Category: Connect

Hello, my lovely blogites. It seems you are among the few recognizable lifeforms left on my computer — my computer whom I now love, hate, and mostly mourn. I had the most terrible “accident” — or maybe it was an act of God — the sort of biblical God who goes around punishing people for being too proud or too successful, eating from the Tree of Knowledge or something.

The good stuff:

It has been an amazing week, and I wanted to share it with you. The book is doing fantastically well. (Here comes the boasty part, but I don’t have to worry about being struck down by lighting because it’s already struck.) The sales rank on Amazon.com hovered between 1,000 and 2,000 for a week or two. That’s out of ALL books. I mean, all the books in the world. (They’re all for sale on Amazon, right?) Including Tolstoy and, I don’t know, Daniel Dennett and Malcolm Gladwell and… And (get this) this week The Biology of Desire got up to #13 in sales of ALL books on Amazon.ca (I’m Canadian — that’s got to count). Move over Margaret Atwood (just kidding, God. Joking…) And it was #1 in substance abuse AND neuroscience on Amazon.ca. It’s # 82 today — still in the top 100 for all books. And, okay, it’s now #2 in neuroscience. But still. AND it was selected as a best book of the month.

The tour:

The week started in New York City: three days of radio interviews. They mostly went just fine, which is one of the main reasons why the book is selling well. By the last one, NPR New York, I was on a roll. Many interviews started off with questions like “Why do you say addiction is not a disease?” There were times I felt like saying and even times when I did say “Whyever would you think it is a disease?” But mostly I behaved well and answered the questions sensibly. It was an experience: going over my own reasoning time and time again, thoroughly convincing myself that I was right.

After a quick visit to California to see family, I ended up in Vancouver. Russell Maynard is the person actively running the Portland Hotel Society, the group that established the famous INSITE supervised injection site in Vancouver’s Downtown Eastside. That and quite a few residences for the impoverished and fragile community of addicts who call these few square blocks their home. Russell took me to many of their facilities. I watched people shooting up without shame or fear….and I met a lot of caring and dedicated young people who help to make sure they stay safe. I’ll share my impressions of that strange tour in another day or two. I’ve never seen anything like it.

The bad stuff:

That evening, my computer had an out-of-body experience. Unfortunately it never came back. All my meticulously saved and organized files within folders within folders within folders — hundreds or thousands of articles on addiction and such, many drafts of things I’ve written or partly written, a huge collection of Firefox bookmarks, the couple of dozen passwords I’ve saved — all gone. Except for the 10% of stuff (luckily including most talks) that I backed up on Dropbox.

The guy at the data recovery store here in Toronto (I arrived on Wednesday) said he’d never seen this particular disappearing act before. But luckily, as he wrote me the next day, most of my data had been recovered. I eagerly got to the store and opened my computer, went to the folder named “Recovered Data,” and indeed there were hundreds, maybe thousands of files there. They all had names like PDF-00162.PDF or D00148.doc. Well, these seemed not very useful, but I would deal. Except that most of the files had bits of text or weird graphics or they just refused to open. My pdf files had degenerated from the latest findings in the neuroscience of addiction to stuff like this.

Have you ever seen these images? Some came with Russian or Chinese text. It was sort of like being laughed at by a coterie of drunken computer deities. Here’s your information bud: don’t lose it this time. Hah hah!

I keep thinking, the book is out, I don’t really have to keep most of this stuff…maybe it’s time to find a cave in the Himalayas and take some time off. Other times I just feel incredibly pissed off. Or stupid. Or…maybe slightly relieved.

But today is Saturday: no interviews or anything else for a couple of days. That’s a good thing. I’ll wait until Monday before I worry about what’s next.

Isabel and I want to share this with you. We hear a lot of former and recovering addicts describe the grim and lonely hours waiting for them on the far side of their addiction. The loneliness and bleakness are real, but that’s not the end. It’s a stage in a transformation that can be breathtaking.

WILD GEESE

-by Mary Oliver

https://www.youtube.com/watch?v=lv_4xmh_WtE

…by Matt Robert…

Consider what you believe about the causes of addiction. Now consider what you think about the importance of anonymity in recovery communities. Is there a relationship?

  Yes, at least historically. In the very early days of AA, most people viewed addiction as a moral failing or a character defect. There was no disease model to ground the argument that addiction should be treated. In the 1930s, anonymity was a saving grace in the design of AA. People could enter recovery in the company of others who understood their experience. Progress could be made without the shame of exposure to the society at large.

Currently, it’s useful to make a distinction between two kinds of anonymity: personal anonymity and public anonymity. Personal anonymity is a right that any person has to choose when, how, and whether to reveal their personal circumstances to others. In my view, as long as there is addiction, some will choose to remain personally anonymous in their recovery efforts, and this right must always be respected. Public anonymity is something else. It refers to the requirement, put in place in the early days of AA, that a member can never “go public” with their membership in AA, or talk about the enterprise in a public way.

Recently, a number of strong voices have come out arguing that public anonymity has outlived its usefulness in the recovery community. This does not mean that meetings would be televised, or that rosters of membership would be published, or that individuals would have to reveal themselves in any way. Rather, it means that when some individuals choose to go public they should not be censured or ostracized by the recovery community, particularly the 12-Step community. The film The Anonymous People makes this issue vivid and compelling.

The film draws a link between public anonymity and beliefs about the causes of addiction. When the disease model became more prevalent and well-accepted, personal anonymity was still useful for most people as they entered treatment. But as the comparison between alcoholism and diabetes, or heart disease, became more commonplace, it became possible for some people to imagine a world of recovery that allowed personal anonymity but did not require public anonymity. If it’s a disease, just go into treatment. And furthermore, let’s publicly advocate for more treatment funding!

Even though the policy of public anonymity in AA is motivated by the goal of subordinating personal aims to larger principles—no monomaniacal “leaders” needed, thanks—some feel that it is now getting in the way of the recovery community’s need to advocate for more treatment and less shame. And that brings us to the latest views on the causes of addiction.

Many of us are now contemplating the views of Stanton Peele, Gabor Mate, Maia Szalavitz, Marc, and others, in which addiction is not a disease but a phenomenon of deep (and pernicious) learning triggered by personal suffering. What—if anything—does this view imply about anonymity of either kind, personal or public? When addiction is conceptualized as learning rather than disease, maybe we should go back to feeling ashamed—ashamed that we were dumb enough, miserable enough, or indulgent enough to allow ourselves to learn to be addicted. Or maybe we were just unlucky enough to be born into a situation where addiction was the best option out of a limited set of coping mechanisms. But still, that’s not quite as innocent as contracting an illness, which could happen if you were in the wrong place when someone sneezed (or because you just happened to get the wrong copy of some dopamine receptor allele).

Or perhaps the learning model of addiction will allow us now, even more clearly than before, to see addictions as something to be accepted and addressed in the open, where we can come to grips with the developmental and environmental variables that make people vulnerable. This post is a call for us to begin to consider the complex issue of anonymity from the new vantage point of addiction as learning.

I was overjoyed to see that Salon.com published a large excerpt from the first chapter of my book. (The headline may still be on the front page!) Until I saw the title: Addiction is Not a Disease. Good so far… Then: How AA and 12-step programs erect barriers while attempting to relieve suffering. Not so good.

They got the phrasing directly out of the excerpt (i.e., the book), so I can’t fault them on that. But now I understand the double-edged buzz/sting of being taken out of context. Nice to be taken… Thanks, guys! But does it have to be out of context?

There’s been enough AA bashing in the last…I have no idea how many years….to just give it a rest. Anyone knowledgeable about the addiction field knows that their success rates are far from stellar: estimated at 5-10% by Lance Dodes (an articulate critic) and other sources. Take a closer look and you’ll see that the way they estimate success is rather stringent, as it depends on total abstinence, and many of us believe that AA/12-step groups do not serve a cross-section of addicts. They serve those who are in the worst trouble. And they’re free. And they’re a support group, not a treatment organization. Etc. Etc.

It’s true that there’s been a sort of merger between 12-step programs and the disease model, mostly manifested in institutional settings such as residential rehabs. This has been going on for decades, due mostly to the influence of mainstream medicine and the coercive power of the court system. It’s exemplified by the doctrine that addicts had better follow the 12 steps in order to fight off their disease — or else. Of course I oppose this view. But it’s not the heart of AA/12-step philosophy as I understand it. Rather, it’s an unfortunate branch in the evolution of a rehab industry that often feeds off the worst of both worlds.

If you want to get an even-handed picture of the pros and cons, truths, myths, and lies about AA/12-step, I suggest you go to Anne Fletcher’s recent article: Setting the AA Record Straight.

I wanted to set my own record straight. Salon.com has a huge circulation. I respect a lot of their coverage, and I’m always up for healthy debate.

But, as my readers know, my book is about reframing addiction as a learning process, countering the dominant view of addiction as a disease, showing why this reframing is scientifically valid, showing why it makes sense in the lives of those affected, and suggesting implications for new perspectives in the science and treatment of addiction.

It’s not about AA.

Addiction.com invited Nora Volkow to pit her “disease” argument against my (and others’) “learning”  model of addiction. She declined, or at least didn’t agree, but I’m happy to announce that we have finally sort of crossed swords in the Huffington Post Blog network.

Here’s her initial post and here’s my response. And I’m really pleased that my response appears on the front page…that column of posts on the left side of the page…next to all that nasty news of the world.

I’d love it if we had a chance to engage in this dialogue directly. But…I don’t fault her. She’s an amazingly prolific neuroscientist, as well as an NIH administrator, and she probably gets publicity requests of one kind or another  20 times per day.

I’m just glad that we anti-disease campaigners got our foot in that particular door…and I do mean we.