The Surprising Truth About Addiction
Stanton Peele, North Arlington , NJ
(http://www.peele.net/lib/surprising.html)
Change is natural. You no doubt act very differently in many areas of your life now compared with how you did when you were a teenager. Likewise, over time you will probably overcome or ameliorate certain behaviors: a short temper, crippling insecurity.
For some reason, we exempt addiction from our beliefs about change. In both popular and scientific models, addiction is seen as locking you into an inescapable pattern of behavior. Both folk wisdom, as represented by Alcoholics Anonymous, and modern neuroscience regard addiction as a virtually permanent brain disease. No matter how many years ago your uncle Joe had his last drink, he is still considered an alcoholic. The very word addict confers an identity that admits no other possibilities. It incorporates the assumption that you cant, or wont, change.
But this fatalistic thinking about addiction doesnt jibe with the facts. More people overcome addictions than do not. And the vast majority do so without therapy. Quitting may take several tries, and people may not stop smoking, drinking or using drugs altogether. But eventually they succeed in shaking dependence.
Kicking these habits constitutes a dramatic change, but the change need not occur in a dramatic way. So when it comes to addiction treatment, the most effective approaches rely on the counterintuitive principle that less is often more. Successful treatment places the responsibility for change squarely on the individual and acknowledges that positive events in other realms may jump-start change.
Six Principles of Change
One. The belief that you can change is the key to change. This is not the powerlessness message of the 12 steps but rather the belief in self-efficacy. Addictions are really no different than other behaviorsbelieving you can change encourages commitment to the process and enhances the likelihood of success.
Two. The type of treatment is less critical than the individuals commitment to change. People can select how they want to pursue change in line with their own values and preferences. They dont need to be told how to change.
Three. Brief treatments can change longstanding habits. It is not the intensity of the treatment that allows people to change but rather its ability to inspire continued efforts in that direction.
Four. Life skills can be the key to licking addiction. All addictions may not be equal; the community reinforcement approach, with its emphasis on developing life skills, might be needed for those more severely debilitated by drugs and alcohol.
Five. Repeated efforts are critical in change. People do not often get better instantlyit usually takes multiple efforts. Providing follow-up allows people to maintain focus on their change goals. Eventually, they stand a good chance of achieving them.
Six. Improvement, without abstinence, counts. People do not usually succeed all at once. But they can show significant improvements; and all improvement should be accepted and rewarded. It is counterproductive to kick people out of therapy for failing to abstain. The therapeutic approach of recognizing improvement in the absence of abstinence is called harm reduction.
Consider the experience of American soldiers returning from the war in Vietnam, where heroin use and addiction was widespread. In 90 percent of cases, when GIs left the pressure cooker of the battle zone, they also shed their addictionsin vivo proof that drug addiction can be just a matter of where in life you are.
Of course, it took more than a plane trip back from Asia for these men to overcome drug addiction. Most soldiers experienced dramatically altered lives when they returned. They left the anxiety, fear and boredom of the war arena and settled back into their home environments. They returned to their families, formed new relationships, developed work skills.
Smoking is at the top of the charts in terms of difficulty of quitting. But the majority of ex-smokers quit without any aidneither nicotine patches nor gum, Smokenders groups nor hypnotism. (Dont take my word for it; at your next social gathering, ask how many people have quit smoking on their own.) In fact, as many cigarette smokers quit on their own, an even higher percentage of heroin and cocaine addicts and alcoholics quit without treatment. It is simply more difficult to keep these habits going through adulthood. Its hard to go to Disney World with your family while you are shooting heroin. Addicts who quit on their own typically report that they did so in order to achieve normalcy.
Every year, the National Survey on Drug Use and Health interviews Americans about their drug and alcohol habits. Ages 18 to 25 constitute the peak period of drug and alcohol use. In 2002, the latest year for which data are available, 22 percent of Americans between ages 18 and 25 were abusing or were dependent on a substance, versus only 3 percent of those aged 55 to 59. These data show that most people overcome their substance abuse, even though most of them do not enter treatment.
How do we know that the majority arent seeking treatment? In 1992, the National Institute on Alcohol Abuse and Alcoholism conducted one of the largest surveys of substance use ever, sending Census Bureau workers to interview more than 42,000 Americans about their lifetime drug and alcohol use. Of the 4,500-plus respondents who had ever been dependent on alcohol, only 27 percent had gone to treatment of any kind, including Alcoholics Anonymous. In this group, one-third were still abusing alcohol.
Of those who never had any treatment, only about one-quarter were currently diagnosable as alcohol abusers. This study, known as the National Longitudinal Alcohol Epidemiologic Survey, indicates first that treatment is not a cure-all, and second that it is not necessary. The vast majority of Americans who were alcohol dependent, about three-quarters, never underwent treatment. And fewer of them were abusing alcohol than were those who were treated.
This is not to say that treatment cant be useful. But the most successful treatments are nonconfrontational approaches that allow self-propelled change. Psychologists at the University of New Mexico led by William Miller tabulated every controlled study of alcoholism treatment they could find. They concluded that the leading therapy was barely a therapy at all but a quick encounter between patient and health-care worker in an ordinary medical setting. The intervention is sometimes as brief as a doctor looking at the results of liver-function tests and telling a patient to cut down on his drinking. Many patients then decide to cut backand do!
As brief interventions have evolved, they have become more structured. A physician may simply review the amount the patient drinks, or use a checklist to evaluate the extent of a drinking problem. The doctor then typically recommends and seeks agreement from the patient on a goal (usually reduced drinking rather than complete abstinence). More severe alcoholics would typically be referred out for specialized treatment. A range of options is discussed (such as attending AA, engaging in activities incompatible with drinking or using a self-help manual). A spouse or family member might be involved in the planning. The patient is then scheduled for a future visit, where progress can be checked. A case monitor might call every few weeks to see whether the person has any questions or problems.
The second most effective approach is motivational enhancement, also called motivational interviewing. This technique throws the decision to quit or reduce drinkingand to find the best methods for doing soback on the individual. In this case, the therapist asks targeted questions that prompt the individual to reflect on his drinking in terms of his own values and goals. When patients resist, the therapist does not argue with the individual but explores the persons ambivalence about change so as to allow him or her to draw his own conclusions: You say that you like to be in control of your behavior, yet you feel when you drink you are often not in charge. Could you just clarify that for me?
Millers team found that the list of most effective treatments for alcoholism included a few more surprises. Self-help manuals were highly successful. So was the community-reinforcement approach, which addresses the persons capacity to deal with life, notably marital relationships, work issues (such as simply getting a job), leisure planning and social-group formation (a buddy might be provided, as in AA, as a resource to encourage sobriety). The focus is on developing life skills, such as resisting pressures to drink, coping with stress (at work and in relationships) and building communication skills.
These findings square with what we know about change in other areas of life: People change when they want it badly enough and when they feel strong enough to face the challenge, not when theyre humiliated or coerced. An approach that empowers and offers positive reinforcement is preferable to one that strips the individual of agency. These techniques are most likely to elicit real changes, however short of perfect and hard-won they may be.
---------------------interesting information for the parents of addicts, and the
addicts themselves, hope it helps some of you--------------
comments appreciated!!!
Very interesting, but I can see how a document like this might be dangerous in the hands of, say, a politician wanting to curb public expenditure & save $$--"Oh, most people kick on their own?Then we can slash the budget on this Treatment centre"...I can see THAT, totally. But in some aspects it is a good thing, this article, as it shows that people are taking responsibility for their own behavior. I've noticed a rather alarming tendency, in the past 18 months, or so, maybe more, how we all seem to be living in a Culture of Blame.This is not limited to the world of addiction.This is a general trend in society to find someone, somewhere to blame (usually George Bush) when things go wrong-& hopefully it ends in a nice fat sum of $$ from the ensuing lawsuit. If more folks took responsibility for their own actions we'd be a stronger more mature society as a whole.
Answers hello
Thank-you so much for the info, i am a cocaine addict and i have been clean now 13 months.
I am at college studying drug- misuse,i will be using some of the info here towards my course work. !!!!!!!!!!!!!!
Brilliant
Emilt
Thank-you so much for the info, i am a cocaine addict and i have been clean now 13 months.
I am at college studying drug- misuse,i will be using some of the info here towards my course work. !!!!!!!!!!!!!!
Brilliant
Emilt
Dear Answers:
How refreshing! We are familiar with Peele! I could say I have quite a Peele-appeal ... LOL!!!
Thank you for posting this vital information. It's most refreshing to find a powerful piece of critical thinking on the addiction issue. I could not have remained off narcotics for over a month (and prior: five years refreshed on buprenorphine solely for pain control) if I had given in to the endless-looping "I am powerless, I am powerless, I am powerless" mantra which the 12-step programs would have had me embrace. To me and my family, their theology appears to be a setup for a self-fulfilling prophecy -- as well as permission to cop out, and of course slip and fall over and over and over again ... ad nauseam. I see this happen again and again to addicts, and I often wonder if they would remain trapped within the narrow confines of groupthink and self-disempowerment if they were not in a strict, doctrinaire 12-step mode of thinking.
Thankfully I come from a strong medical and high-level academic family that emphasized critical thinking, free thinking, freedom from religion, high IQ standards, et cetera. Had I been born in the US (I am originally from Tokyo), I fear the scope of my mind would have been utterly shattered, and irrevocably stunted and damaged -- and I never would be embarking on my Ph.D. back in my second home: Cambridge.
The only person in this forum who fully grasped my medical situation was a man whose screen name was "Silent Partner." He is gone from this group after a two-year stay. He knew how to extend help to all without being judgmental or stuffing everyone into the same treatment model.
I have met many kind people here that I will never forget, but I am no longer able to stay because of personal obligations. This is my last post and I am glad to be leaving on a happy, healthy note -- and right before my 28th birthday, too!
I wish the best fortune and highest standard of healing to all here. :-) It has been an *HONOR*.
(Bow) -- Love & Respect, Ms. Goto
A/K/A -- Ally
Laissez les bons temps rouler!
How refreshing! We are familiar with Peele! I could say I have quite a Peele-appeal ... LOL!!!
Thank you for posting this vital information. It's most refreshing to find a powerful piece of critical thinking on the addiction issue. I could not have remained off narcotics for over a month (and prior: five years refreshed on buprenorphine solely for pain control) if I had given in to the endless-looping "I am powerless, I am powerless, I am powerless" mantra which the 12-step programs would have had me embrace. To me and my family, their theology appears to be a setup for a self-fulfilling prophecy -- as well as permission to cop out, and of course slip and fall over and over and over again ... ad nauseam. I see this happen again and again to addicts, and I often wonder if they would remain trapped within the narrow confines of groupthink and self-disempowerment if they were not in a strict, doctrinaire 12-step mode of thinking.
Thankfully I come from a strong medical and high-level academic family that emphasized critical thinking, free thinking, freedom from religion, high IQ standards, et cetera. Had I been born in the US (I am originally from Tokyo), I fear the scope of my mind would have been utterly shattered, and irrevocably stunted and damaged -- and I never would be embarking on my Ph.D. back in my second home: Cambridge.
The only person in this forum who fully grasped my medical situation was a man whose screen name was "Silent Partner." He is gone from this group after a two-year stay. He knew how to extend help to all without being judgmental or stuffing everyone into the same treatment model.
I have met many kind people here that I will never forget, but I am no longer able to stay because of personal obligations. This is my last post and I am glad to be leaving on a happy, healthy note -- and right before my 28th birthday, too!
I wish the best fortune and highest standard of healing to all here. :-) It has been an *HONOR*.
(Bow) -- Love & Respect, Ms. Goto
A/K/A -- Ally
Laissez les bons temps rouler!