Nearly all of us in the liberal-progressive community endorse the science around climate change, which we regard as undeniable. We fear the disastrous consequences of a powerful lobby’s rejection of this reality. But the overwhelming mass of educated Americans bear a striking resemblance to climate deniers when it comes to mental health and addiction. And the consequences are real and tragic, as witnessed by our suicide and drug-death epidemics.

In 2018, several prominent people, including Kate Spade and Anthony Bourdain, took their own lives. The standard response to the deaths was to recommend instantly reaching out for psychiatric help and calling hotlines.

An important component in standard treatment approaches is searching for and uncovering repressed trauma memories and PTSD as a source for “suicidality.”

The CDC report on suicide rightly portrays it as a complex and human action, which too many others insist on reducing to a simplistic medical problem. 

But standard responses to suicide aren’t working. Quite the reverse. The Centers for Disease Control issued a report,  “Suicide Rising Across the US: More than a mental health concern.” The alarming phenomenon it presented: “The US suicide rate increased 25 percent from 1999 to 2016, even though the rates of psychiatric diagnosis and treatment also greatly increased.” 

While experts reported with depressing predictability that depression, leading to suicide, was a medical “disease,” the CDC found instead that, “suicide is rarely caused by any single factor. In fact, many people who die by suicide are not known to have a diagnosed mental health condition at the time of death.”

The New York Times writer Benedict Carey was driven to present “How Suicide Quietly Morphed Into a Public Health Crisis,” a piece that reeled under the confusion:

The rise in suicide rates has coincided over the past two decades with a vast increase in the number of Americans given a diagnosis of depression or anxiety, and treated with medication.

The number of people taking an open-ended prescription for an antidepressant is at a historic high. More than 15 million Americans have been on the drugs for more than five years, a rate that has more than tripled since 2000. 

But if treatment is so helpful, why hasn’t its expansion halted or reversed suicide trends? [Our emphasis.]

“This is the question I’ve been wrestling with: Are we somehow causing increased morbidity and mortality with our interventions?” said Dr. Thomas Insel, former director of the National Institute of Mental Health and now president of Mindstrong Health, which makes technology to monitor people with mental health problems.

“I don’t think so,” Dr. Insel continued. “I think the increase in demand for the services is so huge that the expansion of treatment thus far is simply insufficient to make a dent in what is a huge social change.”  

Thus the neuroscientist and psychiatrist who headed the National Institute of Mental Health from 2002-2015, during the simultaneous meteoric rises in suicides and depression diagnoses and treatment, interprets that failure as proof that we should redouble our efforts to diagnose and treat more people. In doing so, he expresses an obligatory mantra familiar to those who follow the addiction field: “People deny their disease because of the stigma they unfortunately attach to it—denial they must be encouraged or convinced to overcome before being pushed into treatment.”

In fact, research shows that young people who self-label their mental conditions are more likely to become depressed, and less likely to feel that they are capable of changing. As opposed to the suggestion that the best way to have helped Anthony Bourdain was to uncover his life traumas with him, the best therapeutic approach—per Martin Seligman’s and Angela Duckworth’s positive psychology models, as well as reams of data—is to direct the suffering person’s attention to their purposes in life, to their sustaining values, relationships and goals, and help them to plan forward in fulfilling these positive visions.

This unquestioned acceptance of dysfunctional medical, disease panaceas is regularly rehashed at the Times. As the CDC made clear that most suicides can’t be traced to a mental disorder, the Times’s psychiatric expert Richard Friedman declared: “Suicide is a medical problem that is almost always associated with several common and treatable mental illnesses.”

The Times consistently purveys the mythical narrative, also disproved by research, that our crisis of opioid-related deaths is due to people receiving painkiller prescriptions who become addicted and die, even as painkiller prescriptions declined dramatically over the past five years while drug deaths continued to accelerate.

The CDC report on suicide rightly portrays it as a complex and human action, which Friedman and too many others insist on reducing to a simplistic medical problem. 

Stanton’s Brother

Stanton’s older brother killed himself at age 59. Stephen (not his real name) was—like Spade and Bourdain—a person with some social advantages, but deeper underlying discontents, none of which in Stephen’s case comprised mental illness.

Stephen was an insecure person who accomplished quite a bit but who never felt comfortable in his own skin. He received a PhD in physics from a prestigious university, but didn’t land a position in academia. Instead, he worked at a variety of software companies over a spotty career. He married and had two children, then divorced and had a second marriage, which was substantial and loving.

This experience was so painful to Stephen that he preferred to die instead.

In his late 50s, he had a meaningful family life and friendships, as did Bourdain and Spade. Unlike them, Stephen had not created a secure professional identity.  Meanwhile, a financial investment he had made in real estate had failed.

Stephen finally took a trial job lasting six months. At the end of this period, he was informed that he wasn’t to be given a permanent position. He went home and gassed himself in his family garage.

Although he was economically challenged, Stephen wasn’t in real danger of losing his middle-class position (his wife worked). He was in danger of doubting himself and losing his tenuous hold on self-respect. This experience was so painful to Stephen that he preferred to die instead.

Stephen had friends and family and access to psychiatrists and mental health workers, as did Spade and Bourdain (although we don’t know what life issues Spade and Bourdain faced). He had no obviously diagnosable mental disorder. But he had lost his way financially, and then existentially, in his sense that he deserved to live.

There Are Answers, But They’re Complex and Resisted

 In its report, the CDC—the respected health protection agency of the United States—detailed the needed steps for preventing suicide. Encouragingly, they are the opposite of focusing on trauma or drugs to cure a disease. 

CDC Guidelines: How to Prevent Suicide

 * Identify and support people at risk.

* Teach coping and problem-solving skills to help people manage challenges with their relationships, jobs, health or other concerns.

* Promote safe and supportive environments. This includes safely storing medications and firearms to reduce access among people at risk.

* Offer activities that bring people together so they feel connected and not alone.

* Connect people at risk to effective and coordinated mental and physical healthcare.

* Expand options for temporary help (including financial help) for those struggling to make ends meet.

Stephen could have been helped by a financial consultation and career guidance, which seems simple enough. Many people at risk of suicide require practical assistence to improve the conditions of their lives and renew their sense of purpose. Yet the CDC’s economic, skills and community solutions for suicide are generally ignored.

Despite the headlines generated by celebrities who take their own lives, people experiencing economic insecurity or poverty are at greater risk.

Just as increasing socio-economic pressures and inequalities make addiction anything but “equal-opportunity”—and entail that meaningfully impacting addiction on a large scale would require far-reaching social change—so too with suicide.

Despite the headlines generated by celebrities who take their own lives, people experiencing economic insecurity or poverty are at greater risk. One study found: “the hazard ratios of suicide showed an increasing trend as socioeconomic position decreased. After adjusting for gender, age, geographic location, and disability level, Medicaid recipients had the highest suicide hazard ratio.”

It’s as though the suicides of people in more vulnerable socio-economic groups—like their addictions—are less deserving of care and concern.

We know the steps that would reduce suicide, but will we take them? It seems that instead, we prefer to ritualistically repeat our favored mantras.

Screenshot of Anthony Bourdain via Vimeo

This article is an adaptation of an excerpt from Chapter 11 of Stanton Peele and Zach Rhoads’ book, Outgrowing Addiction: With Common Sense Instead of “Disease” Therapy, published by Upper Access Press in May 2019.

The post We Know the Answers to Our Suicide Crisis, But Prefer to Deny Them appeared first on Filter.

She entered rehab at 14, attempted suicide and spent 18 months in a mental health institution. She then went to live with David Crosby because she “needed to be around some people that were committed to sobriety.” In 1990, age 15, she published a memoir, Little Girl Lost.

Addiction experts had a field day with Barrymore—a name associated with alcoholism and addiction. They explained how she had inherited her disease from her famous paternal grandfather, John, who was addicted to alcohol, and from a father who was addicted to heroin (her parents divorced when she was nine). The solution: a lifetime of abstinence.

That didn’t happen. Barrymore outgrew her addiction to become a film power player as an actress and a producer while, early on, she combined this success with being a wild child. She posed in Playboy in 1995, age 19. The same year she formed her own production company, often making films in which she starred. In 2009 she won a Screen Actors Guild Award and a Golden Globe for her role in Grey Gardens. She also directed her first film in 2009.

In 2009 she said, “I’m not sober.” Rather, she had found “balance” in her life.

In 2013, now age 38, Barrymore re-appeared in People with the new heading, “Drew Barrymore: She’s a Vintner,” “unveiling her eponymous pinot grigio at the Nantucket Wine Festival … [she has] lots of knowledge and is passionate about her wine.”

Barrymore had come a long way from being institutionalized in her early teens for mental illness and addiction. But she doesn’t make a big thing about it. In 2009, then in her early 30s, she said, “I’m not sober.” Rather, she had found “balance” in her life.

In 2017, now in her 40s with two daughters, she starred in the popular Netflix series Santa Clarita Diet. In 2018, she did a deep interview with Willie Geist around the show’s new season. Barrymore had retreated from acting prior to Santa Clarita in order to raise her two young daughters, and because she thought she was overexposed. In that time her marriage broke up, and she was in a “dark and fearful place” when she signed on for the series.

Despite life’s ongoing challenges, we should note that neither Barrymore, nor anyone who knows her, is on record as considering her relapsing to addiction as the remotest of possibilities. Barrymore embraces her entire life, accepting the adversity she faced as a child. Rather than seeing this as a lifelong disease, she announces that it made her the person she is.

Indeed, she told Geist, she worries about how her daughters might never face adversity, which she feels people must in order to fully develop. She cautions her children about maintaining two primary guide lights: kindness and safety.

Undercutting a Dominant Paradigm

A life like Drew Barrymore’s—a large life, but a typical one with respect to outgrowing an addiction—undercuts the American recovery meme that not only adults, but increasingly children, must be permanently diagnosed as “addicts.”

Here is how the Orchid Recovery Center, for example, addressed “Childhood Drug Addiction, Drew Barrymore” in 2008: 

Though Drew certainly went through some very rough years, she seems to have kept her sobriety for a long time. Though she has done some quirky and questionable things as a celebrity, there have been no reports of her relapsing into drug use. She seems to have found good work that matches her talents, service and charity efforts she believes in, and good people around her.

This version of Barrymore subtly portrays her as being on the precipice of being re-addicted at all moments, which she is somehow barely avoiding.  

But even this perspective grants Barrymore too much, according to people like one commenter on Stanton’s blog about Barrymore in Psychology Today: “She’s just in denial and I hope SOMEONE around her will sit her ass down and tell her the TRUTH that she is bound to die addicted and alcoholic.”

As extreme as that thinking is, it is the fundamental view that our society applies to addiction. In the US, a long list of US Surgeons General and Drug Czars have claimed that addiction is a brain disease that can never be escaped. And yet government research itself, as well as the experiences of people all around us, show that the opposite is true.

From the age of 26 and older, the substance use disorder figure shows a precipitous drop of 56 percent.

According to the 2016 National Survey on Drug Use and Health, 15 percent of Americans age 18-25 had a substance use disorder, defined by the DSM V as “A pattern of repeated drug or alcohol use that often interferes with health, work, or social relationships.” Substance use disorder (SUD) thus exists along a continuum, from serious problems to all-consuming addiction. And more than one in six of young people display this condition.

The good news: From the age of 26 and older, the SUD figure was 6.6 percent—one in 15—a precipitous drop of 56 percent. Youth is certainly a high-risk time for drinking and other substance use problems. But older teens and young adults often cut back in a few short years, so that the percentage of people with an SUD after age 26 drops to less than half the number of the younger group.

Recall, too, the NESARC odds that a person, over their lifetimes, will leave a drug dependence behind are 84 percent for nicotine, 91 percent for alcohol, 97 percent for cannabis, and 99 percent for cocaine. And the majority of those who escape addiction to alcohol or other drugs, especially in their youth, like Barrymore, continue drinking. 

The National Survey data nonetheless raise several critical questions: 

* How can we convince more teens and young people to eschew problematic drinking and drug use by maturing at an earlier age?

* What is the consequence of telling young people with an alcohol or drug problem that they are lifelong alcoholics or addicts?  

* How can we build on the natural ameliorative tendencies of age to get even more people to recover from their drinking and drug problems?

Barrymore doesn’t lecture on the topic of how she outgrew addiction. She would rather focus on her accomplishments. But there are essential, helpful lessons to glean from this process in her and so many others’ lives:

* No one is destined to be addicted. 

* Early childhood recreational substance use may (or may not) have downsides, perhaps severely negative ones, but such experiences are not lifetime sentences.

* The route out of early substance problems is to embrace as full—and as fully rewarding—a life as possible.

* This goal is not enhanced by calling a child (or anyone else) an “addict,” and we shouldn’t do so.

A Case of Childhood Gaming Addiction

It is clear that young people often enter self-defeating involvements with alcohol and other substances that may cause serious, possibly permanent, damage. But these involvements do not exhaust the kinds of problems that children encounter. Not all addictions involve substances.

In 2018 gaming addiction was classified as a disorder by the World Health Organization. This condition occurs, according to WHO, when “gaming has priority over other life activities and there is continuation or escalation of gaming despite negative consequences.”

Video games gave Mark a feeling of excitement and connection that compensated for the lack of such experiences in the rest of his life.

Mark was an 11-year-old fifth-grader (a child with whom Zach later worked, whose name has been changed per his family’s request). He complained that nobody liked him, and that even the few people who were nice to him had no interest in being his friend.

Mark had many academic skills: visual/spatial, linguistic and logical/mathematical. After school, Mark played video games, often speaking remotely with strangers as they played, because “it’s super fun, and the people on the other end actually understand me and like me because they’re gamers too.” That is, video games gave Mark a feeling of excitement and connection that compensated for the lack of such experiences at school and in the rest of his life.

Mark became so involved with video games—and so out of touch with other aspects of life—that he began staying home from school, even pretending to be sick, in order to play games all day. He fell behind on his assignments and lost touch with his school life. When he returned to school, he had to do his missed schoolwork during recess. Perversely, Mark’s missing recess deprived him of the opportunity to do what he needed most—to bond with people.

Mark was trapped in a negative, self-perpetuating loop. His difficulty making connections was a problem that led him to isolate himself, a consequence of which was his falling further outside of a rewarding engagement in school, making it harder for him to find friends. On top of this, he also faced the stress of overdue homework and additional burdens being placed on him at school, to which his response was to play more video games—the one thing he knew to do to relieve stress and gain self-esteem and form connections, however short-lived and artificial.

Mark’s developing problem needed to be addressed by finding avenues into real experience, with real people.

We can see that Mark was embarked on a deepening negative path. And he was only 11 years old, with so much life before him, a life to be lived fully.

Mark could clearly articulate what a good life was and what that looked and felt like: “being a good person, which means being honest, polite, taking care of yourself like eating good food and exercise, and doing well in school.”

Instead, Mark felt bad about his own life. Rather than acting according to his expressed values, he did the opposite: He secluded himself; he missed school; he fell behind on class work; he was alienated from his schoolmates; he lied to his parents about what he was up to—for fear that by admitting the truth (that he was going downstairs to play video games instead of doing homework) he would cause his parents to punish him and forbid the one thing that made him feel good.  

Mark’s developing problem with excessive, detrimental gaming needed to be addressed by finding avenues into real experience, with real people—which is precisely how Mark’s teacher helped him.

Mark’s Retracking

Mark’s parents brought up their concerns about their son to his teacher, Mr. Stevens,* who took their concerns seriously but didn’t panic. The next school day, Mr. Stevens began a technology unit—one he had already planned for Mark’s class.

Mr. Stevens gathered his students into small groups in which they would study different video games. The aim of the project was to create their own games using computer software. Mr. Stevens knew that being in groups made Mark anxious. But he knew that Mark had strong computer skills, that he wanted to be helpful, and that he knew a lot about video games. On that basis, Mr. Stevens made Mark his technical point person with all the groups.

It didn’t take long for Mark to become the most sought-after person in the class, answering questions from “How do I do this?” to “What is your favorite console?” This was Mark’s area of expertise.

In short order, Mr. Stevens asked Mark to set up an online discussion board for students in the class. Mark happily created this clearing service at home, which added another way for him to interact with classmates.

He wasn’t actually playing fewer games; but he was balancing his gaming with personal, social and academic involvements.

Mark was now going to school, engaging in class, and playing with friends during recess. His parents reported that he was much more polite and more present at home. He wasn’t actually playing fewer games; he was playing a wider variety of video games with the purpose of building his knowledge base. But, at the same time, he was balancing his gaming with personal, social, and academic involvements.

Although he certainly didn’t consider himself an addiction expert, Mr. Stevens was a sensitive and flexible teacher. By drawing on Mark’s strengths and the available opportunities in the classroom, he created a new pathway for Mark, one that integrated Mark’s skill-set within the class environment. With this support, Mark was able to find a positive balance in his life without having to give up his gaming passion—an example of harm reduction.

Mark’s case illustrates how gaming, in and of itself, isn’t a disorder, but becomes one when it curbs a young person’s cognitive and social development. Rather than simply labeling gaming “addictive,” a better way to describe this process is to say that young people who are not well adjusted may seek out gaming as one kind of unhealthy outlet. 

We should question whether it would have helped in this situation to diagnose Mark with “gaming disorder.” And no matter how much his behavioral cycle resembled an addiction, under no circumstances, no matter what categories WHO creates, should we define Mark a “gaming addict,” as though this were an embedded part of his being.

This article is an adapted excerpt from Chapter 5 of Stanton Peele and Zach Rhoads’ book, Outgrowing Addiction: With Common Sense Instead of “Disease” Therapy, published by Upper Access Press in May 2019.

*Name has been changed to protect privacy.

Photo of Drew Barrymore in 2014 by zuko1312 on Flickr/Creative Commons

The post Drew Barrymore and the Case Against Labeling Children as “Addicts” appeared first on Filter.

Although drug and alcohol harms are far more typical in marginalized areas of society, they also appear in privileged America, frightening those of us who usually feel immune. Terry McGovern, the daughter of former presidential candidate George McGovern, was a 45-year-old mother of two who died of exposure on the street due to extreme intoxication in 1994. In explaining his daughter’s long-standing alcohol problem, McGovern said: “She knew what it meant to love other people. But she fell short of loving herself.”

Any theory of addiction—and any form of treatment or prevention—has to address people who “fall short of loving” themselves or who have other mental disorders. But that task is always easier when people have support and resources and communities. And those things, which are more available to the well-off, need to be found, or created, in order to help people who are marginalized.

The state with by far the highest rate of drug deaths is West Virginia, which had 49.6 opioid-involved deaths per 100,000 population in 2017—more than three times the national average. West Virginia’s health commissioner, Dr. Rahul Gupta, set his department on the task of identifying every one of these opioid deaths.

“We wanted to know who each person was and what we could have done to help them,” he said. The findings ultimately would show a depressing pattern: “If you’re a male between the ages of 35 to 54, with less than a high school education, you’re single and you’ve worked in a blue-collar industry, you pretty much are at a very, very high risk of overdosing.”

The identical process takes place in many American inner-cities, where, like rural Appalachian addiction centers, opioid and other drug addictions are most typical among middle-aged male users. Per NPR:  “According to the Office of the Medical Examiner in Washington, DC, overall [opioid-involved] deaths among black men between the ages of 40 and 69 increased 245 percent from 2014-2017.”

Experts and leaders typically ignore the reality of addicted people’s lives by describing addiction as an “equal opportunity destroyer.”

This awareness of the link between social context and drug deaths is absent in American public health and drug policies. Addiction experts and political leaders typically ignore the reality of addicted people’s lives by describing addiction as an “equal opportunity destroyer.” Of course, this lays the entire addictive process at the feet of drug use per se, as in the “Truth Initiative” message, broadcast on media and billboards nationwide, despite general unawareness of the difference between dependence and addiction: “Opioid dependence can happen after just five days because the drugs are some of the strongest on the planet.”

Do they really believe that the Obama daughters, for instance, with their solid two-parent family, private schools, year abroad and elite university attendance have the same chance of becoming addicted and dying as unemployed blue-collar workers in West Virginia, or as children growing up amidst violence and chaotic drug use in Baltimore?

One of America’s foremost and most insightful medical critics, Marcia Angell, the former editor-in-chief of the New England Journal of Medicine, in reviewing many books on the opioid crisis, rejects the idea that our drug-death epidemic is due to overproduction and over prescription of narcotics. (It should be noted that Angell is a long-time critic of pharmaceutical companies.)

In her December 2018 piece in the New York Review of Books, “Opioid Nation,” Angell notes, “We also need to remember an essential and crucial fact: opioids do have a legitimate purpose, and it’s an enormously important one. They treat severe pain.” Rather, for Angell, “As long as this country tolerates the chasm between the rich and the poor, and fails even to pretend to provide for the most basic needs of our citizens, such as health care, education, and child care, some people will want to use drugs to escape.”

The Definition and Natural History of Addiction

 Although addiction is an identifiable, negative pattern of behavior, no person is by definition an “addict” whose fate is sealed by some accident of birth or traumatic event—or even a persistently traumatic upbringing.

Hart’s experiment speaks to all of us: We respond positively when we see better options open for us. 

Most of us seek out powerful experiences at some point in our lives, especially when younger, often with some greater or lesser negative consequences. We may persist for a longer or shorter time before reducing the behavior or ceasing it entirely. These experiences are capable of dominating our consciousness and emotions, with the potential for creating an addictive process for varying lengths of time. Although drugs produce direct, intense experiences, they are not alone in their ability to do this. And there is nothing chemical about drugs that make them inevitably—or singularly among all that we experience—the sources of addiction.

Addictive involvements do the following:

   1. Diminish awareness of surroundings and feelings.

   2. Provide immediate, predictable and encompassing sensations.

   3. Offer a false sense of control and personal value.

   4. Reduce healthy options (impairing the person).

   5. Worsen negative feelings about self (causing distress).

Along with these defining criteria, addictive involvements are notable because they:

  6. Occur along a continuum of severity.

   7. Reverse as people engage in positive life experiences (“recovery”).

Despite their negative consequences, addictions do not entail losing all control of behavior. People with addictions recognize boundaries and are capable of changing with their circumstances. When smoking was banned from workplaces, daily smokers learned to wait for a break to smoke; people who drink problematically are usually not inclined to get drunk in front of their parents; frequent users of illegal drugs have places where they prefer to take drugs and can defer their use in exchange for small rewards—as Dr. Carl Hart showed in the case of regular crack users in his work, described in his 2014 book, High Price.

Hart’s experiment speaks to all of us: We respond positively and delay and eliminate addictions when we see better options open for us. 

Seattle’s Wet Housing Residents

 Seattle, like other cities, has a famous skid row populated by long-term street drinkers. These men and women often ended up in hospitals and prisons, at great public expense. In order to get these homeless drinkers off the street, Seattle offered them “wet housing”—safe residences where they could drink as they wished. Here is the result, as described in Time by Maia Szalavitz:

The homeless residents in the study cut the number of drinks they consumed daily by 40% over the course of two years in a home that did not require abstinence. Moreover, for every three months of their stay, participants consumed 8% fewer drinks on average on their heaviest drinking days. The occurrence of delirium tremens, or DTs—potentially life-threatening withdrawal symptoms—also declined by more than half, with 65% of residents reporting suffering DTs in the month before being housed, compared with just 23% in the month afterward.

Curtailing people’s worst addictive excesses (e.g., how much they drank at their highest-consumption moments) is harm reduction. We might choose to pray that people would cure their addictions and cease drinking altogether. But for a large, and possibly growing, number of people, often at the bottom of society’s ladder, that doesn’t happen. And these are human beings who are fully capable of living better and feeling better about themselves, as described in interviews with the residents and staff.

 From a staff member, many of whom originally opposed the program:

“I would like to see our residents never drink again. I would like to see abstinence. But . . . that’s an unrealistic hope for our population. . . that’s an option that will only do more harm than good. . .so you want them to have the liberty to drink, but not hurt themselves or anyone else.”

One resident said:

“You’ve got to maintain a certain amount of intelligence to be able to stay here and get drunk at the same time. You don’t have to get drunk, just enough to go down, lay down, take a good, nice sleep. . . . Maintain. That’s it.”

 One of the few women in the housing said:

“I’m not a bad person. You know, I feel like I’m not a bad person. I wanna help, you know? I wanna be. . .I don’t feel like a bad person. . . . I’ll get out of hand, but I stop myself, you know. . . . I’m trying to turn from . . .this person [to] that person. This person was a bad person, and that person is a good person.”

Evidence like this from people who are among the clearest examples of addiction underlines that addicted people are human beings operating under value systems that they struggle to realize. Their problems may kill them or doom them to continued marginalization. But like all of us, they are seeking satisfaction, comfort and self-respect.

 With addiction seemingly all around us—including areas of life where we never previously considered it, like gaming and electronic devices, eating, sex and love—finding a balance between being exposed to powerful experiences and maintaining a stable life is a task we universally face. A negative bias against drugs does nothing to help achieve this balance—quite the opposite.

This article is an adapted excerpt from Chapter 2 of Stanton Peele and Zach Rhoads’ book, Outgrowing Addiction: With Common Sense Instead of “Disease” Therapy, published by Upper Access Press in May 2019.

Photo by Dan McCoy via Wikimedia Commons

The post Social Factors Are an Essential—And Changeable—Element of Addiction appeared first on Filter.

Richard Wilbur, a physician who was the US assistant secretary of defense for health and environment from 1971-1973, said of this phenomenon: “Everything I learned in medical school about addiction—that someone addicted to narcotics remained hooked forever—was proved wrong.”

In fact, over 90 percent of the returned vets who had been addicted to heroin in Asia ceased being addicted in the States virtually at once.

The Vietnam addiction experience was catalogued by Lee Robins, a professor of social science in psychiatry at Washington University in St. Louis, and her colleagues in the 1977 classic, “Vietnam Veterans Three Years After Vietnam: How our study changed our view of heroin”—the most careful and detailed study of a group of hundreds of heroin-addicted people ever conducted.

Lee Robins (Photo via Wikipedia)

Everything Robins and her colleagues took on faith about heroin was disproved. Most soldiers (85 percent) said they found opioids readily available to them at home—so we can discount the idea of lack of supply accounting for their mass recovery.

Half did try the drugs again in the States. But even among the most vulnerable group—the previously addicted soldiers who used heroin again stateside—fewer than a third ever became re-addicted. In other words, non-addicted use of opioids was not only possible for formerly addicted soldiers, but more likely than not under their radically transformed circumstances.

The significance of this finding is overwhelming. Natural recovery is, by far, the norm.

What should most impress us about this research is not so much its amazing results, but how the medical experts were completely unprepared for the reality of human addictive behavior—how sensitive it is to individual outlooks, experiences and settings.

Obviously, for most soldiers, addiction was a temporary response to an acutely threatening and disconnected environment. Opioids no longer held that addictive power over them once they returned to a more comfortable setting. Yet unlike the medical “experts,” most human beings who learn that people leaving a war zone and returning home lose their susceptibility to addiction find this to be simple common sense!

Even this result doesn’t tell the full story of recovery by Vietnam vets. Robins and her colleagues also discovered that heroin was no more likely to be used regularly or compulsively than other street drugs available to returned vets, such as amphetamines, barbiturates and marijuana. In other words, as defined by regular, compulsive use, heroin was not distinctly more addictive than other drugs and experiences. This reality is one that addiction experts are still struggling to grasp.

Furthermore, Robins et al. found that those who entered treatment actually fared worse than those who avoided it.

In fact, they found that the small number of men who continued with their addictions had shown these tendencies and life problems before entering the service.

Unfortunately, these data are ignored. Our societal view of addiction is shaped by those who have the least success in dealing with it.

In 1993 Robins wrote a follow-up paper entitled “Vietnam Veterans’ Rapid Recovery from Heroin Addiction: A fluke or normal expectation?” The clear answer, based on numerous studies: Natural recovery from heroin addiction is the general rule, and not an exception that cropped up in Vietnam.

The significance of this finding is overwhelming. Unlike the widespread assumptions shared by media and the American medical establishment, natural recovery is, by far, the norm. Given a reasonable environment, time and the expectation that we can and will recover, almost all of us will.

Compare and contrast the scientific-sounding fatalism of the following message from the medical body charged with treating addiction in the US, the American Board of Addiction Medicine:

“Armed with that understanding [that addiction is a disease], the management of folks with addiction becomes very much like the management of other chronic diseases, such as asthma, hypertension or diabetes,’ said Dr. Daniel Alford, who oversees the program at Boston University Medical Center. It’s hard necessarily to cure people, but you can certainly manage the problem to the point where they are able to function through a combination of pharmaceuticals and therapy.’”

William White, widely considered the most balanced and thoughtful among traditional addiction experts, analyzed 415 scientific reports of recovery in 2012. White (who is “in recovery” himself) confronted claims that addiction is a chronic disease that can get worse but never better. He found:

“Recovery is not an aberration achieved by a small and morally enlightened minority of addicted people. If there is a natural developmental momentum within the course of these problems, it is toward remission and recovery.”

A decisive demonstration of this truth was provided by a 2012-13 national study called NESARC (National Epidemiologic Survey on Alcohol and Related Conditions). The study involved over 43,000 people in face-to-face interviews about their lifetime substance use.

This research found that people overwhelmingly overcome drug dependencies over the course of their lives: 84 percent in the case of nicotine, 91 percent for alcohol, 97 percent for cannabis and 99 percent for cocaine. People simply rarely spend their entire lives addicted.

Unfortunately, these data are ignored. In place of this reality, our societal view of addiction is shaped by those who have the least success in dealing with it.

Changing the “Addict” Narrative

How is it possible that we hardly ever hear about this? Propaganda from vested interests in the American recovery industry is one factor. But another is that recovery is so normal, we don’t think anything about it.

Many more 20-somethings misuse and become dependent on drugs and alcohol than 50-year-olds, who have usually grown up and gotten jobs, and are often supporting families. Everyone knows and accepts this, yet we rarely wonder what those 50-year-olds’ lives looked like when they were susceptible young people in their 20s (sometimes their 30s and later).

For most people who formerly had a major drug or alcohol habit, their current absence of addiction has just become part of who they are, and they don’t see anything special about it. People grow up, settle down emotionally, concentrating on jobs and careers, responsibilities toward their families, or whatever other positive paths their lives take. This is the natural process of recovery, and we rarely give it a second thought.

Most people who have had a drug or alcohol problem have never thought of themselves as “addicts.” And they were right not to do so.

It is only thanks to the US-rooted recovery movement that people who previously had addictive habits refer to themselves as being “in recovery,” and are encouraged—indeed, admonished—to make that the focus of their identity forever.

Similarly, most people who have had a drug or alcohol problem have never thought of themselves as “addicts.” And they were right not to do so, since this label is an anchor on their identities. Assigning people to that negative, self-fulfilling and self-defeating identity can never be justified.

We can see the phenomenon of natural recovery in Zach’s own life, after he quit a considerable heroin addiction in his 20s. Zach, now in his 30s, withdrew from heroin gradually, on his own. His career and family responsibilities simultaneously developed. These days he drinks alcohol socially.

Zach’s story of spontaneous recovery from heroin addiction is fairly typical, as NESARC demonstrated. Of course, some of those who quit an addictive drug habit take decades to do so, but we should look for chronically unfavorable life circumstances in most of these cases. Here, according to the government’s NESARC research, are the turning points by which half of the people who were addicted to each substance quit:

* cigarettes = 24 years

* alcohol =16 years

* marijuana = 6 years

* cocaine= 5 years

NESARC did not analyze separately the Americans addicted to heroin (there weren’t enough of them), but Lee Robins found exactly the same pattern to hold for those addicted to heroin in Vietnam and elsewhere.  

Most of the people in the NESARC study would have undergone considerable life changes in the time it took them to remit their dependencies. By the time they recovered, they had developed into very different people from when their addictions began. This is an ordinary developmental process, and the opposite of the disease theory.

This article is an adapted excerpt from Chapter 1 of Stanton Peele and Zach Rhoads’ book, Outgrowing Addiction: With Common Sense Instead of “Disease” Therapy, published by Upper Access Press in May 2019.

Top photo by Gregory Hamaker via Flickr/Creative Commons

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Zach is a specialist who works with children in the Vermont school system with behavioral challenges—kids whose behavior is deemed unacceptable by parents, teachers, peers, or sometimes the law. Their negative behavior cycles stem from their difficulty adapting to demands placed on them (for a variety of reasons) in school, at home and by society.

Adults and professionals frequently make moral judgments about these children’s challenging behaviors. These judgments are often transformed into clinical, diagnostic labels—ones that can become self-fulfilling and limit life possibilities. Sound familiar? 

While people often have difficulty understanding addiction experientially—preferring to attribute it to abstract biological causes—they are generally far more receptive to an experiential explanation of childhood developmental problems.

Our new book, Outgrowing Addiction, combines our respective specializations of addiction theory and child behavioral challenges to enhance our understanding of addictions. This understanding leads to the happy recognition of how, as with childhood development issues, people with addictions typically outgrow them. We call this the developmental model of addiction.

To underline the validity of this approach, let’s take a look at five key ways in which childhood developmental and addictive problems are similar.

1. They follow similar patterns.

Challenging childhood behavior: Kids’ behavior is challenging when they have yet to develop the skills and resources to meet expectations placed on them (often adult expectations). Those kids will do whatever they can to achieve the kinds of experiences we all seek—recognition, self-control, connection, purpose—despite negative reinforcement for the behaviors they employ to do so. They express the human impulse that it is better to seek and receive a short-lived and illusory “reward”—one. with negative consequences—than to get no response at all.

If nothing is done to address the root cause of this child’s behavior—if he or she is not offered an attractive alternative source of fulfillment—then the child will continue to pursue the problematic behaviors, from tantrums, to acting out, to isolating themselves, in a destructive cycle.

Dealing with the world this way may mean that the child expends enormous effort for narrower and narrower rewards, while detracting from his or her ability to generate meaningful experiences and rewards. The self-defeating behavior then grows to occupy a larger place in the child’s life and consciousness.

Addiction: People engage in addictive activities—whether using drugs excessively and negatively or engaging dysfunctionally in sex, shopping or eating—that provide temporary experiences and rewards when they are unable to achieve genuine gratifications through positive, sustainable life efforts. (Stanton and Archie Brodsky identified this personal deficiency model of addiction in Love and Addiction.) These artificially rewarding activities expand over time, making more difficult the fruitful pursuit of satisfaction and fulfillment.

2. They are commonly misunderstood the same way.

Challenging childhood behavior: Adults, including many professionals, tend to believe recurring challenging behavior means that the child is manipulative, or else that the child is incapable of behaving otherwise. This is a false dichotomy that alternately leads to punishing children, or testing them for and diagnosing them with developmental disorders—conceived to be due to irreversible brain mechanics.

Addiction: People are told addiction is biologically determined, that (some) drugs are inherently addictive; that (some) people are genetically programmed to respond addictively to (some) chemicals; that addiction is a “chronic, relapsing disorder.”

3. They are commonly mishandled in similar ways.

Challenging childhood behavior: Adults respond to behavior in the heat of the moment and attempt to solve these problems unilaterally (through criticism punishment, incentives/rewards) rather than addressing the underlying problems leading to the behavior (insufficient affirmation, resources and skills).

When kids do not respond to this unilateral approach, the next step is for them to be tested and diagnosed with one of a range of childhood disorders, again to be dealt with unilaterally (pharmaceutically). This process results in labeling children, medicating them, and establishing—for themselves and schools and other institutions—that they have permanent character disorders, behavioral deficiencies, and enduring skill limitations.  

Addiction: We treat people with addictions medically (more often mock-medically) with therapeutic approaches that reinforce the belief that they have a disease, focusing on their permanent limitations with the proscription that they avoid (some) substances, or else by providing them with safer versions of these substances. The latter is solid harm reduction 101, so long as the theory in support of it it is not presented as the person’s being a lifelong “addict.”

As with childhood behavioral challenges, the approach to adult addiction imbeds the behavior/addiction—instead of encouraging personal agency and change by practicing prospective planning and thinking, and learning new coping skills.

4. Most people outgrow major developmental challenges and addictions over time.

Challenging childhood behavior: Children naturally progress through a sequence of developmental stages and will, given normal opportunities, outgrow their labels and problems as they find meaning in later adolescence and adulthood. This is the normal developmental process once accepted as “growing up.”

Addiction: People outgrow their addictions through similar developmental stages, occurring later in life, to those that developing children undergo. Given normal opportunities, they typically discover covered-over values, skills, purposes, motivations, intimate relationships as they assume adult responsibilities in their work, family and community lives. By the age of 35, half of those people who previously qualified for substance use disorder diagnoses no longer do.

This process was once commonly recognized, accepted and encouraged. It is now being discounted, with disastrous societal mental health and addictive results. These negative consequences are universally recognized and lamented. But we are incapable of conceptualizing and addressing them—for instance, by devoting resources to allow people to expand their horizons and capabilities.

5. Similar interventions accelerate the process of overcoming both child-development and addictive problems.

Robust clinical and epidemiological research indicates that both childhood and addictive problems are best resolved by working collaboratively with helpers to: (a) identify the underlying problems and life deficiencies waiting to be solved; (b) consider which domains of life must be improved in order to make headway; (c) discover existing skills and motivation and develop new ones; and (d) see the world, and the future, as being accessible, inviting and manageable—that is, as positive and exciting.

Most people facing problems—developing children and addicted adults alike—will find their way to the positive side of life’s balancing act, on their own, without professional help. Of course, life circumstances are more dire for many underprivileged people, who experience addiction at higher rates and more persistently. These people may require extra help and resources. But the principles for life improvement are the same for all human beings, young and old, privileged and under-resourced.

The best thing we can do for all groups is to foster an environment rich with opportunity so as to encourage them to develop in a productive and positive way. The worst thing we can do is to limit their ability to grow out of their problems—to actualize their problems by convincing them they lack this capacity for change.

Photo by Juan Pablo Rodriguez on Unsplash

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