04/12/2013 07:05 GMT | Updated 02/02/2014 05:59 GMT

Dealing With Toronto's Mayor Two - Enabling, Denial, Disease and Blah, Blah, Blah...

Toronto Mayor Rob Ford has been getting a lot of press. Even this author has hopped on the wagon - recently publishing "Dealing with Toronto's Mayor" in Psychology Today. His substance abuse issues have generated a great deal of - predictable - chatter. Apparently, he is suffering from a disease (alcoholism). You will hear that he can't alter his behavior on his own, and that a belief on his part that he could is simply a function of "denial". You also hear suggestions that rehab of some kind would surely make a difference.

In several recent interviews, I have actually done the unthinkable: take the mayor's side on several points.

If you are one of my regular readers, please pardon the repetition, but some things require it: 1. It is by now common knowledge in the addiction field that most people who change their behavior do it without treatment of any kind. 2. It is also common knowledge that, other predictors being equal, addiction rehab will only slightly increase someone's chances of kicking.

Of course, the treatment/recovery industry has a pecuniary interest in this matter, and that explains a lot of the nonsense you hear.

But it doesn't explain everything. Today in North America, few things are as mystified as addiction. Addiction is seen through a strange lens, one that emerged just over two hundred years ago and received a real boost in the 1980s.

Take the theme of denial. In articles and in interviews, I have pointed out that denial is not specific to addiction. It is a normal human response to adversity. For example, if your three year old shows the early warning signs of a disability, the temptation to ignore those signs can be strong: you don't want to know. It's hard to admit.

That's denial. There's no mystery here, as it is a perfectly understandable reaction. Does Mayor Rob Ford deny the extent of his problems? Probably. Does that mean he needs treatment? Not necessarily.

In one panel discussion I was on, one member dismissed the possibility of natural - meaning unassisted - recovery as "magic". In one article I read, the possibility was dismissed as "bulls**t."

Hmm ... I would counter that most of the rehab options are rooted in "magic", that they help only a little and, unlike some, I am happy to spell it out: bullshit!

It's worth noting that many in the field dismiss harm reduction out of hand. For example, the suggestion that the mayor should stick to drinking at home in order to avoid embarrassment is often ridiculed. But why? Presuming that he won't stop drinking altogether (and odds are he won't) a move away from causing damage is, well, likely to reduce the damage. But in a moralistic climate - wherein only absolute solutions are acceptable - all halfway measures are nixed. Unfortunately, in the real world, half measures are often the norm. They work, they reduce harm, and those who undermine them are, in part, responsible for any harm that ensues.

Some of his family members shave suggested - quite wisely - that the mayor do his drinking at home. This, according to more than one source, shows that they are in "denial". Really? Would the mayor not be better off, and would Toronto not be a better place, if the mayor took such a step?

Oh, this also shows that Ford's family members are "enablers". Two years back, I wrote a column right here: "Tough Love is a Joke - Let's Start Enabling Drug Addicts Everywhere."

As for Ford's many drunken episodes, what do they really prove? I would hesitate to offer a diagnosis from a distance in any case. But, in this case, we really need to wait and see. Even the AA Big Book - a cornerstone of today's delusional recovery culture - distinguishes between problem drinkers and real alcoholics. Only after several sincere attempts to stop have failed would the first AAs invoke the language of pathology. I don't know whether the mayor has ever seriously tried to cool it - and we shall soon find out whether he can. In the meantime, I have had to take issue with one person on a panel who seemed certain that our mayor has a "disease". Hmmm ... Even if we grant that alcoholism is a disease, I really don't have enough to go on to label our mayor as "sick", diseased, and so on.

Just as most murderers are not absolved by reason of insanity, most people who misbehave in public when tipsy (e.g., urinating for the crowd) are not necessarily diseased - some people are just rude and crude, without any medical qualification.