We Need a New Way of Thinking About Addiction
Drugs don’t cause addiction or drug deaths—recovery does
Article by: Stanton Peele, Ph.D – Author of The Life Process Program
Since the turn of the 21st Century, when the National Institute on Drug Abuse promulgated what it calls a “scientific breakthrough in addiction,” drug deaths have quintupled, and continue to accelerate. We need a new way of thinking about addiction.
Most people (including politicians and public health professionals) focus on drug deaths when a celebrity dies. But the information they process based on initial information and impressions is always wrong. These ideas are never corrected, despite being mythical and dysfunctional, and contribute to our bedrock misconceptions about addiction and the dangers of drug use.
Here are the drugs found in prominent drug fatalities: Tom Petty—fentanyl, oxycodone, temazepam, alprazolam, citalopram, acetyl fentanyl and despropionyl fentanyl (the last two drugs are street formulations); Carrie Fisher—cocaine, methadone, ecstasy, alcohol, antidepressants, and opiates (Fisher was a recovery spokesperson); Philip Seymour Hoffman—heroin, cocaine, benzodiazepines, amphetamines (Hoffman actively participated in AA); Amy Winehouse—alcohol, benzodiazepines (Winehouse had just left treatment and was probably given the tranquilizers there); Prince various street painkillers illegally obtained (Prince prided himself on not taking illicit drugs, like heroin or marijuana).
That so many celebrity drug deaths occur despite supposedly miraculous discoveries about the nature of addiction and the ubiquity of high-end treatment is highly alarming about how we view and treat addiction. And celebrity deaths, of course, mirror the accelerating drug deaths nationwide that are occurring alongside these miraculous discoveries and ever-expanding treatment for addiction.
Indeed, the recent bunch of celebrity deaths is most notable since so many had recently been in treatment (Winehouse, Hoffman, Corey Monteith, who died in 2013 combining heroin and alcohol) or who labeled themselves as being in recovery (Fisher) or who called themselves non-drug users (Prince).
We are led to the following conclusions:
1. Drugs do not “cause” addiction.
The most recent edition of the American Psychiatric Association diagnostic manual (DSM-5) does not declare that any class of drugs (including nicotine and caffeine, cocaine and amphetamines, opioids, alcohol, et al.) is “addictive.”
But there is a section of DSM-5 titled Substance-Related and Addictive Disorders. It labels a single thing as being addictive. Of all the activities and substances in the universe, the American Psychiatric Association has decided gambling is addictive.
The official medical classification of drug and addictive disorders lists one addiction—and it isn’t a drug. To say, therefore, not only that drugs are the sole cause of addiction, but that they are even a cause of addiction, defies the clinical reference manual in American medicine.
2. Drugs do not cause overdose deaths.
In 2015, 98 million Americans used opioids either legally or illicitly according to the National Survey on Drug Use and Health. Between 1-2 percent suffered negative consequences—a substance use disorder, dependence, or death.
In a study published in the British Medical Journal that tracked post-surgical patients prescribed opiates for an extended period of time, only 0.6% of patients developed any kind of a problem.
Of course, even a very small percentage of almost 100 million users in the United States is a large number, a number that scares us. But 65,000 American drug deaths represents about a tenth of one percent of all such opioid users.
The best data show opioids are not, in and of themselves, particularly dangerous.
3. User characteristics determine drug deaths.
When a microscopic percentage of users of a substance die, it is not useful to refer to the drug as a “killer.” Rather, it is characteristics of users that are the primary causes of the deaths.
West Virginia far outstrips all states in the U.S. in drug deaths with 52 deaths per 100,000 annually—no other state reaches 40 per 100,000. The state’s public health commissioner, Dr. Sanjay Gupta, conducted an in-depth analysis of every person in his state who had died due to drugs over the preceding year.
Gupta was raised and trained in India, so that he had the advantage that he was not weighed down by American preconceptions. Instead of the idea that drug deaths are an “equal opportunity destroyer” (as is always maintained by our addiction experts), Gupta found a certain type of person was vulnerable: “If you’re a male between the ages of 35 to 54, with less than a high school education, you’re single and you’ve worked in a blue-collar industry, you pretty much are at a very, very high risk of overdosing.”
In fact, this group nationwide is suffering a decline in life span due to cirrhosis, other diseases, and suicide, towards which drugs are only one small contributor.
The lives of drug death “victims” are the problem—not the drugs.
4. Our approach towards drugs is headed exactly the wrong way.
Time and again, expert groups (the Surgeon General, Christie Commission, Governors Council) created to quell our drug death epidemic have announced their primary strategy to be reducing opioid prescriptions and consumption. But painkiller prescriptions have been declining for the last five years—and yet drug deaths continue to accelerate.
Ironically, the drug policy reform movement, which takes a harm reduction, non-abstinence stand, has emphasized the same medical steps as government bodies—reduction in opioid prescriptions along with medicine-assisted treatment (use of substitute opioids such as suboxone, burpenorphine, and methadone). Yet, despite the increasing adoption of these practices, drug deaths continue to grow.
Any strategy for attacking drug abuse that focuses on the characteristics of drugs, rather than drug users’ lives, misconceives the nature of addiction and is bound to fail.
5. The brain disease meme is not a remedy for drug deaths, but accompanies their growth.
A series of studies by leading psychologists in the 1970s, 1980s and 1990s addressed the belief systems of alcoholics. The studies uniformly found that “subjective” rather than objectives levels of dependence, belief in the disease theory of alcoholism, and acceptance that any drinking following treatment caused relapse were the best predictors of alcoholic drinking.
All of these beliefs are characteristic of the disease idea of addiction. The deaths of people such as Philip Seymour Hoffman show that the belief in the disease of addiction is at the root of their inability to control their drug use. As I wrote in an article entitled, “Philip Seymour Hoffman was taught to be helpless before drugs,”
Hoffman is not a good symbol for the efficacy of American treatment. He was famously abstinent after having entered rehab at 22. Then, supposedly abstinent for 23 years, he took some pain medications and went completely haywire, progressing to rampant heroin use. According to this model, a person who is addicted to heroin who simply samples a painkiller is doomed to all-out relapse by this “cunning, baffling and powerful disease.”
And these continued failures are fueling a re-examination of the addiction concept. Even Scientific American, which has championed the brain-disease model of addiction for decades, is now questioning this idea: “Why the Disease Definition of Addiction Does Far More Harm than Good” and “Is Addiction a Disease?: The current medical consensus about addiction may very well be wrong.”
Our way of thinking about addiction, and not drug use, instead of being the remedy for addiction, is the cause of it.
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As I have been saying for nearly a half century now, addiction is not a result of drug use, but rather of the way people engage with drugs, alcohol, love and sex, gambling and gaming, or any type of powerful, potentially overwhelming, involvement.
We have simply been unable to come to grips with this reality. And we are suffering increasingly dire consequences as a result.