Nadine knew she was in trouble after six months of weekend binge drinking. She also drank until she blacked out many week nights. She had been off-and-on the wagon with booze (and drugs as well) in many periods of her life, beginning in college. In fact, she had been in rehab twice, and had attended many Alcoholics Anonymous meetings. But somehow, none of this had stuck, as she hadn't with the programs. She wasn't trying to be difficult, but Nadine was naturally a questioning person. (Nadine is not her real name, and some non-essential facts were altered to shield her identity.)
Nadine remembered the first lecture she and her fellow residents heard in rehab: "You all have been born with a genetic disposition to be alcoholics, from which you can never fully recover," announced the official-looking man at the front of the room backed by large, sun-filled windows that hurt Nadine's eyes.
Nadine raised her hand.
"Yes?" The man was astounded anyone was questioning him.
"Is there any test that shows we all have this gene?" Nadine asked sincerely. "Because I haven't had a medical examination yet."
The group leader no doubt marked Nadine down as a tough case at that moment. The idea of biological determination of alcoholism and addiction is a given in American culture, inside of treatment and out. And, yet, Nadine was 100 percent right. There was not a shred of evidence that she had any particular gene configuration. Neither of her parents, none of her grandparents, none of her cousins or her brother was an alcoholic. But, more importantly, there was no test for either her genes or her brain that would prove Nadine was one. And there never will be such a test. She was an alcoholic because she had begun missing work, had gotten in a traffic accident, and often was either drunk or suffering a hangover—everyone knew she was an alcoholic, or becoming one.
Well after her rehab experiences, at age 27, and following a long period of alcoholic binge-drinking, Nadine awoke after a very bad night with bruises all over her face and body. She decided to quit drinking. It's true that she had said that before—and done so for months at a time. Then she always started drinking again.
Ironically, what had most kept Nadine from deciding to quit and staying quit—and what frightened her most—was what she had heard in rehab and what she had seen on television. She had a brain disease, everyone said. What did that mean? Was she incapable of quitting drinking, at least without joining an AA group or returning to rehab? Nadine couldn't understand that. After all, what was going on when somebody quit drinking, in AA, or rehab, or out? You have to stop drinking one way or the other. Wasn't that just common sense?
The truth is, the vast majority of people quit addictions on their own. Every population study (that is, research with people not in treatment) tells us this. There is no ambiguity, no doubt, no scientific questioning of this truth. Only the neuroscientific, "chronic brain disease" crowd—represented by the new official medical subspecialty, the American Board of Addiction Medicine (ABAM)—strives to convince us of the opposite, even as a never-ending flood of data tells us otherwise.
The marketing rubric "chronic brain disease" originated with Alan Leshner, the former head of the National Institute on Drug Abuse (NIDA). Leshner's announcement in an article in Science that "Addiction is a Brain Disease, and It Matters" cast the die for all that was to follow. As Leshner said elsewhere, "It's a myth that millions of people get better by themselves."
After Leshner came Nora Volkow, who doubled-down on everything Leshner claimed about addiction, the brain disease, when she replaced him as NIDA's director. Volkow's role at the ostensibly scientific NIDA was correctly termed by the New York Times to be "A General in the Drug War." The NIDA wants us to know that drugs (and alcohol) are so inherently dangerous that human beings can never be trusted to manage these substances or recover from an addiction to them.
Arguably Volkow's greatest triumph has been to gain official American Medical Association acceptance for addiction medicine through ABAM, whose mission is to explain why people never overcome addiction:
Armed with that understanding, "the management of folks with addiction becomes very much like the management of other chronic diseases, such as asthma, hypertension or diabetes," said Dr. Daniel Alford, who oversees the program at Boston University Medical Center. "It's hard necessarily to cure people, but you can certainly manage the problem to the point where they are able to function" through a combination of pharmaceuticals and therapy.
Like the roach motel, once you're in the hands of ABAM and addiction medicine, you can't escape.
But what they tell us doesn't happen to be true. People recover from addiction all the time. How do I know? Government research conducted by the NIDA and its sister agency (with which it is soon to be combined) the National Institute on Alcohol Abuse and Alcoholism (NIAAA) tells us that. In the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a massive national study involving face-to-face interviews with over 43,000 Americans in 2001-2002 about their lifetime drinking and drug use, the NIAAA revealed that, "twenty years after the onset of alcohol dependence, three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence."
That's not all. "About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol (rehab) programs and Alcoholics Anonymous. Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment." Wow. As the director of the research project at NIAAA, Mark Willenbring, notes, "These and other recent findings turn on its head much of what we thought we knew about alcoholism. As is so often true in medicine, researchers have studied the patients seen in hospitals and clinics most intensively. This can greatly skew understanding of a disorder," especially in the case of alcoholism and addiction.
Actually, the NESARC results are not surprising, and are consistent with what others have found in alcoholism and addiction. I have been announcing them since the publication of my book, The Meaning of Addiction, in 1985. Willenbring notes the NESARC results are similar to those from another massive NIAAA study conducted ten years earlier, the National Longitudinal Alcohol Epidemiologic Survey, as I pointed out in my review of the downsides of "Addiction as a Disease."
But Willenbring himself was incapable of fully interpreting his results. In a workshop I gave in Minneapolis, where Willenbring now has his private practice, when I announced that in fact drug addicts more readily give up their habits than alcoholics, he objected strenuously, saying that heroin addicts and others couldn't give up drugs. As I told him then, he was dead wrong.
The study Willenbring supervised, NESARC, which also assessed drug addiction, tells us so. Looking at the point at which half the people who were ever dependent on a substance recovered, NESARC investigators found this was 26 years out for those who were ever dependent on cigarettes, 14 years for alcoholics, six years for marijuana addicts, and five years for those addicted to cocaine. As with alcohol, only a minority of drug addicts achieved recovery through treatment.
What about narcotics addicts? The NESARC research simply didn't uncover enough heroin addicts to include in the survey to analyze. But a separate review of research that included narcotics addicts found similar results. Although these addicts had a longer half-life for their addictions than those addicted to other illicit drugs, they still often concluded their addictions and achieved recovery in less time than alcoholics and, certainly, cigarette addicts.
It turns out that Willenbring, an M.D., couldn't escape the conventional notions of addiction he and American medicine are saddled with. For Willenbring, discovering the unimaginable—that most alcoholics recover over time without treatment and while continuing to drink—left him with something else he couldn't imagine: drug addiction shows the same tendency to correct itself.
Why wouldn't alcohol, cocaine, and narcotic addictions follow the same patterns as NESARC found to hold for alcoholics? After all, why should one substance addiction differ essentially from other substance addictions or, really, from all of human behavior? As I said in 1985 in The Meaning of Addiction: Compulsive Experience and Its Interpretation:
The conventional concept of addiction this book confronts—the one accepted not only by the media and popular audiences, but by researchers whose work does little to support it—derives more from magic than from science. The core of this concept is that an entire set of feelings and behaviors is the unique result of one biological process. No other scientific formulation attributes a complex human phenomenon to the nature of a particular stimulus: statements such as "He ate all the ice cream because it was so good" or "She watches so much television because it's fun" are understood to call for a greater understanding of the actors' motivations (except, ironically, as these activities are now considered analogous to narcotic addiction). Even reductionist theories of mental illness such as of depression and schizophrenia seek to account for a general state of mind, not specific behavior. Only compulsive consumption of narcotics and alcohol—conceived of as addictions (and now, other addictions that are seen to operate in the same way)—is believed to be the result of a spell that no effort of will can break.
That drug addiction, including its remission, is simply an extension of ordinary human behavior has actually been known for some time, as I noted in Love and Addiction in 1975. It had been discovered by Charles Winick, and announced in his 1962 paper for the United Nations Office on Drugs and Crime, "Maturing Out of Narcotic Addiction," in which he found that from two-thirds to three-quarters of addicts registered by the Federal Bureau of Narcotics had quit their addictions by their mid-thirties. Indeed, in a sense, Winick was moved to understand why the minority of heroin addicts did not recover. He surmised, based on his investigations of New York City street addicts, "The difference between those who mature out of addiction and those who do not may also mirror the difference between addicts who struggle to abandon addiction and may develop some insight, and those who decide that they are 'hooked,' make no effort to abandon addiction, and give in to what they regard as inevitable."
Thus, ironically, it is those who are most convinced by the "chronic brain disease" narrative who are least likely to overcome addiction! This paradox was contemplated by the distinguished addiction expert William White, who is often associated with the American "recovery movement" (read Alcoholics Anonymous and the 12 steps). Analyzing 415 scientific reports of recovery, from the mid-19th century to the present, White was moved to contemplate the addiction-as-disease philosophy's claims that addiction is a chronic—even, in AA's view, a progressive—disease when, actually, "Recovery is not an aberration achieved by a small and morally enlightened minority of addicted people. If there is a natural developmental momentum within the course of these problems, it is toward remission and recovery."
Nadine was facing a formidable set of foes when she decided to quit her addiction—the NIDA, Alan Leshner, Nora Volkow, Alcoholics Anonymous, neuroscience, what have you. But, it turns out, the forces of science were actually propelling her forward. And she did quit drinking—so far for six years. In White's words: "The central problem is not the difficulty of making recovery possible—that potential clearly exists. It is instead the long time between problem onset and successful recovery stabilization."
As I say in my new book with Ilse Thompson, Recover! Stop Thinking Like an Addict and Reclaim Your Life with The PERFECT Program.
By reinforcing the myth that addiction is uncontrollable and permanent, neuroscientific models make it harder to overcome the problem, just as the 12-step disease model has all along. Telling yourself that you are powerless over addiction is self-defeating; it limits your capacity to change and grow. Isn't it better to start from the belief that you—or your spouse, or your child—can fully and finally break out of addictive habits by redirecting your life? It may not be quick and easy to accomplish, but it happens all the time. In this book I will show you how it happens and what it takes to do it.