Pubdate: Thu, 04 Feb 2016
Source: New York Times (NY)
Copyright: 2016 The New York Times Company
Contact: http://www.nytimes.com/ref/membercenter/help/lettertoeditor.html
Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Herbert Rakatansky

IS SHAME AN ANTIDOTE TO ADDICTION?

To the Editor:

Shame is generally a result of the opinion of other people rather 
than the failure to "live up to one's own standards."

In my work as chairman of a physician health program, we have found 
that the fear of losing a relationship, professional position and so 
on is the most powerful motivator to influence one's choice to enter 
and remain in treatment.

Relapse in addiction is common, as high as 60 percent after long-term 
treatment and much higher after shorter treatment.

Doctors who engage in structured treatment programs with written 
contracts that define the consequences of not adhering to the 
treatment regimen (loss of practice privileges and/or license), even 
in the absence of a relapse, have a five-year continuous recovery 
rate of more than 75 percent.

Rather than using shame as a motivator, it would be better to 
identify specific relationships, professional and personal roles that 
the addict does not wish to lose and structure a treatment plan that 
preserves those relationships and roles only if there is total 
compliance with an agreed-upon treatment plan.

HERBERT RAKATANSKY

Providence, R.I.

The writer, clinical professor emeritus of medicine at Brown 
University, is chairman of the Rhode Island Medical Society's 
Physician Health Program.
- ---
MAP posted-by: Jay Bergstrom