Posts Tagged ‘Cognitive behavioral therapy’


Alcoholics Anonymous: Cult or Cure? front coverby Chaz Bufe, author of Alcoholics Anonymous: Cult or Cure?

Chris Hedges’ series on RT, “On Contact with Chris Hedges,” has a new episode titled “The Fatal Addiction.” In it, Hedges does a fine job of presenting the human cost — the heartache, the deaths (50,000 last year in the U.S.) — caused by opioid addiction and overdoses.

While he succeeds at that, he doesn’t deal with the causes of addiction, nor with the failed, dominant approaches to curbing drug addiction, nor with better approaches. (Of course, it’s too much to expect any of this in a half-hour documentary, and one hope Hedges will deal with these matters in future episodes.)

Since “The Fatal Addiction” doesn’t tackle these issues, we will here. Please consider the following:

  • The dominant view of addiction in the U.S. is that it’s both a result of moral failings and is a “disease” or “illness.” (See AA’s “Big Book.”) This is  wrong on both counts, which can be easily seen when you look at historical addiction and overdose rates. They’re not steady, but vary dramatically over time.

Opioid overdose deaths have multiplied tenfold over the last two decades in the U.S.; reported rates of alcoholism have also fluctuated considerably over the years; the rate of tobacco addiction has plummeted in recent decades; and 95% of American soldiers who were addicted to heroin in Vietnam kicked it without treatment after they came home.

If addiction was caused by moral “shortcomings” (see AA’s 12 steps), one might ask whether former tobacco addicts became more moral over the years, whether morality skyrocketed among heroin-addicted Vietnam vets after they returned home, and whether the spiking opioid addiction rate has been caused by a mass outbreak of individual immorality.

If addiction is a “disease,” not a behavior, as we’re constantly told by 12-step treatment professionals, 12-stepping celebrities, and reporters who accept that absurd assertion at face value and who haven’t done their jobs (investigating, analyzing, raising awkward questions), one might ask the following: Why would the rates of addiction to different substances vary so radically from one substance to another in the same time periods, why would the rates of addiction to single substances vary so radically over time, and what does disease “theory” predict about rates of addiction in the years ahead?

Disease “theory” advocates have no answers to these questions, because disease “theory” is a “theory” only in the popular sense of the word (a conjecture or wild guess). In a word, it’s an assertion. It is in no way a scientific theory, and hence cannot provide answers; its adherents cannot use it to generate testable (falsifiable) predictions.

The dominant 12-step view of addiction (that it results from moral shortcomings and is a “disease”) is very, very wrong.

(As for the actual roots of addiction, one can look to psychological factors — stress and hopelessness, to oversimplify — and the environmental factors contributing to stress and hopelessness. I dealt with this in a separate post, “AA, the War on Drugs, and Disastrous Misconceptions,” so I’ll leave the matter here.)

  • As for AA and the treatment approaches derived from AA with its incorrect assertions about “moral” failings and “disease,” they’re every bit as ineffective as you’d expect.

Twelve-step groups such as AA and its clones (NA, CA, etc.) produce results no better than the rate of spontaneous remission, as shown by the best available studies: studies with control groups and random assignment of subjects, mass-participation longitudinal studies, and AA’s own triennial surveys. I summarized this evidence in “Alcoholics Anonymous Is Not Effective,” so again I’ll leave this matter here.

The formal (“professional”) 12-step treatment programs derived from AA are just as ineffective as AA itself. (I haven’t put up anything about this on the blog, but deal with the matter at length in Alcoholics Anonymous: Cult or Cure?)

One telling segment in Chris Hedges’ documentary is with an interviewee who mentions an addict who’s been in and out of rehab 17 times, which the interviewee says is typical. (The numerous 12-step references in the documentary [“meetings,” “sponsors,” “recovering addicts”] are equally typical.)

Clearly, the dominant American approaches to addiction aren’t working. Why, beyond faulty “moral failings” / “disease” premises?

  • For one thing, we’ve been stuck with the authoritarian, worse-than-useless “war on drugs” and the criminalization of addicts and recreational drug users for decades. This has resulted in untold suffering and incredible waste of tax money (easily $1 trillion over the years, and currently a good $50 to $70 billion per year).  Criminalization has ruined countless lives to no good effect, and it’s been utterly ineffective at reducing drug use and addiction. If you doubt this, consider the number of opioid overdose deaths over the years, that hard drugs are freely available to almost anyone who wants them (see Hedges’ “The Fatal Addiction“), and have become both cheaper and more powerful as the “war on drugs” has ground on.

So, what does work? What will reduce drug use, addiction rates, and deaths from overdoses?

  • On the purely personal level, the only treatment approaches with good evidence of efficacy are cognitive behavioral therapy approaches. (I deal with this in the final paragraphs of “Alcoholics Anonymous Is Not Effective.”)

I should note that methadone “treatment” merely substitutes a legal synthetic narcotic for illegal narcotics; this is substitution, not treatment — it keeps users dependent on an addictive substance.

  • On the societal level, it’s obvious that the “war on drugs” and criminalization of drug users and addicts must be abandoned.

Not only has criminalization of drug users and addicts failed to reduce the rates of drug use and drug addiction, it has taken an incredible human and economic toll. It’s done nothing to reduce the availability nor the price of drugs. And it’s a major component of “big government” intrusion into the lives of individuals.

Criminalization of drugs and drug users has been an utter disaster.

(Those who profit from the enslavement of “war on drugs” prisoners might disagree.)

Criminalization of drugs and their users is in large part directly responsible for the tens of thousands of overdose deaths every year in the U.S. Why? There is no quality control with illegal drugs. Those who buy them (especially opioids) are quite literally gambling with their lives, and multitudes lose that gamble every year.

So, is legalization (or at least decriminalization) a better approach?

Yes.

In Portugal, where drug use was decriminalized in 2001, the rate of death from overdoses has plummeted, as shown in a recent Washington Post article, “Why hardly anyone dies from a drug overdose in Portugal.” The rate of opioid addiction has fallen in half. Portuguese taxpayers aren’t paying ungodly amounts of money annually to lock up drug users and drug addicts. And Big Brother isn’t intruding (or at least intruding less) into one aspect of the lives of individuals.

  • Finally, here’s a question that almost no one asks, and even fewer try to answer: Why do millions of Americans feel so stressed, so hopeless that they drink themselves to death or play Russian Roulette with hard drugs?

The answer to that question has been available for decades.