Friday, July 17, 2009

Substance Abuse and the 12 Steps

In the letters section of the June/July 2009 edition of Free Inquiry two people wrote in reaction to Seven Mohr’s “Exposing the Myth of Alcoholics Anonymous," both with unjustified criticism.

I would like to now respond to these letters.

As someone who, as an adolescent, suffered through and eventually fully overcame extreme, nihilistic and, near the end, suicidal substance abuse, I have direct experience with AA. I was therefore beyond pleased to find a rational secular critique of this dismal religious organization that, like Scientology’s Narconon, sustains itself upon those at their most desperate.

In both letters the writers falsely proclaim that alcoholism, and by extension drug abuse generally, is a “disease.” An absurd notion that many rational people as well as experts on the subject reject, such as the psychiatrist Thomas Szasz who, incidentally, is a contributing editor to Free Inquiry, and who goes through the entire relevant and inglorious social history in his brilliant and incredibly well-informed exposition of “the ritual persecution of drugs, addicts, and pushers,” and all of that which is necessarily related in his Ceremonial Chemistry.

Substance abuse is a behavioral problem/abnormality, it is not a disease. As Lance M. Dodes, M.D. states: “Addiction has long been deeply misunderstood in both our culture and clinical practice. Rather than of being a reflection of impulsivity or self-destructiveness, or a result of genetic or physical factors, addiction can be shown to be a psychological mechanism that is a subset of psychological compulsions in general.”

In response to the proposition that “addiction is a physical disease caused by being addicted to drugs,” Dodes writes: “Physical addiction is often confused with the problem of addiction in general. Actually, it plays a very minor role. Physical addiction is important mainly as a medical problem when people try to withdraw from certain drugs. Sudden withdrawal from drugs like alcohol or certain tranquilizers (benzodiazepines like Valium or Xanax) can be life-threatening. But in terms of why people perform addictive behavior, physical addiction is not important. For one thing, physical addiction is easy to treat. People can be safely detoxified (withdrawn) from drugs usually in a matter of days. But as we all know, even months or years later they may return to addictive use of the same substances…Another illustration of this is that many drugs are incapable of producing physical addiction, yet they can be used addictively (compulsively) and even substituted for addictive drugs. Marijuana, LSD, amphetamines, and others can all be used addictively though they do not produce physical addiction in the way that sedative drugs (alcohol, heroin, barbiturates) can. Non-substance addictions like gambling or sexual addictions illustrate the same point. Since it is well-known that people can switch back and forth from drug to non-drug addictions like gambling or even other compulsive behaviors like shopping, it is clear that the physical component in some drugs is irrelevant to the nature of addiction. For a full discussion of the role of physical addiction see chapter six of ‘The Heart of Addiction’.”

The preposterous notion that it is a disease stems from, as Szasz points out, metaphorizing “disagreeable conduct and forbidden desire as disease – thus creating more and more mental diseases…they [the neuropsychiatrists of the nineteenth century] literalized this metaphor, insisting that disapproved behavior was not merely like a disease, but that it was a disease – thus confounding others, and perhaps themselves as well, regarding the differences between bodily and behavioral ‘abnormalities.’”

A devastating point against AA is its abysmal success rates, a point conceded by the letters. However, the authors wish to credit this general failure with the “disease” instead of the AA program. Galten claims “that without AA the natural course of the disease will almost certainly return after detox” unless the individual continues going to AA. However, for many people, such as me personally, it was the program itself that was a major obstacle to recovery.

One of the greatest factors in the program being an abysmal failure is the stunning revelation that the program actually makes little attempt to reform or cure the addiction and treat the underlying motivation compelling the addictions continuation. A tacit assumption within the program is that one is an addict for life and that one can only survive day by day, humbling one’s self before a gracious god.

The program claims that the individual is “not responsible for his/her disease.” This is an unfortunate, if logical, extrapolation of the false notion of addiction being a disease. The individual that is suffering from the severe consequences – that are the direct product of their decisions – of addiction are culpable for their own behavior, they are themselves responsible and attempting to lay blame on some external force, petty as it would be, is extravagantly malevolent in its undermining of recovery.

In fact, the first step of the program insists that we admit “we were powerless over our addiction.” A proposition that I saw, in times of great crises, severe cravings and so on, as justifying the fact that I simply didn’t have the power to stop myself from further engaging in substance abuse.

This leads to the second step which insists that we believe that a power greater than ourselves can restore us to sanity. This is obviously a problematic step for those who, like me, don’t believe in the supernatural. When anyone within the program attempts to reconcile this second step with secularism, arguing that it need not rely upon god, they necessarily illustrate the irrationality inherent within the program itself. They will tell people that “the power doesn’t have to be god, it could be a rock,” at once insulting the individual with outrageous condescension and making a mockery of their own program simultaneously. Step three only furthers this dilemma by stating that must “turn our will and our lives over to the care of god as we understood him.” Could this too also be only a rock?

Moving along, for purposes of space, to step eleven, we are supposed to seek “through prayer and meditation” the improvement “our conscious contact with God as we understood him, praying only for knowledge of His will for us and the power to carry that out.” This would make as much sense to a Buddhist or a Hindu, for example, as it did to me. Speaking of god in such terms proves what the idea of “God as we understand him” is supposed to be.

Step twelve calls for blatant proselytizing: “Having had a spiritual awakening as a result of these steps, we tried to carry this message to addicts, and to practice these principles in all our affairs.” The Christianity of this program is not even subtle, it’s blatant and transparent. The last step tells the addict that after having a “spiritual awaking” – hopefully through Jesus, as the Christian chaplains at 12-step treatment centers push for – we must now go out and proselytize to the poor and suffering, the desperate and the susceptible.

Why the program is a dismal failure is as transparent as is its Christian dogma. To indoctrinate people with the belief that their behavioral problems and habits are not their responsibility, but are rather the symptoms of some disease, is to emasculate them of any personal responsibility over their problems and, with the further claim that they are powerless without the interference of a divine force and, even further when the program teaches that one can only survive as an addict for life day by day – that’s one of the chief dogmas of the program, that once an addict, always an addict - a desperate notion if ever there was one, can in many, if not most cases, induce paralyzing hopeless despair.

The reality is that addiction is a psychobehavioral problem and the underlying psychological problem/s must be addressed and treated. If people are able to become sober through the program that’s good, although it’s indisputably rare and it’s also not treating the problems that motivated the substance abuse in the first place - as is obvious in many cases by those in the programs, those who still clearly have festering issues that have yet to be resolved – and those who do resolve the underlying problems are not getting their treatment from the twelve steps, but rather are likely getting professional psychotherapy or something of that nature while simultaneously attending the organization. As the dismal statistics of success illustrates, the program simply does not help most are even a significant number of people in recovery, in fact, as in my case and as in so many others, it simply further spurned the downward spiral into desperate darkness and despair.


Anonymous said...

I'm praying for you, ass clown.

JDHURF said...

Well, there's certainly no need for praying, for several reasons (for the first, general reason, see my post entitled “Prayer is Selfish Beggary”) and, for the second, my personal issues with substance abuse revolved, basically solely, around substance abuse and its consequences, therefore, the remedy for myself lie simply in becoming sober and developing from there. I have for a substantial time been fully recovered and have control over such things.

Anonymous said...

I am praying for you, ass clown. A prayer and an insult. So typically fundamentalist. They are white on the outside but full of dead bones on the inside.

JDHURF said...

Typically fundamentalist indeed. Some of the most vile comments I've received, in fact, all of the most egregious examples, have come from fundamentalists.

capecodkwassa said...

Awesome post, JDHURF.

Unfortunately for the loser who can somehow reconcile prayer with calling strangers vulgar names for no reason, you just made yourself and your beliefs look better by comparison.

Anonymous said...

ass clown was a little harsh.
As a substance abuse professional, a person who has struggled, and who has family members who struggled and found remarkable success with AA I'm surprizingly ambivalent your article. I totally agree with much. My own experience personally and professionally is that most people lose it at step 4 and that's when they realize its not the drug. Its them and the need to dig deep and do the real work. As a humanist, or like Carl Rogers said, too spiritual to be religious, I did find a remarkable book called the spirtuality of imperfection that presents a third, I guess, alternative. It draws on many different traditions and has a different take on AA than the one you presented. I enjoy it not as a person with substance abuse problems but as someone who is spiritual and is seeking and who realizes that compulsions are ways of managing emotions. If spirituality, which I believe is, and there's some evidence to this,is hardwired, is a need that must be filled, there are many paths, many not supernatural, mindfulness for example, or a transcendental stance.

JDHURF said...

The problem with AA that you claim is actually the individuals problem with step four actually begins with AA’s very first step. If people are having difficulty confronting their behavioral problems rationally, AA plays no little part in constructing such an obstacle in the first step’s premise that one is utterly helpless and must therefore resign themselves to a life-long daily battle against that which cannot be changed (“once an addict, always an addict”). That is defeatism, that is incorrect and that is dogmatic religious bullshit, period. No one is ever “helpless” and the charlatan teaching of this to people who have hit rock bottom and need inspiration, guidance and reassurance, especially in their own human potential to overcome and recover, in the power of their own will and self, is not only wrong it is perfectly harmful and evil.

Paul MH said...

I've ummed and awwed about responding to this. I think I will. I'll put my cards on the table. I got sober in AA about eight years ago, I was a trade unionist and a Marxist in the eighties, I've got a degree in philosophy and another masters in social business. I got married in a humanist ceremony and if I was going to call myself anything for most of my life it would be humanist, but my humanism is much more informed by the likes of Karl Popper than anyone else. I believe in humanism as a celebration of EVERYTHING that is great about human beings - and that includes the beneficial effects of religion. So I believe that open-mindedness, a spirit of enquiry and a commitment to investigation are traits which humanists should have. Increasingly I encounter people who call themselves humanists who are actually close minded bigots looking to vindicate themselves. You may or may not belong to that group I don't know, I haven't read any more of your blog.

So you'll excuse me - I hope - if I just cut to the chase and say that your article on 12 step is a crock. Now there are two alternative explanations for your article being a crock. One is that you really don't know what you're talking about. However you say that you spent time around AA back in the day, so that being the case, you know something about AA, and you have chosen to write half truths, quarter truths and outright fallacies - purely to score points. In which case this is an excercise in one-sided sophism - or masturbation as we might call it. I'm sure that sounds rude, but I mean it quite specifically - this is just a self-indulgence, but it's dressed up as a serious article about the shortcomings of an organisation (an anarcho-syndicalist organisation, if you have a look at it!) where you have quite deliberately misrepresented what those shortcomings might be. I think they call that a Straw Man argument, yes?

I know, I know I'm not showing much restraint of pen and tongue am I, not a very good example of a person in recovery. Your article is merely the last in a long line of childish rants (please, not many of which are about 12 step)written under the guise of humanist or atheist and you know what my problem ultimately is? I'm embarassed. I'm embarassed to call myself a humanist and an atheist and to be lumped in with this sort of ill-conceived nonsense. I'm embarassed to be associated with polemic like this which can't even be bothered to take account of the likes of Popper's dictum that, if you are going to argue wuth another man's philosophy, argue with it at its best. Do it that much respect. And when it comes to AA, you know the question that people don't ask? How does it work. If I'm an atheist and I don't believe that God is doing any of this - how come, when I was at my lowest ebb and sure I was going to die a drunk, did I end up not only getting sober, but learning how to live a happy productive life without fear. How does this thing work? I can see how they THINK it works, but how does it actually work?

There are lots of places to start if you're genuinely interestd in learning something about the humanism of 12 step. I would suggest Gregory Bateson and perhaps particularly the existentialist Philip Flores, whose work on marrying 12 step with the psychodynamic approach is very good.

All the best.

JDHURF said...

Paul MH:

I couldn't help but notice the lack of substantive content in your response. You never, in fact, even directly addressed any of the points I brought up in my post. I find that revealing.

Let me index for you several of the very serious points I brought up. Points that you apparently assumed didn't need to be discussed because your charges of masturbation and straw-man arguments, both offered without any support or evidence, sufficed.

First point: substance abuse is not a "disease," it is a behavioral problem. One of the primary problems of the 12 step program is that by pretending substance abuse is a disease rather than a behavioral problem the individual with substance abuse issues is emasculated of their own very direct and existential role in their own suffering.

Indulgence in substances is a choice, it is a behavioral choice. The choice can easily cause serious problems when the substances are illicit street drugs and the individual is young, however it remains a choice, a behavior.

Catching a virus is not a choice. Getting cancer is not a behavioral problem. There is a big difference.

Secondly, the success rates of the 12 step program illustrate that it is a fairly remarkable failure. Whatever one thinks about the program is here irrelevant. The numbers don't lie.

Thirdly, the program, working off the original premise that substance abuse is a disease, pretends that individuals are "helpless," and can only survive as "addicts" (one is in this conception an addict for life regardless of whether or not one is using or is recovered) "one day at a time." I already spelled out the ramifications of this in my post which you never actually referred to.

Fourthly, the program is obviously infused with proselytizing Christianity. I cited the AA and NA books as well as several of the 12 steps directly.

There were more points and issues within my post but these four were the most important and prominent and are the four that someone taking issue with the post should address if they are to pretend to offer any kind of serious rebuttal.

As far as your recovery is concerned I obvious don't know anything about it and will not pretend otherwise. As far as how the program "works" for the statistically very few it "works" for I already discussed that in my original post at the end when I observed that:

"If people are able to become sober through the program that’s good, although it’s indisputably rare and it’s also not treating the problems that motivated the substance abuse in the first place - as is obvious in many cases by those in the programs, those who still clearly have festering issues that have yet to be resolved – and those who do resolve the underlying problems are not getting their treatment from the twelve steps, but rather are likely getting professional psychotherapy or something of that nature while simultaneously attending the organization."

Considering the content of my post and the lack of content in your response - the utter nonexistence in your response of any references to my points and arguments - I find it a bit difficult to believe you actually read or understood it.

If you have recovered from substance abuse and have found a healthy equilibrium I am happy for you. That is very good and I know personally how difficult it can be. If you find comfort and support in AA groups that is all fine and well, but you have not gained anything from the ideology behind the program. The ideology is fallacious and anyone with an elementary understanding of philosophy and a passing knowledge of Popper should know this.

Anonymous said...

I am not sure that I can be eloquent about this, so I will attempt to speak plainly and hope that the reader can understand my meaning.

I am a recovering addict. I spent many years involved with 12-step groups, AA and NA specifically. The AA meetings that I attended always left me feeling as if there was a baptism right-around-the-corner and I was always very uncomfortable about that.

I sometimes make the joke that I am also a "recovering southern-baptist".

I discovered NA early in my recovery, and I do not believe that the literature or even "organizational structure" of one group is better than (nor even very different from) the other. What I DID find in NA were people who had the same sorts of problems that I did, and shared my discomfort with religion in-general and christianity in-particular. Not all of them, nor even anything approaching a "majority" but they were there.

Over time, as years passed, I noticed more and more people who eventually succumb to the sometimes not-so-subtle christian proselytization that seems inherent in many of these groups, but I have also managed to stay free of those people and the places that tend to spawn them.

I celebrated 19 years of being free from alcohol or other drugs this past summer.

It is my belief that what is wrong with me (and many others) is indeed a "disease" but not physical nor even mental/psychological. I believe that it is a disease of the soul.

I do believe that I have a soul even if I cannot quantify or define it in any sort of scientific sense (not that I think that means anyone else need believe it, just sharing my state-of-mind).

I believe that I needed to learn how to incorporate spiritual values into my day-to-day activities in order to heal my soul. Spiritual values like honesty, integrity, empathy, compassion, faith (yes, I said 'faith' and NO I do not mean belief in some supreme father-figure-god-being rather just faith that the sky won't fall, the sun will rise, time will heal wounds, and so on).

This is where I find trouble putting thoughts in words.

My "spiritual awakening" has been good for me. I believe it can be good for others to have a similar experience, and I am always happy to share my own incomplete understanding of "how I got here" to anyone who asks. This is the only "message" that I feel I need share with anyone.

I think that there are a great many people who justify a great deal of bad behavior with things they have read or things they were told within the various different 12-step fellowships.

I just wanted to say that it can work, this 12-step thing, withOUT being a "side door" back into a specific church, even if SOME church leaders tend to try to make it work that way.