I read Doug Sellman's distilled wisdom for the next generation with appreciation. I suspect that we, the old men, need the enthusiasm of the young more than they need our wisdom. Cynicism and despair are the concomitants of addiction, and clinicians risk being infected, for our work has many frustrations. Training young doctors (and nurses, psychologists, counsellors) has been one of the joys, an antidote to burnout. There is a fault line beneath addiction treatment, between the 'moral–spiritual' and the 'empirical, social sciences' traditions. The dominant paradigm is moral–spiritual, in which conversion (the 'epiphany') is the basis of recovery. In so far as therapists can promote change it is slow, fluctuating, and lacks the black-and-white clarity that fits the dominant paradigm. Worse, we are in a bind—we must engender 'hope', while avoiding 'unrealistic expectations'. Unrealistic expectations of cure contribute to frustration in the lives of addicts and their families, and corrupt the practitioners who seek to meet those expectations. Young practitioners, you must avoid the lure of being a charismatic healer; the 'first step' towards helping people is to admit that we are powerless to cure our patients.
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