Addiction, Biological Psychiatry and the Disease Model (Part 2)
Challenging the disease model of addiction should not be viewed as just another interesting scientific and philosophical debate. Calling addiction a “disease” is not only wrong from a scientific perspective, but the promotion of this model of treatment can actually be harmful to some people trying to understand and recover from this life damaging and life threatening problem. If people believe it is a “disease” they may end up looking in the wrong places for the necessary solutions to their problem and limiting themselves to only specific forms of poorly designed treatment options, including possibly receiving prescriptions for potentially dangerous medications. Biological Psychiatry along with some medical doctors push several different drugs that they believe can treat this disease and/or provide some type of drug maintenance protocol for managing major symptoms. They rarely, if ever, talk about a cure or a state of permanent abstinence, even though millions of people have actually achieved this goal on their own or with other kinds of help.
As stated in Part 1, many psychiatrists see addiction as a set of symptoms related to an underlying psychiatric diagnosis such as depression, anxiety, or Bipolar Disorder, and because these so-called symptoms usually accompany most major drug addiction problems they will end up prescribing antidepressants, Benzos, mood stabilizers, and more recently antipsychotic medications as their treatment solution. Psychiatrists also frequently combine these particular drugs with various sleep medications (sleep problems also come with the territory of most addictions). We now know that all these medications carry with them a whole other set of their own problems (both negative side effects and main effects), including the potential for addiction and/or major withdrawal problems when people try to taper down or stop their use. Quite often all the above mentioned psychological symptoms are the direct result of an underlying addiction problem in and of itself; unfortunately this is either denied and/or ignored by both the addict and their doctor.
The medicalization of addiction, with all it overmedication abuses, only further complicates an overstressed brain that has already been temporarily altered by the chemical effects of legal and illegal drugs. And because we already live in a culture of addiction (opportunistically seized upon and made worse by Biological Psychiatry) people with these problems have been conditioned (and even promised) that their problems can be solved with the external solution of another pill or injection. This is why people with addictions often flock to psychiatrists; they are so ripe to become preyed upon and ultimately fooled into being used by Biological Psychiatry as a new source of patients and for more drug experimentation. And many patients who are addicts also know all too well that psych meds are mind altering by themselves or in combination with other substances, and they can now self-justify their use because they are legally promoted and prescribed to them by a licensed doctor. Look at all the psych meds, such as Benzos, Lyrica, and even antipsychotics such as Seroquel, that are today frequently sold in the streets. In the end all this just tends to make people even more vulnerable and overall dependent on mind altering substance use, thus making recovery a much more difficult struggle, if not totally impossible.
If the standard psychiatric meds do not become part of the mix, there are some newer drugs like Revia (naltrexone) and Campral (acomposate) which are advertised as pills or injections that will reduce cravings and/or block the desired effects of certain illicit drugs or alcohol. My experience tells me that these medications are over hyped (what’s new) and have very little long term success in overcoming major addictions. Addiction rates are definitely not going down and we are not reading any glowing studies showing any huge success rate with these particular meds stemming the high tide of addiction. It is interesting to note that when Revia first came out, if you carefully read the drug company studies used for FDA approval, they ever so conveniently took the liberty to redefine the concepts of abstinence and relapse. Most people believe that a relapse means a return to drinking any amount of alcohol, but with their studies, they redefined relapse to mean consuming more than 4 drinks per week. Therefore they could claim a false abstinence and/or efficacy of the drug if people in the studies were still drinking, though perhaps less than before they started the medication.
Given the high rates of addiction in our society if these above mentioned medications had any outcomes with even mild to somewhat moderate success they would have already received a huge amount of publicity; this is just not the case. Psychiatrists will often throw these meds into the mix just to cover their ass and hope something good happens. Who cares that they may have raised false hopes in treating this so-called addiction “disease” or added a whole new set of drug interactions into the patient’s body. And then there is the old standard drug for alcoholism called Antabuse; this was quite popular many years ago but is not currently used that much these days. This drug makes people violently sick if they consume any alcohol while it still circulates in their blood stream. In some cases “violently sick” could be very dangerous for people with certain medical problems or if they are in very fragile health; so this drug is not without risk. Antabuse can benefit some people who have been totally unsuccessful at getting started on even a short period of abstinence. Of course there is always the ultimate downside, in that if someone really wants to drink alcohol again they will just choose to stop taking the drug. All of this tends to delay the alcoholic’s inevitable and necessary big decision to finally quit once and for all; a decision that people in the end need to make, both by and for themselves, in order to successfully achieve permanent recovery from their addiction.
Finally, when it comes to specific medications directly used for treating addiction, I must mention the widespread use of methadone and suboxone for opiate addiction. I plan to address this issue in greater detail in a future blog, but I will make a few brief comments now. I stated in Part 1 that within the disease model these drugs are equated with the use of insulin for a diabetic; clearly a totally unscientific and bogus claim. Several hundred thousand people throughout this country are prescribed these drugs every day in programs that are openly called “maintenance” programs. Methadone, in particular, has often been nefariously referred to as the “orange handcuffs.” This reference is made because of the higher rates of crime connected to people needing to find illegal means to support their daily opiate drug habit. Methadone has essentially become a drug used effectively for the social control of a feared section of the population. It is an especially dangerous drug in certain situations, and is associated with a significant number of overdose deaths in this country. These methadone/suboxone programs cost the federal and state governments hundreds of millions of dollars every year and are very financially lucrative to certain “for profit” mental health organizations, and of course, the pharmaceutical corporations also find them very profitable. Full recovery from addiction is rarely discussed at all in these programs and it is quite common, and totally acceptable for treatment providers to say that many people (if not most of their patients) may have to remain on these drugs for their entire lifetime.
For many reasons opiate addiction has become a major epidemic in recent years and may be the most difficult drug problem to successfully treat. However there are millions of examples of permanent recovery from these drugs and it is not the huge mystery that the recovery establishment makes it out to be. Right now this disease model that dominates addiction treatment has become just one more obstacle standing in the way of higher success rates for recovery, and dare I say, with better models of treatment operating (most importantly) in a dramatically different world environment, the virtual elimination of major addiction problems on a broad societal scale, is not out of the realm of possibility (more on this point in a future blog).
It is accurate to say that at this time in history there are no medical/drug solutions for addiction, and calling it a “disease” certainly misdirects our focus and does not bring us any closer to finding an answer for this tragic human epidemic. (I would not rule out the possibility that in the future some medications could be developed to help with addiction problems in a more secondary role, especially with lessening drug cravings and withdrawal symptoms). So therefore according to the proponents of the disease model of addiction, outside of a medical solution, the only other successfully developed method that can provide a state of continuous management (not a cure) of this “disease” is a personal transformation in the so-called “spiritual” realm of one’s life. This is where Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, Al-Non and other groups employing the Twelve Step philosophy enters the picture of the modern day recovery movement; and they all have a particular history that goes back to the 1930s.
The United States was supposedly founded upon the principles of a definitive separation of church and state, especially when it comes to the nature of government, public education, and of course, most assuredly the practice of modern science, including the practice of medicine. So how did it come about over 70 years ago, that when the phenomena of human addiction problems presented itself at the doorsteps of hospitals and the offices of common medical doctors, that these followers of the so-called scientific method would end up sending desperately distressed patients to essentially a religious organization hoping for what they referred to as a “medical miracle” to magically take place?
In the late 1930s addiction issues, such as alcoholism, were commonly viewed as a serious moral defect and a problem related to the absence of individual will power. Medical doctors could not fully comprehend addiction and had a terrible time trying to convince their patients to stop drinking; they simply had no effective answers for these problems. So out of shear frustration and ignorance they had no other recourse but to send their patients for a last resort “spiritual conversion” at the newly founded organization called Alcoholics Anonymous. And their decision was made somewhat easier by the fact that one of the group’s founders, himself a serious alcoholic, was also a medical doctor. In addition to this fact, a few very significant AA recovery success stories had recently received major national publicity in certain magazines and newspapers in that same time period.
AA has its origins in the Oxford Group; a small religious sect from the 1930’s that was rooted in a form of Lutheran religious fundamentalism. The original founders of AA, Bill Wilson and Dr. Bob Smith, were eventually thrown out of the Oxford Group for their over devotion to curing alcoholics and their deviation from the group’s strict adherence to the principles of the “Four Absolutes”, which was their version of the one true road to religious salvation. While AA, from its very inception, always welcomed any person needing help for their drinking problem, including atheists and agnostics, its founding members never abandoned their belief that recovery from alcoholism required a religious type spiritual conversion. An excellent brief history of the founding of AA and its religious underpinnings can be accessed at the following website: www.positiveatheism.org/rw/revealed.htm.
Alcoholics Anonymous and all the other twelve step programs that have historically followed in its footsteps may actually comprise the largest peer driven movement the world has ever seen. But it needs to be clearly stated that if a peer led human service movement or organization no matter how well intentioned, follows the wrong theory, it will end up with a poorly developed program and its real world practice will limit the numbers of people it can help and turn others away from potential recovery, and in some cases it may even harm people.
The value of Twelve Step programs clearly divides into two. Their group meetings are accessible on an almost daily basis in most parts of the United States and in many other countries in the world. Over the past seventy years these programs have clearly helped many people, if not from the shear fact that it was basically the only organized group option out there for people with addiction problems. And to those people for whom it was the only help available at a time of extreme desperation, many will naturally attribute their own recovery as being a truly lifesaving event, and therefore view the Twelve Step programs as not only extremely precious, but almost above criticism. This powerful allegiance may be completely understandable given that these individuals usually have no other recovery experience to compare with their own. But what if there were other recovery choices widely available with a more accurate scientific theory and a related program that contained no ideological or programmatic barriers to keep people from attending its meetings or from eventually being turned away by some overly religious and, at times, rigidly followed practices? How many more millions of addicts would have been helped or would have avoided the tragic end results of chronic addiction problems? For this question we will never know the final answer.
Today Twelve Step programs and the disease model dominates over 90% of all treatment facilities from detox/rehab centers to halfway houses and other residential programs in the United States. Unfortunately this domination leaves a significant segment of the addicted population with very few other viable options for finding compatible treatment. Many people struggling to obtain sobriety have already been exposed to the Twelve Step approach and have not been helped by it and are, in fact, turned off and away from recovery because of certain conflicts with its overly religious underpinnings and a rigid one road/continuous recovery approach to ending addiction. This even includes people who are themselves quite religious but reject the Twelve Step version of spirituality being an essential part of their decision to stop a particular substance abuse pattern.
People who end up seeking alternative recovery approaches are sometimes ridiculed or viewed as a potential threat to the Twelve Step program; they frequently are warned by some members that they are destined to relapse for deviating from the one and only accepted road to recovery. Over the years certain clichéd sayings that may not all appear in official Twelve Step literature have taken on a life of its own and have become accepted dogma that is repeated on a daily basis at Twelve Step meetings throughout this country and in different parts of the world. It might be helpful to take a brief look at the Twelve Steps themselves, as well as, a few of these commonly accepted sayings to see how the disease model is actually presented, and also examine the possible negative effects it has had on some people seeking a desperate recovery from addiction.
The religious component of Twelve Step programs is frequently downplayed and minimized by its members, this is especially true when they are defending it against the criticism that it is essentially a religious based organization. But looking at the actual content of the steps themselves and how they are presented at meetings, its religious presence cannot be mistaken. Seven out of the Twelve Steps either make a specific reference to God or a clear religious/spiritual word connection. And then of course there is the often recited “Serenity Prayer” and the much repeated phrase “Let go and Let God.” However even beyond the question of religion being a potential barrier for some people seeking recovery, let’s examine other programmatic or philosophical problems that addicts confront when introduced to Twelve Step programs at a very vulnerable time in their life.
The first step which contains the phrase, “We admitted we were powerless over alcohol,” needs to be critically evaluated in light of the fact that there are a high percentage of trauma victims who end up in the halls of Twelve Step meetings. In this society having a trauma history often leads many people to addictive substances as a coping mechanism. In addition other categories of people, such as women, minorities, and mental health patients labeled as “dual diagnosis,” who are already marginalized or treated as second class citizens, are also prone to seek out desperate ways to cope with all the intense stress or psychological pain that this society dishes out on a daily basis. Is it really helpful to tell an oppressed person who already feels powerless that they are once again powerless over something else in this world? Not only is it not helpful to tell people that they are powerless over alcohol (or powerless over changing the material world around them) but it is not actually true in the real world. Yes, an addicted person may never again be able to safely drink alcohol or use cocaine or heroin etc., but they definitely have the power to make the necessary decision to stop their substance use once and for all, and that decision and subsequent action is, indeed, very empowering and life changing when it finally happens. And yes, certain social groups of people, including friends and family may become critically important and empowering as a part of this recovery process.
In a similar vein, should we be telling people that in order for them to end their addiction they must “make a decision to turn their (our) will and lives over to the care of God” or some “Higher Power” as stated in Step Three? Many victims of addiction already believe their “will” has been controlled and violated by other people or institutions in this society, so are we not encouraging passivity and submissiveness by adding one more master along with additional feelings of dominance and inferiority? Leaving aside the question of whether or not there really is a “Higher Power,” it can be stated that having a strong “will”, or “will power,” is an important and necessary ingredient for anyone attempting to change themselves and the world around them. This “will” and related determination ultimately leads people to seek out an ideology and the social means to achieve a successful recovery or any other goal that is important to them.
“Addiction is the disease, AA/NA is THE medicine; if you stop taking your medicine then you will relapse.” Another often repeated phrase that not only promotes the unscientific disease model, but also attempts to scare vulnerable people from seeking other recovery methods, or threatens them that if they leave “The Program” they will fail miserably at abstinence and end up relapsing or, even worse, dying from their addiction. Once again a much better and more accurate phrase would be, “One journey; many roads.” In reality, millions of people have recovered from addiction using many other types of individual or group skills and techniques, and many of these people have never turned up at detox/rehab facilities, doctor’s or therapist’s offices, or Twelve Step meetings. And if they did receive help from Twelve Step groups they may have done so on a time limited basis and eventually got on with their lives without either long term or lifelong membership.
Taking this a step further, many people participating in Twelve Step programs have been taught to believe that relapse is almost inevitable, or it is waiting just around the corner ready to strike when they least expect it. For some people this can become almost like a “self-fulfilling prophesy.” They end up using their Twelve Step meetings almost like attending a church, in that when they ultimately relapse by engaging in “sin” (drinking or drugging) during the week; they quickly follow this up with attendance at a Twelve Step meeting on Sunday where they humbly ask for forgiveness and then the congregation (members of the group) forgives them (welcomes them back at the meetings) and then at different points in the future they end up repeating the whole process over and over again. For these so-called chronic relapsers true recovery becomes just an elusive dream. In certain ways this presentation of the disease concept has actually discouraged them from believing that permanent abstinence is an achievable goal; they end up believing that they will forever be stuck on a precipice of an impending relapse, never knowing when it might befall them and only hoping that Twelve Step attendance will keep the “germ” of their addiction “disease” at bay.
“Shut up and get stupid; your best thinking got you here.” How much truth is contained in this frequently repeated Twelve Step mantra? Isn’t this actually an example of “turning reality on its head?” Of course it is true that addictive thought patterns (or the more common AA phrase, “stinkin’ thinkin’”) plays a decisive role in preceding anyone’s choice to pick up a drink or drug and thus continue one’s addiction. But is it helpful to make a principle out of ignorance or make a complete mystery out of the addictive process? Isn’t it more accurate to tell someone that it was their “worst thinking” that led them to addiction or, in fact, now keeps them stuck in it? Don’t people really need to “get smarter,” and isn’t more talking about thoughts and feelings also part of the learning process as well as listening and learning? These are all rhetorical questions for which the answers should be obvious. Unfortunately, aspects of the Twelve Step philosophy tend to promote a certain amount of blind obedience to dogma while discouraging critical thinking skills, just the opposite of what is necessary for anyone seeking the truth and finding liberating solutions to complex problems.
These are just a few criticisms of the Twelve Step philosophy and its programmatic approaches to recovery. While I have stated that Twelve Step programs have helped many people by virtue of its overall dominating presence, I also believe it can be harmful to some people attempting to conquer major addiction problems. Some vocal critics of Twelve Step programs refer to it as a cult. While it is true that some members function in the organization in a cult like fashion, I believe its huge membership is extremely diverse and the character of meetings can vary from city to city. As a person who is a critic of the disease model and at the same time counsels people with major addiction problems, I have never discouraged people from attending AA or NA meetings. People in the throes of a devastating life of addiction often desperately need social/group support, especially from people who have some understanding and/or experience with this life threatening problem. A once a week counseling session can fall way short of the support necessary for successful recovery.
There is one other commonly repeated saying in the halls of AA and NA that does make a great deal of sense for those people attending Twelve Step meetings, “Take what you need and leave the rest.” I find myself repeating this phrase quite often when people I work with are attending recovery meetings in my area. People need to find as many tools as possible in their search for recovery. There are no easy or simple solutions to our pervasive culture of addiction with all the damage it does on a daily basis. The search for the miracle cure has clearly come up empty; we should not be surprised.
In the past, people in Twelve Step programs use to put up spontaneous resistance to Biological Psychiatry and their proliferation of psychiatric meds flooding our society. Group members would often be very critical of people in recovery who claimed abstinence while taking these legally prescribed drugs. More recently an approach of accommodation with Biological Psychiatry seems to have won out in Twelve Step groups. This is also not a surprise given the power of psychiatric institutions and the similarities of both groups’ presentation of the disease model. Until some positive new approaches to treating addiction begin to take hold on a broad scale throughout this country and beyond, we will be stuck with both the dominance and limitations of Twelve Step programs and its disease model of addiction. However this reality should not deter any of us from being critical thinkers and seeking out revolutionary alternatives in the coming period.
Part 3 of this blog will be titled “Confronting the Addiction Voice on the Road to Recovery.” This will explore some of the newer and more alternative treatment options that are now available. Although quite small in number and in size these newer options pose a direct challenge to the dominance of the disease model.
Disclaimer: The above views are based on my study and summation of over 20 years of direct and indirect experience working as a counselor in the mental health field. In no way does this represent a specific criticism of any human service organization or detox/rehab facility. I work with many dedicated professionals who, under difficult conditions, do great service for people experiencing many different forms of extreme states of psychological distress.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Good post. No one person or organization has a monopoly on the truth. Take what you need and leave the rest, (but keep an open mind and try many approaches) has worked well for many people.
This is a very disappointing post, Richard.
Very big sigh.
First, it is too long and convoluted. Second, the title and subtitle do not match the content of the article. Third, AA is founded on the principle of addiction as a spiritual illness, and therefore, not a biological disease. If persons in AA subvert the original message in order to benefit psychiatry and other medical institutions, that is not the flaw of AA.
AA helps people. It works better than anything else out there. I don’t intend to read your part 3. that suggests you have a better plan for addiction recovery than AA. I don’t believe you do.
“Shut up and get stupid; your best thinking got you here.” This is brilliant. I’ve never done AA and haven’t yet heard this one. Thanks for this. AA sayings are priceless.
Today is a gorgeous day where I live in America. I’m going to spend sometime outdoors today with my friend Chris. Chris has the day off of work today to grieve because his friend John died.
John went to an AA meeting Tuesday night and then scored some bad heroin. When the cops discovered John OD’d, they checked his cell phone to find the dealer who sold him the smack.
AA does not fail people; drug pushers (including psychiatrists) fail people. And people fail themselves.
I can guarantee that John’s AA friends will have as much or more sympathy for his passing as his coworkers and family. His AA friends will remember him as more than an addict.
As an addiction specialist you would do well to remember the level of caring and resiliency found within the AA community that you cannot buy from another recovery model.
Hope you enjoy your day, too.
“AA helps people. It works better than anything else out there. I don’t intend to read your part 3. that suggests you have a better plan for addiction recovery than AA. I don’t believe you do.”
My blog states that AA helps some people. The evidence comparing different treatment models does NOT show that AA “works better than anything else out there.” Studies I have read show that ALL treatment models, including AA, do not have very high success rates; no one treatment model stands out as more successful than another.
My blog did not say I have a better treatment model for addiction. My intentions are to present alternative models that have developed along side of, and in some cases, in opposition to the Twelve Step model. Since you don’t plan on reading it you’ll never know if they seem more useful to you or your friends.
Since thousands keep dying every year from addiction deaths it might make sense for all of us to question the so-called gold standard of treatment that seems to be totally above criticism to some people.
Actually, I don’t think anything on this earth, AA included, is above criticism. I don’t think the fundamental problem with addiction is flawed models for recovery. Maybe it has more to do with dealing with flawed people. Of which we are all one. Experts included.
My experience is with “schizophrenia” so called recovery programs, not addiction programs, and I do subscribe to Richard’s view that the models are flawed. I participated as a parent in a two year “recovery” program for my son, and I actually felt worse about his situation, his hope of recovery, the longer he stayed with the program. I felt that there must be something wrong with him since he wasn’t “recovering.” One size does not fit all and more people should empower themselves by seeking alternative help. I did not like thinking that my son was “mentally ill” for life, and that was the vibe that this particular program gave off. I finally got the idea that if your health is important, you have to take charge yourself and do it your way. (I can include myself in this because a diagnosis affects the whole family.)
Hey Rossa, I have read your comments on this site before and am already familiar with your story. I like your writing.
I have to say that I am slightly bemused that four different people found the time to criticize my opinions, yet no one had the time or the compassion to say, “Gee, I’m sorry for your friend Chris’s loss.” Thanks MIA community!
Rossa, you might not be tracking my story, but I was taking multiple psych drugs for my “treatment resistant” bipolar disorder for 12 years. When I finally had had enough and wanted to get off of my drugs, my psychiatrist was not there for me. My friend Chris was. He had two years of sobriety at the time, achieved through old school AA, meaning the free, peer-driven kind. My deliverance from psychiatry was in no small part to my friend Chris’s belief that I was not crazy, the drugs were.
My friend Chris is suffering yet today because of his loss of a fellow friend to addiction. He is not paid to care, but he cares more than money could buy. He was at the club today talking with John’s sponsor and his fiance and organizing his final affairs. That is the power of the AA community.
I identify with the MIA community because of my lived experience of clinging to a psychiatric diagnosis, psychiatric drugs, and psychiatrists for 12 years. But maybe MIA could learn from the AA community about compassion.
AA helps some people. It doesn’t help everyone. My experience with AA people is that they assumed, the people I dealt with, that “one size does fit everyone.” You and I both know that this is a fallacy. I also found them, the people that I dealt with, to have the attitude that you better have a “higher power” or something was wrong with you. I was forced to go to a few meetings for an assignment and I came away being not very impressed. I suspect that results vary depending on the group that you’re attending. I would have to say, “Thanks but no thanks,” to AA. I know of other people that it has helped immensely. I think that the author gave a fair assessment of AA, from my contacts with the program.
Hi Emily. I’d like to respectfully disagree with a number of points in your comment. First, the disease model in Alcoholics Anonymous is not simply spiritual but clearly assumes that alcoholics have an inherited biological allergy to alcohol. Consider the following passage from Twelve Steps and Twelve Traditions: “…first we were smitten by an insane urge that condemned us to go on drinking, and then by an allergy of the body that insured we would ultimately destroy ourselves in the process.” This presumed biological abnormality, which is still unknown to science, is a critical feature of the disease model as it suggests that abstinence is the only acceptable means for recovery (i.e., biological allergy = alcoholics cannot control their use, even when ingesting trace amounts of alcohol). I have worked in substance abuse treatment centers and the biological basis of the disease model is emphasized quite heavily. AA’s disease model is not evidence-based and contains numerous assumptions that are flatly contradicted by science in addition to the assumption of a non-existent biological allergy. For example, AA”s notion that alcoholism is always a chronic, progressive disease is inconsistent with the observation that more than half of former alcoholics who recover do so without treatment and continue drink at low levels without symptoms of alcohol dependence (http://www.spectrum.niaaa.nih.gov/features/alcoholism.aspx).
Lastly, your assertion that AA “works better than anything else out there” is not scientifically supported (e.g., http://www.ncbi.nlm.nih.gov/pubmed/10540977). Despite its immense popularity and longstanding dominance of the treatment industry, the AA approach is not particularly supported by the research evidence, some of which is distinctly not flattering (see here for a rigorous and comprehensive literature review:
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005032.pub2/pdf/standard). I’m not claiming that AA does not help some people or disputing your comments about the level of caring and resiliency of AA members. However, I think it’s important not to promote unsubstantiated claims of a scientific nature about disease models and treatments, on this swebsite of all places.
Thanks for participating in this discussion and providing some interesting comments and source material.
My anecdotal experience over 20 years of counseling people with addiction problems is that very few people can return to safe/social use of alcohol after a period of addiction. Therefore total abstinence remains the safest choice. I believe the longer someone abuses alcohol the more difficult it becomes to turn the clock back to a pre-addiction pattern of use. Obviously my sample of people is limited and skewed towards those who feel the need to seek out counseling.
Hi Richard. I’ve really enjoyed your eloquent thoughts on this topic. My anecdotal experiences and observations from working in addiction treatment centers mirror yours. However, I think you hit the nail on the head in highlighting that we see a skewed sample of clients in these settings.
It turns out that much of what we think we know about the nature of addiction from experience with clients in treatment settings is not broadly applicable to the general population of people with substance use problems.
Total and permanent abstinence as a treatment goal, or in AA as the *only* acceptable treatment goal, may seem the safest choice but is obviously difficult for most people to achieve. AA’s disease model strongly suggests that alcoholics have an innate inability to control their use. It’s possible that people who truly believe this notion are indeed unable to control their use via a self-fulfilling prophecy, which is nicely illustrated in Twelve Steps and Twelve Traditions: “It was then discovered that when one alcoholic had planted in the mind of another the true nature of his malady, that person could never be the same again. Following every spree, he would say to himself, ‘Maybe those AA’s were right . . . .’ After a few such experiences, often years before the onset of extreme difficulties, he would return to us convinced. He had hit bottom as truly as any of us. John Barleycorn himself had become our best advocate.”
Given that the majority of people who overcome alcohol dependence do so on their own and continue to drink without problem, I wonder if mandating a severe and extremely difficult goal with every client is the best strategy.
“Given that the majority of people who overcome alcohol dependence do so on their own and continue to drink without problem…”
I am not sure this statement is accurate. We need to carefully look at the sample of people with alcohol problems from which this conclusion was drawn. Yes, there is much evidence that college age students who abuse alcohol for 4 or 5 years then graduate and get a job and a family (and other responsibilities) frequently “outgrow” their pattern of dysfunctional alcohol use. But what about people who start at young age and continue their abuse of multiple substances for 10 or 15 years; can they learn to moderate their drinking? Most of these people have tried to moderate their drinking hundreds of times and failed miserably at it. That is why they end up searching for a way to successfully achieve abstinence as their goal.
Groups such as Moderation Management have not been that effective in teaching people how to safely drink alcohol. People who are safe/social drinkers seem to automatically have built in limits to their pattern of drinking. If someone suddenly becomes focused on “moderation,” this may indicate that some type of line has already been crossed where the alcohol controls “them” more than they can control “it.” They may start out with the intentions to limit their use, but once they consume a certain amount of alcohol(which affects the cerebral cortex, the area of the brain where judgement is made) there good intentions seem to go out the window. This happens not because alcohol is some “evil substance” that has a mind of its own, but perhaps more because of well established thought patterns associated with impulsivity,compulsivity, and negativity; that is acting on impulse without thinking first, feeling compelled to do something even though you know better, and negativity based on the mistakes associated with their history of drinking and the actual depressive effects of alcohol on the central nervous system.
All of this is important because we do not want to mislead people who have been abstinent for a long period of time into believing that they have a good chance of now becoming a “social drinker” based on misleading statistics. This could have disastrous consequences for some people who have achieved a precious state of stability in their life. People with good sobriety already have alot of experience talking back to their “addiction voice” which every so often starts “romanticizing” having a drink. Just a hint of what is to come in Part 3 of this blog.
Brett, you are correct that in some cases we need to focus more on “Harm Reduction” with some people who do not want to quit drinking drinking and/or seem to be unable to do it for any length of time.
Hi Richard. That statement you took issue with is based on this survey, funded by NIAAA, of a nationally representative sample of 43,000 adults: http://www.spectrum.niaaa.nih.gov/features/alcoholism.aspx. This study is not subject to the limitations you mentioned and is the best science has to offer. I cite two observations from the summary of the study to reiterate my point that impressions about the nature of alcoholism gleaned from clinical experience may not always be accurate:
“Twenty years after onset of alcohol dependence, about three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence.”
“About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol (rehab) programs and AA. Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment.”
Having been in 12 step programs for over 20 years I find a lot of good stuff in this article.
For me the God concept in 12 Steps points to the creative power of the universe and surrender of old ideas. I turn the word God from a noun to a verb. It’s what I do, not just what I believe.
Using the word “religious’ as a pejorative can miss the point. One of the preachiest AA members in my area is an atheist, who speaks and behaves very much like a fundamentalist.
I use the disease concept as a metaphor. It’s not a perfect analogy but in a broad sense it works for me. There are numerous casuative factors leading to my addictions – a cluster of influences – genetics, environment,neurology.
I always encourage 12 Step members to explore other complementary treatments. I have done trauma recovery workshops, psychodrama, therapy, neurofeedback and interactive metronome – all of which were helpful.
I see members who take a broad approach to recovery as the ones who get the best results. Even if all they do in 12 Steps take the program broadly, challenge assumptions about what meaning one ascribes to particular words in the Steps.
Your observations about “take what you want and leave the rest“ is spot on! It allows the recovery process to become organic and non-programmatic. This is why in meetings I ignore members who offer unsolicited advice and who don’t share from personal experience.
Thanks for your comments. Your open approach to recovery seems to be very solid and effective for you. Your support in the recovery movement could be very helpful to many people.
This is a great essay Richard, and highlights the difficulty of understanding the complex nature of addiction and the long road to recovery, beyond our natural craving for a “Miracle Cure?”
My experience with 12 step programs was one of early relief in the “I’m not alone,” value of sharing, leading to eventual frustration about remaining stuck, with no process model for illuminating self-discovery, such as we see in Yalom’s model of group therapy. It was similar to the early relief of seemingly correct medical diagnosis with its hopeful promise of finding the right medications along the long road to recovery, as an increasingly capacity for better self-regulation. Or the recovery of self-discovery, as many now suggest?
As phi96435 points out, the recovery process is very much an individual process and cannot really be defined in a programmatic model, which normally does not address the organic nature of the processes involved;
“Your observations about “take what you want and leave the rest“ is spot on! It allows the recovery process to become organic and non-programmatic.”
In my own search for a recovery method, education about the nature of organic processes within helped me towards better self-regulation on the long road to recovery. Education about the hidden nature of what stimulates my behaviors has helped me to come to terms with the mismatch of socially constructed language and the limits of cognition, in understanding the organic nature of my experience.
Why are we addicted to chemical substances? How mismatched to our internal reality, is the normally “objective” language of our social dialogues? Consider a neuroscience explanation of the chemical nature of addiction;
“Social Bonds, Loss, Loneliness & Addiction:
“I Sing the Body Electric”
I have perceived that to be with those I like is enough.
To stop in company with the rest at evening is enough.
To be surrounded by beautiful, curious, breathing, laughing flesh is enough.
I do not ask anymore delight, I swim in it, as in a sea.
There is something in staying close to men and women and looking on them, and in the contact and odor of them, that pleases the soul well.
All things please the soul, but these please the soul well.” _Walt Whitman.
One of the great mysteries of psychology is the nature of the “something” that Walt Whitman extols in his masterpiece “I Sing the Body Electric.” That subtle feeling of social presence is almost undetectable, until it is gone. We often take such feelings, like air itself, for granted. But we should not, for when this feeling of normalcy is suddenly disrupted by the undesired loss of a lover, or the unexpected death of a loved one, we find ourselves plunged into one of deepest and most troubling emotional pains of which we, as social creatures, are capable.
In everyday language, this feeling is called sorrow or grief, and can verge on panic in its most intense form. At a less acute but more persistent level, the same essential feeling is called loneliness or sadness. This psychic pain informs us of the importance of those we have lost. This type of psychic pain probably emerges from a brain emotional system that evolved early in the mammalian line to inform individuals about the status of their social environment and to help create our social bonds.
Neuroscience is struggling to come to terms with the nature of such intrinsic brain processes, and it is becoming clear that several ancient emotional systems control our social inclinations. In the coarse of brain evolution, the systems that mediate separation distress emerged, in part, from preexisting pain circuits.
It is now widely accepted that all mammals inherit psycho-behavioral systems to mediate social bonding as well as various other social emotions, ranging from intense attraction to separation induced despair. There is good reason to believe that neurochemistry’s that specifically inhibit the separation-distress or panic system also contribute substantially to the processes which create social attachments and dependencies–processes that tonically sustain emotional equilibrium and promote mental and physical health.
The brain contains a least one integrated emotional system that mediates the formation of social attachments. The affective components of this system are “dichotomous–behaviors” with feelings of separation distress on one hand, and those of social reward or contact comfort on the other. Existing data suggests that arousal within this system is controlled by multiple sensory perceptual inputs, and that the evolutionary roots of the system go back to more primitive mechanisms, such as those elaborating place attachments in reptiles, the basic affective mechanisms of pain, and fundamental creature comfort of thermoregulation.
To be alone and lonely, to be without nurturance or a consistent source of erotic gratification, are among the worst and most common place emotional pains humans must endure. Love is, in part, the neuro-chemically based positive feeling which negates the pain of isolation. Brain opioids were the first neuro-chemistries discovered to powerfully reduce separation-distress. As predicted by an opiate theory of social attachment, drugs like morphine are powerful alleviators of the psychic pain induced by grief and loneliness.
Opiate addiction, may emerge largely because individuals who cannot find the needed satisfactions of social attachment in their lives, are tempted to induce the stimulation of internal opioid systems by a pharmacological means, usually leading to a further increase in social isolation. The French artist Jean Cocteau recollects how opium liberated him “from visits and people sitting around in circles.”
Excerpts from, “Affective Neuroscience: The Foundations of Human and Animal Emotions.” by Jaak Panksepp.
Just how far “off base” is our everyday language when comes to understanding our nature, within?
As Panksepp explains how human bonding is foundationally mediated by the primitive brain systems of pain, panic and separation-distress alleviation–he notes how fear overrides the urge to relieve separation-distress. As a primitive survival protection against predator detection, the fear system will automatically override separation-distress, which perhaps explains a hidden aspect of social bonding difficulties for those with childhood abuse histories.
To what degree is an innate, predator fear system, triggered by the social environment, and its forest of faces? What part does innate fear play in “dichotomous–behaviors,” as addictions promote isolation and separation from “social attachments and dependencies–processes that tonically sustain emotional equilibrium and promote mental and physical health.”
Panksepp, points us towards internal systems, as the hidden stimulation of human behaviors with an explanation of addiction as a behavior seeking to stimulate an internal chemical system. Such observations on the “organic” nature of human motivation/behavior, may lead us to question ourselves about the hidden aspects of our self-stimulating belief systems? Do we need to consciously re-define stimulation/motivation, in the light of rapidly increasing revelations about the hidden nature, of human behavior?
In this miracle age, is the internet a key tool in the long road to recovery, with its power to enable self-education, as we seek to free ourselves from dependency? Is it the organic nature of dependency which forms the core need in substance addiction?
Looking forward to part three.
Thanks for such an in depth analysis relating attachment and loss issues to addiction.
Your description of the evolutionary basis for depression and the human reaction to loss powerfully refutes the Biological Psychiatry model of trying to quickly remove the symptoms of depression. Their use of medication totally short circuits the role of depression as a valuable learning process. Of course it is not a good thing to remain stuck in state of depression or to remain stuck in a pattern of using certain substances as a coping mechanism.
David, good to hear from you again as always.
Thanks Richard for your interesting views on addiction that I quite agree with. And as far as AA goes, it had a great path in the 1930s but unfortunately it’s not been practiced today. To understand why AA program today does not work, you can go through this blog: http://12stepsinaday.blogspot.in/2011/09/12-traditions-ruined-aa-program.html
I’ve worked out the natural cure for the alcoholic/addiction disorder. But I’d sure like to read the miracle cure you would be writing in your next blog. ‘Hope to read it soon.
There is a growing network of atheist & agnostic AA groups! A list can be found here on the website put up by the NYC agnostic groups:
There are groups in 23 states and D.C., 3 Canadian cities and 2 in Britain. Our groups in Chicago have a pretty good relationship with the citywide “intergroup”, which is real progress from twenty years ago when they refused to put us in their directory. Change is coming, and we are part of it.
To me the abiding value of AA is that it remains, as the Traditions say, “forever nonprofessional.” Membership is restricted to those who have been there. Nobody is the Leader, the Counselor, the Therapist or the Identified Normal Person. It has enabled me to learn lessons I never could have absorbed from the aforementioned superior beings. In my view the most rigid applications of the “AA program” come not from AA itself but from the treatment centers who see their economic survival and professional prestige as tied to this ideology, like a proprietary product. Outside, in groups of drunks stumbling towards the light, there’s more room for evolution.
I appreciate you providing the information about the out of the mainstream AA groups. It’s good to know that there is struggle going on in Twelve Step organizations that might lead to better and more inclusive options for people.
“Nobody is the Leader, the Counselor, the Therapist or the Identified Normal Person. It has enabled me to learn lessons I never could have absorbed from the aforementioned superior beings.”
I am a bit troubled by the above commnet about “superior beings.” Do you believe that all counselors or therapists act “superior” or believe themselves to be so? Did you find my blog helpful? Did you think it was presented in a way that was condescending? I would appreciate the feedback from someone who has battled addiction. Thanks in advance.
Hi Richard! You are right, that remark about superior beings was too fast and clever to be fair. I have known many counselors or therapists who took the approach of superior beings — including some undeniably kind and well-meaning ones, and some who were not so kind. In general, they seemed to feel that any addict or psychiatric patient before them had simply failed at the developmental task of becoming a mature adult — whether by free will, miseducation or a biological disease, it didn’t much matter.
However, I have known some others who were among the best human beings out there — mainly because they were not afraid to acknowledge they were just flawed humans themselves. And I thought your blog post was really interesting, food for thought and not at all condescending.
(Sigh.) Can a *system* be condescending even if many of the individuals are not? Because there are good people working in professional treatment centers, and on the other hand you will meet fellow drunks in AA from time to time who are pompous know-it-alls. But the treatment-center industry at its best seems to do a lot more to disempower people than AA itself on a bad day. I just think it’s really important to distinguish between the industry, and the peer-driven recovery group — they are different paths, and there’s far more hope for the latter than the former. Guess that’s all I was trying to say.
Thanks for responding to my probing questions. Your feedback and your clarification of meaning is helpful to me and to the overall discussion.
Having watched the take over of the medical model in community mental health over the past 19 years I have experienced how this has negatively influenced the way clients are both viewed and treated by the doctors(no surprise there since this is how they are trained) and more disappointedly by counselors. So often a person is only discussed as a set of symptoms; the narrative(the story of who the person is and how they got there) is completely lost. I purchased and circulated 5 copies of “Anatomy of an Epidemic” in my clinic to both a few doctors and several therapists; only a few really took the time to read it. I believe there is an undercurrent of alienation and dissent among people working in the field but we all have much work to do to build on this as part of our movement.
By the way I wish you would look at some of the above discussion going between myself and Brett and participate with your experience and perspective; I think it is a very important discussion with potentially serious ramifications.
I am forced to respond to you down here because there was no “reply” at the end of your last post.
I plan to do more investigation on the statistics you are presenting. But I will say that in one of the early Rational Recovery groups I attended there was a young Harvard student there who made the following statement on this subject: “It might be possible for me to learn how to be a social drinker but I don’t think it is worth the risk.”
I would like to hear from some other people in this particular discussion.
About that question of “can people recover from alcohol dependence on their own? and can they return to moderate drinking?” I took a look at the federal survey of 43,000 Americans that was linked to by Brett. A lot does depend on your definition of “alcohol dependence.” They did find this to be a phenomenon with a mean onset age of 22 that definitely peaks in the twenties. Among the people they count as having “mild to moderate alcohol dependence” they say that very few have severe health, relationship, vocational or legal problems as a result. That alone says to me that they are counting “transient alcohol abuse” or “transient stupid drinking” of the type that’s condoned or even romanticised for young adult males in our culture as “alcohol dependence.” These are not the people who show up at AA or treatment centers looking for help, or those who are marched in by outside authority. I’m not sure it’s helpful to lump them in with people who have shown real signs of addiction.
The other thing that dogs this survey, I think, is the demon of self-report. In other words, anyone who says “I used to get shit-faced every weekend in my twenties but I am oh-so-much more mature now, I’ve got it under control” is believed and counted among the success stories. Some of their stories would check out, and some would not. For most of my active drinking career I would have reported myself to be a responsible moderate drinker, and if you did not know me well you might even have believed me. Woulda been a fib, though.
My attitude towards controlled drinking strategies is this: here’s something that could let me have a little more bourbon, and there is almost a 10% chance that it will not screw up my whole life. The odds don’t look good to me. Most of us arrive at AA only after failing at dozens of self-directed “got to cut down” efforts over the years. To hear from professionals that this is a strategy that can still work if we just do it right? Not useful. That said, I think it’s good to recognize that some people will go through a phase of unhealthy drinking, or one DUI or drinking on the job bust, without being dependent, and sending them into substance abuse treatment when they have at most a potential problem is stupid. That did not use to happen very often, but it may be happening more today. Especially with teenagers who can be treated on their parents’ say-so without their consent.
Thanks for your feedback on this issue. I tend to agree with your perspective on the difficulty of assessing these statistics. There may be a small percentage of serious alcoholics who at some point in their sobriety return to drinking without serious repercussions, but my experience tells me that those individuals would be the rare exceptions. And we know that the risks for such an experiment can be very high.
The other problem is that when the people who return to drinking are interviewed or become part of a survey they may not be having major problems at that particular time or be willing to admit they are. In other words “the jury may still be out” and a true verdict on their success or failure may not be rendered for months or even years. Some people who attempt a return to drinking fight very hard for a period of time to keep their drinking under control; they desperately want to hold on to their alcohol and prove to themselves that they can drink safely. For example,in counseling I see one person who otherwise functions very well (job and family etc.) and returned to drinking after 10 years of sobriety. It actually took a few years for her drinking to once again become a problem; so much so that she decided to go on antabuse inorder to get herself started on a significant period of abstinence.
Johanna and Richard: I think we are largely in agreement here but are approaching this issue from different perspectives. My original point is that an unrepresentative group of people with substance use problems seeks help in 12-step programs and/or treatment clinics. I do not doubt your claims that your personal experience with addiction paint a different picture than that revealed by population-level research. In fact, this is exactly my point: opinions about the nature of addiction formed by experience with a skewed sample of individuals may not be accurate when applied to the experience of addiction in general.
Where we have to be careful is using our personal experience with an unrepresentative group of individuals to discount findings from the largest and most scientifically rigorous study ever conducted. I’ve noticed a tendency, both here and elsewhere, for observers to conclude that people who formerly met diagnostic criteria for alcohol dependence but subsequently recovered without treatment, many of whom went on to become non-problem social drinkers, were not “real alcoholics.” Presumably, the only “real alcoholics” are those individuals whose drinking problem progresses, and responds to treatment, exactly as you expect it should based on your preconceived notions. I don’t think it’s that simple. Research clearly reveals the experience of addiction to be much more varied than many experts think, and in many cases people with substance use problems recover on their own and demonstrate a clear ability to control their use.
My thinking on these topics has been heavily influenced by psychologist Stanton Peele. Author of many books and scientific articles, including the classic book “The Diseasing of America,” Peele was out on limb calling out disease-model pseudoscience decades before Robert Whitaker and David Healy and is a personal hero of mine. He recently posted this blog on the topic of this discussion: http://peele.net/blog/2012/09/the-deluded-world-of-addiction-experts/.
I am forced to respond to your post under my own (which is actually above your posting) because for some reason there is no “Reply” moniker to work with under your post.
I have always liked Stanton Peele and I have read and been positively influenced by his publications in the past.
I have started reading some of the research material for the NIAAA study that you have cited. I am unable at this time to do more of this reading and will withhold judgement until I can devote some serious time.
I will say that I believe addiction is really a particular relationship that someone forms with a certain substance or behavior. It is unique to each person and has its own special meaning related to their history of both positive and negative life experiences. We can measure statistics in terms of number of drinks and frequency of use ect., but these statistics do not tell us much about this particular relationship. Statistics are very important but so is what’s at the heart each person’s narrative. What are people running from and how is their substance use or behavior filling an empty void in that person’s life? Coming to terms with these questions may help us determine the actual degree of addiction and the difficulty of recovery and possible re-addiction at some future time if a person starts to drink again.
Great contribution! I’m so glad you’ve named the pharmaceutical and bio-psychiatric interests in addiction “treatment” here on MIA. As far as I can tell, psych drugs are creating more dependency and contributing to the numbers of lethal overdoses (particularly the benzos).
The medical Tx of addiction has funneled money out of the pockets of street drug dealers and into the pockets of pharmaceutical company executive. The products are essentially the same. Maybe some drugs are more fast-acting than others. Maybe that methadone is legal keeps some people out of jail. But then I know a many people who were locked up, got ‘clean’, and feel it was, though not without its problems, a life-saving experience.
I disagree with your analysis of AA as religious. AA promotes a spiritual way of life. One in which people get to discover and engage with what’s meaningful to them in the place of that which felt empty . It doesn’t force anyone to subscribe to a particular belief. It only encourages peers to connect with and make decisions based on something greater than self-centered fear. Here’s a quote from author David Foster Wallace which I really like. He was in and out out ‘treatment’ and on a lot of psychiatric drugs until he tragically committed suicide–I think it aptly reframes the notion of AA’s ‘religious underpinnings’:
“Because here’s something else that’s weird but true: in the day-to day trenches of adult life, there is actually no such thing as atheism. There is no such thing as not worshipping. Everybody worships. The only choice we get is what to worship. And the compelling reason for maybe choosing some sort of god or spiritual-type thing to worship — be it JC or Allah, bet it YHWH or the Wiccan Mother Goddess, or the Four Noble Truths, or some inviolable set of ethical principles — is that pretty much anything else you worship will eat you alive. If you worship money and things, if they are where you tap real meaning in life, then you will never have enough, never feel you have enough. It’s the truth. Worship your body and beauty and sexual allure and you will always feel ugly. And when time and age start showing, you will die a million deaths before they finally grieve you. On one level, we all know this stuff already. It’s been codified as myths, proverbs, clichés, epigrams, parables; the skeleton of every great story. The whole trick is keeping the truth up front in daily consciousness.”
Look forward to reading more–Vanessa
I have found your blog entries to to passionate, well written, and educational.
You are so right about the fine line (or no line) between legal and illegal drug pushing. Every psychiatrist I have spoken to in community mental health (especially when they first arrive) have said to me that they know Benzos are dangerous and plan to only rarely prescribe them; their words are hollow. Benzos prescriptions are enormously high and growing; many people coming to community mental health already have been prescribed them by their primary care doctors who get nervous when their patients get worse and inevitably ask for higher doses. Outside of a hospital setting I believe these are the most dangerous drugs in the world and do far more harm than good.
“I disagree with your analysis of AA as religious. AA promotes a spiritual way of life. One in which people get to discover and engage with what’s meaningful to them in the place of that which felt empty . It doesn’t force anyone to subscribe to a particular belief.”
Vanessa, For me “spiritual” has two meanings. One is the desire and need for human connection with some type of meaning beyond the self, as you point out. The other meaning of “spiritual” is clearly religious, that is, worshiping a god or higher power that can only be recognized by faith. AA promotes both meanings in its literature and practice. Yes, it does not outright force people into these beliefs, but the strong influence of group morms and group conformity is very powerful. I have witnessed both its positive and negative effects on people struggling with addiction problems at a very vulnerable time in their life.
Your quote from David Foster Wallace is very interesting but I cannot say I agree with the thrust of his essential message.It clearly has a theme of cynicism and accommodation. It reminds me of the debate that took place around the Bob Dylan song “Your Gonna Have To Serve Somebody.”
“Well it may be the devil or it may be the lord
But we’re gonna have to serve somebody”
Many people from the 60’s movements eventually became burnt out and demoralized when the crest of the wave of those powerful movements began to subside along with many of the leaders being coopted into community development and urban planning endeavors attempting to reform the system. Some people turned back to religion or accepted defeat when they no longer believed it was really possible to radically transform the material world around them.
When Wallace says: “everything else you worship will eat you alive” Maybe the answer is simply to not worship( as a deity or something above us) anything, in the sense that we should not place any person or thing above reproach. I say, no we don’t “have to serve somebody.” We should always retain our critical thinking skills and courage to question all authority. In other words we should serve nothing but the truth and that which will truly move all of humanity forward. I don’t think that means that we should have no trust in leaders; but genuine leaders should welcome and encourage their ideas to be questioned and interrogated as well as inspiring every one to become a leader themselves.
Biological Psychiatry must be defeated; it will not just wither away. We have much work to do and I look forward to uniting with you in this struggle.
I like that Dylan song. 🙂 I see what you mean about the cynical tone of the DFW’s quote. He was cynical. He also suffered a whole lot. Essentially, his suicide was a causality of psychiatry’s bad medicine and torturous practices. He’d been in and out of rehabs and institutions–he underwent ECT at McLean, he’d taken Nardil for 20 years, and came off (because he could not feel emotion) without information about how the drug had affected his brain and body, and without any withdrawal support. I wish he’d had this movement. He’s an example of someone who never had a shot at a sober life without psychiatric drugs. He’s early death is an example of what happens when we replace open and honest communication, compassion, and, in my opinion, a spiritual practice, with psychiatric labels and long-term, toxic and mind-altering substances.
I still disagree with your belief that AA is essentially religious. I’ve read the text. True, it has roots in religious experience. But it’s preserved and used by many as essentially that- a text set within a historical, cultural context.
The text doesn’t ask that AA members serve an individual or institution. It does, however, as DFW says, point to the value in upholding “some inviolable set of ethical principles”: honesty, hope, faith, courage, service, justice, spiritual awareness, etc. There’s plenty of room to uphold these principles and also affect change in the material world. In fact, if one is awake in their process, they’d be obliged to!
Unfortunately, this message is often missed by members of the AA community who believe they are supposed to “follow directions”. Following direction is important for a time-while the brain is still hot and wired to drink or use substances- but over time one gains clarity, freedom, intuition, and a genuine sense of internal direction. Your keen observations of AA highlight the fact that this possibility for activism and true liberation is often missed by AA’s critics and members alike.
There are so many interesting people in AA. People who have built their lives around supporting others to live more freely and comfortably in the world without altering their consciousness. I feel sad that this gets missed or obscured among a sea of people who are coercive or prescriptive in AA meetings.
I also look forward to uniting with you in this struggle! It was so great to meet you (briefly) in NYC. Hopefully again soon…–Vanessa
Quick add-on note: An interesting phenomenon about meetings is that they reflect the local culture. In a Texas, someone might praise Jesus. In Cambridge, MA someone might refer to a New York TImes article. In San Francisco a woman mentions the joys her newfound life in sobriety as a sex worker. In India, a man shares the shame he feels over his daughter’s decision to eat meat. The common thread among each member’s life experience or values, is that all these people want to stop drinking, and they’re willing to set aside their differences to help each other do just that. For example, the one who praises Jesus in Texas attends an AA meeting while on business in SF and listens to a bi-sexual sex worker share her experience. Maybe she says something helpful to him. Maybe he says something helpful to her. This happens everyday. It’s quite amazing. I can’t think of any other organization which facilities this kind of unlikely connection, compassion and bridge building. In it’s most pure form, AA is an incredible model for personal and community evolution.
If I were a better writer, I would have wrote this. Thanks Vanessa. There is nothing in the whole mental health industry that can touch the effectiveness of AA. It is an “incredible model”. I am not a part of it, but I want to be! I’ve seen what it has done for others.
It might be relevant to this discussion to note that a dozen (or so) court cases have examined claims from plaintiffs arguing that legally mandated attendance at AA is unconstitutional. In each case, the court sided with the plaintiff and concluded that AA is an overtly religious organization, and therefore that forced participation in religion violates the constitution’s establishment clause. Even a cursory perusal of the 12 Steps demonstrates the inherently religious nature of AA (e.g., Step 11: “Sought through prayer and meditation to improve our conscious contact with God as we understood him, praying only for knowledge of His will for us and the power to carry that out). AA is not *only* a religious organization, and people may benefit from it in ways that have nothing to do with its religious content, but I find it hard to disagree with the court system’s assessment that religion is essential to AA.
Emily, It’s always so great to read your comments here on MIA. I’m so glad you’ve joined this community! You’re are an excellent writer. Ever thought of writing your story? Wondering where you live and if you’re interested in connecting with activist/community building efforts. Feel free to email if interested!
I must confess that I knew nothing about Davis Foster Wallace until you brought him up in this discussion. I began to read about him on line and listened to some testimonials from some people who were powerfully influenced by his writings. I don’t know if you ever met him, but I have noticed that people in their grief spoke about him as if he were a dear friend even though they never spoke with the man. He comes across as a very compassionate and loving person as well as a very skilled writer. You obviously view part of his loss through a prism of knowledge related to the mind crushing effects of Biological Psychiatry. It is interesting to note that both Ernest Hemingway and Sylvia Plath also committed suicide following ECT treatment. There is the famous quote from Hemingway in a letter to his friend, Hotch, shortly before he shot himself:
“Well what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business. It was a brilliant cure but we lost the patient. It’s a bum turn, Hotch, terrible.” Ernest Hemingway (1967)
A person I have been counseling recently lost his wife to suicide shortly after she received ECT. We know that ECT damages memory (among other things). People sometimes initially feel better because they have temporarily forgotten why they are depressed. Their unresolved issues with life soon return full force and now what’s left to confront these existential dilemmas? It seems to me that a person’s resilience is also part of their memory; destroy or damage someone’s resilience and perhaps you’ve not only weakened their coping mechanisms but their reason to exist.
Vanessa, obviously you have taken (and still take) great meaning and a sense of human connection from AA, I know many people who do; this cannot be refuted. Unfortunately the experience is not universal and hopefully we can find other useful alternatives for those that have been left out of a postive recovery experience. And hopefully the movement that we are building can provide a similar sense of community combined with a liberating ideology and program; I look forward to building that with you.
Thanks so much Vanessa! A little encouragement can go a long way, particularly when one is a newcomer/beginner at something. I will be emailing you by November 18th, as that is the date for a story about coming off psych drugs!
Having sleep aids that allow us lots of sleep is better than any psych med. In a year or two, or three, after plenty of sleep & support with needs, we’ll bounce forward, maybe not perfectly well, but as survivors & advocates. Sleep deprivation should be my diagnosis. ~Sister.
For those interested, there is an important discussion further back in the blog focused on the question of whether or not people with an alcohol addiction can ever return to safe/social drinking. Look for the blog contributions of Brett,Johanna and myself.
Bad habits are only bad habits if you want to live a long life, and if the bad habit stops you doing things society says you should do.
Bad habits can only be broken by willpower and resolve.
Bad habits are a moral problem.
AA is a cult, and government forcing people into AA is disgusting.
“addiction” is just a word invented by mankind that has got us lost, very lost, and far away from any understanding of bad habits.
Thanks for reading my blog. I always look forward to your take on issues and respect your unrelenting criticisms of Biological Psychiatry.
I think you were on a temporary break when Part 1 of my blog was up on MIA. I hope you take the time to go back and read it; I would be very interested in your comments if you choose to respond.
“Bad habits are a moral problem”
Accepted morality is determine by the ruling classes and their instutions of power. Clearly today their morality stands in opposition to what represents the ideas and actions that would truely move all of humanity forward.
I enjoyed reading your post, even though I did not agree with some of it. I enjoyed it mostly because I absolutely agree that new approaches to addiction need to be tried.
I have a less critical take on both the biological theory of addiction and the 12 steps, even though I am VERY critical of the biological theory of “mental illness” and am not religious.
Addiction, I believe, is absolutely biological. A chemical enters the body, the reward mechanisms in the brain go wild, and the body craves, even needs the drug in severe cases, to operate. Take alcohol and benzos, which I would argue are the most difficult drug problem to overcome (not opiates). Stop them cold turkey and you can die. Nothing more biological than that.
I believe that methadone and suboxone, as well as Valium for sedative withdrawal, are overused and used too long. But they have their uses, namely to stem seizures, suicide, physical wasting, and other biological phenomenon.
The goal, however, for true addicts, should be abstinence, which is where AA or NA comes in. I agree there are problems with it. My biggest critique is that in the opening, they claim that some people do not have the strength of character to recover. This is very disempowering. But I find the first step very empowering. Most addicts get there because they have a sense of “terminal uniqueness” and an overexaggerated sense of responsibility. To release their power, control, hold on something can be very liberating…though I’d agree the words can seem disturbing at face value. It took me years to realize how awesome that first step really is.
I never went to AA. I went to al-anon. And we used the terms “Higher Power”, not God, and it did not feel religious at all. I also learned that part of why “Bill” was so successful is that he titrated the most ill addicts off of alcohol, not because of any religiosity.
Biological. Addiction is. But I also agree that the psychological componenets often come from the addiction itself, as I also believe is true with eating disorders. If we could have programs that understood these things, tweaked the 12 steps and did not bow down to the pseudoscience of psychiatry, we’d have something.
Thanks for reading and responding to my blog. Yes, you are right to say that biological things happen in the body when someone becomes addicted and also when they recover, but this does not mean it is disease. The same is true of extreme states of psychological distress; brain chemistry may be temporarily altered but is also not a disease.
And anyone can develop both problems if subjected to certain enviromental conditions for a long enough period of time.
As to the First Step, sometimes with some men a little ego deflation can be helpful in beginning an effort to give up their addiction, but overall I stand by what I said about the negative aspects of accepting “powerlessness” in today’s world.
Now then, after reading this post I turned to Dorothy Rowe’s book, Beyond Fear, a kind of bible of mental health for the critical thinker. I turned to the chapter, “A Bodily Solution,” and read the section on alcohol.
One point she makes is that the idea of addiction being a disease is one that the alcohol industry likes. They use the idea that most people are sensible drinkers and it is just a few rotten apples who need help to minimise the control society puts on alcohol by such measures and heavy taxes, minimum prices, controlling the hours it can be sold etc etc. She quotes from Nick Heather and Ian Robertson’s book, Problem Drinking, “The diseased alcoholic was made a scapegoat for society’s inability to control its favourite psychotropic drug,ethyl alcohol.”
She writes of Aboriginal Australian communities where the whole community takes responsibility for people who consume dangerous amounts of alcohol and cause trouble for others. Consuming large amounts of alcohol is associated with crime, violence, family breakdown and other social problems. So it is sensible for society to control access to this drug but the alcohol industry wants to sell lots and lobbies government to control it loosely.
Ms Rowe also points out that to relinquish the compulsion to drink a person needs to understand what drove them to do it, what fears were the drink covering up? If you don’t do that you are always at risk of relapsing. AA talks about people being, “In Recovery,” and therefore never really recovered. So if you think that you need to not drink in case you find you cannot stop you probably have not resolved the problems that drove you to drink in the first place. This worry is quite a burden to carry round. Many people don’t like this message but according to Nick Heather and Ian Robertson there is scientific evidence that people can stop compulsively drinking and drink sensibly.
Me – I don’t drink alcohol at all. It used to give me panic attacks, probably something associated with the effects in my young psyche of my mother’s bottle of vodka a day habit. So although I’m not an alcoholic I can’t say I have resolved the problems alcohol bought me.