Drugs and Alcohol (Part 2)

In my previous post on this subject, I discussed addiction to alcohol and other drugs.  I made the point that addiction to these substances is not an illness, but rather an extremely strong habit.

Treatment Programs

The notion that alcoholism is a disease gained popularity in the 50’s and 60’s.  At about the same time, employers were beginning the practice of offering medical insurance to their staff, and insurance companies routinely included 30 days of treatment per year for alcoholism and/or drug addiction.  At the time, there were very few treatment units for these problems, and little use was made of the drug and alcohol provisions in the insurance policies.

America, however, is nothing if not entrepreneurial, and soon private treatment units began to appear, fuelled by insurance dollars.  At the same time, a quasi-religious group named Alcoholics Anonymous was thriving, and the commercial treatment units forged a symbiotic alliance with this organization.  The treatment units hired senior members of AA as counselors, and “patients” were required to attend AA meetings as part of their treatment.  In fact, for most of the units, treatment consisted of induction into the AA fellowship.  Group therapy, individual therapy, lectures, films, etc., were all aimed towards encouraging and fostering membership of AA (and, of course, Narcotics Anonymous for people addicted to other drugs).  Because alcoholism and drug addiction were conceptualized as illnesses, these programs were technically under the direction of a physician director, but his/her role seldom extended beyond the physical issues of detox, alcohol-induced tissue damage, etc…  The actual running of the unit was in the hands of a counselor director (usually a recovered alcoholic and a member of AA).

By the late 80’s, chemical dependency treatment had become one of the fastest-growing (possibly the fastest-growing) industries in the United States.  Around 1990, however, the insurance companies decided to pull the plug. And just as the treatment unit boom had been fuelled by insurance dollars, so its demise occurred when these dollars stopped flowing.  I was involved in the chemical dependency treatment arena when these changes were occurring, and there was undoubtedly a good deal of hardship on the individuals who lost their employment.  But in hindsight, I find myself on the side of the insurance companies.  Their position was (and still is, I presume) that alcohol and drug addiction are not in themselves medical problems.  So they would pay for detoxification, where this was medically necessary, but not for the 30 days of group therapy and induction into AA.  Sometimes they would pay for these kinds of psycho-social interventions in an outpatient setting – but the days of the 30-day-residential (inpatient) programs were over.

There are still a small number of units serving individuals who can foot the bill from their own resources.  And of course, there is still a publicly funded system.  Most (perhaps all) states provide an involuntary commitment procedure for alcohol and drug addicts who have become dangerous to themselves or others.  These individuals are committed to treatment units, sometime at the state hospital, sometimes free-standing.  These programs are usually operated on the same general lines as the private units mentioned earlier, and are often described as “revolving doors”.  This is because the “clients” routinely return – sometimes two and three times a year -for further “treatment”.

War on Drugs

The war on drugs has been around since the 60’s, but gained enormous momentum in the early 80’s under the Reagan administration.  This so-called war which the United States government (along with the governments of many other nations) is waging against its own citizens, has to date cost the tax payer an estimated one trillion dollars (thirty-nine billion dollars so far this year).   In addition, it has criminalized literally thousand (millions?) of ordinary people, has filled our prisons to overcrowding and beyond, has fuelled the biggest prison-building program in our nation’s history, has destroyed quality of life in many of our urban areas, and has turned the Mexico-US border area into a war zone.

And all for what?  All for the US government’s claim that it has the right to tell people what they may and may not ingest.

First, let me clarify my position.  The only drug I have ever used is alcohol.  I have had a great deal of illness in recent years, and have occasionally received morphine and dilaudid for pain during inpatient stays at hospitals.  I do not advocate the use of drugs for recreation, self-medication, or coping with life’s difficulties.  Alcohol, nicotine, cocaine, heroin, etc., are all drugs, and they are all bad for you.  And the more you ingest, the worse it gets.  And some of the damage is permanent.

However, it is also my position that governments have not the right to tell people what they may or may not put into their bodies.  In a democratic republic, political power ultimately resides in the people.  And we surrender some of this power to an elected government in the interests of mutual safety, organization of services, etc.. But the notion that the government has the right to determine what an individual may or may not ingest is a throwback to a monarchical type of tyranny that should have no place in a country such as the United States.  And as the War on Drugs has clearly demonstrated, they aren’t able to enforce their prohibitions.

So my position is legalize everything.  But I would have certain safeguards and protections in place, which I will outline in my next post.  Stay tuned.

Next Post:  Drugs and Alcohol (Part 3)

  • Gene

    I agree that we should not police the use of drugs/alcohol on the public and that the money could be better spent. I don’t agree that addiction is just a bad habit taken to extremes. Something is different in those people who use despite horrible outcomes. Many of those become criminals to support the “habit”.
    Your experience with Morphine speaks to the difference between you and an addict. Once an addict takes the first drink/drug a mental obsession begins leading to another crash. You had no problem stopping, an addict would have great difficulty or may be even without defense from the next drug without help.

  • Gene,

    Thanks for your interesting comment.

    You write “I don’t agree that addiction is just a bad habit taken to extremes. Something is different in those people who use despite horrible outcomes.”

    I have two points to make in response. Firstly, I think it’s a mistake to say just a bad habit. Habits, whether productive or otherwise, are extremely powerful determinants of behavior. Secondly – and more importantly – you may be correct that people who become addicted to these substances are “different,” but the onus is on you to state what that difference is. Over the years, the “treatment” industry has generated various theories as to the nature of this difference – “the alcoholic gene,” etc. – but to the best of my knowledge none of these theories has stood the test of time. For about five years of my career I worked in the drug and alcohol field, and for most of that time I believed and promoted the “something different” theory. In retrospect I now believe I was mistaken, and that heavy, irrational substance use is best conceptualized as a habit.

    I do agree that people are different in their response to any given substance. Some people drink alcohol and don’t particularly like it; others like it a great deal, and other things being equal, individuals at the latter extreme will be more likely to become heavy drinkers than those at the former. But in any distribution of this kind, it’s important to remember that the great majority of people fall somewhere in the middle, and many of these become heavy drinkers. So the matter is not simple.

    Why, for instance, do some people like alcohol, while others don’t? Is this the result of learning or just simple biology? And what about people who don’t care much for alcohol initially, but later become heavy drinkers?

    There is a great deal of dogmatism and muddled thinking in this field. I think dialogue and clarification provide the way forward, and I greatly appreciate your perspective. At present I’m sticking with the habit formulation. I think the important issue here is critical self-appraisal. Some people develop this habit early in life – usually because of parental influence. Others develop it to a lesser extent – others hardly at all. In my view it is this latter group who are likely to become heavy drinkers/drug users. This is because, as drug-related misfortunes accumulate in their lives, they habitually attribute the responsibility for these to agencies outside themselves – a stance which militates against self-correction. The person who habitually does engage in critical self-appraisal, on the other hand, takes appropriate corrective action long before the problem becomes severe.

    Once again, thanks for coming in. I hope you’ll come back.

  • all too easy

    It tells you you don’t have it. Why do alkies end up in hospitals? Your definition of illness is too narrow. Check the genetic links.

  • Rob Bishop

    Psychoactive drugs assist us in avoiding our inner emotions. They numb us. Addicts usually don’t consider their true motivation for altering their brain chemistry. This article is great Phil. I get the whole “difference” question but it might be equivalent to asking if a dislike of chocolate is genetic. A lot of emotional and physical pain accompanies addiction, and some believe addiction is, in part, an expression of self-hatred… related to cutting, eating disorders, and the shame and self-loathing of obesity. I noticed during my 20 years of narcotic use the agonizing pain that went with using was as seductive as the high. If heroin junkies were offered $1,000,000 each to quit for two weeks, most would do it, which calls into question that addicts are “out of control”. I think addiction is an obsession with control. Show me an addict and I’ll show you a control freak.

  • Rob Bishop

    The “I Am Powerless” mantra of AA has infected our culture like a virus. That addiction is called a “disease” by the government and medical community demonstrates the power of collective delusion. Addiction is a type of ignorance. Sobriety is a cognitive skill, just like resisting the seductive lure of depression, anxiety, and violence. We need education. The Disease Theory of Being Miserable is based on the idea we’re victims of causes (genes/biochemistry/events) outside our control… AKA…”powerlessness”.

  • all too easy

    Stevie, you mean like diarrhea? Good girl.

  • all too easy

    They numb us? Proof, please. Ain’t none. Fool. I think Stevie loves to think she’s smart.

  • Rob Bishop

    There’s interesting studies that reveal addicts can stop or modify their use in response to rewards, such as cash. For more info, check out the Carl Hart (neuroscientist at Columbia University) book, “High Price: A Neuroscientist’s Journey of Self-Discovery that Challenges Everything You Know about Drugs and Society”

  • Rob Bishop

    I used to spent a lot of time with crack-heads and dopers, and once concluded addiction is similar to love. Since then I’ve read books that make this exact point. When we are in love with someone, we are obsessed with our desire… and that obsession is not necessarily related to liking the person. We often desire something that we don’t necessarily like so much. Have you ever desired a snack at midnight and eaten something you didn’t like because there was nothing good to eat in the kitchen?

  • all too easy

    No kidding. Often they can and do abstain for long periods of time. The I am powerless mantra is not a mantra. Wrong again, Stevie. If you quit your bad, bad habit, without recognizing your powerlessness, that’s all it was. If you try everything to stop and can’t stay stopped, you have something too difficult to manage. That is powerlessness and arriving at that conclusion opens the door to freedom for you and your addicted pals.

  • all too easy

    You are an infection. You and the fools who deny reality are blithering idiots, and are a menace to society.

    Instead of lying so frequently about your vast experiences, support all the garbage you write with facts.

  • Rob Bishop

    If you defeat your addiction, they claim you didn’t have the disease of addiction. If you conquer your depression without drugs, they say you didn’t have the disease of depression. If you learn to become resilient and are no longer plagued by memories, you never had the disease of PTSD. This circular logic is one way The Cult of Powerlessness maintains a grip on its victims. There’s an attitude of elitism in many people…”My suffering is SO much WORSE than normal people’s suffering. I feel so BAD compared to people who don’t have MY mental illness. You can NEVER understand the HELL I’ve gone thru and how much PAIN this disease has caused ME.”

  • bulbous1

    For a start, people need to stop calling this a “war on drugs”, as absurd as the so-called “war on mental illness”. In both cases the use of such a military metaphor is preposterous, suggesting as it does mutual hostilities, a state of armed conflict between two sides, which is of course absurd; inanimate substances and abstract concepts can’t engage in war.

    True, the word has undergone a metaphorical extension, now also denoting a crusade against some perceived evil, but viewing it as a war still only serves to foster the belief that society is under attack, and this isn’t true, at least not from “drugs” or “mental illnesses”.

    And the “war on drugs” is not aimed simply at drugs, but only certain drugs.

    These aren’t wars on drugs or mental illnesses; they are the persecution of people, of a piece with just about any other example thereof wherewith the history books are replete, all of which exhibit the same pattern; all of which, pared down to their essentials, are ultimately interchangeable.

    Some group is identified as an evil, be the prime mover here hysteria, self-interest, or whatever. The evil may be defined as intrinsic to the group or not, but it is the group that will have to pay. The propaganda machinery menaces the populace with these chimeras, or strange composites of fact and fiction, and the belief therein gains currency, is reinforced through assorted media outlets, and through its circulation viva voce.

    These malignant outgrowths of the imagination held in hysteria’s grip, and the monstrosities hatched therein, soon come take on a life of their own, and the victim of this madness walks as if “into an enchanted circle” (Chekhov) from which there is no escape. In the grip of this hysterical madness, everything seems to validate it. The hysteria even spreads to the victim; try as he might to push against the tide of popular sentiment, it nevertheless infiltrates his thoughts and feelings, and by imperceptible encroachments the ideas his oppressors hold of him establish themselves in the innermost realm of his being, wherein the stories we tell ourselves about ourselves are constructed. Try as he might to resist the onrush of popular sentiment, he feels rushing in upon his mind a force equivalent to that of a crowd of people pressing in upon his person, and no matter how much he endeavors to convince himself otherwise, there is always the underlying suspicion that his oppressors are right.

    Laws are drafted to accommodate the hysteria. People are stripped of their rights, separated from the rest of society, concentrated in ghettos or detention facilities, and often tortured and exterminated

    And of course the oppressor always makes language an accessory to his crimes, before and after the fact.

    Though things may not always necessarily follow in the same order, man’s humanity to man (yes, humanity), in each of its successive avatars, is but a variation of these themes. The costumes, the dramatis personae, the dialogue, the scenery, and the time period, all vary, yet the same drama, with the same themes, is enacted.

    How break free from this cycle?

    Some will say that the truth will set us free. Every age has its perishable panaceas, and the quacks who proffer them.

  • Cledwyn Laureate of pus poetry

    The solution lies in the rejection of the world all together, which follows its own implacable laws, indifferent to the will of men, which is mostly corrupt anyway.

    Nevertheless, men can’t countenance such a notion, for they are like people suffering from dropsy, thirsty for more of what ails them, who crave life as blindly and irrationally as a smack-addict his chosen instrument of self-destruction. The addict of being may see the damage that is being done, yet he is homo duplex, torn between the rational awareness that life is an unremunerative and futile slog, and his physiological dependency thereupon.

    Hope, the belief in progress and optimism are merely varying symptoms of the same addiction.

    Each successive generation makes the same mistake; it tries to act upon the world. Yet action, as Conrad said, is a “barbed hook, baited with the illusion of progress.”

    The belief in progress is a will-o-the-wisp, luring the species on with its light, whilst the hell about them – into which each generation wanders in pursuit of this ignis fatuus – lies enshrouded in darkness.

    It is a sacrificial altar steeped in human blood.

    Trying to reform society almost always makes it worst, for those seized of the conviction that it is to their keeping the enlightenment and betterment of humanity has been entrusted, they carry, so to speak, the plague bacillus too, spreading some great evil insidiously in the attempt to eradicate some illusory or lesser one.

    Religions have created hell on earth in the war on evil; the attempt to eradicate suffering spreads more suffering, and so on and so forth.

    True, sometimes, as with the abolition chattel slavery, things may turn out turn out well, for every avatar of oppression has its end, but directly one head of this multi-cephalic monster is lopped off, it sprouts another. The world doesn’t become a better place just because you remove one evil.

    “If there’s one thing I hate, it’s a reformer. A reformer is a man who sees the world’s superficial ills and sets out to cure them by aggravating the more basic ills. A doctor tries to bring a sick body into conformity with a normal, healthy body, but we don’t know what’s healthy or sick in the social sphere.”

    Fernando Pessoa, The Book of Disquiet

    Yet as Montaigne said, nothing is so firmly believed as that which is least known. Without a way of identifying with exactitude the world’s problems, and given the epistemological shortcomings inherent in such an endeavor, great progress is nigh on impossible. Even if technology existed that could identify with pinpoint accuracy the problems of this world, it wouldn’t matter, because in the marketplace of ideas, the truth has little currency anyway.

    Yet such is the overweening presumption of most reformers and revolutionaries, these considerations matter not; they don’t apply to them. Their center of gravity being entirely outside of themselves, they rarely frequent their own depths, they love themselves too much to think it necessary, leading to a focal imbalance whereby they come to focus disproportionately on the evil without, but rarely within, lack of insight whereinto gives them an air of insufferable sanctimoniousness and self-righteousness.

    For example, the politically correct sanitizers of human thought and speech – and I am by no means opposed to the attempt to create a more inclusive idiom, and to attempt to encourage people to be more discreet in their choice of words – are very good at detecting bigotry in others, yet to a proportionate extent are they bad at detecting their own prejudices.

  • all too easy

    Thanks goofy. I needed a pick me up and you provided it. What a horse’s rear end.

    How many millions have been killed/maimed from drivers under the influence? How many people have been murdered/assaulted/robbed by addicts seeking their drug of choice?

    Try increasing the size of your massive ego with more self-pity and self-righteous indignation at all those less wonderful than thou art.