An Unscientific PostScript

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VOLUME 1, ISSUE 7 PSYCHNEWS INTERNATIONAL Nov-Dec 1996

AN UNSCIENTIFIC POSTSCRIPT

David J. Essex

If it were not so appallingly vicious, the dominance of a

nonsensical paradigm over current consideration of "addictions"

might well be the stuff of high comedy. Perhaps sometime in the

distant future, smug comedic pieces will be constructed around

the quaintness of beliefs which seem to that age as silly as the

notions of egocentrism, alchemy, and witch-fear do to ours.

But unless those who know better now challenge the shibboleths of

the addictionologists vigorously and courageously, that day will

be regrettably postponed, and come to after much needless

suffering. Plainly today, political demagogues, professional

opportunists and religious zealots have decided there are

demonic substances in the world which steal souls through a black

sacrament, through mere contact, and they have decided

against this Satanic evil, the deployment of many lesser evils is

necessary to effect a mythical good. Primary among these

necessary evils is the compartmentalizing of the

addictionologists' dogma, its insulation from the logic, method

and critique which distinguish science from scientism, which

distinguish sense from nonsense. The demons of addiction, our

putative leaders seem to feel, are so dangerous that we merely

err on the side of caution if we misrepresent and overstate the

menace. This is a dangerous mistake.

It has long been axiomatic in medicine that what an

individual believes about the effect of a drug will often change

the effect of the drug. So basic is this assumption that double-

blind (even triple-blind) testing is the standard procedure for

determination of a new drug's efficacy. Under this model, neither

patient nor researcher knows which of the subjects is getting

the drug under review and which is getting a placebo. This

ensures the actual effects of the drug, if any, will be

distinguished from the psychological effects of the placebo.

So scrupulous are the testers, that the administrating researcher

is not even permitted to know who gets the placebo, lest his

nonverbal cues clue to the subject and skew the differentiation

of results. Given this apparently sound and prudent practice

is almost universally accepted in the medical community (save in

the rare case of immediate and desperate need for new treatments)

it seems surprising the principle is not translated to our

policies regarding hypnotic, narcotic or recreational drugs,

legal and otherwise. Here, well-credentialed practitioners are

allowed, or even required, to make from the highest professional

pulpits pronouncements of "fact" about drugs which are untested,

or discredited, scientifically absurd, or emptily tautological.

We ought to wonder, mightn't they be doing grave harm by

promoting false beliefs in the trusting citizenry?

Foremost among the shibboleths of the American medical

community, at least as it speaks to the general populace, is the

disease model of addiction. This paradigm, as it might be handed

down to a sophisticated lay person, might be summarized thus:

it is the notion that addiction, a compulsive resort to certain

self-destructive practices, is manifestation of a lifelong,

incurable disease, acquired through repeated exposure to certain

sorts of substances or stimuli, perhaps in conjunction with or

through a genetic predisposition to that disease. A chief symptom

or consequence of the disease is the moral decay of the afflicted

individual, his or her devaluation as parent, citizen, employee

or consumer.

I'll not attempt a scientific refutation of the disease

model here; most people who believe in it do so either, like the

majority of Americans, in the ignorant belief that it is

established scientific fact, or in faith, in willful disregard of

the evidence, akin to that of the educated Creationist. Most of

my readers here, I assume, are acquainted with the real terms of

the debate over the paradigm and are not likely to be persuaded

by such review of the research as I could muster here. Doctors

Peele, Schaler and Szasz have, in various media, made the case

against this model much more strongly and thoroughly than I

could. But I would like to invite consideration of how this

concept has been compartmentalized, insulated from the sort of

revision which other assumptions and practices in our society

have undergone in recent years.

To the layman the most impressive argument for the

scientific validity of the disease model is the most esoteric

one: the idea that addiction, especially alcoholism, is

genetically caused. The average citizen is utterly unaware that

that there is considerable debate about the validity of such

claims. Indoctrinated by the popular organs like _Parade_

magazine, daytime talkshows, and recovery posterpersons, the

citizen often regards genetic causation as settled scientific

fact. Now it's quite probable that, though the links are not

clearly established, our heredity has an influence on our

temperament; the more surprising claim would be that one's

genetic makeup has nothing to do with out behavior. Still, even

if one's abusive behavior has some biological or genetic

component (which is really only to say it isn't

metaphysically produced by the fates or devils), this does not

necessarily make it a disease. Many people postulate biological

bases for such things as left-handedness, musical talent,

athletic ability, various forms of intelligence, but we do not

therefore regard these as pathological. A biological

predisposition isn't sufficient for disease classification;

obviously some harm or risk to the predisposed must also inhere.

Some studies suggest that the left-handed have significantly

shorter average life-span, so some risk may be assumed there, but

we don't regard left-handedness as thing to be treated these

days.

Less trivially, we might look at a contrast in actual

policies. The American Medical Association (AMA) defines

addiction as a disease, possibly in view of its alleged

biological basis, but that professional organization may thus

classify in view of the economic and public-relations interests

of its constituents. Note that the AMA is quite ready to ignore

very similar, if similarly inconclusive, evidence for the

biological basis of homosexuality, which was removed from the

roster of diseases in 1973. Clearly the doctors are able to

separate the risks of (particularly male) homosexual practice

from the actual diseases which today constitute those risks,

perhaps because it is not anymore so politically safe or

profitable to sell gay people, in virtue of their sexualities, on

a diseased self-image. In this instance the doctors have wisely

advised modifying risky behaviors, with some success; but they

have not channeled gay people into quack treatments, and a

lifetime of recovery from their incurable nature. Would that this

were so with respect to the "addict."

Receiving his prejudices from the mass-media, the average

citizen, insofar as he thinks about it at all, wrongly believes

four things about the sort of drug treatment an American is

_likely_ to get. He or she believes, (1) treatment is necessary,

(2) treatment works, (3) this treatment will be secular, (4) and

it will entail or produce lifelong abstinence from the object of

addiction. For their own reasons, people in the treatment

industry would like to make universal the belief that one needs

help to drop any habit, and they spend big money to promote that

misconception. Epitomal is an ad placed in a local paper by the

drug-treatment wing of my local community hospital. Its photo

depicts a mans hand crushing a pack of Tareyton 100's; beside it

is the headline "Quitting is easy, I've done it many times."

Underneath that headline, the following text runs:

You've tried everything. Now try the smoking cessation

program that really works. Studies have shown that only

about 1% of smokers who try to quit alone are

successful. At Nicotine Services, the long-term

success rate is 40-60% -- a rate much higher than

similar programs. Why are we so successful? There are

many reasons.

We follow a 12-step program and limit our classes to

small groups. Each of the seven classes is based on

proven techniques, focusing on personal growth and the

development of a healthy, smoke-free lifestyle. The

program is under the direction of a Medical Director

who is a trained Addiction Specialist, and a free, on

going support group helps ensure lasting abstinence.

All these things work for you, to provide you with the

best resources to help you quit smoking -- for good.

References available.

I truly wonder about that study that "shows" how only about 1% of

us have been able to quite smoking alone. That claim would

probably surprise many of the tens of millions of American who

have managed to quit cigarettes without benefit of Nicotine

Services. The fact is, insofar as their habits are

problematical, most people most people "mature out" of those

habits without any professional help. The opposite impression is

given not only by the treaters, but also by the law enforcers,

for reasons having to do with their own prejudices, and again in

view of their employment security. And the mass media promote the

idea that people must be saved from their addictions for the

simple reason that it's more dramatic than the truth. That people

often grow tired of the costs and liabilities of their

indulgences and moderate or give them up without much struggle is

not news, precisely _because_ it is the most usual the case; it's

a dog-bites-man story. Much better to have a recovering athlete

or celebrity tell his story of sin and redemption, the miraculous

clinical intervention, and the recent "personal growth" which

allowed him to get whatever monkey off his back.

It is of course to be hoped that counseling and support

would hasten one's maturing out of a harmful habit, but it is by

no means certain they will. Moreover, there is no evidence

whatsoever the monolithically predominant mode of

"treatment," or counseling and support, Nicotine Services' "12

step program" (based in Alcoholics Anonymous' famous program of

recovery), is the most effective. Indeed, some say there is

no evidence of _any_ efficacy of 12 Step treatment. True, people

do sometimes "get better" in the course of these "treatments" but

then again they were quite possibly going to get better anyway.

Even Dr. George Vaillant, one of the nation's most famous

addictionologists, and inexplicably a leading proponent of 12-

Step treatment, has said of the method, that for the alcoholics

he treated, it yielded results "... no better than the natural

history of the disease."

Consider this finding as possible evidence of a

compartmentalization necessary to the pseudoscience of

addictionology, an instance where medical logic and scientific

practice are given a pass in service of prejudice. If in one of

the aforementioned double-blind tests, the action of the test-

drug is shown to be "no better than the natural history of the

disease" that drug is most assuredly not certified for treatment

of that condition. Nonetheless, in most areas of America,

ineffective 12-Step treatment is not only the most prevalent

type, it is the _only_ type of drug treatment available. Once,

having pointed out this and other inconsistencies in drug

treatment policy to a counselor I was asked, "So what's the down

side; if people are going to get better anyway what harm does it

do?"

Twelve Step dogma and the "treatment" which springs from it,

are immensely harmful in many ways. Most obviously this form of

treatment sucks up billions of health-care dollars which might

be better used, perhaps even used on more efficacious forms of

counseling for people with troublesome habits. More generally

the 12 Step believers degrade the public discourse on drug issues

by injecting into it, and selling a great many people on, a lot

of fervently held nonsense. Unfortunately some of this nonsense

is falling into that category the late Karl Popper called the

"Oedipus effect," that is to say, a prophecy which fulfills

itself. Thus the claims of the 12 Step addictionologist might be

not descriptive of reality, or even predictive, but prescriptive

of reality. Recall that with respect to drug action the belief

of the user can be influential; might it not be, in a sense,

counterproductive to tell people that they have a one-percent

chance of managing their habits on their own. Mightn't it also be

harmful to tell people that because they have a lifelong

incurable disease, any future indulgence of their forbidden

tastes will lead to disasters that they will be powerless to

control? If the first claim brought the sufferer to a counselor

who convinced him of the second with such thoroughness that he or

she did in fact abstain for life, some net benefit might ensue.

But that's not the way it works down here on the ground. A lot

of people are in fact convinced they _are_ to some degree

powerless over their drug habits, that they can't manage them or

their lives without help, so they're not going to try too much,

until that far off day when a post opens up in a free clinic,

when they're really scared, when they can or must finally submit

(declaring Moral Chapter 11) to the radical cure of total,

penitential abstinence. Thus the dominant preconceptions about

drug habits, promulgated by 12 Step believers may actually erode

people's inclination to improve their behavior. Perhaps, 12 Step

treatments and dogma constitute a problem masquerading as a

solution.

There is evidence that 12 Step treatment, once undertaken,

actually makes some people worse. A good friend of mine spent

several years working for the state as a counselor of young

people with drug histories, most usually alcohol problems. He

grew very disillusioned with the standard practice, complained

he and his colleagues were "confusing the kids more than

anything". He found particularly regrettable the observed

tendency to take quite literally the beloved "One drink equals

one drunk" mantra of the group. His charges sometimes made that

prophecy self-fulfilling, reporting things like, "Well, Friday I

found myself with a beer in my hand, and I thought 'it's off to

the races now' and next thing I know it's Tuesday and I'm at

juvie hall again...." My friend left the field and became a

lawyer.

Another 12 Step alcohol counselor reported to me something

she seemed to feel was axiomatic in her field, that people who

don't fully "get it," i.e. become totally abstinent, "...get

worse after treatment." (She said this, I might add, with a

strange sort of glee.) The few such studies as have been done,

and there doesn't seem to be a lot of money or future in bringing

this kind of news, suggest drunk drivers who are referred to

treatment actually are more likely than the untreated to repeat

the offense. So perhaps our dominant mode of "treatment" ought

to go on the medical scrap heap along with phlebotomy, lobotomy

and aversion therapy.

It might not really seem surprising the 12-Step

treatment does more harm than good, if one looks at real nature

and its typical method. The average citizen takes his or her

notion of the 12 step program from the mass media; perhaps he or

she sees Michael Keaton or Meg Ryan making a cinematic recovery

in a tough-loving 12 Step group. But what the citizen doesn't

see, what is carefully airbrushed out, is the atavistic, faith-

healing fundamentalism which is integral to all such programs.

The first principles of the fundamental 12 Step dogma are never,

but might well be, explicitly stated, "Your addiction is a

disease from which only God can save you," and "God helps those

who abase themselves before the faithful." Most citizens don't

know that six of the twelve famous steps invoke God, and that

treatment based on that liturgy is a catechism, a doctrinal

preparation, and a march through a series of sacraments intended

to bring one into a state of grace, that is, "recovery." This, I

think partly explains the American dominance of 12 Step treatment

despite its dismal efficacy. Americans have a sort of a

sentimental fondness for religion, in the abstract. At a rate

unmatched in the western nations we claim to believe in God,

though that claim doesn't correlate, as often as elsewhere, with

any religious practice. A great many Americans seem to think a

little old time religion is just what sinners other than

themselves need more of these days, so they're not concerned if

those drunks and addicts get a whiff of God in with their

supposed medicine. Still, many American grow rather incensed

these days at the idea of prayer or Creation "Science" in the

classroom, and they might grow even more incensed if they

realized what religious idiocies were foisted on the politically

powerless in the name of treatment.

In the first sacrament of a 12 Step program, we admit that

we are powerless over (drug of choice) and that our lives have

become unmanageable. This is a preparing of the heart so that,

in later steps we can "turn our will and lives over to the care

God" so that He can "restore us to sanity." What this means

practically is that at some point early in treatment the

"patient" will be asked to break through "denial" and confess

before the group that he or she is an addict or alcoholic. The

administration of this sacrament can be fearsome to behold. I

once saw a man who had been brought the point of "making first

step" before his group. His history, as he'd been relating it to

the group in previous weeks was this: he was a worker on a local

assembly line and had been for thirteen years. He was married and

a father. He smoked marijuana on rare occasions, and he'd done so

at a party shortly before his number came up in his employer's

occasional random drug screen. His urine showed positive; the

employer suspended him until he completed "drug treatment," at

which time he might or might not get his job back. Apart from a

few puffs of pot, this fellow seemed about as normal and decent a

person as a Republican could conjure up in a stump speech.

On his big day he brought a sort of prepared statement, a

little confessional speech. In it, he said he'd been reckless,

that he saw now how drugs had put his family's security in

jeopardy and, which was just crazy, for that he was heartily

sorry. This sounded sensible enough but it wasn't nearly enough

for the group leader. She kept asking him questions like, "What

kind of person takes such chances?" And the young man kept

hedging, "A confused person... a person with a problem." He knew

what she wanted to hear but stammered around trying not to say it

for fear, I think, that if he said it, it might somehow become

true. Finally, with the counselor silently mouthing the words in

accompaniment, the man, fear and trembling in his voice, said, "I

guess that makes me a drug addict."

The counselor was elated; another of her wards had made that

first step on the road to recovery from infrequent marijuana use.

If the man kept making such progress he might he allowed to

remain with the program and perhaps get his job back, restored to

sanity. She regarded it as unfortunate when the man dropped out

of the group several days later, and presumably went looking,

sans reference, for another job.

Why, we might wonder, when enlightened people nowadays call

disabled people "challenged" and we otherwise regard pigeonholing

by pathology as perhaps cruel, counterproductive and at least

disempowering, do we think it therapeutic to get the merely

self-indulgent to adopt a diseased self-image? Once again the

normal principles don't seem to apply to addictionology. All of

this self-flagellation and repentance might be fine if one comes

to it freely, but a great many people are forced into this type

of treatment by the courts, their employers, their parent or

spouses. Because he wants his license back, her sentence

shortened, needs a job, or wants a spouse, a citizen may be

forced to assent fervently to any number of propositions she or

he disbelieves or perhaps doesn't even understand. Moreover,

because the counselor who monitors compliance with the program is

listening to the citizen's declarations with an ear for the

subtle nuances of sincerity, the confessor must screw himself

into a sort of salesman's convenient belief in his spiel. This

maximizes the compromise, minimizes the chance he'll be able

to blithely go through the motions, whether he originally

believed any of the stuff the counselor wants to hear or not.

Also, he'll be in a group, there expected to help browbeat other

people into making the same sort of dubious declarations he has.

Here is a common result: the citizen who came into treatment

thinking himself perhaps a bit of a fool, leaves after his public

confessions and other mummeries thinking himself perhaps

diseased, but knowing himself a liar, a hypocrite, a coward, and

a bully. Thus demoralized, is it any wonder he sometimes seeks

deeper oblivion. A fellow writer made this sweeping, but not

altogether insensible, generality, "A defeated people is a drunk

people; look at the Soviets, the Irish, the American Indians." I

can think of few things more likely to inculcate a sense of

defeat than being forced into "spiritual awakening," as the

twelfth step calls it, on someone else's terms.

It seems to me then, this type of "treatment," is not

only of questionable practical value, but worse, is morally flat

wrong. We recognize many decisions cannot be rightly made

under duress. For instance, no matter how blissfully happy I know

I could make my student, it would be ethically wrong for me

to attempt to romance her. The moral turpitude stems from the

fact I have power over her, which compromises her whole

freedom to give uncoerced consent. Why does this moral principle

not apply to the spiritual progress of the so-called addict?

Surely to all those very spiritual people in the 12 Step

fellowship, matters spiritual are more sacrosanct than matters

sexual. Why then aren't these personally growing people outraged

at the grotesque travesty of true, free spiritual "awakenings"

which takes place under their auspices? Could it be that like so

many zealots -- know them sometimes by the strangely menacing

smile, the body-snatched modulation of their voices -- they have

parted company with the examined life and with ethical

reflection? Perhaps they have traded these responsibilities for

bumper sticker principles: "the Big Book says it, they believe

it, that settles it." Perhaps too this breach of ethics is just

another of those little evils necessary to the war on Big Evil.

As it gets translated into public policy, the belief most

fundamental to addictionology is this: There are certain

substances which certain individuals are powerless to resist,

and some substances which almost all of us are powerless to

resist. These things are true only to the extent the user

believes in them; most of us show them to be false every day. In

fact, the belief in this powerlessness is merely bad science in

service of religion and authority, as egocentrism was bad science

in service of the church and the supposedly divine rights of

Europe's rulers. The direct logical extension of this false

premise is prohibition, the notion the authorities must,

acting _in loco parentis_, protect us, the infantilized

citizenry, from exposure to those things we are powerless to

resist. The government will lift this impossible responsibility

from us; of course it must take freedoms from us to do the job

properly. That this notion is completely inimical to democracy,

to the notion that each adult citizen rightfully has the power to

regulate his own existence, seems all but lost on our citizens.

This is because our discourse has become, thanks to the zeal

of the Disease Cult, so frightened, sanctimonious and

simpleminded.

Sir Karl Popper was quite skeptical about psychoanalysis; he

didn't think Freud's claims were really scientific assertions. I

share that skepticism but still like the related analytical style

we have grown comfortable with in the humanities. Thus I

really sometimes believe nothing is so self-disclosing as

the devils we project onto the world. So I find it wholly fitting

that perhaps the last possible heresy in America is the

criticizing of addictionology and its armed offshoot, the War on

Drugs. This tells us something about the national dementia.

A friend of mine once oracled darkly, "Drugs are American as

Coca-Cola." We had been pondering what a strange inversion is our

national mania for addiction busting; in the War on Drugs we have

truly, as Walt Kelly said, "met the enemy and he is us." Our

society is now predicated upon the idea of continued progress,

sustained growth; we're going to invent a technological fix for

the liabilities of technology, and we're going to grow the

economy out of its deficit. But looked at from another angle,

sustained growth (Edward Abbey regarded it as the "ideology of a

cancer cell") is really just "escalating dependence," complete

with the consequent moral decay imputed to the dope-fiend. In a

society dedicated to sustained growth, coveting thy neighbor's

goods is a virtue and conspicuous consumption is a patriotic

duty. We call this, in a phrase which should have resonance for

addictionologists, "keeping up with the Joneses," and we are

called to it at every turn by the advertisers whose job it is to

see that the registers keep ringing so the assembly lines

can keep turning. One's life is incomplete without this or that

thing, they tell us constantly, adding, happiness is just a

purchase away. In a culture sponsored by this mode of thinking,

which promises a material fix for everything (for a fee you can

even make an Addiction Specialist responsible for your self

control), can we be surprised that people use drugs

irresponsibly? So it is deeply telling and ironic that the

Advertising Council (mostly tobacconists and distillers) feels

called upon to sponsor its inane and often mendacious series of

anti-drug ads. This is the moral equivalent of pimps preaching on

the street corners about the evils of masturbation.

David J. Essex is assistant professor of English at the

College of William & Mary, Williamsburg, VA, where he teaches

creative writing, contemporary literature and film. He is a

writer and documentary filmmaker. He is currently developing

_Medicine Show_, a documentary about drugs, drug-use, and drug

issues as depicted in the American popular media.

His e-mail is: djesse@facstaff.wm.edu

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