In Fighting Both the Taliban and Addiction, We Missed What Vietnam Taught Us

We’ve missed something fundamental for decades.

It seems impossible that the entire U.S. Government could follow a delusional policy that is an utter failure, while administration after administration and their experts declared it a success.

That’s what happened in Afghanistan. After spending two trillion dollars and twenty years, the United States discovered that it had accomplished nothing. In fact, just the reverse was true — as has occurred with the disease theory of addiction.

The United States invaded and conquered Afghanistan after 9/11. Successive administrations concluded that we could create national unity, make Afghanistan a democracy, form a reliable military, and engender Western values in this far-off outpost.

What faith we had in our beliefs! Yet these were exactly the same delusional beliefs that governed our failed approach in Vietnam. We simply redeployed them in Afghanistan more than fifty years later—with exactly the same result.

Fredrik Logevall, a professor of history and international affairs at Harvard, described the American-backed Afghan government’s doom:

“Much like South Vietnam a half century before, it could never escape being tainted by its association with a foreign occupying power.” Put simply, Afghanis would fight for their country (like the Vietnamese would theirs), but not for America.

And, so, in a few short weeks the Afghanistan government and military dissolved like sugar in water after we left, just as they did in Vietnam.

The war didn’t dissolve opium, it should be noted. Ironically, in 2000 the Taliban banned opium production, thereby alienating farmers and laborers who depended on the crop. Learning this lesson, the Taliban switched strategies. In fact, Aljazeera noted, “Afghanistan’s drug trade fueled the Taliban. The Taliban are involved in all facets, from poppy planting, opium extraction, trafficking to charging smugglers export fees.”

As for ourselves, we are incapable of learning. One U.S. official in Afghanistan analyzed how our collapse “shows we missed something fundamental for decades.”

That inability to reckon with the truth applies to more than just the military debacle.

Exactly the same hubris—where America enacts its cultural blunders no matter what world history and cultural differences teach us— has occurred with addiction. For starters puzzle over this: As was true in Vietnam, in Afghanistan opiates aren’t considered a problem. Afghans and Vietnamese simply don’t view opiates and heroin as the monster that takes control of and destroys people the way virtually all Americans (including doctors) do.

Our worldview explains both our experience with opioids and our theories of addiction. In Love and Addiction, in 1975, Archie Brodsky and I analyzed the Vietnam heroin addiction experience. Large numbers of G.I.s were addicted in Asia. However, most quit as soon as their feet hit U.S. soil—only five percent were addicted in their first year back. Virtually no one underwent withdrawal. Although half of the addicted men did consume a narcotic stateside at some point, these users too largely resisted addiction.

It seems that, in a supportive environment, people readily reject drug addiction. As we noted in L&A, assistant secretary of defense for health and environment, physician Richard Wilbur, declared: “Everything I learned in medical school about narcotic addiction— that once addicted you were permanently, irreversibly hooked — was proved wrong by Vietnam.”

But if Wilbur went to medical school this fall he’d learn exactly that same thing, girded by the “new” “chronic, relapsing brain disease theory” of addiction.

The result: a steadily increasing drug addiction and death toll, culminating in a breathtaking jump of 30 percent to 93,000 such deaths in 2020. This represents an annual quintupling in drug deaths over 1997, when Alan Leshner, then director of the National Institute on Drug Abuse, proposed his brilliant theory in Science: “Addiction is a brain disease, and it matters.” Since that time, nearly 900,000 Americans have died due to drugs.

And yet, still, the NIDA director (which she has been since 2003), Nora Volkow, insists that the brain disease approach represents a scientific revolution that is destined for success. Just give it time. In 2020, in recognition of her career contributions, the American Medical Association presented Volkow its prestigious Dr. Nathan Davis Award.

But as drug deaths have piled on drug deaths, the titles of articles defending the brain disease model seem a tad bit defensive—titles with question marks along with admonitions to rescue the disease theory:

Volkow (2015), “The brain disease model of addiction: Is it supported by the evidence and has it delivered on its promises?”

In the National Institutes of Health Record (2020), “Addiction is a complex brain disease, says Volkow.”

Markus Heilig et al. (2021), “Addiction as a brain disease revised: Why it still matters, and the need for consilience,” to wit:

“These criticisms state that the brain disease view is deterministic, fails to account for heterogeneity in remission and recovery, places too much emphasis on a compulsive dimension of addiction, and that a specific neural signature of addiction has not been identified. We acknowledge that some of these criticisms have merit, but assert that the foundational premise that addiction has a neurobiological basis is fundamentally sound. We also emphasize that denying that addiction is a brain disease is a harmful standpoint since it contributes to reducing access to healthcare and treatment, the consequences of which are catastrophic.” (My italics)

The article appeared at the internationally prestigious website, nature.com.

Vast evidence has accumulated to dispute the disease theory, while its failures have run amok. Yet, as I discuss in my memoir: A Scientific Life on the Edge: My lonely quest to change how we see addiction, institutional science and medicine have redoubled their propping up of the disease theory.

Next Leshner and Volkow should win the Nobel Prize. Unlike Afghanistan and Vietnam, we seemingly can’t withdraw from this morass.

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