Treatment dependence: preliminary description of yet another syndrome

The last decade has witnessed an expansion of treatment services and research into alcoholism and addiction. As so often happens when attempting to find solutions to pressing individual and social problems, the solutions have come to acquire an importance of their own, obscuring the problems they were intended to solve. Many programmes are characterized by stereotyped approaches to treatment, which seem more in line with the needs of the staff than with the problems of the clients. The hopes that treatment for addictions will solve some of the problems of contemporary society have given treatment a salience which cannot be justified in terms of results. Frustrated at the results of treatment, clinic staff intensify their efforts and attribute the shortcomings of treatment to a lack of client motivation. There are disconcerting parallels between these behaviours in clinicians and the behavioural changes of the Alcohol Dependence Syndrome. The label 'Treatment dependence syndrome' is proposed to characterize a pattern of individual and institutional behaviour which is both self-perpetuating and self-defeating.