More Than ‘Just Say No’

Addiction studies thrives in academia

A version of this article was originally published January 4, 2005 in The Village Voice

Seven years ago, Joseph Barczak’s daily consumption of rum averaged half a gallon. Divorced and living in his parents’ basement, he says, he “couldn’t concentrate on anything, except getting the alcohol and drinking it.” One morning he had an unforgettable dream. “I saw my daughter’s godfather, who’d died six months prior to that, and God, standing over me, saying, ‘Enough is enough.’ ”

He telephoned the operator and requested a detox center. “They asked me when I’d be ready, I said now, and they sent a car four hours later.” Barczak hasn’t tasted liquor since that dream. During his rehabilitation, he returned to school after a 35-year hiatus. He graduated last month from CUNY’s John Jay College of Criminal Justice with a degree in addiction studies, en route to a career in substance abuse counseling.

Enough is enough—the addict’s anti-motto—may be a more compelling message coming from God than from a counselor. But in many cases, counselors serve as indispensable angels on the shoulders of recovering addicts. Addiction studies at John Jay represents a budding academic field. Counselors traditionally received training in non-academic institutions, which still thrive. But more than 400 academic programs now operate nationwide, generating research and teaching the findings. The upshot is a more supple approach to substance abuse, as the discipline embraces experimental approaches and iconoclastic theories.

Daniel Yalisove, the head of the John Jay program, points to “research-based practice” as the pivotal recent development in the field. “That is our overriding philosophy—to integrate research and practice,” he says. Sounds sensible, but the notion is actually quite radical. Researchers and clinicians have historically engaged in surprisingly little dialogue. McWelling Todman, a New School professor who studies the interface of psychopathology and addiction, explains, “The treatment part is largely populated by ex-users who are very much wedded to the traditional 12-step model,” and who were trained in non-academic institutions. Most researchers, many of whom inhabit academia, “have never been dependent on anything, and have a very scientific approach to the way they think about addiction,” says Todman. Much of our current understanding of addiction results from “actually researching alcoholism and drug use, as opposed to simply focusing on, How do we stop people from drinking?”

As more counselors pass through academia, research increasingly seeps into practice. Some studies confirm the intuitive, such as the reluctance of recovering addicts to offend drinking buddies or to jeopardize relationships based on drug use; treatment must therefore help them maintain valuable relationships without relapsing. In the most contentious departure from the AA-based ethos—which universally prescribes just saying no—studies have shown that some users can learn when to say when. Counselors might endorse, in appropriate cases, controlling use rather than trying to quit.

Todman’s own research involves the traditionally overlooked role of boredom in addiction. “Boredom is as potent a contributor to the relapse cycle as any other affect state, whether it’s depression or anxiety, and it needs to be managed,” he contends. “What we’re trying to find out now is what kind of techniques you can develop to have [addicts] become better observers of their own boredom states.” Ongoing research also turns the microscope on counseling techniques, assessing, for example, cognitive behavioral strategies, in which clients learn how to recognize, avoid, and manage relapse triggers.

Such scholarship informs John Jay classes like “Psychology of Alcoholism and Substance Abuse” and “Chemical Dependency and the Dysfunctional Family.” But some students like Joseph Barczak have already had firsthand education in addiction. Many students arrive at the field for personal reasons. Indeed, the profession belongs with rock star as one of the few in which a history of substance abuse can be a résumé enhancer. Barczak believes his past will help him identify with patients, as does Catherine Boccassi, a John Jay student who recovered from drug addiction and alcoholism with the help of AA. “Because I’ve witnessed it, I think I’m a little more empathetic,” she says.

Counselor LaCrease, a 2003 John Jay grad, confides, “My biggest downfall is that I don’t have a substance abuse problem.” She is nevertheless intimate with addiction’s cruelties. The child of an alcoholic mother, Curtis, now a case manager at Beth Israel Medical Center, remembers “finding Colt 45 in the refrigerator and no food. Pouring out the vodka and putting water in there—the stuff you do as a kid.” While former addicts such as Barczak consider their contribution “payback,” Curtis chose addiction studies to make sense of her experiences. As a counselor, “I go with my gut. But studying helped me to put a name to what I was already feeling.”

Regardless of the motivation, professors note growing interest in the field, possibly reflecting expanded professional opportunities. Coursework satisfies the educational requirements for a CASAC (Certificate of Alcohol and Substance Abuse Counseling), the state-sponsored credential required of substance abuse counselors by most programs. But a degree also opens doors to careers as researchers or clinicians specializing in addiction. Professor Yalisove has also begun to incorporate public policy into John Jay’s curriculum. In 2000, he inaugurated a class that addresses alcohol-related policies. Unsurprisingly, he favors policies backed by research—it’s shown that raising alcohol taxes reduces consumption, for instance, whereas DARE doesn’t keep kids off drugs. Experts agree that prison is no substitute for drug treatment, and many of them favor some form of decriminalization. Todman’s personal position has an element of characteristic realpolitik: “I think we just need to make better drugs,” he says—recreational pharmaceuticals engineered not to impair cognitive functioning and to make overdose impossible.

As academic programs incubate such subversive ideas, they haven’t necessarily abandoned traditional ones. Catherine Boccassi professes unflagging gratitude to AA, but says, “Look, what worked for me is not going to work for everyone. I wasn’t drinking, I wasn’t doing drugs—and I was a bartender.” For users with less miraculous self-control, she thinks an AA-style approach “married with another type of counseling would be beneficial.”

Research multiplies the possible solutions, to maximize the chances for happy endings. These are hard-won, but they make an emotionally exhausting profession emotionally lucrative too. The counselors themselves often represent triumphs: Boccassi, Barczak, and Curtis chose the profession as a constructive response to the ruination of addiction. For Curtis’s family, the happy ending is double. Her mother—the one once known to eschew conventional kitchen staples for Colt 45—is now enrolled in a master’s of social work program at Fordham. She plans to sit for her CASAC exam in June.

Source: The Village Voice

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