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.
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