“Substance abuse and addiction cross all social lines; they do not discriminate based on wealth or class. They can ensnare the successful and the seemingly well-adjusted, and the effects can be devastating regardless of one’s social status.”
– paraphrased from Former U.S. President Bill Clinton
In today’s society it is public knowledge that the wealthy and famous are not impervious to addictions of all types – substances or processes. Press releases about yet another celebrity, politician or royal family member checking into exclusive ‘rehabs’ are sadly all too frequent.
What is Addiction Stigma?
Given that addiction has become a major problem in all areas of society, it is surprising that it is still widely misunderstood. How is addiction best defined?
We could start with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which states Substance Use Disorder is defined as a complex condition in which there is a harmful pattern of substance use leading to significant impairment or distress. The DSM-5 provides specific criteria for diagnosing substance use disorders, which include the following: Impaired control, social impairment, risky use, tolerance, and withdrawal.
The above indicates a mental health condition, not weak moral fiber, laziness, or degeneration. This understanding is sometimes broadly described as the ‘disease concept’. Surely, in today’s world, we do not blame anyone for having a mental health condition, or do we?
The stigma and shame are still echoing in our minds as we struggle to come to terms with the chaos and destruction that addiction causes. This is illustrated by the words of another US president, Joe Biden, who has experienced addiction within his close family. “I lost my son to the horrors of addiction. It was the best of him. I hope you all familiarize yourself with the fact that addiction is a disease, not a moral failing.”
Perhaps a more layman’s definition may be found in the work of the best-selling author and founder of the Meadows Treatment Centre in Arizona, Pia Melody. To paraphrase her, she describes addictions as ‘any process that relieves intolerable reality and becomes a priority, taking time and attention away from other priorities, and creating harmful consequences that are ignored’.
The Underbelly of Privilege
While addiction affects all areas of society, it is probably more easily understood in the lives of working people facing challenges of scarcity and lack of opportunity. It is perhaps less expected in the lives of people who appear to have abundant possibilities.
However, some studies indicate that access to affluence can increase the vulnerability to compulsive behaviors. According to the 2019 National Survey on Drug Use and Health (NSDUH), individuals with higher socioeconomic status were reported to have higher rates of certain substance usages, including cocaine. This often occurs in environments where alcohol is prevalent, such as upscale parties or clubs.
Another factor is of course the pressure of increased responsibility and high expectations, lifestyle indulgences, and the need to maintain an unblemished public image. A clear example of this is an Asian family I have worked with who own a hugely successful business throughout Asia. The parents had created this ‘empire’ through hard work over many years. Their son, groomed to be heir to this corporation, lacked confidence in himself to match the success he was inheriting. He became badly addicted over many years to alcohol and cocaine. Thankfully, after treatment, he is now assuming the responsibility that comes with his inheritance and is learning to value himself as much as he is grateful to his parents.
The Stigma of Addiction
100 years ago addiction was baffling to Western society. Alcoholics and addicts were judged heavily for their startling and unacceptable behavior. Under the influence, they defied social norms and frightened others with their unpredictability and irresponsibility. They wreaked havoc socially, financially, and within their families. On top of that, they confused things more with blatant dishonesty about the problems addiction was causing. The usual methods were used to counteract this threat to stability – addicts were chastised, threatened, and eventually hidden away or locked up as hopeless cases.
Curiously, it was not psychology, psychiatry, or religion that eventually made any breakthrough and gave hope that recovery was possible. Instead, 2 alcoholics in Ohio – Dr. Bob and Bill W – found that mutual support from fellow recovering addicts enabled them to stop drinking and find a new way of life sober. They formed AA in 1935 and it has grown to become a worldwide network of meetings using a mix of practical advice and spiritual principles described as 12-step recovery. A major aspect of these groups was a sense of empathy, instead of judgment. Finally, the addict did not feel so alone.
While this gave hope of recovery, it did little to lessen the stigma of addiction. The idea that an addict can, and should, control their behavior ignored the mental health aspect of addiction – later more identified by clinicians and the medical world in recent editions of DSM.
The judgmental, controlling approach to addicts is mirrored in our courts, our prisons, and in ourselves as we grope for answers as to why our loved ones, who we know are good people, could act in such inconsiderate ways. We failed to understand that the addict is desperately trying to balance 2 incompatible drives within – the need to protect their substance use to cope – and the need to maintain relationships with their loved ones. Addicts found that the only way to do that was to enter a zone of dishonesty and denial. And the dishonesty becomes yet another addiction, convincing even to themselves.
As mentioned earlier, all these negative behaviors are more easily explained in the lives of people who have adverse living conditions. Understandably, they struggle to make ends meet, become successful, and create opportunities.
However, when society looks at the lives of the ‘privileged’, the successful, the famous, and the wealthy the stigma becomes even greater. How can these people who have all their material needs so abundantly met, choose to medicate themselves and ignore their responsibilities?
The answer lies in the word ‘choose’. If addiction is a mental health condition, then does the addict have any choice over their compulsion? Almost by definition, they cannot.
Here we can go back again to the disease concept used in 12-step circles, especially Narcotics Anonymous (NA). Recovering addicts often say “I am not responsible for having this disease, but I am responsible for my recovery”.
Once again, we find a particular problem here for high-profile families. Their more acute need for discretion and confidentiality creates great resistance to joining any groups that might define them as addicts. Instead, empathy and understanding have to come from the clinicians treating them. The ‘bespoke’ approach was created to meet this need.
Often addicts will not be aware that recovery is even possible. Bewildered, judged, and full of defiant shame, they hide themselves away from family, business associates, and friends. This leads to isolation, inviting depression, and enabling greater substance abuse. It becomes a vicious circle. A wealthy person can afford to do this for a long, long time, often until they die.
Many individuals report having faced this stigma. Famous artists and actors like Elton John and Robert Downey Jr. have faced addiction and described the stigma that came with it in their public lives. Curiously, they are all now advocates for understanding addiction as a disease rather than a moral failing. Aristocrat families are also vulnerable. The Windsor Family is an obvious example. The late Princess Margaret, the late Queen Elizabeth’s sister, faced a long battle with alcohol dependency, which was often discussed in the context of her public life as an aristocrat. The scrutiny she faced only added to the stigma associated with her attempts to recover, complicating matters even further.
Bespoke Therapy – Tailored and Discreet Solutions
If recovery from the complexities and shame of addiction is possible, then where can it be found? Where is help available? What can be done once a family or individual recognizes that alone the addict shows little success at overcoming compulsion – despite all the threats, efforts to control, judgments, and negative consequences they experience in their lives?
Fortunately, a greater understanding of addiction has led to a wide range of recovery or treatment options. These range from mutual support groups like A.A. or SMART, outpatient programs of different types, and residential treatment where the addict retreats from their daily life to focus fully on their healing.
The residential treatment offers also vary, but one major distinction between them will be whether the treatment includes a group therapy element or not. Group therapy can be a very dynamic modality as the client joins a peer group that will challenge and support them during the recovery process.
However, for high-profile families exposure to random addicts seeking recovery is simply too much of a risk in terms of confidentiality and is often ruled out as unacceptable. The other alternative is bespoke treatment which deals with only one client at a time, remaining highly discreet and personalized to the individual.
The bespoke option is usually significantly more costly than the group option, primarily for reasons of scale. This extra expense allows for much more freedom in creating a treatment plan which is individualized for each client. There is a shift away from the ‘one-size-fits-all’ approach to a program that takes into account all the intricate complexity of each client’s psychology. This can embrace family background, culture, education, religion, financial standing, trauma, and co-occurring mental health disorders – all this in a highly confidential environment.
Bespoke options can also more easily provide the high expectations any client might have around accommodation, food, concierge services, flexible treatment timetables, and schedules.
The delivery of complete confidentiality helps the high-profile client relax into the treatment environment, safe from exposure to public interest and curiosity. This is extremely important in creating a good therapeutic relationship between the client and the clinical team.
At Thera Bespoke, a personalized treatment approach is created by working with the client to create a collaborative treatment plan that is agreed upon by the client, their significant others, and the clinical team. This happens on arrival at Thera, after a thorough psychosocial assessment and mental health evaluation by Zoom calls or interviews before admission. As the client moves through the recovery process, this collaborative plan is easily updated and adapted to the needs that arise in therapy.
As the client begins to recover, they are able to select the sessions that best suit them and discard modalities which they feel are not helpful. Throughout this process, the lead therapist and clinical team keep their finger on the pulse and gently provide input and suggestions to guide the client while making their choices. As the days pass, the client becomes aware of their agency in their healing process. They no longer see themselves as victims.
Thera Bespoke – A Sanctuary of Healing
To maximize the benefits of bespoke treatment for high-profile clients, the basic pillars of confidentiality, flexibility, and comfort must all be in place to create a compassionate sanctuary of healing, far removed from the more rigid and cold clinical settings offered by many facilities.
Thera Bespoke takes great pride in skilfully delivering all three of these pillars. The chosen villas are set in stunning rice-field scenery. We offer a fusion of Western and Eastern design particularly to Bali. Spacious, secluded, and luxurious they create an inspiring atmosphere for healing. Rural Bali is ideal for its nurturing and happy culture where people express gratitude for life through beautiful daily offerings in the fields, the paths, the houses and the temples.
The Zero Protocol™ treatment model is fully supported by this serene and inspiring environment. Again a fusion of the west and the east is found in the modalities offered. Evidence-based Western psychological and psychiatric practices are balanced and enhanced by Eastern modalities such as Traditional Chinese Medicine and energy healing. Encompassing this powerful blend of healing are the concise scientific modalities based on more recent research in neuroplasticity, heart coherence, epigenetics, and quantum theory.
Clinical experience indicates that when an individual understands why they are doing something, they find purpose in it, and apply themselves with more vigor. So education sessions about the nature of feelings and thoughts, the play between conscious and subconscious, brain wave states, and the disease concept all give meaning to practices that encourage the individual to look inward for answers, becoming agents of their own healing as opposed to victims of life.
Thera offers extremely high standards of both hospitality and clinical support. The villas offer all luxury amenities – private tropical gardens and swimming pools set in natural stone. The dedicated chef ensures that the food is gourmet. The luxury vehicles are the best in Bali and are available for 12 hours every day. The recovery concierge service is lovingly caring and efficient. The entire team is there for the client and their healing. There is no other distraction.
The clinical team is outstanding, each in their own field. They bring together a wonderful blend of clinical expertise, compassion, and an inspired belief in the infinite potential to change. All of these are what makes Zero Protocol™ unique.
Breaking the Cycle of Addiction Stigma
Slowly our society seems to be learning the judgemental stigma around addiction is simply not helpful, though it is understandable. What can be done to break this cycle more quickly?
Successful recovery outcomes speak louder than theory, but people recovering from a history of addiction can be reluctant to share their stories of success. It is a highly personal part of their lives – especially in high-profile lives. However, there is a growing understanding that judgment and blame are counterproductive to dealing with addiction. In the film “The 27 Club” which explores the tragic demise of several 27-year-old high-profile artists who died from substance-related causes, Barney Hoskins, author of ‘Never Enough: A Way Through Addiction’ reflects on the past “We didn’t have the vocabulary we have now. No one knew or talked about rehab or addiction”.
Public awareness is improving and attitudes are slowly changing. Perhaps we are about to achieve what some researchers refer to as the 100th Monkey Theory where observations of Japanese macaque monkeys on Koshima Island in the 1950s led researchers to believe that collective behavior can evolve and spread within groups once a critical mass of individuals adopt a behavior or idea. This emphasizes the potential for significant changes through the adoption of new understanding or practices. Though lacking in clinical vigor, the theory does inspire thoughts on how collective behavior can evolve and spread within groups. Perhaps this is how the stigma of addiction will finally be broken.
Until that shift occurs it is down to individual efforts. Family networks play a great part in this. Addiction treatment is stronger when it includes modalities to involve family members or significant others if the client agrees. Here the important people in the client’s life learn about a more skillful approach to addiction and more effective ways to support recovery.
The damage to families and relationships that addiction causes is sometimes referred to as the ‘family disease’. Relationships become damaged and distorted so badly by the addict’s behavior that those around them also lose their love for life, learn dysfunctional coping mechanisms, and end up scarcely recognizing themselves. The family also needs to recover. As more families learn that recovery is possible, they will spread the word.
Personal Transformation and Lasting Change
As discussed, the most effective way to break the harmful stigma towards addiction is to share stories of successful recovery. Often this sharing only happens within private family or social circles as mental health is such a private matter. A large population of recovering addicts around the world do share their success stories in the privacy of their anonymous 12-step meetings. These people report decades of life without alcohol or drugs and proudly follow a path of complete abstinence. Sometimes even high-profile people will go public about their struggles and successes with substance use disorders.
However, the vast majority choose to keep their recovery stories private. Despite this silence, us all need to know that an addict or alcoholic is not a lost cause. There are countless stories of successful recovery where individuals have learned to live free from addiction and find a new love for themselves, those around them, and life itself.
For high-profile people there are excellent bespoke programs designed for those who do not want to participate in groups, and who require high standards of personalized attention, clinical care, and hospitality. Thera Bespoke is one such place with its innovative and inspiring Zero Protocol™ program. It is well worth reaching out for more information. We all have a tremendous potential to change once we find the right support.
