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 People can be safely detoxified (withdrawn) from drugs usually in a matter of days.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.

Thursday, July 02, 2009

Socialist Organization

One of the most critical issues for the left is the question of organization. For the purposes of this duscussion I would like to focus upon two general tendencies, the decentralized, democratic libertarian left and the centralized, authoritarian vanguard that stems from Bolshevism (a contrast between the libertarian and authoritarian left, if the latter can be considered left at all), although various alternatives presented by others are welcomed.

By way of introduction I would like to present a quote by one Otto Ruhle about social revolution in general, that social revolution, by definition, “is not a party affair; politically and economically it is the affair of the whole working class.” Social revolution is either carried out by society, by the people, the workers and so on, or it is not a social revolution (this is simply a matter of elementary definition).

In the footnotes to Noam Chomsky’s famous “Objectivity and Liberal Scholarship” he emphasizes that it must be noted “…the ways in which exercise of control over steps of the [early] revolutionary process [in China] was a factor in developing the consciousness and insight of those who took part in the revolution, not only from a political and social point of view, but also with respect to the human relationships that were created.”

Importantly, as Chomsky here emphasizes, integral and direct participation in the revolutionary process is central to the raising of revolutionary consciousness and the further unfolding and expansion of the revolution, leading to its likelier success. Rather than forcing processes upon the people – although, actually, the Bolshevik program constituted the destruction of revolutionary processes, such as the immediate dissolution of workers’ soviets and councils and so on – the people must be in control of the processes themselves. Instead of leading a vanguard party of mostly bourgeois intellectuals, the masses must be the central agent in revolutionary change.

The left-Marxist Anton Pannekoek explained that “belief in the party constitutes the most powerful check on the working class' capacity for action. That is why we are not trying to create a new party. This is so, not because our numbers are small -- a party of any kind begins with a few people -- but because, in our day, a party cannot be other than an organization aimed at directing and dominating the proletariat. To this type of organization we oppose the principle that the working class can effectively come into its own and prevail only by taking its destiny into its own hands.”

Rudolf Rocker, one of the leading proponents of anarcho-syndicalism, concurs writing that “[p]articipation in the politics of the bourgeois states has not brought the labour movement a hairs' breadth closer to Socialism, but, thanks to this method, Socialism has almost been completely crushed and condemned to insignificance. The ancient proverb: 'Who eats of the pope, dies of him,' has held true in this content also; who eats of the state is ruined by it. Participation in parliamentary politics has affected the Socialist labour movement like an insidious poison. It destroyed the belief in the necessity of constructive Socialist activity and, worst of all, the impulse to self-help, by inoculating people with the ruinous delusion that salvation always comes from above.”

It is critical that people realize progress must be made by the whole of the people involved, from the bottom up, democratically, and do not wish for and rely upon a Christ-like savior, someone like Lenin, who is allegedly going to initiate, progress and defend socialist revolution alone with their vanguard party of intellectual and revolutionary betters, for history has clearly shown to us the consequences of such an elitist, authoritarian program: it’s known as the counterrevolution.