Anyone Can Escape Addiction—But Fatalistic Views of Biology or Trauma Persuade People Otherwise

Oct 21 2016

Anyone Can Escape Addiction—But Fatalistic Views of Biology or Trauma Persuade People Otherwise

October 21st, 2016

Earlier this year, Maia Szalavitz, my fellow Influence columnist and an old comrade-in-arms, released her masterful book, Unbroken Brain, one that displays skills I only wish I had, and that I try to emulate. In it, she’s kind enough to praise my own Love and Addiction (1975, with Archie Brodsky), as “groundbreaking.”

I’ll add my voice to the many praising her work and its valuable insights.

Yet I will politely differ with one of her key themes—that, although ”potential addicts cannot be identified by a specific collection of personality traits,” based on her own experience, they nonetheless inherit a variety of neurologic sensitivities that lead to “the desire to feel accepted and secure when you typically feel alienated, unloved, anxious, and in danger.”

I don’t believe that God puts people on earth to be addicted.

(Note: I will speak of God in this post. For the record, I am a Jewish atheist. I don’t believe in God. But I am imbued with a Jewish outlook that I find helpful for progressing through life.)

In our 2015 book Recover!, Ilse Thompson and I express the Buddhist truth that we all have a place on earth, that no one doesn’t belong here. We use mindfulness meditations to help people realize their places through radical self-acceptance—the act of embracing themselves.

I reject world-views which tell people that their bad feelings, their need for addictive experiences, sometimes their doomsday spirals, are inbred, or branded on them forever by trauma, and can never be escaped. And sadly, these fatalistic stories can emerge from both 12-step and harm reduction thought.

My rejection of such fatalism isn’t just based on hunch. It’s borne out by the reality that people often recover from addiction and improve their feelings and their lives (see my last column, where I recounted that only a quarter of untreated people who were ever alcohol-dependent are still dependent at the time they were interviewed in NESARC).

Of course, Maia has also driven this home. As she put it in a classic article: “Most people with addiction simply grow out of It. The idea that addiction is typically a chronic, progressive disease that requires treatment is false, the evidence shows.”

But some people don’t get better, I hear you reply. And you’re right. And those people deserve our care and love and, even more important, their own self-care and self-love.

Yet while it’s true that some people remain addicted, that does not demonstrate that in no circumstances would it be possible for them to recover. Neither is it true that people who don’t initially get better can’t do so eventually. Rather, belated recovery very often occurs.

Gene Heyman, a Boston College epidemiologist, analyzed the most recent NESARC data according to a timeline of people’s likelihood of quitting a drug dependence. He found that “each year a constant proportion of those still addicted remitted, independent of the number of years since the onset of dependence.”

Translation: Some people retire from their addictions late, even very late, in life, and after many years of reliance on an addiction. Natural recovery does not discriminate based on how long a person has been addicted.

Let’s turn to smoking. In 2002, the Department of Health and Human Services published a volume entitled, “Those Who Continue to Smoke.”

The volume’s researchers uniformly assumed that those who continued to be addicted to smoking were handicapped in some way.

Their results confounded all expectations. Despite a variety of research efforts to discover the core resistance that prevented people from quitting smoking, the investigators found instead:

“In summary, these trends do not suggest that the population of smokers who remains is more addicted, more resistant to cessation messages, less likely to attempt cessation, or increasingly composed of those with limited activities or poor mental health” (p. 143).

One particularly interesting and surprising finding in the monograph was an interaction between age and degree of dependence in smoking cessation: More dependent younger smokers were less likely to quit than less dependent ones; more dependent older smokers were more likely to do so than less dependent ones.

Jettisoning all assumptions about addiction, a sensible deduction would be that older heavier smokers, sensing their mortality and wanting to delay death, which they knew was more likely to ensue given the severity of their habit, were more motivated to quit and more often did so.

The whole point of such smoking cessation research was to classify smoking as addictive, something which is now universally accepted. Yet these results confound our notion of addiction—or certainly the ironclad, neuroscientific, brain-disease version of it.

So what do we accomplish by telling people that they have a disease?

My colleague, Steven Slate, has recently presented to TEDx the freedom model, which he learned at St. Jude Retreats, an alternative program. There he reversed all that he had been taught about addiction, including that it was a lifelong disease. Instead, St. Jude taught him that he could choose not to be addicted.

Steve says, “I know this sounds simplistic, and that many people think this is an offensive message. But to me, it was and still is a massive relief.” He quit and hasn’t used for 14 years.

It’s inspiring stuff—although I do think the message is a bit oversimplified. People don’t quit just because they learn that they can. Escaping addiction is still a process—one that should be followed knowing that given the right circumstances in their lives, the right support, the belief that they can quit or moderate, and the desire to do so, people are able to leave their addictions behind.

It is never our job to convince them otherwise.

And if people have become convinced that their heroin addiction or alcoholism is a lifelong metabolic condition (Dole and Nyswander), God-bestowed biological trait (AA), or chronic relapsing brain disease (Nora Volkow), what do I do?

I pray to differ, to set out my evidenced reasons for believing otherwise, and to offer them a larger vision of themselves, of how the universe accepts and welcomes them, and offers them a place in which to explore life.

Read more from The Influence:

Women Who Use Drugs Need Gender-Specific Services—My Own Life Proves It

Seven Things We Must Understand About Addiction to Undo the Mistakes of the Past 40 Years

Follow us on Facebook and Twitter, and sign up to receive daily stories to your inbox.

I once created a residential rehab program. People tended to go there as a last resort—that is, after other treatment options had failed them, repeatedly.

One young resident told me, “I’ve failed at nine 12-step rehabs. This is my last stop.”

Then he argued with me that his substance problem was a disease, just as he had learned in all those other rehabs!

My program taught him, and other residents, otherwise.

I’m often roundly attacked for doing so. Steven Slate, who was also kind enough to credit my work, said of me: “We all owe Stanton a debt of gratitude for willing to be hated for so many years, while standing by what he knew to be the truth.”

I’m quite willing to be hated, by Recovery Nation or even harm reductionists, if that’s what it takes.

Without blaming people for their failures, I will always try to err on the side of convincing them of their potential to get better, and to do so largely under their own auspices.

Call it a Jewish-Buddhist faith of mine.

Stanton Peele is a columnist for The Influence. His latest book, with Ilse Thompson, is Recover!: An Empowering Program to Help You Stop Thinking Like an Addict and Reclaim Your Life.  He has been at the cutting-edge of addiction theory and practice since writing, with Archie Brodsky, Love and Addiction in 1975. He has since written numerous other books and developed the online Life Process Program. His website is Dr. Peele has won career achievement awards from the Rutgers Center of Alcohol Studies and the Drug Policy Alliance. He is currently working on his memoir. You can follow him on Twitter: @speele5.

  • “People don’t quit just because they learn that they can”
    “people are able to leave their addictions behind”
    “It is never our job to convince them otherwise”

    I’m impressed that you fail to see the contradiction in those statements, and in your case, hypocrisy.

    I think it’s funny though how this topic always gets so religious despite the protestations. If I didn’t know better I’d think you’re not an atheist but a theophobe.

    • i honestly don’t see the contradiction there.
      “people don’t just quit because they learn they can”-obviously true. it’s more than just knowing you can, it’s being ready to do so. sometimes people know it’s possible, but are just not in a place where they’re interested in it.
      “people are able to leave their addictions behind”-also true. once a person both knows they’re able to and feels they’re ready to, then with the right support for them, they can. but i guess it goes back to the previous idea that one can *know* it’s possible to kick an addiction but not be actually prepared to do so, for one reason or another. lack of fulfillment in life, underlying mental and/or physical health issues, being largely rejected or denigrated by society for things they can’t help-things like race, sexuality, gender orientation, or neurodiversity-that are integral parts of their identity…all of these things can cause a person to use drugs in a problematic way to cope with the pain in their lives, and while they may know (considering they’re ever even exposed to the idea that addiction isn’t a permanent and progressive brain disease) that they can quit, they don’t feel immediately prepared to do so. idk if you ever have this feeling, but i have always had the experience of knowing things in an academic sense, but being unable to translate that knowledge into belief that applies to my life. a sort of cognitive dissonance, i suppose, not sure if that’s exactly the term for it but it seems applicable. for some people, i guess, because it happens to me and i can’t be the only one, there is a gap between knowing something factually and believing it emotionally or on a personal level.
      “it is never our job to convince them otherwise”-you know the cliche “you can lead a horse to water but you can’t make it drink”? kinda like that, i think. we have the responsibility to provide what information we have, but what happens with that information in the mind of another is not something we can force. besides, i think what he means with this is a matter of not shaming a drug user or making them feel bad if they’re not ready. it’s up to the individual to come to terms with what the information presented means to them. it can take weeks or it can take decades-there are a lot of factors that influence a person, and it’s not ethical to try to overcome these factors by forcing them into believing something they aren’t ready to believe at the time. that’s why harm reduction is so vital-for some people, it can take a long time to both understand that they can overcome an addiction *and* to have everything, within and without, that they need to do so. if it takes decades for someone to get from the knowing to the acting, they deserve the chance to survive to see the day when they’re fully able put their knowledge into action, as well as support to facilitate that ability.
      i see where there could be clarification, but i really don’t see what’s contradicting or hypocritical in these statements. btw this isn’t meant as an attack, just as an interpretation of the words provided. i’m really not trying to be rude or anything, just offering another possible view of words that you’re taking one way but i’m taking another. i hope it made sense lol i tried really hard to piece it all together in a coherent way.

      • *in the first paragraph, i meant “ready for” and not “interested in”, poor wording there

      • Have a sip or snort it won’t kill you. Oh you already know that? Good. Then stop making other people confess it surely will (and then claiming that it’s not up to you to decide their ‘treatment goals’).

        • hmm. it’s entirely possible that i’m missing something (i just got done trying to argue that being on suboxone doesn’t mean i’m gonna die of an overdose to an NA lifer and my brain is a bit frazzled so forgive me if i’m overlooking something glaringly obvious, and humor me by explaining it in some depth) but i’m not totally following you. you’re saying that he’s posited that people must admit that their habits could be dangerous then saying that it’s still up to them to decide their treatment goals? i mean, yes, in the current atmosphere, using *can* be deadly. it’d be foolish to say otherwise. but they’re all external factors unrelated to drug use itself in its purest, safest form, and just because those external factors can make it deadly doesn’t mean that it’s a contradiction to say that you can still develop your own way to proceed without coercion. does it? again, please correct me if i’m wrong, this is just what i gathered from what you said.

  • David Koss

    Maia Szalavitz, and Stanton Peele, along with Tom Horvath and many others, are writers and researchers who are making the case that the old ways of working with individuals with substance abuse issues are not just tiresome and mean-spirited, but most importantly, are counterproductive and actually make recovery harder is not impossible. Substance abuse is not an evil crime requiring long county or state imprisonment. Substance abuse is not a moral failing requiring recognition of personal helplessness before recovery can begin. Substance abuse is not an incurable lifelong physical disease (What does that even mean? Cancer is no longer, for the most part, incurable.) and individuals who abuse alcohol or drugs are not “alcoholics” or “addicts” or “failures” or “losers” or “dirty.” The old ways of “treatment” — still all too prevalent — combine all of those elements and actually harm chances of recovery. Couple that with the Rat Farm research, which Maia Szalavitz describes in Unbroken Brain, that proves how important a family and a social network are to recovery — research demonstrating that removing someone from one’s family and friends, and putting them in jail (or even in an in-patient program thousands of miles from home) makes recovery that much more difficult. Fortunately, the tide is starting to turn, but I don’t know how fast. David Koss

  • natriley

    As the nation recognizes that drug use is a constant that will not go away, isn’t the time to look at the experience of the LGBT community. It was a crime (crime didn’t result in the same level of incarceration 55 years ago), families rejected their relatives, and the medical profession believed with proper care a person could change and become normal. The belief that alcohol and other substances deprive people of their control can also reflect that drug use is an important aspect of a person’s identity.Certainly, the willingness of users to endure legal and social hostility suggests that strong force are at work. I wonder what will happen when being a stoner is one path in life. Even under present hostility, the record is clear users can perform at the highest level of their profession, e.g. miles davis, robert downey, billie holiday, and the list goes on. The LGBT community has gone from being pitied or distrusted to being major contributors to out communal life and a source of fun for all. I expect drug users will move in that direction as support grows and hostility declines. It leaves me wondering if the demand that users quit is a major cause of their problems.

    • as a proud member of both the LGBTQ+ community and the drug users’ community, i thank you for your input. i hope that someday it will be recognized that drug use is a natural, normal human drive, and that addiction is a temporary state that does not require abstinence to overcome-one that instead requires love and wellness so that if a person wants to continue to use, they do so because it makes them happy, not because they need it. i’m excited for a future in which drug use, whether it’s problematic or not problematic, is viewed in a completely different way than it is now. the human race is better served by acceptance of individual desires, desires that have potentially negative impact on nobody but the individual who chooses them, than by condemnation.

  • painkills2

    I believe addiction is a type of disease, just like Major Depressive Disorder and intractable pain. And that the disease of addiction does not always follow one path, just like there are varying levels of depression and pain. We don’t know enough about the brain to understand something as basic as pain, just like we don’t really understand something as complex as addiction.

    But it seems to me that we know enough about human nature to know that people will always use and abuse drugs — a lot of people and a lot of different drugs, from sugar to alcohol to heroin. Of course, drugs aren’t the only things that people are addicted to. There’s adrenaline, risk, love, hate — almost every human emotion. Sadly, people can even be addicted to physical abuse and pain.

    I think anyone can escape addiction, but it would be just like curing a disease. Perhaps the disease is never really cured, but the great thing about being human is our ability to adapt and overcome just about anything. Even drugs. If we need and want to.

    Human DNA and reproduction are not perfect. We don’t all belong here. But it’s not like we had any choice. We were all brought here by other people (that we happen to be related to). No, we don’t all belong here.

    • Olmy Olm

      “Now, thirty years after the hypothesis was first produced, the Royal College of Psychiatrists and the Institute of Psychiatry have accepted that depression isn’t caused by a chemical imbalance. But you’ll find this out only if you visit their websites. They haven’t issued a press release saying, ‘We were wrong.’” – Dorothy Rowe

      • painkills2

        Do you think, if depression isn’t caused by a chemical imbalance, that it doesn’t exist?

        • Olmy Olm

          No. Is everything that exists a disease?

          • painkills2

            Would it make you feel better if I called it a medical condition instead of a disease?

          • David Koss

            Not really. The current research is that substance abuse is neither an incurable medical disease nor a medical condition. Substance abuse will alter brain chemistry, but that is a different thing altogether. Some would argue that substance abuse is a matter of choice or a learned behavior, like falling in love. Personally, I am more convinced by the research that finds a relationship between substance abuse and treatable if not curable mental health conditions, whether depression, OCD or ADHD or still others (all of which can begin in childhood). But that is far different from calling it a medical condition or incurable physical disease.

          • painkills2

            So, when the brain is sick, it’s not considered a medical condition? When someone suffers from Major Depressive Disorder, it’s not a medical condition? I guess you think that there’s a big difference between physical pain and mental pain? And I never said anything about addiction being incurable, but I guess that depends on what you think constitutes a cure.

  • Pingback: Anyone Can Escape Addiction—But Fatalisti...()