Own your ow legal marijuana business | Your guide to making money in the multi-billion dollar marijuana industry |
Other Information on Drug Policy |
|
_________________________________________________________________
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
--------------------------------------------- To join the PsychNews International (PsychNews) forum, send the command SUBSCRIBE PSYCHNEWS YOURFIRSTNAME YOURLASTNAME; to leave the forum, send the command SIGNOFF PSYCHNEWS to LISTSERV@LISTSERV.NODAK.EDU or, if you experience difficulties, write to PSYCHNEWS-request@LISTSERV.NODAK.EDU.
|
Contents | Feedback | Search | DRCNet Home Page | Join DRCNet
DRCNet Library | Schaffer Library | Other Publications related to drug policy