PERSONAL VIEWS ON RECOVERY

PERSONAL VIEWS ON RECOVERYPersonal Views Page

(This page will carry from time to time the personal views of some of our members on issues which they believe are important in the recovery process. Our present policy is that these authors will remain anonymous and will be limited to members of the Washington, D.C. Area SMART groups. They do not necessarily reflect positions either of the Washington, D.C. Area SMART groups, nor its National Headquarters. Comments are welcomed.)

Moyers on Addiction

Many of us who watched Bill Moyers' PBS special on addiction were greatly disappointed that the overall message of the program was merely an updated version of the same old story: Addiction is a "disease," the victim is "powerless," and the only answer to the problem is a "spiritual awakening," plus lifelong attendance at 12-step recovery groups. Only if you listened carefully, maybe half a dozen times in the total five hours, was there a phrase suggesting alternative approaches, such as "while some people have done it on their own....," or "while different people require different approaches." When it came to recovery programs, the whole five hours essentially referred only to 12-step groups. It would be instructive to see what was left on the cutting-room floor.

Please don't mistake the view presented here. Any method which has helped many people defeat the serious problem of addiction is worthy of praise, 12-step programs included. The problem is that the program never indicates to its audience that there are serious recovery alternatives to 12-step programs, alternatives which are at least as effective overall as 12-step programs, and which can be much more effective for some individuals who reject the "powerlessness" approach and are intent on taking charge of their recoveries from addiction.

The first program, concentrating on the science, was the best of the lot. Again, only if you listened carefully would you notice that even the scientists Moyers chose made no claims about finding scientific evidence identifying a later addict before she/he becomes one. And only one said that after some time in recovery he hoped to find some distinguishing characteristics (i.e., less dopamine-producers). But even he didn't say he had found them. All of the scientific evidence presented had to do with people using, or just coming off using, but the program cleverly hopped from these illustrations to those in recovery, suggesting that the same evidence applied to the latter group. In other words, the "scientific proof" that Moyers offers of a "hijacked brain" consisted of areas which "light up" during brain scans of substance-abusing individuals. "Saying these changes predict that someone will relapse amounts to modern phrenology," says John P.Seibyl, a nuclear radiologist and psychiatrist at the Yale School of Medicine, in a recent NYTimes article. "We don't have any data linking these images to behavior, so how can we call addiction a disease of the brain?"

The second program was nothing more than a paean to AA, as if no other programs existed, let alone people quitting on their own, let alone moderation in use regarded as a positive outcome. And it suggested over and over again (in fact throughout the entire series) that "treatment works." This in the face of repeated evidence that the success rate is quite low, if you define "working" as achieving their pronounced goal of long-term abstinence. As Vince Fox has pointed out in his book, "Addiction, Change and Choice," the best evidence is still that the overwhelming bulk of people drop out of AA within the first year, and that more intensive treatment programs, if they're lucky, have about the "3 in 10" rate quoted by one practitioner on the show (and incidentally, never citing the common finding that most out-patient programs are about as effective as in-patient ones--indeed, quite the reverse was presented as "fact."). Again, Moyers was disarmingly indirect in his recommendation for AA: if you listen carefully to his introductory remark about AA in the second night's program (toward the end of the third portion called "Changing Lives,") he says only that AA is "the most accessible form of treatment around." Who can challenge that statement?

The section on children was more objective, dealing with practical efforts to help them in the schools, etc.., plus something on the children of users. The one annoying aspect, however, was the frequent drumming throughout the show, based on the genealogical leg of the "disease" theory, that children of addicts were 4 times greater at risk for addiction; it almost became a self-fulfilling prophecy by the end of the show. This figure may be based on the famous Swedish study of identical twins separated at birth and raised by different families. There is some evidence that many of the twins involved weren't quite as separated as supposed, and that the definition of "alcoholism" used was questionable. Anyway, recent studies show only that the link between males, particularly among those who are so-called early "primary" alcoholics, is a real statistical probability.

The final section on politics was the standard answer, not so much of AA, but of treatment professionals who are members of AA---throw more money at the problem and throw it my way. Whether the politicians will buy it and whether the programs proposed will be a useful expenditure of dollars spent on health is never seriously addressed. It is the "right thing to do." Of course by implication the only programs worthy of this new money will be 12-step based, although they may run into real problems with any Federal mandates involved which would require financing of religious-based programs; virtually every court decision on this issue has gone against coerced AA attendance. Maybe alternate approaches will receive some support, too, if this thing ever happens, (the first step is an Alcoholism Commission, or something like that), although it continues to be the view here that "self-help" mostly means just that; low recovery rates in the programs might sink even lower if these programs become an alternate free Government-mandated program. The one thing that was kind of interesting in this section was Moyers toying with the idea of liberalization of drug laws, using the Arizona law on marijuana as an example.

Overall, the series was a pretty sad illustration of the professional standards of journalism in which Moyers was raised---which is to challenge and recheck sources, and look for alternate explanations and sources. (Would he take Monica Lewinsky's word alone for what went on at the White House?) But since only 2 percent of the television audience watches PBS anyway, who cares?

Here, then, are some of the propositions in the show which viewers should challenge:

1. Assuming that all addictions are alike. This comes most prominently in discussions in the program about the various addictions, stating they all originate in misfunction or changes in the neural pathways involving the brain's "pleasure center". The greatest problem with this "pleasure center" approach is that the overwhelming bulk of all sorts of activities involving the "pleasure center" do not involve addiction, and when they do, it is only for a limited number of people. In other words, you get the same readings for addicts and non-addicts! But even with addictive behaviors, clearly cigarette-smoking is not like heroin addiction, nor are the two the same as alcohol addiction, let alone "addiction" to, say, the Internet or chocolate, nor should they be treated alike.

2. Asserting that addictions are "lifelong." Because of the "disease" approach in the show, it is assumed that the addictions discussed will continue for the life of the addict. Yet no real evidence is presented for this; indeed, the emphasis on neural pathways should lead to the opposite conclusion---these are created and therefore they can be changed. More important, the program fails to distinguish between full-blown, active addiction---which frequently does require medical attention---and simple excess use (or even non-use!) in periods when no physical dependency exists. Furthermore, in the absence of incontrovertible evidence that addiction is a disease, the assertion has the negative effect of assuring addicts that if they relapse they will inevitably fall back into full-blown addiction, something which numerous studies have disproved (i.e., there are different types of addicts.) Finally, whether substance dependency is a disease or not is a moot and pointless argument. The fact is that there is no known medical cure, no operation, no drug which solves the problem. All known treatments are psychological in nature, and aimed at changing behavior.

3. Assuming that all "addicts" are alike. The program fails to make the distinction between degrees of usage, and even the more fundamental difference between addicts who are actually currently using, and "addicts" who have stopped using, sometimes for decades, motivations and surrounding circumstances for using, etc. Here, the emphasis on a "lifelong disease" and abstinence has led the programmers to ignore totally the whole range of cognitive approaches and alternate treatment outcomes such as simply moderating use.

4. Asserting that 12-step "treatment works." Given their hypothesis that addiction is life-long and can be combatted only by total abstinence, listeners might have expected the program to cite specific and objective scientific research to prove this. They should be able to produce controlled long-term longitudinal studies showing that 12-step treatment programs can produce this result for, say, more than 50 percent of their clients. In fact, only generalized statements are given, some by recovery center directors with a vested interest in the outcomes given.

This misleading assertion that "treatment works" leads on to the remaining fallacies:

5. Repeatedly asserting that addicts need to resort to "others" and "treatment" to recover. In fact, most addicts recover on their own: i.e., the overwhelming majority of smokers who quit do so without any resort to a cessation program, and, in a famous study, most Vietnam veterans who used marijuana and heroin ceased to do so on their return to the U.S. In the alcohol field, the one long-term longitudinal study of excessive drinkers shows that the only significant correlative factor between cutting back on drinking and the participants was increasing age.

6. Assuming that identifying "alcoholism" as a "disease" aids recovery. There is no evidence presented that this is in fact the case, only highly questionable assertions that the disease concept itself is scientifically proven. In fact, a strong argument can be made that acceptance of the disease concept by the addict or ex-addict can have the opposite result: if his/her condition is a "disease," then he/she need not take responsibility for it, can dismiss the fight against it as a hopeless cause, and go on using or relapse. Indeed, the longitudinal NIAAA study mentioned below suggests precisely this result.

7. Blaming other people and things for addiction, rather than concentrating on the actions of the addict him/herself. There is a constant stream of finger-pointing in the show toward sources other than the individual---tobacco companies for misleading or outright falsification of studies and advertising, insurance companies for legitimately balking at financing recovery programs with poor results, politicans for a "lock 'em up" attitude, etc., etc. All of this caters to the addict's misguided (but understandable) desire to blame his actions and conduct on others, rather than taking personal responsibility.

8. Implying throughout that a "spiritual" (read, "religious") approach is the most effective means of recovery from addiction. In fact, the 12-step approach (which repeatedly emphasizes the need for submission to a "Higher Power"), while highly effective in individual cases, overall has a very low rate of success. The one longitudinal study available of AA attendees, done by AA itself, showed that 90 percent drop out within the first year. Furthermore, no treatment model has ever been shown to be superior to any other. This fact was demonstrated by NIAAA's Project Match, the largest psychological study ever done, and similar results were obtained in an even more recent study done by the Veteran's Administration. Indeed, one earlier NIAAA longitudinal study suggests that when the option of "no treatment" is considered, and the goal is reduction in addictive drinking, rather than total abstinence, "maturing out" without treatment actually produces a better outcome.

This is Essay No. 4, issued May, 1998.

Previous Essays

March, 1998--Should People With Gambling or Overeating Disorders Be Welcome At SMART Meetings?

January, 1998--Differences Between SMART and AA

November, 1997--Fifty Ways to Recover

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