Dr. Peele, are you still relevant?
I received three letters from people describing themselves as long-time fans (going back more than a quarter of a century), but all of whom questioned whether I am still the powerful voice for reforming views of addiction that I once was. Indeed, the answer is, my views on controlled drinking and drug use (harm reduction), the role of motivation and values in treatment, the uniformity of compulsive behaviors whether or not they involve drugs, environmental factors as dominant in overcoming addictions, the need for alternatives to exclusively abstinence and 12-step oriented therapy, and so on has never been more clear! Time has been on my side in terms of bringing the addiction field closer and closer toward my views – although it still has a ways to go.
You are the most remarkable rebel from your 80’s and 90’s theories (your books) I am a strong advocate of most of your theories, but I would like to speak to you about how your views fit today from a social and professional perspective.
I read Love and Addiction years ago, in the late 70’s. Still have my old battered paperback copy. Thank you for your work. I would like to read your comments about the current movement toward faith-based counseling and some of the provisions of the “charitable choice” law that circumvent equal opportunity employment law and allows states to determine whether education and training provided by a religious institution meets state certification and licensure requirements. The “addictions treatment” field is moving toward a new paradigm in thinking about “addictions” and how to provide effective services (strengths-based, motivational, cognitive-behavioral, harm reduction…) ……and now, this….what is it? ….a regression, a last gasp of an old paradigm?…..I don’t know how to frame it for myself. It’s frightening to me. I look forward to any response you may have.
You are correct in perceiving that there has been a large movement towards effective services as you identify them – strengths-based, motivational, cognitive-behavioral, harm reduction – except, the movement is sometimes more apparent than real. That is, treatment is still dominated by recovering alcoholics and addicts and their philosophy, counseling skills are often woefully deficient, and U.S. agencies refuse funding for treatment or research using the phrase “harm reduction.” Meanwhile, the NIDA and NIAAA continue to pursue the holy grails of alcoholic genes and drugs to overcome addiction.
We are in a transitional place, where conflicting views of addiction and its reformation are at war. But no one questions the need to expand treatment options and to recognize outcomes short of total abstinence. Are these stop gap measures, until we really “cure” addiction – or are they fundamental to our views of the nature and treatment of addiction? Meanwhile, I am amused – if that’s the right word – to see the turning towards faith-based treatments. Of course, these are often unconstitutional and ineffective – since they try to provide private succor in place of systematic public efforts to bring needed resources to bear on the plights of underprivileged addicts (and I don’t mean simply providing them with more treatment, particularly of the traditional type). Ironically, George Bush – who quit drinking without going to AA, but who simply relied on his own religious beliefs and resources – now proposes something more religious than the 12-steps themselves.
As for genetics, the particular gene the study David refers to concerns is one proposed to produce the protein that enables drunkenness (in worms). But this gene is not related to alcoholism in humans. Indeed, how could it be? Do alcoholics get drunk easier from consuming alcohol, or does it take more alcohol to make them drunk (there are theories going in both directions). In any case, however readily one gets drunk from drinking, does that really determine whether the person progresses to becoming an alcoholic? Maybe people who become drunk to readily will be less likely to drink. Conceivably, if the experience of drunkenness could be blocked (one therapeutic derivation of the research), than a person might be willing to stop drinking. But is that all there is to overcoming alcoholism?
Ironically, at the same time the “drunk gene” research appeared in the journal Cell, a rather unusual study was published in the Archives of General Psychiatry, finding that environmental factors were critical in determining whether even twins with a supposed genetic loading for alcoholism develop drinking problems – to wit, offspring with no history of alcohol abuse (AA) or dependence (AD) monozygotic twin whose co-twin was AD were no more likely to exhibit AA or AD than were offspring of nonalcoholic twins. The appearance of this study, whose emphasis is very different from scores of studies published in this and similar journals, was really remarkable. But, David, the answer is, no – no gene will ever be discovered to account for or prevent alcoholism/addiction.
Davies AG et al. (2003), A Central Role of the BK Potassium Channel in Behavioral Responses to Ethanol in C. elegans. Cell 2003; 115:655-666.
Jacob T et al. (2003), Genetic and Environmental Effects on Offspring Alcoholism: New Insights Using an Offspring-of-Twins Design. Arch Gen Psychiatry 2003; 60:1265-72.