Sunday, June 12, 2011

America Anonymous

The Good Men Project

Why do we fail so spectacularly at treating addiction? Maybe because we’ve never been able to agree on what it is.

The best definition of addiction I’ve found comes from a pamphlet published by Sex and Love Addicts Anonymous: The use of a substance or activity, for the purpose of lessening pain or augmenting pleasure, by a person who has lost control over the rate, frequency, or duration of its use, and whose life has become progressively unmanageable as a result.

It’s not a perfect definition. Cigarette smokers are hooked on one of the world’s most addictive substances (nicotine), yet for those smokers who don’t contract cigarette-related illnesses, it’s a stretch to argue that cigarettes cause progressive unmanageability in their lives.

The same is true for someone hooked on the world’s most abused substance—caffeine. Four trips a day to Starbucks likely constitutes an unhealthy dependence on coffee, but does it cause severe negative consequences? Probably not. As writer John Ernest McCann put it, caffeine “intoxicates, without inviting the police.” (In one large-scale study, it also proved to be a lifesaving coping mechanism. Nurses who drank two to three cups of coffee each day were significantly less likely to commit suicide than nurses who abstained.)

Still, it would be foolish to claim that people reliant on nicotine or caffeine to get them through the day don’t suffer from addictions. They may not need rehab, but they are undeniably hooked.

So what happens if we scrap “progressively unmanageable” from the above definition? Does that mean that anything we do in excess to lessen pain or augment pleasure constitutes an addiction? Can we be addicted to things that are good for us?

Further complicating any attempt to define addiction is that it is undeniably a cultural construct—what’s good or bad for us is in the eye of the beholder. Countries and cultures understand the problem of addiction, and propose dealing with it, in different ways.

In China, for instance, addiction is still widely viewed as profound moral failing demanding punitive action. Many Chinese drug abusers are sent to labor camps, where they receive little treatment. And until a few years ago, police in China would sometimes shoot heroin dealers in the head and send a bill for the bullet to their families. In recent years, the Chinese government has become fixated on preventing and treating Internet addiction, particularly video game addiction among its young people.

In France, meanwhile, “recovering alcoholics” are a rarity, and food and sex addiction are mostly mocked as silly American inventions. So are there fewer addicts in France, or is the country in deep, blissful denial? Having spent plenty of time there, my guess is that it’s probably a combination of both. But it’s difficult to say for sure, because the French have a staggeringly different (and, I would argue, generally healthier) relationship to food, alcohol, and sex than we do. If the French don’t have a cultural framework for food or sex addiction, can we label their behavior addictive?

Here at home, we’ve been maddeningly inconsistent in our understanding of addiction and recovery. We’ve vacillated throughout our history on what constitutes an addiction, what causes addiction, and what can be done to treat addiction.

We’ve also changed our minds countless times about which drugs are most problematic and addictive (we’ve been perhaps the most befuddled by cocaine, which has been considered everything from an addiction cure to the most addictive substance ever).

Occasionally there was a scientific basis for why we stigmatized a particular drug, but just as often it was based on political or economic interests. “Merchants, capitalists, and the political elites who tax them have long appreciated that drugs are seductive products and lucrative sources of revenue,” historian David Courtwright writes in Forces of Habit: Drugs and the Making of the Modern World. “The clash between opportunities for profit and concerns about health forms the central moral and political conflict running through the history of psychoactive commerce … The growing cost of the abuse of manufactured drugs turned out to be a fundamental contradiction of capitalism itself.”
For most of the 1800s, there were no laws in this country regulating drug use, even as many Americans were hooked on opium and its derivatives. We mostly tolerated drugs, just as we tolerated—and sometimes celebrated—our cultural inebriety.

Americans drank more alcohol per capita between 1800 and 1830 than at any other time in our history. While some sounded an alarm (journalist Anne Royall wrote in 1830, “When I was in Virginia, it was too much whiskey—in Ohio, too much whiskey—in Tennessee, it is too, too much whiskey!”), few thought of perennial drunkenness as anything approaching a disease.

One man who did was doctor and Founding Father Benjamin Rush, who in 1810 articulated the idea that alcoholism—although the word itself wouldn’t be introduced until 1849 or used widely until nearly a century later—was a progressive illness, and that the only solution was abstinence.

Rush believed that lasting sobriety could be achieved through “religious, metaphysical, and medical” avenues, and that addicts seeking recovery should be placed in a “sober house” where they could be treated.

Rush conceded that he had few backers in these beliefs. In an essay, he wrote, “I am aware that the efforts of science and humanity, in applying their resources to the care of a disease induced by a vice, will meet with a cold reception from many people.”

But by the mid- and late 1800s, Rush’s beliefs were gaining currency. Addiction was increasingly being understood as an illness that wasn’t necessarily the result of vice (heredity probably had a lot to do with it). Many called for a compassionate response, prompting treatment centers to sprout up across the country.

Speaking at an 1842 meeting of the Washingtonian Society (a short-lived fellowship for alcoholics seeking sobriety), Abraham Lincoln argued that addiction should not be viewed in moral or criminal terms. “In my judgment,” he said, “such of us who have never fallen victims [to addiction] have been spared more by the absence of appetite than from any mental or moral superiority over those who have.”

But the winds of public opinion shifted again early in the twentieth century. As the word “addict” came into common usage, it resonated “around stereotypes of the opium-smoking Chinese immigrant, the ‘cocaine-crazed’ and sexually threatening African-American male, the marijuana-smoking and violent Mexican youth of the Southwest,” Janet Farrell Brodie and Marc Redfield write in the introduction to High Anxieties: Cultural Studies in Addiction. “Medical professionals, police and criminologists, government bureaucrats, policymakers, and social reformers harnessed the mass media, the language of statistics and academia, and harrowing descriptions of newly discovered ‘deviant subcultures’ to mount campaigns against the perceived threats of racial minorities, the urban poor, and the foreign born. Anxieties about addiction meshed with wider American anxieties about lost autonomy and the dangers of the un-American.”

In 1914, the federal government began regulating the sale and possession of narcotic drugs. Sixteen years later, the establishment of the Federal Bureau of Narcotics prompted the first of the century’s drug wars.

By then, most of the treatment centers founded in the 1800s had long closed. “The country eventually fell sway to the argument that, if alcohol and other drugs were effectively prohibited, there would be no need for addiction treatment programs,” William White writes in Slaying the Dragon: The History of Addiction Treatment and Recovery in America.
How wrong we were. Today, nearly 23 million Americans—9.2 percent of the population 12 or older—are hooked on alcohol or drugs, another 61 million smoke cigarettes, and millions more are slaves to gambling, compulsive overeating, and sex and pornography. (By studying the brain’s reward and pleasure systems, researchers—many of whom used to dismiss an expanded understanding of addiction as just another example of this country’s addiction to calling everything an addiction—are discovering that drugs and behaviors like gambling, sex, overeating, and online gaming affect the brain in some similar ways.)

Those men and women who don’t die from their addictions clog our hospitals, courts, and prisons, and the neglected and abused children of addicts overcrowd our juvenile justice and child welfare systems. (More than 70 percent of abused and neglected kids in family court and child welfare agencies have substance-abusing parents.)

In 2007, the economic cost from alcohol and drug abuse alone was estimated to be $534 billion. But as Joseph Califano Jr. makes clear in his book High Society: How Substance Abuse Ravages America and What to Do About It, the real cost of substance abuse is practically incalculable: “What funds terrorism, spawns crime, drives up health-care costs, breaks up families, spreads AIDS, promotes unwanted teen pregnancy, and frustrates so many efforts to eliminate poverty?” The answer, he correctly points out, is “substance abuse and addiction.”

Remarkably, while untreated addiction triggers and exacerbates many of our country’s most pressing problems, we seem uninterested in tackling it—or even talking honestly, intelligently, or compassionately about it. And, sadly, politics and profit seeking continue to have more to do with how we combat addiction than does science or rational thinking. (How else to explain that the two deadliest substances in America—nicotine and alcohol—are legal, while marijuana, which kills virtually no one, remains the obsessive focus of our staggeringly ineffective drug war.)

But effectively combating addiction would require more than a complete rethinking of our drug policies. It would necessitate nothing short of a radical cultural shift of consciousness. In his book Addictive Thinking: Understanding Self-Deception, Abraham J. Twerski points out that curbing addiction would demand that American culture establish a “tolerance for delay” and “ultimate goals in life other than sense gratification.”

In 1948 author and Trappist monk Thomas Merton wrote, “We live in a society whose whole policy is to excite every nerve in the human body and keep it at the highest pitch of artificial tension, to strain every human desire to the limit and to create as many new desires and synthetic passions as possible.”
Sixty years later, as we find more and more ways to distract ourselves—and as we obsessively search for new and innovative ways to escape the reality of the present moment and make ourselves feel “better”—we’ve created a schizophrenic culture where nothing is ever enough, where stillness is equated with boredom, and where we need increasingly intense experiences just to feel alive.

In essence, we’ve created a culture that supports and encourages addiction while at the same time shames, ridicules, and criminalizes those of us afflicted with it. As writer and addiction psychologist Stanton Peele once said, “Addiction is not, as we like to think, an aberration from our way of life. Addiction is our way of life.”

But recovery is the American way of life, too. We are a nation of anonymous Twelve Step soldiers in a war against our insatiable appetites. Unfortunately, the collective recovery of these millions of men and women has had little impact on the stigma and confusion that still shape our cultural understanding of addiction.

Although the American Medical Association first defined alcoholism as a disease in 1956, a series of recent focus groups sponsored by the National Council on Alcoholism and Drug Dependence, and Faces and Voices of Recovery, makes clear just how far we are from accepting addiction as a true medical disorder.

Half the participants called it a personal weakness, and even most who saw addiction as a disease put it in a special category, along with AIDS and lung cancer, that people get by making poor choices. In a 2004 poll of the general public, two-thirds said they believe that a stigma—defined by the pollsters as “something that detracts from the character or reputation of a person, a mark of disgrace”—exists toward people in recovery.

Even the family members of addicts seem conflicted. In a USA Today/HBO drug addiction poll of adults with an addicted family member, 76 percent called addiction a “disease,” but a majority of those same respondents identified “lacking will power” as the main impediment facing addicts. If those closest to addicts erroneously believe that willpower is their loved one’s main problem, then it’s no surprise that nearly half said they felt shame over having an addicted family member.

Ironically, people in recovery, many of whom have been sober for decades, are partly responsible for our cultural confusion and apathy surrounding addiction. By keeping our recoveries private and anonymous at all costs (except for the addicted celebrity, who often enters and exits rehab with great fanfare), we have unwittingly excluded addiction and recovery from the national conversation and cemented the popular belief that being hooked is something to be ashamed about.

But that may be about to change. Across the country, a growing number of people in recovery from drugs and alcohol are coming together to speak out. They’re holding marches, lobbying Congress for more research and treatment funding, challenging a federal law that barred young people convicted of felony drug offenses from receiving federal student loans, and otherwise coming out of the closet as people in recovery—advocating with anonymity by not naming the specific recovery fellowship they belong to, in keeping with the Twelve Step traditions that have been so critical to the success of groups like AA.

“Can you imagine the power of millions of recovering addicts walking on Washington, demanding that the government devote as much money to addiction research and treatment as they do to breast cancer and AIDS?” wonders addiction expert Patrick Carnes. “I predict it will happen, but I wonder how many more addicts will have to die before it does.”

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