THE GRAY AREA OF DRUG ADDICTION
By Neal Williams
This article is an opposing viewpoint to the Wharf Rats, Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and all other twelve-step mutual-help support groups. These groups, unfortunately, are part of the problem, not the solution. They only serve to perpetuate myths that have clearly been proven false based upon the vast amount of research that has been done in the field of substance abuse. I am sure that these groups operate only out of the best motives but we have all heard that the road to Hell is paved with good intentions.
All twelve-step support groups teach the disease model of addiction, which was popularized by AA and adopted by professional organizations and government agencies. The disease model of addiction is intellectually sloppy and unscientific. This model does much more harm than good because it undermines peoples' feelings of self control. Here are its basic premises: Addicts inherit the disease of addiction. They are born with this disease and are therefore already addicts long before they ever use drugs. Their disease is characterized by loss of control and progression. In other words, addicts can never control their drug use and their disease inevitably gets worse and worse. Their only hope is to remain completely abstinent from all drugs and become a lifelong member of a twelve-step support group. I did not make up this definition of the disease concept; I took it from the book of Narcotics Anonymous.
Counselors, AA members, and other disease proponents often talk about inheriting "the gene for alcoholism." These genes have never been found (although a lot of time and money has been spent looking for them). Most researchers, in fact, agree that it is highly unlikely that any such genes exist. A study was published in the Journal of the American Medical Association(JAMA) on April 18, 1990, linking alcoholism to a specific gene. The study was accompanied by press releases, news conferences, and interviews with the researchers. Eight months later another study was published in JAMA that reported a lack of association between alcoholism and this gene (the dopamine D2 receptor gene). Of course this study was not publicized like the original study and most people never heard of it. They still believe that the alcoholism gene has been found.
All scientific attempts to define an addict have failed because the concept itself is fundamentally flawed. Addicts exist in our minds but not in the objective world around us. The DSM-III-R, which is the authority on psychiatric disorders, contains two categories of pathological patterns of substance use: abuse and dependence. It's important to note here that the criteria used to diagnose alcohol problems is exactly the same as those for all other substances. The American Psychiatric Association (APA), therefore, doesn't appear to believe that alcohol abuse is any different from that of other substances. Once the person stops using the substance, he no longer meets the criteria for abuse or dependence. In other words, he is no longer an addict or an alcoholic. This is what is known as all-or-nothing thinking; either you are or aren't an alcoholic or a drug addict.The truth is that people have widely varying patterns of substance use and can be addicted in greater or lesser degrees. Let's take overeating as an example. (Overeaters Anonymous [OA] is another group that doesn't understand, yet proclaims the disease model). Imagine a person who weighs five hundred pounds and is so obese he can't fit through the front door. It's obvious that he has a food addiction. But on the other hand there is a person who is not overweight but doesn't keep junk food in his house because if he did he would not be able to control himself. Does he also have a food addiction? Probably. But is it helpful for him to identify himself with the "hard-core" food addict? Probably not. This is the trouble with the drug and alcohol treatment industry and twelve-step support groups: they take those people with the worst success in controlling their own behavior and allow them to tell the rest of us what our attitudes should be! If you tell people enough times that they have no hope of controlling themselves, they will eventually start to believe you and prove you right. Whatever happened to choice, responsibility, and the ability to control your own actions?
Loss of control over drugs and alcohol is much more a cultural phenomenon than it is a symptom of a disease. Take for example the Italians. They respect their alcohol. They drink beer or wine at every meal but only drink one or two glasses. They think of alcoholism as a problem over which people can exert control and they object to those who become intoxicated. The Italians (along with the Chinese and the Jew), have the lowest alcoholism rates. Ethnic groups with high alcoholism rates, however, (such as the Irish and Slavs) are the leaders in the acceptance of the disease concept.Which of the following two groups would you predict to have more problems with alcohol? The Irish, who believe that alcohol is an evil substance that undermines people's freedom of choice? Or the Italians, who view alcohol as something that can be enjoyed and controlled in social settings, with family, friends and good food?
If the disease concept is directly contradicted by the huge amount of research that has been done in the field, why is it becoming more and more popular? I have broken the explanation down into three separate yet interrelated reasons.
The first is because of all of the self-proclaimed "recovering addicts." These are the people with the highest visibility. They go on the news and say things like, "If you try crack, heroin, alcohol [insert the name of any drug here] you will get hooked and it will destroy you." How often do you hear about people who had a drug or alcohol problem and quit or cut back on their own, without treatment? Not often, even though it happens all the time. The trouble is that these people don't feel the need to join a crusade, run to the media, or become drug counselors.
The second reason that the disease concept is so popular is that it gives people an easy way out. They believe that they inherited their addiction, therefore they're not responsible for their own behavior. At first glance this practice may seem helpful. The argument is that it absolves substance abusers of blame and therefore makes them more likely to enter treatment to get help. But keep in mind two things about calling addiction a disease:
1. It's not true.
2. It doesn't help and keeps us from doing things that really would help.
We believe that alcoholism and drug addiction are diseases because we want to believe it. It makes us feel better to think that our problems are beyond our control. We desperately search for something outside of ourselves to blame things on. Real solutions to real problems, however, will never result from ignorance and misinformation. We are a society that applies short-term solutions to long-term problems. Our current social policies are based purely on fear. If we could start trying looking at the world a little bit more objectively we could begin to develop social policies that actually make sense. And until we do our society will continue to deteriorate.
It's far easier for parents to accept substance abuse in their children if they believe it's because of a disease. It's easier for addicts to accept their behavior by blaming it on the drugs and denying their own participation it. But the problems and the solutions are all within us. It may be comforting to learn that drugs are not as powerful as we've been led to believe, but it's also hard for us to admit that the causes and the solutions are within ourselves. We have met the enemy and he is us. The answers are actually quite simple: open up, don't judge. Communicate with others and try to understand their worlds. Do they like themselves? Are they hopeful about the future? Do they have the social skills they need to get what they want?
The third (and probably the most important) reason that the disease concept is so popular is because of greed and money. Alcohol and substance abuse treatment programs are predominantly private agencies that are run for profit. They invented the disease concept and the public bought it, hook, line and sinker. What makes matters worse is that there is so much competition among treatment centers that they will say practically anything to keep up their share of the market. They air commercials filled with misinformation designed to scare parents into thinking that drug and alcohol use is such a serious problem that their offspring will probably die unless they get treatment.
Drug and alcohol treatment is ineffective, and therefore a waste of money. Substance abuse is a problem that is never going to be completely prevented and it's never going to be solved through treatment. What goes on in treatment? Patients in treatment centers are coerced by the counselors and other patients to "discover" that they have the disease of addiction. They are shown a list of symptoms (blackouts, loss of control, progression of the disease, etc...), and told to admit that they have them.If they claim that they never experienced one or more of these symptoms they are harassed and brutalized in an effort to combat their denial. In all likelihood their denial is completely justified. The concept of denial is a dangerous one because as soon as people claim they don't have a problem, it means they really do have it. Denial is viewed as a symptom of the disease. Parents usually send their children to these treatment centers for the best of reasons, but you have to wonder how this type of treatment could possibly help your children (and the research is pretty clear that it doesn't).
There is an excellent book called The Truth About Addiction and Recovery. The information contained in this book is so valuable that it is a must for any parents who are concerned with preventing substance abuse in their children. In fact, this book should be required reading for everyone working in the field of addiction and everyone who uses or abuses substances. Here the authors give this explanation of how people develop addictions: Most children who use drugs do so casually and ultimately reject drug experimentation, simply because they grow up and have better ways to spend time, and because they have more to lose than to gain from drug use. People who have the worst substance abuse problems, on the other hand, are those who cannot gain a foothold in life. They more often come from deprived environments or from seriously disrupted homes, or have severe personal or emotional problems. Drugs do not make people indolent, antisocial, or delinquent. Rather, people choose to use drugs because drugs allow them to feel and act in ways they need or want to.
They make a very powerful statement. They're saying that drugs themselves pose very little threat. They practically ignore their addictive properties and instead emphasizes the individual's psychological makeup and the environment in which he or she lives. Keep in mind that the vast amount of research that has been done on addiction confirms this view. But again, we come back to my point that it makes us feel better to have something for us to point our fingers at. We've decided that drugs are the cause of most of the evil in the world, and have thus turned drugs into some sort of bogeyman. Unfortunately, the drug problem in this country is getting worse and worse and our current views certainly aren't helping the situation.
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