(Nora Volkow is the neuroscientist who directs the National Institute on Drug Abuse)

Dearest Nora (and thanks for the Passover card),

My last two posts at my blog for Psychology Today—"The End of Addiction" and "End Alcoholism—Bomb Spain" — have raised some consternation. Are they supposed to be funny, or what?

In the first, pretending to be a community college instructor, I point out that the endless optimism of neuvo-neuro theories of addiction are really rehashes of theories long past—all of which have had no actual impact on addiction. Addiction doesn't exist at the neuro-level. Addiction is given meaning— really only experienced—in a social and historic context, as I explained in The Meaning of Addiction in 1985.

This has been proven continuously in the case of alcoholism. In my "Bomb Spain" post, I begin by quoting the typical modern medical formulation that alcoholism is caused by repeated exposure to alcohol, so that the earlier people drink, inevitably the more likely they are to be alcoholic.

In physics, fake theories are quickly discarded—how long could humans maintain that the earth is the center of the universe? (Okay, so Pope John Paul II waited until 1992 to apologize to Galileo for the Church's banning of his theories in 1616. The Church doesn't like to be precipitous.)

But, in the case of alcohol—as my last post points out—cross-cultural evidence which cannot be denied (and which has now been affirmed by systematic international surveys) shows that cultures where alcohol is introduced early in a family context have far lower rates of intoxication, drinking problems, and alcoholism.

The reasons for this are partly practical—in these cultures drinking is not done in episodic bursts which produce the most unhealthy and dangerous outcomes.

But the issue is more fundamental to how humans function than that. Alcohol's image—the very way drinking is experienced—varies with cultural visions of the substance (as is true also with drugs).

As I said, these differences can never be resolved at the neurological level. Indeed believing that drug use patterns are biological inevitabilities actually influences the person's susceptibility to addiction. (I know, Nora, this is a real Escher brain twister!) Individual and cultural interpretations of drug experiences demonstrably overwhelm other considerations. Drinking within countries and cultures is remarkably consistent—and differs monumentally from drinking in others.

When you first go to Norway—a country with clean streets and remarkably nice people—you are shocked to see so much public drunkenness and alcoholism. I remember walking through a park on a Sunday morning and being stunned to find ordinary people lying where they fell drunk the night before. Where else can you see a statue of a man lying drunk in the street? But—and here's that brain twister again, Nora—Norwegians actually drink less than those in Southern European countries.

You may go decades without seeing a drunk person in Spain or Italy. Conventional wisdom was that these people were so accustomed to high blood alcohol levels their alcoholism was disguised. But cross-cultural research now shows that not only do drinkers in these countries have far fewer drinking problems—they even have less cirrhosis (an organ failure supposedly due solely to levels of alcohol consumption). It turns out that the cultural meaning of substance use is more fundamental to basic biological functions than even I could imagine!

Humans regard their own experience as inviolable truth. They believe that what happens in their minds is the way God and nature intended people to be. This is why addicts and alcoholics are positive that these substances have special effects. That is why people are convinced the way people drink around them is the way drinking affects all humans. The human mind is simply not good at transcending personal experience to imagine other ways of being—as most notably evidenced in their views about God, substances, and addiction.

This is why, my dear Nora, your effort to formulate addiction in the laboratory will never capture the truths of addiction. Yet the limits of individual experience are also what has convinced you and your colleagues that your experiments showing how cocaine impacts the brain "proves" how and why cocaine is addictive. Generalizing from your limited perspective to universal truth is actually a psychological dysfunction, just the way AA members' beliefs about their alcohol use contribute to their alcoholism.

I thought you would want to hear this from me first.

Best regards,

Stanton

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