SMART Recovery® News & Views, Vol. 9, Spring 2003, pp. 6-8.
Let me list what I see as the best and the worst signs of how things are going in addiction treatment, addiction theory, and alcohol and drug policy:
The Eight Best Signs
1. Even traditional providers are beginning to feel a need to expand their treatment portfolios, and some are considering client skills, motivation, and other elements of appropriate addiction practice. Sometimes they hire me to teach them how to do it.
2. The heads of NIAAA, Enoch Gordis, and NIDA, Alan Leshner, retired (at the end of 2001, actually). Both should have been run out of town on rails years ago. While Gordis pushed throughout his 15-year tenure for real medical treatments for alcoholism, the first multisite trial of naltrexone, the one new drug therapy introduced for alcoholism during his regime, found it produced no better outcomes than placebo. Leshner, who lectured ubiquitously with the aid of MRI images about how cocaine affects the brain, left the NIDA with the announcement that scientists were now considering how drugs were actually just one of a range of activities that cause compulsions in human beings.
3. It is now almost universally recognized that moderate drinking prolongs life by reducing coronary artery disease (CAD). That is, abstinence from alcohol is a risk factor for heart disease and an unhealthy habit with life-threatening consequences.
4. The evidence that long-term cognitive functioning is improved by moderate alcohol use is approaching the breadth and depth of that for CAD. Among others, see Kalmijn, van Boxtel, Verschuren, Jolles, and Launer, “Cigarette smoking and alcohol consumption in relation to cognitive performance in middle age,” American Journal of Epidemiology, 2002,156:936-944. The authors concluded: “[A]mong middle-aged subjects, current smoking was inversely and alcohol consumption positively related to psychomotor speed and cognitive flexibility.” Reaching a similar conclusion were Ruitenberg, van Swieten, Witteman, Mehta, van Duijn, Hofman, and Breteler, “Alcohol consumption and risk of dementia: The Rotterdam Study,”Lancet, 2002, 359:281-286: “These findings suggest that light-to-moderate alcohol consumption is associated with a reduced risk of dementia in individuals aged 55 years or older.”
5. The public now broadly accepts that marijuana is a drug that can be used with ameliorative purposes by some people, and they should be permitted to do so. This suggests that the average American is capable of something other than knee-jerk hysteria in reacting to drug use.
6. That alcohol dependent people regularly moderate their drinking has been shown so many times that perhaps this will some day be acknowledged for the fact that it is. See Hasin, Xinhua, and Paykin, “DSM-IV alcohol dependence and sustained reduction in drinking: Investigation in a community sample,” Journal of Studies on Alcohol, 2001, 62:509-517. “According to clinical expectation, individuals with a current diagnosis should be less likely to reduce their drinking than individuals without such a diagnosis. We studied the question longitudinally among nonpatients, using different ways of measuring alcohol consumption and different statistical strategies. No strategy supported the hypothesis.”
7. That prevention programs do not prevent adolescent substance abuse and may often increase it has been demonstrated again. Someday this may actually cause us to change our attitudes toward and messages about drugs and alcohol. See Werch and Owen, “Iatrogenic effects of alcohol and drug prevention programs,”Journal of Studies on Alcohol, 2002, 63:581-590.
8. The largest international study of alcohol-related mortality, conducted by the world’s leading alcohol-control advocates to show that increased alcohol consumption CAUSES more alcohol problems, instead found an inverse relationship between consumption and mortality. Thus, it established scientifically the health impact of cultural patterns of drinking. See Norström et al., Alcohol in postwar Europe: Consumption, drinking patterns, consequences and policy responses in 15 European countries, Stockholm: National Institute of Public Health, 2002.
The Eight Worst Signs
1. In America, it is still virtually impossible to find treatment for substance abuse which is not steeped in the 12 steps, and such treatment is regularly forced on people by courts and the social service system.
2. Leshner was immediately replaced by a researcher, Nora Volkow, who knows nothing about addiction beyond brain chemistry and who boasts that in the last five years this view of addiction – which holds that culture, society, personality, and the individual have essentially nothing to do with addiction – has been widely accepted.
3. Anti-alcohol and anti-drug “Reefer Madness”-type propaganda is worse than ever, and is the bottom line of every education curriculum for children.
4. The Monitoring the Future study shows that high school students are more likely to disapprove of regular light-moderate drinking by adults than they are to disapprove of weekend binge drinking, thus guaranteeing future generations of screwed up American drinkers.
5. Addiction journal editors have organized themselves into a combine that rejects and punishes unpopular, out-of-the-box ideas and authors, justifying their persecution by showing that many have been funded by commercial interests rather than by public health agencies. See Davies, Drucker, and Cameron, “The Farmington consensus: Guilt by association,” Addiction Research and Theory, 2002, 10:329-334.
6. Just behind and disguised by our preoccupation with terrorism, American foreign policy is being driven by anti-drug mania, as evidenced in Colombia, Bolivia, and Mexico, where we are expending millions of dollars to eradicate crops, support totalitarian regimes that promise to suppress the drug trade, and in fact encourage massive corruption that dominates these developing world societies. See Bowden,Down by the river: Drugs, money, murder, and family, New York: Simon & Schuster, 2002.
7. The United States government continues to increase the legal, police, and military pressure against the use of drugs. The fact that this policy fails is disregarded, because it goes against vested financial interests. Instead, their failures are used to bolster their pious requests for still more funding for their ever-increasing attacks on drug use.
8. The greatest impetus for drug policy reform is to compel more and more people into treatment, treatment that is usually not required, treatment that is usually not successful, treatment that is usually unconstitutional and aims to rearrange people’s self-conceptions to suit “recovering” addicts who are in fact the worst models for attitudes towards drugs and alcohol.
So, am I optimistic or pessimistic? When I entered the addiction field with the publication of my book, Love and Addiction, in 1975, I knew that I was tackling a field mined with prejudice and irrationality. There is still much to do; there will always be much to do. Who wants to be in a field where problems are actually approached productively and solved?