Rise and Fall of the Official View of Addiction

*ahem* quite a snotty pretentious topic to introduce here in my redundant opinion, the beating heart of harm reduction online, but it holds a few truths, as well as a few lumps of coal. read on if your heads bigger then a walnut:

(Revised 23 December 2010)

Bruce K. Alexander, Professor Emeritus, Simon Fraser University

3. There is no substantial evidence that the minority of drug users who do become addicted lose their will power, and strong reasons to think that they do not. This contradicts the weak form of the 2nd foundational element of the Official View.

Although it is sometimes convenient for street addicts to let police, their parents, or other power figures believe that they have lost their willpower or had their brains "hijacked", they are not, in fact, drug-zombies. Clinicians and drug counselors who listen carefully in situations of trust know that many people who are addicted to drugs, as well as other habits and pursuits, can explain in great detail why they lead the life style of an addict. They can detail the functions that their addictions serve for them, and explain why socially acceptable life styles are so difficult for them to achieve.[77]

This is not to claim that addiction is simply a matter of "free will". The freewill vs. determinism debate is an irresolvable philosophical dispute not only about drug addiction, but about all human actions. However, there is no substantial reason to think that addicted people have less control over their actions than anybody else, even though some of them sometimes claim that they are out of control, especially when they are explaining themselves to their parents or to a judge.

Some addicted people probably do sincerely believe at times that they are out of control and cannot comprehend their own behavior, but these beliefs are readily understood psychologically in terms of psychological attribution theory,[78] Freudian defense mechanisms,[79] or a simple desire to avoid being punished. Furthermore, addicted people are aggressively taught to believe that they are out of control by the omnipresent rhetoric of the Official View and of many treatment programs and self-help groups. The current doctrine of the Official View holds that any thoughts addicted people may have of not being out of control are themselves results of a disease process, such a denial, or drug-induced brain damage.[80] Many addicted people cannot bear to attend 12-step groups precisely because they know that they are not out of control.

4. Genetic research provides no substantial evidence of a genetic predisposition to addiction. This contradicts the 3rd foundational element of the Official View.

Addiction, like all other human activities is influenced in various ways by the shared genetic endowment of the human species and by the particular genetic complement of each individual. Therefore, evidence of some genetic effects on addiction is not surprising. However, neither the experimental evidence that hundreds of genes can influence the likelihood of addiction in some species and in some situations, nor the reports of substantial heritabilities of alcoholism from human adoption and twin studies comprise evidence of an inherited predisposition to addiction. Genes can effect various risk factors. For example, a gene that affects the sensitivity to a particular drug may make an experimental subject more or less vulnerable to addiction to that drug. A gene that affects one of the qualities expected in a particular human group, the absence of which predisposes a person to social exclusion, can increase the probability of addiction in the persons that carry the gene. These kinds of genetic effects could have measurable effects on the frequencies of some addictions in some situations, but they comprise no evidence at all for a genetic predisposition to addiction in general.

Moreover, there are many reasons to question claims of heritability of addiction of as high as 50% that have come from some human adoption and twin studies. These claims are being vigorously disputed by many biomedical researchers on a variety of grounds.[81] For example, there is no way to control for prenatal and perinatal stressors produced by alcoholic parents whose children serve as subjects in adoption studies. Such factors could have a major effect on future addiction which would be incorrectly counted as genetic variance, under current experimental designs.

5. Natural recovery is the most likely outcome of addiction. This contradicts part of the 4th foundational element of the Official View.

Large-scale field studies and clinical studies of "natural recovery" show that about three-quarters of the people who become addicted to a drug in their youth recover, usually without receiving any addiction treatment at all. More than half of them recover by the time they are 30.[82] The relapse rate for people who go through treatment is much higher than the relapse rate for those who overcome addiction without treatment.[83] This difference in differential relapse rate does not reflect badly on treatment, since the people who present for treatment are those who did not recovery naturally, and are therefore more resistant to change.

The basis of natural recovery without treatment is no mystery since so many case have been documented. Natural recovery occurs because people establish stronger relations with the community, or find a strong sense of meaning in a new life.[84] Addicted people who do not recover on their own fill the treatment agencies and social service centers. A large number are refractory to treatment, creating the illusion of a chronic disease, which has been incorporated into the Official View to explain the marginal success of treatment regimes built on its doctrine.

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Conclusions and Speculations

All six foundational elements of the Official View are untenable, its scientific faith is illusory, and its medical promise is expiring -- like any long-repeated promise that has not been kept. The War on Drugs that the Official View tacitly supports is a cruel farce. Addiction is more accurately, usefully, and peacefully conceptualized by Dislocation Theory. It is time for a paradigm shift.

The Official View has maintained its hegemony over modern thought for too long. It has become entrenched, I believe, because it narrows society's understanding of addiction in a way that protects the modern status quo.

Historically, medicalization and criminalization of addiction in the 19th century were more than an attempt to solve a pressing social problem with the methods of medical science and moral exhortation. Medicalization and moralization served the largely unconscious function of reassuring an increasingly nervous population that the brave new world of 19th century modernity was secure. With addicted people safely labeled as diseased or immoral misfits, or both, and with the growing malaise of addictions conceptually limited to drugs, there remained no possibility of seeing that the rising tide of addiction was an understandable way of adapting to an impoverished social milieu. The realization that successful intervention would have to come more from societal change than from individual treatment or punishment became unthinkable. At the same time, major benefits accrued to the nascent treatment and pharmaceutical industries that devoted themselves to tirelessly seeking cures to the non-existent disease of addiction.

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Harm reduction practice challenges some of the foundational elements of the Official View, most obviously because it usually does not envision the addicted person as sick or immoral, but rather as struggling to adapt to difficult circumstances in ways that are not always socially acceptable. The essence of harm reduction practice is not dispensing needles, condoms, and drugs. These tasks can be accomplished with vending machines. The essence of Harm Reduction is establishing ongoing, respectful relationships between addicted people and caring service providers.[152] Therefore the harm reduction movement may be expected to play a chasm-bridging role in the paradigm shift from the Official View to Dislocation Theory.

While recognizing the importance of treatment and harm reduction, Dislocation Theory of course puts the greatest emphasis on dislocation as a root cause of addiction and on fundamental social change as the most important means of bringing addiction under control.

Addiction is one of the windows through which we can view the widespread psychological malaise and the underlying structural problems of a tottering civilization. Addiction is not only a scourge for modern humanity, but also a teacher. Unfortunately, its lessons have been obscured by the stultifying presence of the Official View.

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now, i feel it's time you go to your room 21st century medicine, you've been a very naughty boy. no drugs, phone, computer or tv for 100 years. you can come down when you've cooled off 4-6 grays (400-600 rads)