The Search for the Miracle Cure

Richard D. Lewis
42
99

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.

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42 COMMENTS

  1. 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 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.

  2. 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.

    Best,

    Brett

  3. 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.

  4. 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.

    Best wishes,

    David Bates.

  5. 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.
    All best

  6. 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:

    http://agnosticaanyc.org/worldwide.html

    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.

  7. 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.

  8. Hi Richard,

    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

  9. 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!
        –vanessa
        [email protected]

  10. 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.

  11. 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.

  12. Hi Richard,

    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.

    Peace~

  13. 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.