Historically,
people made moral judgments about addictions without doing much about
them. Calling addiction a sin, of course, is not very effective in
bringing about a change in behavior. The early moralistic period is the
First Level of our understanding of addiction. These were the
times up until about 1900 during which disorders of appetite were
viewed as moral weaknesses or curses inflicted by God or the Devil.
People tended to explain addiction as greed and sloth, sins that only
religion could fix. Of course, it seldom worked that way, but some
people still think religion may be an easy way out of an addiction.
Medicine
had few real cures for anything during most of our human history; opium
and heroin were commonly available, along with alcohol, as painkillers
until about 1905 or so. There were no other anesthetics until the
discovery of ether in the mid 1800s. Medicine based on science didn’t
get started until the rather recently in human history.
Although
the judgmental moral view of addiction is not very helpful, learning
moral behavior, as opposed to religious behavior, may be of great help.
Much more of that later.
By
the way, not long after its development, ether became the focus of a
new dependency as a few people found its relaxing oblivion to be a
wonderful. if very temporary and dangerous, escape from stress and
anxiety. It seems true that many new drugs, designed to relieve one
human misery or disease, suddenly find a role as recreational drugs,
and such was the case with anesthetic ether. (If you’ve ever gone
through ether withdrawal after surgery you have to think nobody could
ever get addicted to the stuff, but some did.)
Violence and physical
abuse as a result of drinking alcohol were so common in history that
drunkenness seems at times to have been an accepted part of life, a
kind of scourge inflicted on humans about which nothing could be done.
Immorality and lack of willpower were the usual explanations of
alcoholism. In the United States, after the end of the Civil War,
alcohol abuse raged out of control among traumatized war veterans and
families exposed to all kinds of loss and misfortune. Medical treatment
of combat wounds was primitive and the resulting life-long disabilities
went untreated. Chronic pain and depression, made worse by economic
hard times, created vulnerability to addiction. Certain opium based
drugs were also freely available without prescription for those who
could afford them.
And now for a basic idea we learn from history: addictions are self-medication for pain and emotional misery.
There ought never be any shame or guilt attached to the simple human
desire for a pain-free life, a life of tranquility and satisfaction.
Forget the moralistic baloney and just accept the fact that we all
reach for comfort in life whether it’s good for us or not. People want
to feel good. Is that so mysterious or immoral?
Of course, sometimes people want to feel really, really good all the time, and then trouble follows.
The long moralistic
First Level resulted in the Temperance Movement during the 1800s. We
were having a national plague of alcohol abuse, and the Temperance
Movement carried forward into the Twentieth Century resulting in a
flawed and ineffective Constitutional Amendment prohibiting the
manufacture and sale of alcoholic beverages in the United States. Opium
and other pain relieving drugs were also made illegal except by
prescription early in the Twentieth Century. Tobacco on the other
hand—a highly addictive product—was never made illegal although it is
subject to increasing taxation and regulation. You might want to try to
figure out our inconsistent policies toward the different addictions. I
can’t. It probably has a lot to do with money and with who gets paid or
even which politician is addicted to which thing.
Somewhere in the early 1900s, ideas about how to deal with addiction began to change from moralistic to legal.
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Other countries
experimented with regulation, prohibition and micromanagement of
addictive stuff with little success. In England, for example, gambling
and other potentially addictive behaviors were first prohibited, then
regulated and finally selectively banned once more.
The
legalistic Second Level was society’s attempt to do something about
addiction by attempting to manage addiction through law and regulation.
These efforts occupied most of the Twentieth Century and began with the
emerging view that the addict had some power and responsibility to
correct the problem by living a legal, moral and sober life. Two very
important developments began at the beginning of this legalistic Second
Level, developments that have set the stage for a new and still
emerging understanding. The first was the birth of Alcoholics Anonymous
in the 1930s. The second was a gradual awakening of interest in
addictive behavior among medical experts. Sensing that legalistic
solutions were not the answer to personal misery, alcoholics began to
turn to each other and to modern science for help, but science in the
early part of the Twentieth Century had little to offer except interest
and sympathy. As Alcoholics Anonymous grew so did medical concern with
the treatment of addiction.
Rather
quickly, the legalistic or Second Level of understanding changed into
what some have called the disease model of addiction, and this is yet a
third level of understanding. When physicians got interested in these
curious alcoholics they showed real compassion, and they were not
looking for more income, control, status and power. The first
physicians in the field were true humanitarians. When there isn’t much
we can do about something, we can at least show compassion.
The Swiss psychiatrist Carl Jung became interested as the result of his frustrating attempt to treat an alcoholic client in Switzerland at a time when most psychiatrists didn’t want a drunk stinking up their nice offices.
We’ve
also had our non-medical folk heroes who readily accepted the disease
model. In his attempts to gain sobriety, William Wilson (Bill W.) in
the United States corresponded with Jung, and Jung offered interest and
encouragement as Wilson went on to establish Alcoholics Anonymous
incorporating some of Jung’s ideas such as a spiritual experience.
I’m
never sure what that is supposed to be, but I’ll accept it as the
desire to learn to behave in what are called spiritual ways. That
ambition may be realized slowly or as a sudden thunderclap, but
unfortunately seeing the light can sometimes turn alcoholics
into sober but very annoying blue-nosed preachers. Never let a
spiritual experience turn you into a pain in the butt. Keep it a
secret, I say.
The
importance of a spiritual experience was also suggested by a religious
movement in England, the Oxford Movement that urged followers to return
to a kind of early Christian living characterized by simplicity,
honesty and service to others. Wilson had read their literature and
talked with members of the movement realizing that if he were to be
able to stop drinking he would have to make important changes in his
thinking and behavior. He would have to try to change his personality.
If there is a question about the existence of an addictive personality,
there is little question that one can build a sober personality. One
can learn to be normal, if you will.
Early in Wilson’s
recovery, the American physician William D. Silkworth, M.D., who was
one of the first physicians to publish professional articles about
alcoholism and its treatment, also encouraged him. In the early 1960s,
E. M. Jellinek, M.D. published his important book, The Disease Concept of Alcoholism,
Suddenly, the rush was on to turn alcohol abuse into a medical problem
that, in so many ways, it certainly is. It became a formal subject of
scientific concern and research by physicians, psychologists, social
workers and others.
Gradually, the
various addictions were incorporated into the medical literature and,
in the United States, health insurance began to cover the cost of
treatment in some cases for some people.
So, we went from the
old moralistic view of addictions to a legalistic strategy, and finally
to a medical model or Third Level that involves education, self-help
and therapy.
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Nothing ever seems to
go for very long before money and outside self-interests creep in.
That’s why the self-help organizations can be trusted. They don’t send
bills to you or your insurance company. They don’t lobby congress, they
don’t apply for government grants and they don’t charge admission.
Wonder of wonders, they aren’t even communists or religious nuts. The
big problem, of course, is knowing how well they work and for how many
they work.
Health professionals
gradually become more active as the first government and private
treatment facilities began to open their doors to desperate alcoholics
and drug addicts during the middle years of the twentieth century. A
few religious orders and charitable organizations such as the Salvation
Army also gave emergency aid to addicts seeking detoxification and
inspiration, but many alcoholics are still left to sleep it off in
local jails.
Although we have many
different programs for dealing with addiction, we have no broad formal
social policy at a national level. As a result, our treatment of the
different addictions is inconsistent. The politics of addiction, as
I’ve said, tends to confuse me. If we start arguing the notion that
addictions are medical diseases we’ll never get to anything
constructive. Personally, I think the rush to medicalize every human problem is a bit overdone, but I’ll put that discussion off for now.
Over the years,
people copied the Alcoholics Anonymous Program in various forms to help
with other dependencies such as food, drugs and gambling. Also, by the
end of the Twentieth Century, hundreds of narrowly specialized
treatment programs were opening in North America and Europe, many of
which either used or strongly recommended the Twelve Step philosophy of
A.A.
The Third Level of
understanding is still emerging and is encouraged by the growing number
of newly recognized addictions and by the growth of Twelve Step
philosophy into a gaggle of different, specialized groups, each
mirrored in the mental health professions by corresponding specialized
treatment programs.
Another big problem
with holdovers from the legalistic Second Level is the impossible cost.
The so-called War On Drugs results in the United States having one of
the highest incarceration rates in the world. The War On Drugs has had no effect on drug abuse,
and it is based on the old ideas of prohibition and on politics. The
War On Drugs is not based on scientific evidence. Illegal drug
consumption is out of control while the police and prison industries
have become huge and politically powerful. We spend much more on
prisons than we spend on education. The Drug War has failed, but
powerful political and religious groups continue to tell us it is the
only way. This War On Drugs is a war on our own people, and it’s about
money and power, in my opinion, not about helping people with
addictions.
I am not saying that addictive drugs and activities should all be legalized. The right word is de-criminalized, more on that in later columns.
[BB]
The full emergence of
the next level of understanding will recognize three very important
things, things that my unknown passing strangers in Atlantic City knew
in their hearts to be true. Firstly, many different addictions are
socially, psychologically and biologically related; they may, in fact,
be different signs of the same underlying disorder that I call The
Addictive Response. Second, efforts at abstinence or recovery from one
addiction is almost never the end of the story since, unrecognized,
other addictions can suddenly appear as substitutes for the abandoned
demon. Substitute addictions sabotage efforts at abstinence and hinder
personal growth. Finally, it will help if we stop focusing on all the
different addictive responses one by one and formulate a personal
growth process that will take the addict to new and higher levels of
emotional and psychological maturity, a maturity that can make a return
to addiction of any sort much less likely.
We need a unified theory of addiction and a unified approach to dealing with these problems.
As a name for a new,
comprehensive self-help program based on a unified theory of addiction,
a program based on the important concepts of the classic Twelve Step
programs, I suggest something like Addictions Anonymous. Although I
have no interest in starting an organization or a program myself,
recovering addicts may wish to try out some of these ideas to see what
works for them.
The interested reader
will find that a great deal of historical information is available. The
study of self-help for addiction usually begins with a reading of
official publications of organizations such as Alcoholics Anonymous
even if alcohol is not the primary problem. These groups sell their
literature at cost, and many offer auxiliary groups for the support of
family and loved ones of the addict. If you haven’t done so, put on
your disguise, sneak into a meeting and buy their stuff. Say hello and
shake a few hands if you dare, but you don’t have to do anything else,
make excuses or feel stupid (unless you want to).
Self-help
groups are helping people deal with problems of alcohol, drugs, food,
sex and love, gambling, shopping and spending, tobacco dependence, and
so much more. Health professionals, of course, want to help, extend
their authority and make some money, too. We see the rapid development
of for-profit commercial treatment programs and programs sponsored by
government. We must, somehow, get all these people and all these
programs together in one place with a common set of values and goals in
order to make important progress.
We
seem to realize that moralistic and legalistic efforts to end addiction
are doomed to failure, but, when we begin to ask, “What’s wrong with
the person or the personality that becomes addicted?” we are stepping
on feelings. The modern mandate of pop psychology seems to be, “Don’t
ever make anyone feel bad.”
Many times clients, speaking about their addictions, have asked me, “Why me, why do I do that?”
“You
don’t really want to know,” I tell them. “Work with us a while and
you’ll figure it out yourself.” I didn’t think they were ready for the
truth just yet. They wanted some kind of psychoanalytic mumbo-jumbo,
some fancy psychological jargon.
Truth
is hard to tell sometimes. People become addicted because they are
trying to fix feeling bad all the time. But, they make their own misery
because there are things that are terribly wrong with how they live and
think. They are incomplete, defective, immature, selfish, immoral,
impatient, demanding, self-centered . . . you catch my drift. We can’t
tell them that up front, but they know already in most cases at some
level of awareness.
What
causes addiction? Is addiction a medical illness? Do self-help groups
help and, if so, how and why? How important is religion and the
spiritual experience in recovery from addiction? And, of course, is
there such a thing as an addictive personality?
You
will decide all this for yourself, of course. Keep an open mind and
let’s see where we go. I think we are at the threshold of a new and
very productive Fourth Level of understanding.
