The Disease Theory Succeeds by Failing Part 2: Drug Cures
Heard about some pills to cure addiction lately? It's BS.
Posted February 5, 2014
News Item: According to the LA Times (via the NY Daily News), along with 50 bags of heroin, Philip Seymour Hoffman was found with FDA-approved buprenorphine (brand name Suboxone), which has become the medication of choice for many for treating heroin and other narcotics addictions.
In 1979, leading neurologist Richard Restak wrote about the brain chemistry of endorphins, calling them "a veritable philosopher's stone—a group of substances that hold out the promise of alleviating, or even eliminating, such age-old medical bugaboos as pain, drug addiction, and, among other mental illnesses, schizophrenia." Writing in 2013, the New York Times's Pam Belluck and Benedict Carey said of neuroscience research: "Decades of spending on neuroscience have taught scientists mostly what they do not know, undermining some of their most elemental assumptions."
What do you think is the most remarkable neuroscientific discovery? If I then asked you, "With what mental disorder (which includes substance use disorders) has neuroscience revolutionized treatment?" you'd be at a loss. There is no treatment revolution that has arisen from neuroscience research.
But as to the first question, you'd probably say "addiction." This is because of a nonstop flow of publicity about great new brain discoveries in relation to addiction. Recently, the Wall Street Journal published "A Pill to Cure Addiction?" based on a study reported in JAMA Internal Medicine. The article trumpets the cure for addiction by "transforming" the brain's "chemical architecture."
Of course, the study's actual results—that just 17 percent of alcoholics who received the highest dosage of the drug abstained, while a larger group, 28 percent, drank without bingeing—are a world away from revolutionizing addiction treatment. But, more critically, the view of addiction in the WSJ and conveyed by the research reveals a basic misunderstanding of why—and how—people overcome addictions.
Worse, this view makes it less likely that they will do so. Contrary to the idea that withdrawal is the hardest part of quitting, people kick drugs and alcohol all the time. Most rehab patients abstain in treatment, only to relapse afterwards. The real task is not to quit, but to stay quit. This research, which measured the drinking of alcoholics treated with the drug gabapentin for only the twelve weeks of the study, doesn't tell us that.
Consider one study participant, Kathy Selman, described by the WSJ. She didn't actually know if she was on gabapentin, which means she may have experienced a placebo effect. She felt that she was taking the drug because she became depressed after completing the 12-week course of capsules. But becoming depressed after ceasing the medication would be a prompt for her to resume drinking. According to Ms. Selman, she relapsed in the past whenever she tried to quit but faced economic stress.
What was different this time? Ms. Selman says that she still faces a good deal of stress in launching her business ventures (one of which is now addiction coaching). But, she told the Journal, as a part of the research "she learned how stress triggered her desire to drink and ways to cope with the related wave of anxiety." Her story points mainly to the benefits of cognitive-behavioral counseling, not the drug.
Let's examine some of the major insights research on addiction has yielded over the years. In a study of Vietnam vets addicted to heroin in Asia, fewer than 10 percent remained addicted stateside—even though a third used a narcotic here. It isn't really surprising to learn that soldiers addicted in a war zone ceased relying on the drug when they returned home. Unless, that is, you are one of the anointed addiction "experts" who claim that a person, once addicted, can never escape this fate.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA), which funded the research reported in the WSJ, conducted its own research that confounds the JAMA study. Called NESARC (National Epidemiological Survey on Alcohol and Related Conditions), the study interviewed more than 43,000 Americans about their lifetime drinking. The NIAAA reported: "Twenty years after onset of alcohol dependence, about three-fourths of individuals are in full recovery." Moreover, the large majority of these were never treated for alcoholism nor joined AA! Also surprising to those anointed experts, as in the JAMA study, a majority of those who recovered in NESARC drank at "low-risk levels without symptoms of dependence."
In another recent study, the Center for Global Tobacco Control at Harvard tracked smokers trying to quit who either did or did not use nicotine gum or patches. The investigators found that those who used nicotine replacements to quit didn't do better than those who quit without it. In fact, the most dependent smokers were twice as likely to start smoking again if they used these aids than if they did not!
Those heavily dependent smokers who relied on the replacement drug were convinced they couldn't succeed without it, and thus they relapsed when they stopped using the chemical boost. As Maia Szalavitz noted in a Time article entitled "Defining Obesity as a Disease May Do More Harm Than Good": "labeling something a disease increased pessimism about recovery, probably because people assume that as diseases with biological and genetic bases, they are immutable."
And, yet, the neurochemical thrust is infiltrating our society with the notion that all of our addictions (which now go far beyond drugs and alcohol) are diseases that only medicine can cure. This is the message propagated by the heads of the National Institute on Drug Abuse, first Alan Leshner and now Nora Volkow, and by the freshly minted medical subspecialty the American Board of Addiction Medicine.
The "medicine cures addiction" message is wrong: Most people quit smoking, alcoholism and drug addiction on their own. They do so primarily due to their desire to quit. This desire is marked sometimes by previous failures—the CDC lists frequency of attempts to quit smoking as a primary predictor of ultimate success, since these efforts bespeak the intensity of the smoker's motivation.
For Selman, this motivation included both her work and her fear that her "two sons would only know her as an alcoholic." On top of this motivation the critical elements for her overcoming addiction are her beliefs that she is capable of quitting (without which some addicts doom themselves) and that she can live a fruitful life without it. She illustrates that recovery, whether through treatment or self-cure, requires faith in oneself and a life purpose.
This study—and neuroscience—have told us nothing about these things, and never can.
P.S. According to the LA Times (via the NY Daily News), along with 50 bags of heroin, Philip Seymour Hoffman was found with FDA-approved buprenorphine (brand name Suboxone), which has become the medication of choice for many for treating heroin and other narcotics addictions.
Stanton Peele's new book (with Ilse Thompson), is Recover! Stop Thinking Like an Addict and Reclaim Your Life with The PERFECT Program. Follow his guided self-cure program at lifeprocessprogram.com