a money-losing proposition.

Tough, boot-camp-style addiction treatment programs, on the other hand, are profitable. Staff members are primarily low-educated former addicts, who are usually paid little or nothing, since “giving back” can be framed as essential to their own recovery. Their training consists of being treated — no expense there. The inmates in such rehab programs must work too, of course, and that labor is not only free, but, again, can also be justified as service or training necessary to help addicts get back into the workforce. Even better, the fruits of the addicts’ labor can be sold for profit.

Some coercive programs forgo the cost of maintaining a facility altogether simply by selling harsh “wilderness therapy,” which involves sending clients into the woods to essentially fend for themselves — or starve, so no need to pay for food — in order to teach responsibility.

What should be considered red flags are often cast as selling points. For example, here’s how the Times described one Russian program known as City Without Drugs:

A thick silence fills the little room crammed with tall metal beds, obscuring the fact that there are 37 men lying shoulder to shoulder, each lost in a personal world of misery.

Outside the chamber, known as the quarantine room, 60 men who have emerged — after as long as a month with only bread and water or gruel — work at menial jobs, lift weights or cook in a regimen of continued isolation from the world that staff members said usually takes a year.

“To put someone in handcuffs, it calms them psychologically,” Mr. Shipachev said as he paged through photographs of men shackled to their beds or to each other.

Obviously, in most cases, handcuffing one’s clients wouldn’t be something to boast about.

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