Life for Psychiatrists after Reading Bob Whitaker: Let’s Take Back Substance Abuse Treatment

Jill Littrell, PhD
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An astounding development is the explosion in the numbers of substance abusers being diagnosed with Bipolar. I teach a class in Substance Abuse at Georgia State. Typically, this course draws persons in recovery. In the early 1990s, most were recovering alcoholics. Now, with the current prescription drug epidemic (think oxycontin), the recovering addicts tend to be people addicted to some type of opioid drug. Invariably, my recovering students offer details about their Bipolar II disorders. For those students working in treatment centers and who are assigned the task of passing out the meds, they marvel at the numbers on the atypical antipsychotic, Seroquel.
Since the early 1970s when the genetic case for alcoholism found research support, it has been known that alcoholics are more likely to score high on the MacAndrew scale of the Minnesota Multiphasic Personality Inventory. The MacAndrew scale measures an upbeat, risk-taking, extroverted personality. Persons with high scores on the MacAndrew scale endorse such statements as “I like to talk with strangers on buses.” In the early 1970s, Kammeier, Hoffman, and Loper took advantage of the fact that at the University of Minnesota the entire freshman class took the MMPI. Kammeier et al. followed up on the high scorers on the MacAndrew scale. Not surprisingly, those who were the high MacAndrew scale scorers were more likely to be drinking heavily at age 40 than the low scorers. Thus, traits of enthusiasm, high energy levels, and extroversion describe a lot of alcoholics. Anyone who has ever been to an AA meeting knows this to be true. Most of them like to laugh and most of them have a sense of humor. They are an adventurous lot. But, guess what, that means they will meet criteria for Bipolar II disorder.
For those of us who were in the field during the 1970 and 1980s, medicating substance abusers is really hard to grasp. In the 70s and 80s, and indeed for those in AA since its inception in 1935, many substance abusers would have met criteria for Bipolar II if the diagnosis had existed. They all recovered from alcoholism and drug addiction in AA without any drugs at all (except for the coffee). Their lives became dramatically better, once they found sobriety. They did not require any pharmaceutical interventions; they just went to meetings. But, now, with the modern take on treatment and the new diagnosis of Bipolar II, they will receive a prescription for lithium, which destroys kidneys; an anticonvulsant, which is toxic to the liver; or for an atypical antipsychotic, which shrinks the brain cortex. Modern treatments have made things considerably worse. Ironically, the street drugs were arguably less toxic than modern medical treatments. Alcohol takes a good twenty years to destroy the brain. According to animal work cited by Ho et al. (2011), Seroquel only takes 2 years to reduce cortex volume. Heroin does not really do much to the organ systems of the body, (although you can easily die of an overdose). In contrast, the antipsychotics and antidepressants increase risk for weight gain, Type 2 diabetes, osteoporosis, and movement disorders.
For recovering substance abusers, who will attend a least a couple of AA meetings, taking psychotropic meds creates dissonance. At the AA meetings, recovering people are told to abstain from mood and mind altering chemicals. In Twelve Step treatment programs of the past, an importuning addict asking for a chemical to relieve his/her distress would be told to go to a meeting. Lining up for drugs just is not part of the Twelve Step recovery program. Most people who are familiar with AA are struck by what a positive philosophy the program offers. Rather than self-focus (a recipe for depression), the program stresses gratitude and service to others. Indeed, the AA philosophy is remarkably similar to the treatment for depression designed by Giovanni Fava.
Presently, recovery centers are hiring psychiatrists with traditional pharmacotherapy training. They are passing out the meds. But, again the meds are antithetical to the articles of faith of the Twelve Step program. Because they are Twelve Steppers, many recovering individuals might be looking for help which truly is free from mood and mind altering chemicals. Perhaps Twelve Step treatment programs might offer a home for psychiatrists who wish to discontinue dependence on the prescription pad. Here psychiatrists might be able to practice without violating the Hippocratic oath: First, do no harm.

Fava, G. A. & Tomba, E. (2009). Increasing psychological well-being and resilience by psychotherapeutic methods. Journal of Personality, 77, 1903-1934.

Kammeier, M.L., Hoffman, H., & Loper, R. G. (1973). Personality characteristics of alcoholics as college freshman and at time of treatment. Quarterly Journal of Studies on Alcohol, 34, 390-399.

19 COMMENTS

  1. Thank you for this intriguing information. I was recently struggling to make a parallel point in my blog – that what used to be called a nervous breakdown is now more likely labelled schizophrenia or bipolar. The important distinction is that that medications were not usually prescribed for nervous breakdowns, to the best of my knowledge.

  2. I really agree with what you are pointing out. My favourite bit is:”Perhaps twelve step treatment programs might offer a home for psychiatrists who wish to discontinue dependence on the prescription pad”. Mind you the worst culprits at least here in Britain, are those who impose their guidelines and rules and regulations on the psychiatrists practising for the NHS and those who teach junior psychiatrists that medication is the answer to all emotional problems.

    • I felt compelled to write this post after reading Dr. Key’s blog about feeling like she wanted to abandon the profession for which she trained. I feel sorry for psychiatrists. I have spoken with Phil Sinaikin (who wrote Psychiatryland), who no longer believes in much of what he is doing, but doesn’t have the money to retire and is a little too close to retirement to retrain. I also know that if a doctor breaks from standard treatment, the doctor can get sued. When I was in clinical practice, I did discuss medications with clients. I think informed consent requires this—it’s the patient’s choice not mine. But, what I also did was to detail the ill effects of the drugs. Few people asked me to make a referral. So there are ways around the meds. However, substance abuse treatment is an arena in which the medication issue rarely comes up. I think for substance abusers a psychiatrist could easily justify the “no drugs” option. Even though it might be pretty obvious that a patient meets criteria for BPII (which I think is a bogus diagnosis-see previous post on this issue), much of BPII behavior can be chalked up to the “stinking thinking” of addiction. So there is a place for psychiatrists who don’t want to medicate. Substance abuse treatment is also a lot of fun. Watching people’s lives become dramatically better with sobriety is pretty inspiring. I would be very happy to recruit more doctors who don’t want to medicate into substance abuse treatment. Presently, the medicating types seem to be invading this domain, which previously had offered a safe haven from the meds.

  3. Dr. Littrell,

    The genetic or disease/genetic theory of alcoholism and other so called addictions has been widely debunked.

    See book, PSEUDOSCIENCE in BIOLOGICAL PSYCHIATRY. Here is an excerpt exposing why alcoholism is not genetic nor a disease:

    http://www.antipsychiatry.org/br-pibp.htm

    Great books like THE TRUTH ABOUT ADDICTION AND RECOVERY, HEAVY DRINKING and others also debunk the disease theory of addictions. Unfortunately, such authors took a great deal of heat because the addiction/recovery INDUSTRY is also very lucrative especially with inpatient facilities often doing more harm than good.

    I believe disease theories of bad habits are just as damaging as disease theories regarding emotional distress. AA and other 12 step groups have come under a great deal of criticism due to their cult like brainwashing approach and lack of evidence of success. Plus, the fact that many with DUI’s or other problems are forced to go to AA has not helped its image or success either.

    Having a label as an alcoholic or drug addict is hardly an improvement over such bogus life destroying stigmas as bipolar I or II especially for women who are the main targets of psychiatry due to their greater risk of abuse, rape and other sexist harm. Dr. David Healy exposes how this fad, fraud epidemic of bipolar came about in his great book, MANIA: A SHORT HISTORY OF BIPOLAR DISORDER. No surprise that this false huge epidemic of so called bipolar coincided with the new lethal drugs, lithium, Depakote and atypical antipsychotics on patent doing far more harm than good per Dr. Healy and Bob Whitaker. Bipolar has become the new garbage can “sacred symbol” (Dr. Thomas Szasz) of psychiatry largely replacing the equally degrading stigma of schizophrenia.

    Some doctors prescribe fish oil and vitamins for emotional distress misdiagnosed as bipolar. Doctors in the UK can now prescribe exercise for depression/improved health. Would prescribing such natural remedies be an alternative?

    Dr. Stanton Peele in his book, THE TRUTH ABOUT ADDICTION AND RECOVERY, points out that one must SUBSTITUTE healthy alternatives and goals to replace addictions to recover. He cites the famous case of “BINGE” Crosby who drank so much that one night he threw up on his shoes while singing publicly. This reality check made him realize that the singing career he wanted so badly was not consistent with binge drinking, so he gave it up for good on his own and the rest is history given his highly successful singing/
    acting career. Smoking is known to be harder to give up than heroin, but as Dr. Peele points out, most smokers quit on their own. They are not stigmatized as SMOKERS for the rest of their lives either. Dr. Peele also wrote books like THE DISEASING OF AMERICA about the great harm of labelling many bad habits as diseases, which become self fulfilling prophecies.

    I greatly appreciate your exposure of another source of bipolar fraud, but self destructive numbing behaviors that can lead to addiction are a main symptom of trauma, so they should be included under a trauma model per many experts. Dr. Judith Herman, Dr. Carole Warshaw, Dr. Aphrodite Matsakis and other abuse/trauma experts are excellent sources about trauma, its symptoms and recovery.

    As for discouraged doctors unable to change gears now, what about offering holistic, alternative psychiatry with no stigmas or lethal psych drugs for which people with means would pay for out of pocket and a sliding scale could apply to those with lesser means? The author of MANUFACTURING DEPRESSION says that he tells patients he will give them the documentation to make claims for insurance once they pay him, but warns them that he will have to provide a diagnosis that will follow them for the rest of their lives. I appreciate such informed consent, another possibility for doctors to do damage control.

    12 step groups with trauma survivors labelled addicts or alcholics may be a good place for doctors, but not such a great place for trauma survivors, especially women. Of course, if it is an individual choice, AA or NA may be helpful, but the minute it is forced on anyone, it becomes harmful and unfair to both the trauma victims and those attending AA by choice. I believe this is one more “blaming the victim” approach. And let’s not forget that doctors used to prescribe alcohol which is no different than the addictive drugs prescribed by doctors today except that alcohol and some illegal drugs can provide a temporary high, which is why toxic psych drugs must be forced on people since they do the opposite.

    • thanks for the differing point of view. My books on alcoholism were effectively arguments against many of the tenets heard in AA. Nevertheless, I think that if a person wants to be there, AA can sometimes provide a supportive atmosphere. They do say “take what you can use and leave the rest.” The positive thing is that AA comes in many different flavors. You can sample meeting to find one that fits for you.

      With regard to genetics, I’m an empiricist. I think normal personality is genetic. Finding that a behavioral propensity has a physical basis does not imply it is bad. In fact, I think that the temperament associated with risk for alcoholism is good: extroversion, enthusiasm, and high energy level.

      With regard to trauma leading to heavy drinking, I think for some it does. But, I also think that many alcoholics had very positive childhoods and no trauma in their lives, yet, they drank very heavily. In fact, I think my Dad, who had the greatest parents ever, is in that category. He just had the genes for liking the alcohol. My Dad has a great personality. He quit drinking outside of AA. (Research suggests that most alcoholics recover outside of AA.) But, I think if my Dad had gone to AA, he would have had a good time. My point is just because there is a physical basis for some behavioral tendencies, need not imply a value judgment.

      • Dr. Littrell,

        I am against unscientific, unproven eugenics theories that target certain groups for good or bad traits due to the horrors that came out of these theories to destroy certain groups. I saw a program on PBS recently, which made clear that genetics research is far from proving much yet because though one or two related genes (which do not prove causation) may be found, there are hundreds of other genes that also determine whether one has a trait or not remain unidentified. Moreover, most experts believe that environmental causes are far more influential than genetics. For example, one may have inherited a tendency to be overweight that is only triggered when one overindulges in junk food, avoids exercise and has an unhealthy life style, which is great news.

        Dr. Stanton Peele in his book, THE TRUTH ABOUT ADDICTION AND RECOVERY, exposes the fallacy of alcoholism as a disease caused by genetics by pointing out social factors that influence drinking. For example, Irish Catholics are or were far more inclined to drink heavily while Jews and Mormans are/were far less inclined to drink due to their long term customs and social influences that prohibit or frown on alocohol and similar drugs.

        Dr. Jay Joseph in his books, THE GENE ILLUSION and THE MISSING GENE, debunks psychiatry’s neverending quest for genes to back up their bogus stigmas in the junk science DSM to justify their toxic treatments of lethal drugs, ECT, etc. He, too, provides much evidence that emotional distress pathologized by psychiatry is caused by environmental factors. He also exposes the fact that such eugenics theories promoted by psychiatry leading to the horrors of World War II and other ethnic cleansings in modern times are used to perpetrate a right wing agenda for the power elite to justify their very unjust actions and policies.

        I can’t speak about your father, but many experts are exposing the fact that certain substances are addictive in themselves, which include overly refined flour and sugar mixed with fats and salt that have greatly contributed to the obesity epidemic. Dr. David Kessler, Dr. Mark Hyman, Dr. Joel Fuhrman and many others have exposed this danger and give advice on how to heal from such toxic food addiction. Cigarettes, heroin, alcohol and other addictive substances fall into the same category and it seems that if one overindulges to a certain point for any reason, one may find it hard to indulge in them again without getting addicted again if one is fortunate enought to quit. I have certainly found this to be true of certain foods, cigarettes and even certain behaviors like most people. That’s why such groups as Overeater’s Anonymous and Nicotine Anonymous like AA were on to something for those who indulged in certain subtances like refined sugar and flour or nicotine to excess and became addicted needing to avoid those substances altogether if they hoped to “recover” permanently.

        That’s why I agree that such support groups can be helpful if one does so by choice rather than force as I said above. They have lots of wisdom based on personal experience as long as one is free to take what they need and leave the rest as you say.

        I certainly applaud your goal in freeing people from toxic psychiatry and its lethal drugs and stigmas, but I still believe the trauma model is best as an umbrella to address any self destructive numbing behaviors resulting from abuse or other related causes.

        Thank you for letting me know about your books. I look forward to checking them out.

  4. In my experience, people in recovery from substances are often those most intent on getting onto psychiatric drugs to treat emerging symptoms of anxiety and dysphoria. I must say I am not as optimistic as you are that psychiatrists would refrain from prescribing in this setting.

  5. Dr. Littrell,

    Bill Wilson (co-founder of AA) worked closely with Abram Hoffer, M.D., Ph.D (founder of Orthomolecular Medicine.

    A few years after its inception, AA was as much a nutritional program as a spiritual one, with a heavy emphasis on the role of niacin (vitamin B-3) in sobriety.

    Bill Wilson worked tirelessly to get the word out on niacin, so much so that he was inducted into the Orthomolecular Hall of Fame. More information on this page (scroll down to the section on sobriety) –

    http://discoverandrecover.wordpress.com/wellness

    Duane Sherry, M.S.
    Certified Rehabilitation Counselor (retired)
    Sober since 1987

    • Duane

      Thanks for this great informative post and the link to a fantastic web site with a wealth of information on not only recovery, but achieving and maintaining great health naturally. Having done much research in this area myself, I can see that this web site includes many well known, credible experts in holistic health. Congratulations on your long term sobriety. Your many contributions to this site are greatly appreciated.

      • Donna,

        Thank you.

        I’ve been reading some of your comments, and as one who remains concerned about much of what is taking place in conventional psychiatry, I’m grateful to see your passion for reform.

        We can do better than the current paradigm of care. We really can. And I’m certain, we will.

        Duane