The Politics of Addiction
It is ruining the field.
If the world were a perfect place, our efforts to understand ourselves would be based on reason, experience, and evidence, and free of the poisoning influence of politics. Alas, the world of addiction is just as beholden to political tradewinds as other fields.
If the world were a perfect place, our efforts to understand ourselves would be based on reason, experience, and evidence, and free of the poisoning influence of politics. Alas, the world of addiction is just as beholden to political tradewinds as other fields.
Every field of inquiry is burdened by politics to some degree. But when people who are in positions of authority and power hold onto their views despite reason, experience and evidence, the result is that new knowledge, and the people who espouse it, are suppressed. This act, of clinging to outdated dogma, is where politics fights against progress.
Recently I read Nobel laureate Paul Krugman’s book “End This Depression Now!” Before describing his views, I must make a disclaimer: my own education in economics began and ended with a single college course I took 40 years ago. So I’m not writing to endorse or refute Professor Krugman’s views, but to underline his description of his field. He writes that in recent decades, macroeconomics became divided into two great factions described as Keynesians and non-Keynesians (after the economist John Maynard Keynes). The non-Keynesians, he writes, “Soon got carried away, bringing to their project a sort of messianic zeal that would not take no for an answer… [a leader of this group predicted] in 1980 that participants in seminars would start to whisper and giggle whenever anyone presented Keynesian ideas. Keynes, and anyone who invoked Keynes, was banned from many classrooms and professional journals… [non-Keynesians developed] quasi-religious certainty that has only grown stronger as the evidence has challenged the One True Faith.”
Anyone familiar with the addiction field will recognize this description immediately. But unlike economics, in addiction we have two sets of overconfident whisperers with a history of ignoring or suppressing other views. One of these groups are the followers of the “chronic brain disease” idea – a notion that has been repeatedly shown to be false (see other posts in this blog) yet still remains the official view of the National Institute on Drug Abuse and the American Academy of Addiction Medicine. The influence of this group has led many professional addiction journals to avoid publishing any contrary views for many years running. In fact, a recent review I conducted of all the major addiction journals for the past three years turned up no discussions at all of the psychology of addiction. (This isn’t because there were no articles submitted; my own paper describing the limits of both neurobiological and psychological views, which was published in a respected peer-reviewed journal in the United Kingdom, was turned down by every addiction journal in the US, because, I was explicitly told, it did not fit the editors’ narrow view of what was correct.)
The other powerful group is of course AA, and its 12-step brethren. Anyone who has tried to criticize the 12-step approach knows full well the hostile reception this produces from devoted members. In fact, because of my position as an independent voice in addiction, I have often heard from counselors working in addiction treatment programs around the country who tell me they are afraid to challenge the 12-step model for fear of losing their jobs.
Addiction deserves better. One online addiction website, The Fix, recently published my guest piece taking a critical look at both the official description of addiction in the new edition of the Psychiatry Diagnostic and Statistical Manual (DSM-5), and the brain chemistry people at NIDA. The Fix is a wide-ranging site that publishes a variety of views, some of which I don’t agree with, but that’s the point: like Psychology Today, it is a rare forum for contrasting ideas and discussion. We desperately need more open-minded resources like this, and a new national addiction conversation that doesn’t reflexively strangle dissent.
Lance Dodes, M.D.
9 Comments
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Reader Comments (9)
It's a real pity when the scientific method gets pushed aside for the sake of politics. I don't have the means to evaluate your theories of addiction, but the idea that people could lose their jobs for challenging an idea makes me sick. This wouldn't even be such a problem if the success rate from those programs were higher. I really think that every hypothesis needs to be on the table so we can really get some insight into how to help those who are suffering.
a handful of legal cases have challenged employers’ rights to bar employees from medical marijuana use and/or to dismiss employees due to such use.
It made me smile that you mentioned being published in the UK. The leader of the Liberal Democrat party was an alcoholic, and our the deputy prime minister for the labour party openly admitted trouble with binge eating. The fact you were published in the UK was pleasing as quite a few public figures have been diagnosed with addictions and the media rarely responded overtly hostile to them (not just politicians, e.g. George Best - Footballer, Amy Winehouse - singer, Kate Moss - model).
I have just read "The Heart of Addiction" and will never read another book on addiction again...because I don't need to. You hit the nail right on the head. I also strongly suspect that your techniques may be adapted to also help people with learning disabilities who act out frustration with extreme bursts of anger. I am not doing too well sadly as I am an unpublished writer (so have no status with which to sway others) and getting into a classroom as even a volunteer teaching assistant is harder than pulling teeth from a crocodile whilst armed only with a plastic spoon.
Thank-you for being willing to be the voice that questions the system. My family of origin was /is challenged by multiple addictions (gambling, alcohol, smoking, heroin). 50 years ago, AA was what we had and it is better than nothing and worked well for some(no-one in my family). However we have so much new neuroscience to support new treatment methods. As a daughter and sibling of people with serious addiction issues, even I could see early on in life that starting a treatment plan by say :"I am an (alcoholic/drug addict/compulsive gambler) and I admit I am powerless over my addiction" was some pretty negative programming. As I have watched loved ones work the program I have come to consider AA as a revolving staircase and one that faces backwards at that. I always wondered why I managed to escape "the family disease". I realize that at a very young age, somehow I was able to ask myself- how can I live differently. Since training as a life coach and studying NLP I have been working on my own book about this topic, hoping to add to the conversation that looking backwards is not the answer any longer. We have discovered more powerful parts of the brain that need to be supported and activated. I hope that programs like AA can be willing to change and adopt the new knowledge, rather that staying addicted to their agenda. Thank you again for knocking a few bricks out of that wall.
Just finished "The Sober Truth", which I picked up after hearing your interview on an NPR station. What you say can easily be transferred to the diet industry & people's attempts to lose weight & keep it off by focusing on diet & exercise. It's a mega-billion dollar industry, & so probably will keep on repeating as long as their is money to be made.
There were two sources relating to eating & attempts to lose weight that seemed useful in my former life as a dietitan: Ellyn Satter, who helps parents understand the feeding dynamics of children, & the work of the radicalized dietitian Laurel Mellin, who has authored a series of books/group guidelines around "The Solution" and "The Pathway". While not that well written, her series at least introduces the concept that when it comes to food choices, thoughts & feelings have something to do w/behavior! Interesting concept.
Thanks for your work.
Of possible interest: http://ellynsatterinstitute.org/
I have read your article, The pseudo-science of Alcoholics Anonymous: There’s a better way to treat addiction. I was disappointed in the fact that you as a doctor would repeatedly state that AA is based on religion. It is absolutely not. There is a HUGE difference between Religion and Spirituality. I would think that with your level of education you would know there is a difference between the two. You might want to educate yourself on this fact before you go writing about it. Just my opinion.
Beth
I agree that this is a large and loaded issue and we need to hear everybody. The Anti AA group and the AA groups are hostile to each other quite often and you must strictly adhere to one group or the other. I like Dr. Dodes approach when he sayss: if someone can make use of the Steps, then that's fine. If another person cannot make use of them, then it's the wrong program for them. Or even that a person can have psychotherapy while utilizing some 12 step principles or even meetings. I for one, am not willing to throw away all of my years in AA, and turn on AA and call the founders conmen and thieves, and go atheist. Recycle, recycle, recycle. Why throw things away and waste everything? Find the value in your life experiences and keep moving forward. Work for change.
Good luck to all on their journey to better mental health!
@Beth Finzel:
There is no difference between religion and spirituality, and I am sick to death of that meaningless argument.
I am grateful and relieved after spending many sober years attending AA with a family member who stayed sober for over 20 years I could help but think at some point that so many of the people in those meeting rooms didn't seem to be getting happier and needed some type of therapy. I do not write that with sarcasm i include myself in the equation. i believe i was more afraid of becoming an alcoholic, was struggling with depression and lacked coping skills to deal with life.
Thank you Dr. Dodes for being willing to shed some light and bring hope to so many who need it even if they don't realize they may need it at this time. I am also grateful for Monica Richardson's documentary "The 13th Step" there were a lot of predatory individuals in those meeting rooms and both men and women were cruelly taken advantage of.