October 2, 2006

This is a recollection of my four sober years, previously published in three parts.

Lohan’s Disease Defense

“Substance abuse is a disease, which unfortunately doesn’t go away over night. I am working hard to overcome it.”

So tweeted Lindsay Lohan in the wake of her latest failed drug test. It hardly seems worth saying that she didn’t actually write the words herself — her public relations team would have done that, and clocked about 10 hours’ in billable hours for their efforts.

Lohan’s flacks deserve every last dollar of their whopping great fee. The tweet is a small masterpiece in the sub-sub-genre of rehab PR. Allow me to parse.

“Substance abuse is a disease” is presented as a statement of fact when, of course, it is nothing of the sort. Abuse of any kind is not a disease; it is a behaviour. A schizophrenic may commit violent crimes, but assault or GBH are not medical conditions. Subtance abuse is a verb, not a noun: it requires someone to do it in order for it to happen. It is the outward manifestation of something else — depression, bipolar disorder, a physiological addiction, a reckless or destructive personality, youth, peer pressure or boredom, to posit but a random sampling.

What Lohan’s people have done — with breezy audacity — is to frame their client’s behaviour as something that happens to her, entirely outside her free will. In this fiction, you can no more blame Lohan for her drug taking than you can criticise a cold-sufferer for a runny nose.

The disease defense in the public discussion about addicts and addiction is so well-entrenched that Lohan’s tweet raises not a single eyebrow; nor does the second part of that sentence: “[substance abuse] unfortunately doesn’t go away over night”. Here, substance abuse is presented even more explicitly as a “thing” that attaches itself to hapless victims and over which they have minimal influence. The use of “unfortunately” strikes me as especially cheeky — can you imagine an abusive partner apologising to his victim by saying “we both want this to end, but unfortunately my explosive temper and violent outbursts are here to stay.”

The notion that substance abuse “doesn’t go away overnight”, as if it’s an embarrassing rash, flies in the face of the experience of millions of addicts who have successfully stopped abusing, including me. In order to give up substance abuse, you necessarily have to transition from abusive behaviour to non-abusive behaviour which, also necessarily, happens at a particular moment in time. It doesn’t go away “over night”, it goes away in an instant — and stays away until you decide, in another split second, to get back on that destructive horse.

If Lohan is a drug abuser, then she will cease to be one when she no longer abuses drugs and she doesn’t have to wait “over night” for that to happen. Nor is it all that complex a matter to “overcome” — nothing a few day’s Valium, a comfy bed, and some yoga and yogurt won’t fix. If, however, she can’t see the point in staying straight — and getting high is just too enticing an escape or too pleasurable to stop — then she will keep using and abusing, and good luck to her. The rest of the world should direct their attention to more interesting subjects than Lindsay Lohan’s partying ways, which would include almost anything else at all.

Stanton Peele: Reason in Addiction

I am very bad at promoting this blog. This is because I have always been prone to a patchy kind of laziness which I have gamely tried to defend my whole life as impatience with “process”. “I don’t do details” is a very flattering way to characterize indolence, and I tend to flatter myself generously and often.

So, while I work quite hard at producing content for the blog — primarily as a vanity project, if I were honest — I invest nary a scintilla’s effort into getting people to read it. WordPress automatically links with Facebook and Twitter and occasionally it falls into the hands of much more popular and well-read blogs, and traffic happens almost entirely despite my best non-efforts. In the same way, during my campaigning days, I was prone to writing and producing pamphlets and media releases but then letting them sit in piles in the garage or gathering dust on the printer unless and until a “process person” aimed a boot at my lazy arse.

Occasionally, something prompts me to get off said same lackadaisical bottom of my own accord. These interludes can be quite decisive and productive, but they are rare and invariably fleeting; I am talking minutes, not hours or days.

I was grazed by such an impulse this morning, when I sent a link to yesterday’s post to Dr. Stanton Peele. Yesterday, I wrote the first in what I plan to be a series of posts to reflect on my first four years of sobriety, the anniversary for which is on October 2nd. Whether the series develops beyond the initial post depends on the extent to which I am able to navigate around the very personality flaw I have spent most of this post attempting to describe. (It’s like the old joke: “I am never able to finish anyth….”).

But send to Dr Peele I did.

Stanton Peele is a trailblazing psychologist and AA heretic who has spent four decades dissecting the conventional wisdom about the causes and treatment of addiction. Peele rejects the disease concept — he argues that the research demonstrates that addiction is a life problem that is more often than not overcome, not a medical condition that deserves radical intervention and constant vigilance. Further, he believes 12-step programs, such as AA, can be actively harmful to some addicts. Here is a money quote:

What about joining support groups such as Alcoholics Anonymous? Here, too, research reveals the opposite of what we have been led to believe. A.A is a valuable community resource for those who find support in a certain type of religiously oriented group ritual. But the best we can say about A.A is that it works for those for whom it works. Meanwhile, there are plenty for whom it doesn’t work. There is no scientific evidence that A.A. works better than other approaches when randomly selected alcoholics are assigned to A.A. or other treatments. In fact, the evidence is that the people who are now often compelled to attend A.A—after being arrested for drunk driving or being sent by a company Employee Assistance Program—do worse than those who are left on their own.[9] Source: http://peele.net/lib/truth_1.html

Religiously oriented group ritual? Ouch, double ouch.

Dr Peele was kind enough to respond to my email, and extremely promptly. He thought my post a “good read” although — full disclosure — “too long”. He also took the trouble to single out a couple of my AA-directed zingers for special mention. Since I have long admired his writing and research, which I find both persuasive and close to the bone, I am most grateful for his email.

This post, too, is too long. Its only purpose is to direct you to Dr Peele’s work if the topic of addiction interests you. His is is a truly compelling voice of reason in a field weighed down by bullshit marinated in snake oil.

His excellent website can be found at www.peele.net .

October 2, 2006: Part One

Addiction perplexes and intrigues me. There are obvious personal reasons for this — I was addicted to alcohol for around ten years until October 2, 2006 — and I find the whole subject an enticing and elusive intellectual puzzle. The origins and causes of addiction are essentially a mystery and its treatments are notoriously random and sporadically effective at best. The medical profession, who are enamored with certainty, have all but outsourced its management to a non-existent god in the form of 12-step programs that, according to screeds of research, are either marginally effective or not effective at all.

My own experience with Alcoholics Anonymous persuaded me it is the world’s most elaborate placebo trial: if you believe hard enough, it may just work. Certainly, the “success stories” of AA are typically people with a certain cultish vibe, right down to the chanting of prayers and platitudes…”one day at a time”, “the elevator to sobriety is broken, take the steps!”, “Seven missed meetings makes one weak!”. The over-reliance on exclamation marks, and the non-ironic reveling in word-play, were early signs that I would not be an AA “lifer”.

At the heart of AA-world is the anthropomorphication of alcohol. AA members characterize booze as a nemesis with human, and inhumane, qualities. Grog itself — the actual liquid in the glass — is evil, pernicious, endlessly capable of plotting. It is out to get you! In most AA meeting soliloquies, the word alcohol could be replaced with the name of an abusive parent or partner without losing anything in coherence.

This is not to say I am anti-AA. For the first 3-6 months after I downed my last drink, it helped me. More than anything, it gave me something to do with the relentless hours and days of early sobriety. Also, I put together a confessional spiel — “Hi, I’m Phil and I’m an alcoholic”, “Hi, Phil!!!” — that proved quite popular among the AA faithful and gave me a timely ego boost ever time I delivered it (which was at every meeting; I was fresh meat and the throng couldn’t wait to hear what depths of depravity I had reached).

AA soon lost its appeal for me, but it undeniably works well for some people. It provides a supportive network of relatively non-judgmental and like-minded souls, and regular meetings certainly act as a buffer between the tenuously sober and relapse. But I could never shake the nagging feeling that the whole exercise was kind of missing the point.

From my experience, I felt that alcohol was a means to intoxication, and intoxication was a ticket out of reality, and reality was shit. The shiteousness of reality, therefore, struck me as main game.

For a booze-hound, as long as the calculation remains that being drunk — with all its dreary and dreadful personal costs —  is preferable to being sober, then all the AA meetings in the world won’t keep you on the wagon. This assessment misses one obvious element — namely, that drinking (or drugging) to “self-medicate” actually makes the original condition worse, creating a misery spiral. I hate my life — I drink – my life gets even worse — I drink more — and so on.

The alcoholic keeps drinking — the exaggerated and easily treatable physiological dependence aside — because the hypothetical notion of a contented sober life is fantastical. If they were happy sober, they wouldn’t have ended up drunk.

At best, then, AA is a form of cognitive behaviour therapy — symptom treatment — and that’s not nothing. It is certainly better for a miserable drunk to be simply miserable, just as it is a good idea to train anorexics how to eat properly, or the obsessively hygienic to cease their irritating compulsions. But it leaves the black box — the reason we drank to begin with — untouched and, as long as that is case, the prospect of either relapse or the emergence of new symptoms seems inevitable to me. Never met an edgy, intense, chain-smoking, instant-coffee swilling, sex-obsessed recovering boozer?  Find a church hall and wait a few hours.

If I am right — and this is one area where I am chronically unsure of myself — then this represents a direct challenge to the AA philosophy which is that sobriety is an end in itself; and that active non-drinking is the one and only answer. In response to my half-formed ideas, AA types will undoubtedly pull out the disease card: alcoholism, so it goes, is a disease, often inherited, for which there is no cure.

My cursory reading on the disease concept is that it began life as an instructive metaphor — alcoholism is very much like a disease — but it has taken on a literal meaning. I heard several AA members describe their condition as being akin to diabetes or heart disease, to which there is only one possible response: “Um, no it isn’t”.

As far as it goes, the disease metaphor is a useful way of focussing the attention of the addict on the chronic nature of their problem — but it is easy to stretch this to breaking point. Granted, there is a well-established genetic predisposition to alcohol abuse — my Irish ancestors, for example, were rarely sober — but this, I suspect, is far less significant that what it seems. In my case, it probably made it far more likely that I would resort to grog as my escape of choice than, say, self-mutilation or bulimia — but what else does it prove? Untroubled, the black box gathers dust.

AA adherents will have one of two responses to this: either, I am an alcoholic in denial on a one-way fast-track to relapse, or I was never really an alcoholic to begin with. To the true believers, it is simply inconceivable that sobriety can ever be achieved without the 12 steps, despite mountains of empirical evidence that it happens all the time. For them, the key to a sober life is to focus on not drinking with the same single-minded ferocity that they applied to getting hammered. But such an approach seems to me like a permanent, self-imposed and entirely avoidable hangover.