Clashing viewpoints: But change is in the air

koalaI’m off to Australia for two weeks. I’ll be doing talks, public debates, etc, on the subject of gambling as well as substance addiction. Apparently gambling is a more serious public health issue than alcohol or drug addiction in Australia. I’ll also be spending some time on a farm somewhere where they shear sheep and herd cows. Should be a nice break from urban life in Holland.

So in lieu of a blog post, let me leave you with a link to an article recently published by David Schimke in the Chronicle of Higher Education, August 7, 2016. Despite the title, it’s a broad and thoughtful review of the whole gamut of current trends in the study and treatment of addiction, covering perspectives from biological science, social science, public health, psychiatry, and so forth. As a touchstone for this review, Schimke describes choice moments in a conference I participated in (along with Carl Hart, Owen Flanagan, Sheigla Murphy, Michael Pantalon, Mark Willenbring and others) a year ago in Minnesota. The talks, panel discussions, and ad-hoc debates ranged from antagonistic showdowns to insightful analyses of where we are now and where we’re going — which pretty much epitomizes the field overall.

Here are a few paragraphs, to give you a sense:

The panelists at the conference expressed a range of opinions about the disease model. Though their views did not break down entirely along disciplinary lines, the social scientists tended to be the most wary of the label. On the one hand, nearly everyone ceded, it’s an established fact that addiction alters dopamine receptors in the brain and can affect how the limbic system functions. There’s also compelling research that some drugs, such as naltrexone for opiate abusers, can help curb certain cravings, which suggests that dependence is at root a biological phenomenon.

Still, a slim majority of the panelists…did not want to emphasize the word “disease,” because it implies that chemical dependence is primarily a function of pathology, when in fact environmental factors (dysfunction at home, stress at work), learned behavioral patterns (binge drinking, for instance), and economic disparities have been shown to play a significant causal role. Clearly, the debate was not just semantic.

The disagreement over terms is rooted in the 1930s and 40s, when AA came of age and provided a life raft for chronic alcoholics, many of whom had been doomed to suffer crippling isolation, institutionalization, and early death.

Schimke then goes on to cover the goals, achievements, and failures of AA as it has evolved over the decades. He also reviews recent, cutting-edge research, the differing implications drawn from it, and the diverse politics, treatment philosophies, and public-health agendas that often come together more like a playground brawl than a maturing field of study.

Here’s another tidbit:

That institutional bias is, in large part, what upsets many social scientists. They’re concerned that precious federal funds are too often pushed toward studies and programming steeped in status-quo assumptions, instead of challenging longstanding treatment paradigms and biases.

And near the end:

Sheigla Murphy says she would like to see more gatherings like the conference at Gustavus Adolphus, where people from different disciplines can engage in public debate and, ideally, find more opportunities for mutual understanding and compromise.

Anyway, take a look and see what you think. I’ll be back in two or three weeks.

30 thoughts on “Clashing viewpoints: But change is in the air

  1. Mike Searles October 14, 2016 at 4:27 am #

    Hello Marc – hope you enjoy visiting Australia in a few weeks.

    ->> ‘Apparently gambling is a more serious public health issue than alcohol or drug addiction in Australia.’

    This depends on who you are talking to – and who is paying them to express their views.

    The funding for addiction related services in this country of mine is heavily government influenced – which means strings the thickness of lines that keep ships moored at port. And you have gotta tow that line.

    I’m a 58 year-old and formerly alcohol/drug addicted. Sober for seven straight years. And I know a thing or two about addiction in this country.

    Yes, gambling addiction is a problem in Australia… no doubts about it.

    But let me raise another perception – one that will surely jarr a few readers into reality.

    Cancer kills – this we know. And in Australia – given the public attention given to breast cancer (an insidious killer of women) you’d be forgiven for thinking that breast cancer kills far more Australian women in one year than prostate cancer kills Australian men.

    And you would be wrong!

    Facts don’t lie. More Australian men die each year than do women from breast cancer.

    But breast cancer gets more of the ’emotive’ attention. The fundraisers of research into breast cancer ensure this is the case.

    What’s cancer got to do with addiction? Nothing directly… I’m making a point. And it’s this…

    Perception creates reality — even more than reality itself.

    In somebody’s perception – gambling addiction ‘is a more serious public health issue than alcohol or drug addiction in Australia.’

    Sorry – but somebody is also spreading ‘propaganda’ to meet an agenda.

    I’m annoyed to think somebody is spreading such falseness…

    Marc – I sure hope you get the chance to check some truly independant views on what addictions in Australia are more serious serious health issues than alcohol or drug addiction..

    Gambling, I would strongly suggest, it definitely not one of them.

    • Marc October 14, 2016 at 4:37 am #

      That’s really interesting, Mike. It sort of fits. Addicts everywhere tend to be demoted or sidelined, unless they make a lot of noise. Organs of policy, public health agendas, and just public dialogue often express the wish that they’d just disappear off the edge of the earth. I wonder whether gambling is touted more vociferously because well-functioning, middle- or high-income people suddenly go bust, their families fall apart, their children’s education falls apart, etc, etc.

      I’m also going to be giving a talk about addiction at another event, also in Melbourne, and I’ll be in some debates and interviews with others who are deeply involved in addiction work. So….I guess I will see that side of things as well.

      • Gabi Byrne October 14, 2016 at 7:50 pm #

        Mike is not correct when he states that gambling is not a serious health issue. The fact that it is State and territory governments in Australia increasingly rely on gambling tax for revenue, which helps explain why Australia is currently going backwards on the issue despite clear evidence of a public health threat. The damage that gambling especially poker machines cause in Australia is demonstrated in the award winning documentary Ka-Ching directed by the late Neil Lawrence http://kachingfilm.us11.list-manage1.com/track/click?u=1aeb3769a3895b1acf6117474&id=6d688ea0f7&e=886af9cd22
        I am very much looking forward to meeting you at the conference.

    • Terry October 16, 2016 at 5:33 pm #

      I agree. unfortunately the whole issue of addiction is clouded in Australia primarily by the media using, especially drug use, as a reason to sell copy through sensationalistic reporting creating fear. The current scourge that is creating axe wielding zombies is Ice. Drug users are demonised in this country and little ground is being made in drug law reform due to the media influences on public opinion and governments at all levels that are too afraid to make any decisions of any controversy. even gay marriage has fallen over recently as they fight amongst themselves. the biggest addiction issue in Australia is alcohol.

  2. Annette October 14, 2016 at 4:57 am #

    Thanks, Marc! It sounded like fireworks. I guess addiction treatment is founded predominantly on our internal biases, versus actual science….? 😉

    Whilst you’re in Oz, you should look up Chris Raine, who founded the online forum, http://www.hellosundaymorning.org. Thousands of members from all over the world, mostly 30+ who are looking to quit drinking, or severely moderate! I’ve been posting there for almost 18 months. He and his team are developing an app which they’re launching soon – it will be alongside the conventional website.

    A few have tried AA, and swear by it, but most want something that’s emotionally supportive – community – without the Higher Power model and shame/guilt which AA seems to inculcate in people.

    I think God gave us our prefrontal cortex all those thousands of years ago to USE it. That part of the brain is vital in making changes and self belief is paramount. Many can and will overcome addiction, of all kinds, but we need to look into all the factors which create and then keep people mired in addition, which includes our culture. $ Billions are being made from addicted people 🙁

    I stick to mindfulness, reading up about addiction and enjoying every day free of any substance, which is mostly amazing! Any crap days are more easily overcome because I’m not hungover or feeling anxious!

  3. Marc October 14, 2016 at 5:06 am #

    Hi Annette. I just learned about that organization — apparently the biggest addiction support site in the word. Someone got in touch about the positive language you guys use, in lieu of the scare tactics that are so common, both in AA and elsewhere. Seems to me like a breath of fresh air, and I also appreciate the emphasis on control/cutting down as an alternative to total abstinence. Almost managed to arrange a visit, but not quite.

    Anyway, looking forward to being in your lovely country soon…not so much the 24-hour flying time to get there.

  4. paul October 14, 2016 at 8:13 am #

    It is a good reference. Thank you.

  5. William Abbott October 14, 2016 at 10:10 am #

    Watching the whole conference was a treat , Marc’s fine talk was the keynote but the best part was seeing him mix it up with Eric Kandel 🙂

  6. Jo October 14, 2016 at 10:45 am #

    As an addict who no longer uses (11 years now) or attends 12 step fellowships of any kind for about 7 years, I need to say that control/cutting down never worked for me. Abstinence was the only way. Also the only way I could even come close to getting a foundation to start building any self worth was through the support of other recovering addicts in those first few years. Things are different for me now, and Ive been able to use the coping tools I learnt from NA as that very foundation, I suppose, to rewire my brain, and change my thinking and my response to life in general as opposed to reacting through being fearful of pretty much everything all the time. Most of the other addicts/alcoholics (it’s all the same to me) were in such a desperate state to stop using that NA or AA was the last stop after trying many other approaches. I don’t believe I have a disease, and never did, but the identification with the community of recovering addicts was certainly the only support that I could trust. But, I also believe that staying in that environment for too long ( for me 4 plus years was enough) can halt deeper recovery from underlying issues. But hey, different strokes for different folks I guess!
    Happy travels Marc, be safe.
    Jo.

    • Marc October 16, 2016 at 10:47 pm #

      Hi Jo. Thanks for your good wishes. Although most of us recognize how different the process can be for different people, your story seems to highlight some general truths. I think it’s particularly hard to not quit in full before going on to “controlled use” — which is also James’s (the author’s) experience. And then, as many people say, why bother with it?

      But though drugs and alcohol look the same in many ways, they’re not the same viz controlled use, in that taking most drugs gets you out of a culturally normative context, back into that old whispery world of triggers and life on the edge. That’s too big a context shift for most people to stay “in control,” and they fall back in, whereas as I think with alcohol you can stay more or less in the middle of your culture and do the control experiment. You rarely hear of controlled heroin use, though sometimes you do.

      And what you say about being immersed in the recovery community, that there’s such a thing as too long — I hear that a lot. Check out this marvelous article by April Smith: http://theinfluence.org/overcoming-problems-with-substances-is-great-but-recovery-month-rubs-me-the-wrong-way/

      • Eric October 20, 2016 at 1:15 am #

        Hi Marc, controlled use(microdosing) of psilocibin has helped me with depression and when I need to take an “impartial” view of my circumstances. Also a recent dmt experience(my only one) quite significantly changed my perception of myself and my place in the world. Mindfulness when taking these substances is important in using them as a tool. Cheers Eric.

  7. Matty H. October 14, 2016 at 11:22 am #

    I’m skeptical of the idea that those brain changes have any effect at all. I mean, we see that people with those changes quit, right? And then years later, when those changes are reversed, some of them go right back to heavy use for one reason or another. Is there actually any established correlation between the amount of drug use and the severity of those changes, let alone causation?

    • Matty H. October 14, 2016 at 11:27 am #

      P.S.: Let’s say I’ve been drinking heavily and as a result of that, those brain changes are obvious. But then I quit drinking. I assume those changes don’t abruptly reverse immediately? And yet, I’m not drinking at all. It takes those changes a while to reverse, and yet in this time the amount of my drinking is a steady zero all the way. Do you get what I’m saying here? That there’s not even a correlation between my behavior and that particular brain state?

      • Marc October 14, 2016 at 11:34 am #

        In that sense you’re completely correct. So lasting brain alterations don’t condemn a person to ongoing use. In fact, some research shows that the “addicted brain” starts building new circuits for self-control when people quit. (I write about this in my book.) So brain change can precede, follow, or correspond with changes in behaviour.

        • Matty H. October 14, 2016 at 2:01 pm #

          Ah, I see, I see. I have to read your book. 🙂 I’ve been meaning to for a while now.

    • Marc October 14, 2016 at 11:31 am #

      Good point, Matty. I was interested in this myself. But the research shows that increased pruning (or decreased synaptic density) in a few choice regions of the prefrontal cortex and closely related areas does indeed correlate with duration of addiction. Which you can also read as depth of addiction. There are similar correlations with binge eating disorder. The common interpretation is that there is a loss of connectivity with ongoing drug use (or other impulsive/compulsive behaviour patterns). But it’s also possible that individual differences in cortical structure (preceding any drug taking) create different degrees of vulnerability to ongoing use. I think the first model is more interesting, but take your pick.

      • Matty H. October 14, 2016 at 11:39 am #

        Oh, I see. That’s interesting. I didn’t know that.

        • Matty H. October 14, 2016 at 11:57 am #

          This leads me to another question: So it’s not actually the alcohol (or any other substance) that causes those changes, but a certain type of behavior, regardless of what exactly the object of addiction is?

          • Marc October 15, 2016 at 9:04 am #

            Yes, exactly. Drugs and booze do NOT cause brain change unless taken at toxic levels. What causes brain change is the ongoing repetition of a highly attractive behaviour and the repeated surrender of control.

            • Matty H. October 15, 2016 at 10:27 pm #

              Thank you for all the interesting information. I appreciate it.

  8. Adriana October 15, 2016 at 12:41 am #

    Hi Marc,
    So exciting you’re coming to Australia! Could you please send me the dates and locations for public talks, I can’t miss the opportunity to hear you and meet you in person. Really admire your work!
    Thanks
    Adriana

    • Marc October 15, 2016 at 9:00 am #

      Hi Adriana. Your email address isn’t working for me. I’ll be in Melbourne from Monday to Friday. Let me know if you want details.

      • Adriana October 20, 2016 at 8:33 am #

        Hi Marc,
        Yes, would love to know the details. I’m in Hobart Tasmania, (let me know if you have time to visit!) but can organise a flight if there’s still time!
        Could you please try adriana.neumeyer@gmail.com? Thanks 😀

  9. Michael October 16, 2016 at 8:01 am #

    Hi Marc, I look forward to again seeing you speak this time at the Turning Point Symposium this coming Thursday after having seen you in both Melbourne and the Sydney Opera House for last years festival of dangerous idea’s. With the influence from your book and with Maia’s book Unbroken Brain there is a real shift from many leaders in the AOD sector in Melbourne taking place. Michael , Family Drug Support

    • Marc October 16, 2016 at 10:34 pm #

      Hi Michael. Please come and say hello and let’s have a coffee or something. Thanks for such a personal welcome back to Australia, and for the mind-blowing idea that my work (and Maia’s) is actually having an impact here. Australia is beginning to feel like a second home, work-wise, almost a first home. It’s good to be back! (it’s an eerie reminder: every time I come here I get stopped in immigration because I’ve got a conviction or two on my record…I start thinking, that was me a long time ago)

      I’m at the Grand Hyatt if you want to get in touch before the conference.

  10. Glen October 16, 2016 at 11:14 pm #

    Learning about addiction is the first step in winning the fight. We have a massive problem with methamphetamine in New Zealand and reading web sites like http://www.activetestingsolutions.co.nz makes me think that we need to concentrate on the addiction as well the after effects.

  11. Gary October 17, 2016 at 12:59 pm #

    It seems some people would rather criticize and/or finger point at what “they” say doesn’t work or is “out-dated” instead of accepting that their are numerous ways to healing rather it be “old-Age” , “New-Age”, “evidence-based” or “Scientific” methodologies. Who am I, or anyone else, to say what is best for anyone? Perhaps it’s the mind itself, needing to be right, that conjures up what is right or wrong. Terminology and buzz words appears to catch the ears of many such as “Mindfulness”, Motivational Interviewing, Cognitive Behavior Therapy, etc..,

    We are just people who suffer with similar like problems no matter where you reside on this planet. “We” (society) have created that which we don’t want all in the pursuit of money. The issues around addictions, in many respects, are byproducts of the systems in which we live. Gambling, all over the world, brings in huge bucks despite how many people are impacted due to financial crisis, bankruptcies, suicides, divorces, multiple addictions etc.

    There is one drug that causes more death and destruction than gambling, alcohol or other drugs combined and that is Nicotine Addiction. Usually nicotine is the first drug of choice and the very last one to ever put down, that is if you can. The problems in Australia In terms of gambling, aren’t unique to Australia, although I’m sure they have their own significance.

    However, if a person gets help for their addiction via professional therapy, self-help, joining a gym, going back to school, volunteering, meditating, etc…as long as its makes a difference for the person in ways that enhances their life why knock it. Can we ever really see, listen or perhaps ever learn given the enormous depth of conditioning that we have endured. We make judgments, accusations, predictions, etcetera with a mind that rarely, if ever, Clear. A clear mind doesn’t have any need to judge and/or perhaps to even choose. However, a conditioned mind tends to choose within the circumference of a pattern or knee-jerk reaction.

    At the end of most problems, in our culture, you are likely to find “Money”!~

  12. matt October 19, 2016 at 5:25 am #

    I facilitate recovery meetings of different formats and “philosophies,” usually framed around the platform of SMART Recovery. Often, someone who got sober through 12-Step will introduce themselves with something like this: “I got sober through AA 12 years ago, and it saved my life. I love the fellowship and the friends I’ve made. But it’s just not enough. There is something missing, so I thought I’d take a look at what else is out there.”

    People in “recovery” are on a difficult journey of navigating a profound change in their lives. Addiction, whether it’s deep limbic learning, a disease, or a spiritual malady, is a coping behavior. But at some point, if we’re lucky, we see that it has become an unnecessary coping behavior that has trained us to settle for less.

    It helped us adapt to difficult situations that caused heightened anxiety, and gave us a feeling of control in our lives. But that control over immediate relief from our anxiety that came from feeding the brain’s reward circuitry, also obscured long term goals and plans. And it stunted the developmental effort necessary to achieve them. So we settle for less.

    This settling for less is stark and salient in addictive behaviors where our consciousness isn’t altered by substances– like eating, gambling, sex and åshopping. Many people whose addictions don’t involve substances can feel even more acutely the malaise that arises around addiction, the feeling of “is that all there is?”

    The existential malaise that persists can be lifted by helping people find or regain purpose in their lives; to give them back their self-concept of uniqueness, worthiness, and belonging. Human interaction and identification—like meetings—can facilitate this. Otherwise the hamster wheel keeps turning, and we continue to settle for less.

  13. Carlton October 19, 2016 at 6:34 pm #

    Hi Marc,
    Yes, this is generally true;

    “Addicts everywhere tend to be demoted or sidelined, unless they make a lot of noise.”

    But it is also generally true that ex-addicts tend not to relate to addicts as they once used to, and the motivation to help, generally and naturally evaporates.

    For example:

    Concert halls, Theaters Halls, Sports stadiums, etc, are filled with people that share a sympathetic bond with the the others present, not unlike how Addiction support groups and Programs do.

    If a persons thoughts, feelings or beliefs change, the sympathetic bond changes too,
    and naturally, they do not continue to spend their time and energy being involved.

    The point is, studying ex-addicts that are no longer involved may help lead to a deeper and clearer understanding of addiction and recovery.

    Paradoxically, Recovery itself generally effects the motivation of ex-addicts to participate, and those that do, have generally stayed involved the the field in some manner, and have a different perspective.

    Currently, the definition of Recovery is still unclear, but as your post title states, change IS in the air.

  14. Karen October 23, 2016 at 6:01 pm #

    Kandel’s assertion that anything that any finding which can’t be replicated is “bullshit”, is the typically defensive reaction of someone whose funding is threatened by a paradigm change! This insistence on meticulous replication of findings in tightly controlled environments, costs money, and is sometimes like studying the arrangement of the deck chairs on the Titanic.

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