Ultracrepidarianism

"Ultracrepidarianism" is a wonderful word. It refers to giving opinions and advice about things a person knows nothing about. We've all been subject to this aggravating experience, forced to listen to people with little experience or knowledge insist they know best about a subject. Sadly, this occurs often in the field of addiction.

One reason is that research in the field of addiction is like the proverb of the blind men and the elephant. One man feels the trunk and says, "This animal is like a snake." Another feels the leg and says, "This animal is like a tree." And so on. In addiction, the matter is complicated because the blind men are actually touching entirely different animals. Those who investigate, and are trained and knowledgeable about the effects of drugs on the brain say, "Drugs affect the brain, so that is the nature of addiction". Others look at physical tolerance and withdrawal (physical addiction) and say, "People get physically addicted, so that is the nature of addiction". Psychologically trained people look at the facts that people switch between drug and non-drug compulsive behaviors, that addictive behavior is precipitated by emotional upset, and that addictive behavior is treatable with psychotherapy and even group support and say, "Addiction is a psychological symptom."

So, like the blind men, who is right? The answer, of course, is that these men are seeing different animals. Drugs do have an effect on the brain. But that is separate from addiction. If the brain effects of drugs caused addiction then people could not shift as they often do from drug addictions to entirely unrelated non-drug compulsions, including compulsions that have no pleasure. If addiction were caused by a chronic brain disease then it wouldn't be treatable by talking to people (psychotherapy) or group support (12-step programs), or even no treatment (alcoholism has a 5% "spontaneous remission" rate). And, most important, the only way to truly study the "brain disease" idea is to take a large group of people from the general public, expose them to high doses of a drug, like heroin, thereby producing the brain effects in them, and see if they become heroin addicts. This is of course exactly what was studied by Robins in the 1970s, and her famous result was that these people did NOT become heroin addicts. Nor did the millions of people given high doses of narcotics for medical reasons leave hospitals and go out to find the local narcotic pusher; they did not become addicts. Thus, the researchers knowledgeable about brain effects of drugs were indeed seeing brain changes but erred in expressing opinions about what they did not know or pay attention to: the lack of effects of those brain changes on causing addiction in human beings.

The same applies to those focused on physical addiction. They were correct to say physical addiction is a very real medical condition. Their opinion about its importance to the nature of addiction, however, was based on ignoring the fact that people return to addictive behavior when there is no longer any physical addiction (after detoxification) or the existence of addiction where there has never been physical addiction (as with drugs like marijuana and all non-drug addictions).

What about those of us with psychological training and knowledge? We would be ultracrepidarian if we denied the existence of other areas of research about the brain effects of drugs or the presence of physical addiction. But, while knowing about that work, we pay attention to the overwhelming evidence that those factors do not explain the nature of addiction, as well as the positive evidence that addiction is fundamentally a psychological problem. We understand that the elephant does have tree-like legs and a snake-like trunk. But we see that these do not describe the animal, which is actually a very different kind of creature.

Those who insist that they know the nature of addiction while failing to be knowledgeable about its psychology are guilty of ultracrepidarianism. That is more than aggravating. It produces false conclusions and bad treatment.