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

Sep 29 2016

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

September 29th, 2016

When Archie Brodsky and I were writing Love and Addiction in the early 1970s, a medical resident told us, “Oh, we’ve established what addiction was long ago.”

It turns out, that wasn’t true.

In 2013, DSM-5, the most recent edition of the American Psychiatric Association’s diagnostic manual, redefined addiction to include gambling—American psychiatry’s first official recognition of a non-drug addiction. And, strange to say, it doesn’t declare that any type of drug causes addiction (indeed, neither did DSM-IV) out of confusion about the term.

Rather, DSM-5 uses a sliding scale of bad things drug users do, or suffer from, or both to gauge the severity of “substance use disorders.”

DSM’s authors seem to be wending their way back to where I was in the 1970s. With luck and a little bludgeoning, they may end up where I am now—which I’ll explain in a seven-point summary below.

***

In 1977, I wrote The Addiction Experience for what was then the Addiction Research Foundation’s (now called the Centre for Addiction and Mental Health, CAMH) popular journal, Addictions. I then turned it into a pamphlet for Hazelden Publishing.

But Hazelden discontinued publication of the pamphlet in 1988, after eight years of consistently high sales. Their new editor-in-chief wrote to me that she had taken this step because, “Unfortunately, we have heard much criticism from our customers who are not in agreement with your stand on the disease concept.”

Lately, the whole question of The Meaning of Addiction (the title of my academic book following Love and Addiction, in which I assessed the scientific basis for neurochemical and learning theories of addiction) has been reopened, by Marc Lewis and by my distinguished co-contributors at The Influence, Johann Hari and Maia Szalavitz. Marc and Maia, among their exceedingly valuable contributions to addiction theory, describe the intricacy of the way neurochemicals relate to behavior.

My argument in The Addiction Experience was that this reduction is impossible, and dangerously misleading:

 

Addiction is not caused by a drug or its chemical properties. Addiction has to do with the effect a drug produces for a given person in given circumstances—a welcomed effect which relieves anxiety and which (paradoxically) decreases capability so that those things in life which cause anxiety grow more severe. We are addicted to the experience the drug creates for us.

Addiction is clearly a process rather than a condition: It feeds on itself. We have also seen that addiction is multidimensional. This means that addiction is one end of a continuum. Since there is no single mechanism that sets off addiction, it cannot be viewed as an all-or-nothing state of being, one that is unambiguously present or absent.

At its most extreme, in the skid-row drunk or the almost legendary street addict, the person’s entire life has been subjugated to one destructive involvement. Such cases are rare when compared with the total number of people who use alcohol, heroin, barbiturates, or tranquilizers.

The concept of addiction is most apt when it applies to the extreme, but it has much to tell us about behavior all along the spectrum. Addiction is an extension of ordinary behavior—a pathological habit, dependence, or compulsion. Just how pathological or addictive that behavior is depends on its impact on a person’s life. When an involvement eliminates choices in all areas of life, then an addiction has been formed.

We cannot say that a given drug is addictive, because addiction is not a peculiar characteristic of drugs. It is, more properly, a characteristic of the involvement that a person forms with a drug. The logical conclusion of this line of thought is that addiction is not limited to drugs.

Psychoactive chemicals are perhaps the most direct means for affecting a person’s consciousness and state of being. But any activity that can absorb a person in such a way as to detract from the ability to carry through other involvements is potentially addictive. It is addictive when the experience eradicates a person’s awareness; when it provides predictable gratification; when it is used not to gain pleasure but to avoid pain and unpleasantness; when it damages self-esteem; and when it destroys other involvements. When these conditions hold, the involvement will take over a person’s life in an increasingly destructive cycle.

 

I’m now in my 70th year and writing my memoir, which has given me plenty of opportunity to reflect. Here is my updated version of addiction:

 

1. Addiction is not a special chemical trait of narcotics or of drugs at all. There is no specific brain process that is addiction. Addiction is a way of being, of relating to a specific experience, and can occur with any powerful involvement.

2. As a corollary, most drug use is nonaddictive. This emphatically applies to opioids, the subject of our current national drug scare: Tens of millions of Americans take the most powerful painkillers, in and out of hospitals, without becoming addicted to them.

3. Drugs have the same range of potential benefits (e.g., analgesia, relaxation, conviviality, therapy—as in use of psychedelics), as well as drawbacks (such as addiction) as many other activities. Whether these benefits and drawbacks manifest depends on the individual, the situation and society.

4. If people do become addicted, to whichever drug, or to alcohol, or to other experiences, they typically outgrow the addiction. Maturing out of addiction is the ordinary course of events. This fact, which I began pointing out in the early 1980s, is periodically re-revealed (including by Maia and me), and each time greeted with amazement and disbelief.

5. The most important determinants of addiction and recovery are not the drug or other addictive object, nor the kind of treatment the person receives. Instead, they are the cultural milieu and the social and economic conditions in which the person lives, along with the person’s life outlook and beliefs about addiction and the involvement.

6. Since addiction results from a combination of elements, it occurs along a continuum. People may be more or less addicted. There are exceptional cases that may look like full-bore, media prototypes. But nearly everyone who is addicted is capable of varying their behavior in the short-term as well as the long, and their addictions wax and wane.

7. In the past four decades, our lives have changed radically in ways that are often disempowering. These changes disconnect us from our physical environments and from other humans. Our addiction and mental illness epidemics can’t be reversed without addressing these trends, individually and as a society. Our current conception of addiction doesn’t do this, and in fact it contributes to this alienation and disempowerment.

 

As I wrote in The Meaning of Addiction:

Our conventional view of addiction—aided and abetted by science—does nothing so much as convince people of their vulnerability. It is one more element in a pervasive sense of loss of control that is the major contributor to drug and alcohol abuse, along with a host of other maladies of our age. We feel we must warn people against the dangers of the substances our society has banned, or attempted to curtail, but cannot eradicate. This book argues that our best hope is to convey these dangers realistically, by rationally pointing out the costs of excess and, more importantly, by convincing people of the benefits of health and of positive life experience. Otherwise, the idea of addiction can only become another burden to the psyche. Science cannot increase our understanding of ourselves and our world—nor can it show us the way to freedom—if it is held captive by our fears.

This vision has manifested itself in our current addiction epidemic, as I have described for The Influence. It will only be remedied when we are able to normalize drug use and focus instead on ways to enrich our world and our lives.


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 Peele.net. 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.

  • We also must identify children who are most at risk of addiction (sensitively, of course), and provide them with early intervention and treatment so that they and their families can be aware of the trigger factors and mental illnesses that will make them susceptible to having decades-long drug fueled sexual adventures which started off fun but later became miserable and then they tried to kill themselves with the very drugs that once made them so happy, and identify these early so they can be provided with early intervention and treatment.

    • RED

      Did you read the same article? Are you reading the same website? ‘Cause it sure sounds like you’re pushing the same old tire tropes and stereotypes that have made the U.S. the largest imprisoners of human beings ever and destroys millions of lives and has turned us in to a police state.

      • Olmy Olm

        He’s being sarcastic.

  • I suggest looking into the work of Dr. Gabor Mate who shows that frequently what make a given person susceptible to becoming addicted is brain development under stress when an infant or young child- even in the womb. These people never have the normal brain responses to life’s stress due to these developmental abnormalities. Frequently addicts will report that they had NEVER felt normal or at ease until they tried their drug of choice. It wasn’t about getting high so much as simply feeling okay, often, for the first time in their lives.
    Also people who have suffered abuse and/or abandonment tend to be more susceptible to addiction as is born out in the clients he works with at the Vancouver Canada Harm Reduction clinic thar gives addicts a safe place to use their drugs with medical supervision.
    https://www.youtube.com/watch?v=_-APGWvYupU

    • Olmy Olm

      There actually isn’t any correlation between mental illness and prolonged substance use problems.

  • Scott Sanchez

    I have always felt that the biggest problem related to drugs has been “Society”‘s “war on drugs”.

  • David Kerr

    Stanton, Well done. Excellent piece. I’ve been in the field of addiction treatment as a parole officer in 1965 and since founding Integrity House in Newark, NJ in 1968 (https://www.google.com/#q=integrityhouse.org). Here’s my blog: http://blog.nj.com/njv_david_kerr/index.html. My book “The Voices of Integrity” is on Amazon.com and Barnesandnoble.com. Stay in touch via email if you have the time. dkerr.recoveryadvisorygroupi@gmail.com. Dave

  • Oddlady

    A beautiful and oh so wise post, Stanton. I could hug you! I shared your post on http://www.hellosundaymorning.org, a forum for recovering alcoholics – or should that be alcohol dependent people?

    The past 10 years, I’ve investigated family genes and early childhood trauma for the reasons why me and my two brothers became addicts, yet our half-sisters never did. Brought me to a place of great tears and latterly healing.

    As we heal, so we can REALLY help others heal and accept each other. Most of all, the unconditional acceptance of each of us, as we are, understanding the pain which brought each of us to our knees. We common sense people MUST drown out the judgmental people, and we can help that through our honesty and by giving hope to other addicts and their families.

  • Knog Knebronson

    Thanks Dr. Peele. Keep up the fight and great work. Seems to me like very slow progress is being made in “undoing the mistakes of the last 40 years. I certainly hope so. It may seem this way to me, due in large part to my own personal change. Your book RECOVER! reinforced my efforts and new beliefs around addiction and myself. I no longer think of myself as “diseased”. I “stopped thinking like an addict and reclaimed my life”. Lots of work to still be done and consequences to deal with. I am know self-empowered and I exercise the “power of choice” in getting through the consequences of my past and in building a better future, dealing with life and our human conditions. I am convinced of the benefits of health and of positive life experiences.
    I look forward to reading your memoir.
    Thank again, “Shadow of a doubt”, Santa Rosa, CA

  • The New Impostor

    I agree with most of what Stanton Peele says, who provides intelligent and experienced insights into regular drug use. However, “addiction … relieves anxiety and (paradoxically) decreases capability” is an over-generalization. Many people function better when using drugs regularly, even after decades of use – particularly those in pain or suffering mental stress. I’ve interviewed hundreds of these people over the last 35 years, some of whom are regular contributors to drugs research and drug services.

  • This excellent review helps, but we need to address the latest from NIDA’s Volkow and company. Last January they published a paper titled Neurobiological Advances from the Brain Disease Model of Addiction. In it they gave a new
    definition. Now, in addition to the old “chronic disease of the brain,” formula, they tell us addiction is only “the most severe chronic stage of substance-use-disorder,in which there is a substantial loss of self-control, as indicated by
    compulsive drug taking despite the desire to stop taking the drug.” Then, having explained how DSM 5 uses the term substance-use-disorder, they add this to their definition: “In DSM 5, the term addiction is synonymous with the classification of severe subsistence-use-disorder.” DSM 5 offers no such use of the term addiction. In effect, they are now saying there is no addiction unless it is both both severe and chronic. Chronic means it lasts ten years or more and requires treatment. Yet we know many with severe substance disorders grew out of them and quit on their own well before ten years. Volkow is telling us those people did not suffer real addiction.