Addiction theories & realities

Stanton Peele challenging the flawed disease concept and the current tried and failed methods;
despite all the claims that AA is the only way. The reality is still a 95% FAIL rate, no better than those who just quit or "mature out" of addiction.

Addiction—Choice or Disease

Both views in the “addiction is a choice/disease” point-counterpoint (Psychiatric Times October 2002, p54) leave out critical aspects of addiction, without which it is not possible to make sense of the matter.

Jeffrey A. Schaler, Ph.D.’s, view that addicts choose to use seems glib in the face of those addicts like David (son of Robert) Kennedy and Terry (daughter of George) McGovern who were children of privilege who killed themselves with chronic drug/alcohol use. These are extreme cases where the substance seemingly takes over the individual’s ability to choose.

However, I believe it is wrong to generalize their fates to all drug and alcohol misusers, including even quite compulsive users, for whom internal and environmental cues and options continue to play critical roles.

R. Brinkley Smithers: The Financier of the Modern Alcoholism Movement

The dominance of the disease view in America is due in good part to one man — R. Brinkley Smithers. Through his personal contributions and those of the Christopher D. Smithers Foundation he commanded, Smithers influenced the course of the major national groups concerned with alcohol problems in the United States.

One presentation at the conference, titled "What Works Best Is What We Do Least," reviews the evidence on alcoholism treatments.

The effective treatments are not the disease-based ones that dominate American treatment, the kind that Terry McGovern was exposed to and that Vaillant practices. The effective programs teach people life skills and enhance internal motivations to change, rather than convincing them they are lifelong alcoholics whose condition is incurable and who will relapse should they cease to be dependent on treatment.

Stanton replied:

When an individual comes to AA, he/she knows some things are required for fundamental membership. Chief of these is to declare yourself an alcoholic. It may be friendly (although I have observed great hostility towards individuals who refused to declare themselves this way) but there is no backing out, and many people (especially the DWIs who quit as soon as they can) experience great anxiety around it. When people are compelled to take on a self-identification with which they disagree or about which they are unsure, when great group pressure is placed on this identification, what do you call it? Again, these tales are described in detail and at length in David Rudy's Becoming Alcoholic and Ken Ragge's More Revealed. (Room also recommended that I read Charles Bufe's book, Alcoholics Anonymous: Cult or Cure, which decided AA is not a cult. I replied: I know Bufe's book and I believe I am writing a preface to his new edition. Not being a cult -- for example not having a charismatic [living] leader or using physical coercion -- takes one out of one category, like Nazism, but leaves much room for mind control and psychological coercion.)

Of course, the claim is, this was a false alarm but now we have really discovered the site in the brain that governs addiction. In fact, this research tells us nothing about addiction:

1. These findings do nothing to explain the most striking and commonplace observations about the street use of drugs. Most people who take "addictive" drugs do not become addicted. Most people who become addicted cease addiction, often simply cutting back on the drug. Vietnam soldiers addicted to heroin in one setting (Vietnam) were not able or were unwilling to be addicted when they returned home, even after resuming drug use. Those who fail to achieve remission from addictive drugs differ significantly in social and psychological profiles from those who do -- those with more ample resources achieve remission most readily and stably, even given continued exposure to the addictive substance.
2. Such supposedly scientific discoveries immediately require whole new levels of supposition and hypothesis in order to account for data on actual drug use. The researchers who acknowledge reality and note that most drug users, even regular users, do not become addicted are immediately required to hypothesize inbred biological differences in the neurological mechanisms that predispose some people to addictive drug use -- although their own data show no such differences related to addictive drug use. That people recover from addiction and resume non-addictive use of the same drugs forces hypothesizing about complex neurological-situation interactions on which the researchers likewise have no data. That susceptibility to addiction and failure to achieve stable remission are related to systematic social differences could result in racist theories -- i.e., inner city addicts fail to escape addiction (to heroin, crack, cigarettes, and alcohol) as readily as middle class people because they are biologically predisposed to addiction.
3. Those drugs now lumped in as addictive with heroin -- such as cocaine and amphetamines -- were for decades labelled by leading psychopharmacologists as non-addictive. Isn't it strange that now we discover biological hard wiring to explain cultural variations in labelling, such that leading psychopharmacologists averred unhesitatingly until the 1980s that cocaine and amphetamines, which are now said to stimulate the same pleasure centers as heroin, did not produce the addictive effects that heroin does? (see "Addiction as a cultural concept," Stanton Peele's Greatest Hits).
4. The wide range of activities that stimulate the pleasure centers of the brain -- including sex, eating, working, chocolate -- should alert us that these brain theories tell us nothing about differences in behavior, let alone addiction. Most people experience orgasm as among the most pleasurable sensations -- yet how many people become addicted to orgasms? Chocolate stimulates the pleasure centers, but only a few people compulsively eat chocolates or sweets. Apparently, stimulation of a pleasure center is only one small component in the entire addiction syndrome. Moreover, if any activity can be pleasurable -- from work, to sex, to parenting and so on -- identifying activities as stimulating the pleasure center simply begs the questions: Why do people find different things pleasurable and Why do different people react in destructive, addictive ways to some of these things, while others incorporate them into a balanced overall lifestyle?