Posts Tagged ‘Disease model of addiction’


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.

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Alcoholics Anonymous: Cult or Cure? front cover

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

There are direct connections between the beliefs underlying Alcoholic Anonymous and those underlying the “war on drugs.” The most fundamental is that alcohol and other drugs are “cunning, baffling, powerful!” (to quote AA’s  “Big Book”) This belief is reflected in the common “drug war” term “dangerous drugs” in reference to illegal drugs, which combined, until recently, to kill about 5% of the roughly half-million Americans killed annually by tobacco and alcohol; today, about 50,000 are killed annually by overdoses, the vast majority by opioid overdoses. In other words, alcohol (roughly 100,000 deaths) and tobacco (roughly 400,000 deaths) kill ten times as many Americans as all illegal (and misdirected pharmaceutical) drugs combined.

To put this in further perspective, “drug warriors” almost never refer to alcohol and tobacco as “dangerous drugs,” while they do routinely refer to marijuana, which has never killed a soul, as a “dangerous drug.” Some of them might actually believe that it is.

The concomitant belief, that human beings are “powerless” over “cunning, baffling, powerful!” drugs, is shared by both AA and drug prohibitionists. In AA and its clones (NA, CA, etc.) that belief is enshrined in the first of the 12 steps. It’s also part of the bedrock of the “drug war”: if people are powerless and drugs are powerful, the only way to stop the harm of drug addiction is to cut off the supply of drugs.

The other underlying “drug war” belief is based in punitive Christian morality: the belief that the only way to deal with prohibited (sinful) behavior is through punitive measures–in the case of drugs, that it’s necessary to lock people in cages for using drugs and for making drugs available to others.

Another aspect of this belief system, common to both AA and the “drug war,”  is the belief that drug use and abuse are an individual matter, that individual drug users and abusers are either victims of a “disease” (according to AA — never mind the absurdity of labeling behaviors as “diseases”) or are criminals (according to “drug warriors”). What ties these two seemingly disparate beliefs together is that they both divorce drug use and abuse from their social and economic contexts.

A moment’s reflection shows that this is an absurd approach. If drug use and abuse were entirely the result of individual immorality or individual powerlessness over drugs,  the rates of drug use and abuse would not vary drastically (if at all) from one nation to another, nor would the rates vary wildly within nations over the years. But they do. Neither “disease” advocates nor “drug warriors” can explain these variances. To explain them, you need to consider social and economic contexts.

A case in point is a study published in Proceedings of the National Academy of Sciences by Princeton researchers Anne Case and Angus Deaton on the increased mortality rate among middle-aged white, especially male, Americans aged 45 to 54 from 1998 to 2015, with the increase being .5% per year. During the previous two decades, 1978 to 1998, the mortality in that age range had been decreasing by about 2% per year–as indeed it’s continued to do so in all of the other developed countries since 1998. Why? The researchers posit that, while there’s no definitive proof, these increases are likely due to an increased suicide rate and increased drug and alcohol abuse triggered at least in part by increased financial stress.

If 12-step advocates and drug prohibitionists were correct that the use and abuse of alcohol and other drugs is a result only of individual “disease” or inherent “criminal” (sinful) tendencies, this increase in drug and alcohol abuse would not have happened. But it did. The solution advanced by 12-step advocates is treatment, and by “drug warriors” is a combination of imprisonment and treatment. In both cases, the treatment offered is almost exclusively 12-step treatment, which does not consider social or economic contexts nor social or economic solutions, but rather focuses exclusively on individual “wrongs,” “shortcomings,” and “defects of character” (respectively, steps  5, 7, and 6), with the solution to alcohol/drug abuse being “prayer” (step 11), taking a “moral inventory” (step 4), and “turn[ing] our will and our lives over to the care of God” (step 3).

As one would expect, the 12-step religious program does not work very well. As covered in  a previous post, Alcoholics Anonymous is not effective, both AA’s own statistics (“Comments on AA’s Triennial Surveys”) and controlled studies report that the recovery rate in AA is no better than the rate of spontaneous remission, about 5% annually. Controlled studies of formal 12-step treatment have been even more dismal, with some components used in such treatment, e.g. confrontational “counseling,” having negative outcomes.

So, what do AA advocates and “drug warriors” lean on for scientific support?

One of the standard studies cited — quite possibly the most commonly cited — by 12-step advocates and prohibitionists was conducted in the 1960s. It involved placing rats in Skinner boxes (small boxes with no toys or other amenities–essentially solitary confinement for rats in an ultra-deprived environment) and then giving the rats the choice of either plain water to drink or water laced with morphine. Surprise, surprise — the rats chose the water with morphine. This study was widely cited by both drug prohibitionists and the mass media as “proof” that rats, and by extension people, are powerless over irresistible drugs.

In the 1970s, researchers at Simon Fraser University conducted a similar study, but with the rats in a much larger cage filled “with things that rats like, such as platforms for climbing, tin cans for hiding in, wood chips for strewing around, and running wheels for exercise. Naturally we included lots of rats of both sexes, and naturally the place soon was teeming with babies. The rats loved it and we loved it too, so we called it ‘Rat Park.'” The results? The Rat Park experiment showed that in this rich environment the rats ignored the morphine-laced water and drank plain water instead. The initial study was published in 1978 in the scientific  journal Psychophramacology. The mass media, government, and disease-concept advocates ignored it, and AA, 12-step treatment, and the “war on drugs” rolled on, leaving millions of ruined lives in their wake.

The lessons of all this are obvious: It’s time to stop blaming those who are self-medicating, and to stop looking at drug use, abuse, and addiction as the result of individual sinfulness or “disease.” It’s time to stop locking people in cages.

It is time to start looking at, and addressing, the environmental, economic, and social reasons why millions of people find life so intolerable that they — like rats in a deprived environment — feel the need to seek solace in drugs, alcohol, and illegal drugs. And it’s long past time to start doing something about the environmental, economic, and social reasons for drug use, abuse, and addiction.

* * *

For more information on Rat Park, see lead researcher Bruce K. Alexander’s 2010 book, The Globalization of Addiction: A study in poverty of the spirit. 

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