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Stanton's Blog

August 24, 2008

From God's Mouth to Biden's Ear -- Addiction IS a disease, and it's against the law to say otherwise

Joe Biden has had some ups and downs in life. As a young Senator, his wife and infant daughter were killed in a car wreck. During his 1988 bid for the presidency, it was revealed he cribbed sections of other politicians' speeches. He had a life-threatening aneurism.

Whatever problems he has had and overcome, however, Biden is an addiction nut. Thus, his remarkable effort to compel government agencies to call addiction a disease, titled the "Recognizing Addiction as a Disease Act of 2007," has been introduced for debate in the United States Senate this month.

Biden's nutty, mistaken bill will rewrite government language regarding addiction and recovery. Outside of China, most technologically advanced countries don't pass bills announcing scientific truths. Einstein had to muddle along seeking recognition and acceptance of his ideas from the scientific community, while Galileo labored under the Catholic Church's declaring that his finding that the sun was the center of the solar system - not the earth - was doctrinally unsound.

Biden is seeking to replace the word substance "abuse," which suggests that addicts intentionally abuse substances. Well, some do. What about all the people who abuse substances who don't achieve the level of addiction (or "dependence"). DSM-IV (for which I was an advisor) divides substance use disorders into "abuse" and "dependence" categories, which is already a complex oversimplification.

And nearly all addicts are aware at various points in their careers that their use is excessive, negative, and dangerous - as a result of which many quit. Some do not, at least right away. But you can't capture this complexity by replacing the term "drug abuse" with "brain disease."

In fact, Biden's bill, while oversimplifying, self-consciously recognizes it is oversimplified (see below) - note such formulations in section (1) as "it is considered a brain disease," "scientists have identified many of the biological and environmental factors that contribute to" (let's not go out on a limb and say something definitive here). As for personal shame and social stigma in part (2), what if an addict kills a child in their care. Should they be ashamed? What if people quit addictions like smoking because they can't take the stigma of huddling in the courtyard with other smokers, or if addicts or alcoholics quit drugging or drinking because they don't want their children to be ashamed of them?

Here is the bill:

S. 1011: Recognizing Addiction as a Disease Act of 2007

Sponsor: Sen. Joseph Biden [D-DE]

Introduced: March 28, 2007

Schduled for Debate: August 1, 2007

(1) Addiction is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain's structure and manner in which it functions. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs. The disease of addiction affects both brain and behavior, and scientists have identified many of the biological and environmental factors that contribute to the development and progression of the disease.

(2) The pejorative term "abuse" used in connection with diseases of addiction [note that part (1) itself speaks of "people who abuse drugs"] has the adverse effect of increasing social stigma and personal shame, both of which are so often barriers to an individual's decision to seek treatment.

I like Biden because he is independent, brave, hard-headed, and says what he believes. But isn't this bill getting into totalitarian territory, declaring what researchers and clinicians may call and regard a problem? I have never, and will never call addiction a brain disease (although once HBO joined with the National Institute on Drug Abuse in declaring this God's truth it amounted to an official coronation).

When Jeff Schaler got me kicked off the St. John's server (including addiction groups on whose boards I served) after I disagreed with how he handled opponents to our anti-disease views on the Controlled Drinking/Drug Use Listserv, I thought I was as much in Siberia as I was likely to get. But now I suppose the government could declare my views on addiction illegal and confiscate my computer. However, even if they put me on the rack I won't say addiction is a brain disease -- you have to stand for something.

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

August 23, 2008

At long last sanity -- The Amethyst Initiative

As described in a previous PT blog, 100 university presidents signed the Amethyst Initiative, asking to lower the drinking age from 21 to 18. Two initial signatories (both from Georgia, where American temperance traditions of abstinence-binge drinking run deep) immediately withdrew their support under pressure, but then 20 more presidents signed on.

The debate is not likely to be based on data - as the sound bites arising from each side in this superheated environment make clear.

What is important is that a respectable interest group has spoken up for the most ethically clear and psychologically sound principles. The United States is the only Western country that delays legal drinking until 21. As Americans, we are forced once again to ask, "What the hell is the matter with the rest of the world?" Everywhere else, people realize you can't prevent 18-21-year-olds from drinking, you can only encourage them to drink in more antisocial, guilty, and illegal ways - which is what we do.

The bizarre ritual of sanctioned binge drinking takes place on virtually every campus around the country (I remember asking a young man who attended a Christian Science college where he learned to drink - "At college, like everyone else," he answered). Instead of taking an opportunity where young people are in a protected environment which wraps around their entire lives to teach them to do something critical like drinking in a reasonable way, the best we can currently say is, "We know we can't tell you to drink sensibly - so go out and booze at bars and parties, but please don't kill yourself or anyone around you."

As I describe in Addiction-Proof Your Child, every campus should offer drinking environments where beer and wine are served to all students, along with food, in brightly lit settings with people (including faculty and grad students) of all ages present, and where civilized drinking is the rule of the day. How better to counteract the ubiquitous instruction in week-end bingeing now taught at fraternities and military bases?

Whenever suggestions like this are raised, a host of interest groups - stemming primarily from America's blue-nose tradition of ambivalence towards intoxicants - rush from the woodwork to say, "You're telling kids it's okay to consume addictive substances." Yes, and we need to give them some practice in using them responsibly, happily, and even healthily. But this usual group of opponents can't simply discount the Amethyst Group as industry stooges - they are our leading experts on what the hell kids are up to after they leave our homes before they enter the world. Who, exactly, if not they should teach our kids to drink?

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

August 12, 2008

Use More; Don't Touch

At the Olympics, President Bush was questioned about performance-enhancing drugs, in baseball (where he formerly worked) as well as the Olympics. Surprise - he was against them. Of course, Bush now abstains from alcohol and tobacco - after being a heavy smoker and drinker for years.

There you have it - he should know. But steroids and other substances employed to improve functioning - including mental acuity - occupy a more ambiguous place. Most users don't voluntarily decide to desist due to health problems. Rather, athletes like Barry Bonds are suspected of using and uncovered due to their superlative performances. As the case of Roger Cleamons revealed, the two classes of athletes are not those who use such drugs and those who don't, but those whose use is more-or-less ignored (Cleamons) and those who are prosecuted for it (Bonds).

The ongoing conflict between use and abstinence received an interesting jolt when the New York Times featured an article by respected science writer John Tierney entitled, "Let the games be doped." In other words, substances that improve performance can never be eliminated, so allow and monitor their use.

Tierney actually has created a Web site to invite suggestions for how to do this! Good luck. I recently discussed my alcohol use with my doctor, who said that my thinking 2-3 drinks daily was good for me (a 62-year-old male) was a self-deception. I am familiar with this literature, and the most respected medical journals regularly publish information that this is so. But I have come to see that this advice will never be publicized by public health and medical authorities in the United States. We just can't go there. If you're going to live longer, you're going to have to sneak your drinks.

There are many things the truth of which Americans deny. But what is so amusing in the case of these substances is that, somehow, many millions of Americans use them, at the same time as the American public at large disapproves of them. When you count all the drinkers, smokers (sometimes secret), antidepressant and other mood-modifying pharmaceutical users (legal and illegal), performance substance consumers, and so on - we incorporate not only the majority of - but virtually all - Americans. And, of course, I haven't even mentioned coffee drinkers.!

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

August 12, 2008

Talk to the Hand

Interviewed by Bob Costas, NBC's Olympics host, George W. Bush described his interactions with Soviet leader Vladimir Putin and Chinese leader Hu Juntas. Virtually every question Costas asked amounted to: "So, did you tell them we were unhappy about their invasion of Georgia/human rights violations/denial of civil liberties?"

And Bush's answer was the same in each case: "I told them we were unhappy with their policies." With what result? Bush shared a box with Putin during the Olympic opening ceremonies, and apparently told him about America's unhappiness with Russian bombing of Georgian civilians. The next day, Russia invaded Georgia.

As for Bush's lecturing the Chinese on religious freedom et al., Costas seemed to be fascinated with Juntas' reactions. Bush seemed almost bemused by the question. "I can't read his mind. But he listened politely."

Of course, the President could have gotten a reading of what the Chinese leader was thinking - he could have asked him. But in this - as in so many interactions by politicians, moral and religious leaders, educators et al. - asking questions is not the order of the day. (Can you imagine John Edwards seeking reactions to his affair with Rielle Hunter?)

The only problem in all of these cases is that, not only do the speakers have little idea of what the supposed object of their communication is thinking; in most cases a direct verbal thrust produces an equivalent reaction in the opposite direction by the recipient. The recognition of this truth has created a whole brand of therapy, called motivational interviewing (MI).

In MI, the therapist simply restates and explores whatever the therapy client tells the therapist. This approach is based on the simple principle that lecturing people to change doesn't work, and in fact cements their current dysfunctional views and actions. If you want people to reconsider their behavior, you must enter their minds enough to allow them to review their way of doing things.

Perhaps the best example of the futility of lecturing people to acknowledge guilt and change their ways is Judge Judy - the widely syndicated small claims court TV show presided over by former family court judge, Judith Sheindlin. Sheindlin regularly lectures plaintiffs and defendants about their misdeeds - indeed, about the whole direction of their lives.

But I have never yet seen a person acknowledge any fault based on Judge Judy's lectures when questioned after their hearing. Not once. Being humiliated in front of millions of TV viewers (and probably more important to the participants, several score of court room spectators) makes people defensive, not open to self-examination and change.

I don't think that Bush's asking Putin why Russia is intent on bringing Georgia to its knees or Juntas why China refuses to allow protestors to speak up would bring about instant change in these countries' policies. But at least the President would have some notion when asked what exactly is on the minds of those who can, and do, impact the lives of billions of people worldwide.

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

August 10, 2008

Edwards' confession shows us just how nutty he is

The National Enquirer reported last December on an affair then Presidential candidate John Edwards had had with campaign cinematographer Rielle Hunter. Edwards immediately and repeatedly labeled the story a lie, and for the last eight months no other major media outlet had picked up the story. But on July 21st, the Enquirer reported catching Edwards visiting Hunter and her baby daughter at a Los Angeles hotel, leaving after 2AM in the morning.

Once again, Edwards denounced the story, but it set into motion the events culminating in Edwards' public confession last Friday on ABC's "Nightline." While he admitted having an affair with Hunter, Edwards minimized it as short-lived, labeled it a liaison, and definitively rejected claims he was the father of Hunter's baby. At the same time his wife Elizabeth posted at her blog that she forgave her husband and requested privacy for their family.

Edwards' TV performance will go down in history. It is hard to find a way to parody it. He confessed to "a narcissism that leads you to believe you can do whatever you want, you're invincible, and there will be no consequences." We knew that. But, more incredible, Edwards was demonstrating the same narcissistic sense of invincibility in his supposed confession!

Edwards told Nightline that his purpose in meeting with Hunter was to try to keep her from revealing the affair. But this does not hold water on a number of grounds. While Edwards told Nightline he would gladly take a DNA test, Hunter said on Saturday she would not participate in testing. The hotel meeting obviously required a good deal of planning, and Hunter was accompanied by a friend and took two rooms so she could meet privately with Edwards after allowing him contact with the baby, according to the Enquirer. What was that about?

Hunter's entire living situation is - and remains - shrouded in mystery. She originally moved from New York to North Carolina, near Edwards' headquarters, through 2007 (Edwards claimed the brief affair ended in 2006). She has since moved to California, and is reportedly in close contact with long-time Edwards friend and associate Andrew Young and his family, who likewise moved to California. This is stunning news, since Young confessed to being the baby's father, although no father is listed on the North Carolina birth certificate.

Edwards' entire conceit in imagining that he could run for president while keeping the affair secret - a secret he would presumably have maintained if elected President (and if his wife dies of cancer) - represents a breathtaking self-centeredness. But it seems entirely possible he has made this very belated announcement of the affair as part of an effort to cover-up his continuing involvement with Hunter. Edwards claims, for instance, to have no idea about how Hunter supports herself, is living in California, and any connection she has with Young! The Enquirer meanwhile reports Edwards has had several assignations with Hunter in California.

If there is any truth to these allegations (and both the Enquirer and ABC are promising to reveal more about the situation), Edwards telling the public as much as he must while hiding other information - and claiming to be entirely forthcoming - represents a greater level of arrogance, self-reference, and psychotic distortion of reality than has ever been displayed by the many political figures who have gone down in flames giving expression to their sexual urges as the just deserts for their political prowess, from Gary Hart, to Bill Clinton, to Elliot Spitzer.

And what does this say of the men (or is that people) who would be our president?

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

August 8, 2008

Edwards Reveals Affair in Order to Cover Up Homosexuality

John Edwards, God-fearing, family-oriented, losing Democratic presidential hopeful, today revealed he had had an affair with a woman, Rielle Hunter, which he had repeatedly denied.

However, Edwards claims he did not father Hunter's child. Commentators were thus puzzled by the timing of Edwards' revelation - why disclose the affair now, while his wife is battling cancer, when he is not being considered for the vice presidency, and when Hunter had shown no signs of disclosing the liaison.

But a secret tape recording of a strategy meeting among Edwards and his key advisors explains his supposed admission.

Edwards: I understand someone is going to disclose my homosexuality. (Edwards, a God-fearing, Christian candidate, has steadfastly opposed homosexual marriage.)

Advisor 1: You mean, everyone didn't know that already when they found out you spent $500 at a beauty salon? What straight guy pays that much to get a haircut? (See You tube Edwards "I Feel Pretty" clip, at http://www.youtube.com/watch?v=2AE847UXu3Q)

Edwards: Yeah, but what are we going to do about that? Then everyone will know that my marriage to Elizabeth is simply one of convenience, and my kids are stage props for my election campaigns.

Advisor 2: I've got it - just tell everyone you had an affair with that Hunter woman! She IS a woman, right? Pay her off not to deny it - I understand she's a single mother and "novice" filmmaker, so she can sure use some dough.

[Note: This is NOT a real conversation -- it's farcical -- I made it up wholecloth]

Interestingly, whichever way Edwards' hypocrisy cuts, his situation answers the age-old question, "Is it just religious conservative politicians who are hypocrites?" Apparently not - all religious politicians are hypocrites. As is typical of such confessions, Edwards announced that he had been "99% honest," after previously claiming media reports about the liaison were "lies." He said he would refuse to say anything more about his affair, despite making a midnight hotel visit to see Hunter recently. He also swore he gave her no money, although reports are that supporters have paid her off handsomely.

Wife Elizabeth, meanwhile, is standing by her man, and requesting that their family's privacy be respected, despite Edwards placing his family at the center of his campaign. No one can fault a woman combating potentially terminal cancer anything, but we must wonder about a family dynamic where Edwards relies on his wife's illness for sympathy while cheating on her.

Uh-oh - isn't Barack Obama religious?

[Psychological note: Some readers complain this post isn't psychological, although I think it is psychological through and through. Let me express exactly what I think is happening with Edwards. An ardent Christian, he has suppressed his ambiguous sexuality throughout his life, and married a sexually non-challenging woman. When confronted with a younger woman who found him sexually attractive (see You Tube clip in which Hunter gushes about Edwards http://www.youtube.com/watch?v=bFg2Qhst1t8), he was knocked off his pins (see You Tube clip by Hunter where Edwards giggles and boasts like a school boy to her http://www.youtube.com/watch?v=WY768bAO2l8). He had no defense against such emotions, along with simply feeling the power of being a politician. Presto -- a brief affair which was only secondarily sexual.]

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

July 20, 2008

What's Cindy McCain Like in Bed?

Public opinion polls are revealing a remarkable dichotomy. Although John McCain scores higher than Barack Obama on many crucial dimensions - trustworthiness, commander-in-chief qualifications, patriotism - Obama still leads McCain in support for the presidency.

The answer is simple - people think that Obama is the man for a new era. Each time McCain stumbles in naming a country, or brags that he doesn't get the Internet, or reveals that he thinks women are an alien species ("No way insurance should cover oral contraceptives, like they do Viagra!"), he reminds voters - even older ones - that he is a fossil.

And nothing reminds them more than his trophy wife, Cindy. A cool blonde with a razor-thin figure, elaborately coiffed hair, and clothes and make-up to die for, Cindy looks like someone who doesn't like to get mussed-up. Why, even back in the days when she was a drug addict, she favored prescription sedatives and other downers that hardly suggest she was a barrel of monkeys in bed.

What's funny is that McCain had quite a reputation as a partier - and in fact dumped his middle-aged wife for the much younger and more beautiful (and wealthier) Cindy when he returned from Vietnam. But John doesn't look much in the mood for a party himself these days - and certainly not with the uptight Mrs. McCain, who seems like she's reading a teleprompter whenever she's interviewed.

People want someone, like Obama, who looks like he could still party (if he ever stopped campaigning) - even after having given up drugs eons ago and becoming a self-confessed nerd. At least his wife, Michelle, looks like she could wipe that dumb grin off his face.

In the past, this sort of thing wouldn't have mattered -- who cared whether Mamie Eisenhower was a hot tamale (of course, General Dwight did depart from marital fidelity with Amry driver Kay Summersby, according to her book, Past Forgetting). But now Cindy's coldness and the dispassionate nature of the McCain's connection (he rarely hugs her, and then in the most awkward way) seems to speak to a distant time, one out of keeping with the way most Americans now view intimacy, marriage, and gender relations.

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

June 27, 2008

Public Health and Well-Meaning Media Will Save Your Children -- If It Kills Them

A woman described to me alcohol and drug awareness night at her son's secondary school. "They told us never to let our kids drink at home, that that was the surest route to alcoholism. I looked around at all the parents I knew who gave their kids alcohol - many of them Jewish and Italian - and not one of them peeped up. So I certainly wasn't going to say anything.

"But I was shocked to learn how many young people died of alcohol poisoning, and it really worried me."

There were three elements to the back story to this presentation that this mother wasn't aware of:

1. The people lecturing them about alcohol didn't drink. This could have been because they were recovering alcoholics, or else because they came from conservative Protestant sects (e.g., Southern Baptist, Mormon, Christian Scientist) which disallow drinking. Such anti-alcohol proselytizers dominate alcohol awareness programs around North America. They embody the all-or-nothing approach to alcohol I outlined in PT a decade ago.
2. Alcohol poisoning incidents are extremely rare, remarkably enough, given the widespread binge drinking that occurs among young Americans in late adolescence, college, and through their mid-twenties.
3. Those fatal drinking events that do occur are most likely to befall young people from abstinent backgrounds who have no experience limiting their drinking when they participate in extreme initiations with other teens or college students.

One point these speakers make is that, the earlier young people begin to drink, the more likely they are to become alcoholic later in life. Perhaps they are harkening to a study led by Wake Forest Medical School researcher Kristie Foley which found that teens whose parents permitted them to attend drinking parties were twice as likely to binge, a finding broadcast around the country.

Less publicized was this result from the study: children who drank with their parents were one third as likely to binge outside the home. The difference between young teens sneaking into the woods to become falling-down drunk and kids sitting around the table with their parents drinking small amounts of wine is so obvious you wouldn't think the distintion would need to be drawn, would you?

Here's another mother I spoke to. Although her father, mother, and brother all had serious drinking issues, she drank moderately. Moreover, she made sure to introduce her two children to alcohol at home. When I complimented her for overcoming her own troubled family background with alcohol to create a moderate drinking household, she disclaimed credit.

"It's so obvious that I didn't want them to learn to drink by sneaking drinks around the house like I did or by bingeing when they got to college, I really can't take any credit for doing something so sensible."

I respectfully demurred. This woman, although not from an ethnic background (e.g., Jewish, Italian, Chinese, Greek) that socialized drinking in the home, figured out that this was the best policy on her own. And, apparently, there are other Americans out there like her!

Which gets me to my appearance on ABC World News. As author of Addiction-Proof Your Child, I was brought in as an afterthought (along with my 20-year-old daughter, Anna - that's her sipping wine in the picture) when a new study found that many kids were introduced to alcohol by adults, usually parents. Surgeon General Steven Galson denounced this approach. "Parents should not be permissive," he said. ‘"They should not facilitate.'"

And who wants to facilitate their child becoming an alcoholic, or dying from an alcohol OD?

My voice was a very minor one in the program. They used one quote from me: "Your children are going to drink; who should teach them how?" Anna's remarks about how moderate-drinking parents should model this approach for their children, as opposed to the binge-drinking one so prevalent around them, was left on the cutting-room floor.

But what struck me most in my daughters' ignored remarks was that our approach was not such a big deal among her friends - most of the parents she knew practiced it. After all, it IS so obviously the sensible and healthy one. That is, until enough alcohol education takes place to make us just like the alcoholics circling the globe teaching parents and children how to drink.

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

June 19, 2008

American Kids Health Alert

Results of the World Health Organization's international survey, Health Behaviour in School-Aged Children (HBSC) - comparing 11, 13, and 15-year-old children in 40 North American and European countries - are just in (a three-year embargo is placed on these data, but I have connections). How are we doing?

The two most important things young people can do for life-long health are to maintain age-appropriate weight, and not to smoke. We're the best in the world on one, worst on the other. Can you guess which is which?

I guess you want the bad news first - American kids are the fattest in the world. They rank number one in obesity/overweight among 11- and 13-year-olds, and are just barely edged out by Malta in the 15-year-old category. For the youngest kids in the survey, overweight/obesity figures range from 6% for the Netherlands and Switzerland to 29% in the U.S.

Somehow, all those soccer leagues, low-fat foods, and dieticians in American schools don't add up to trim - or even normal-weight - children.

On the good side, the United States has the fewest 15-year-olds who smoke at least once a week - 8%. Our anti-smoking messages presenting hard information about realistic health issues have gotten through.

Now, for what really concerns Americans about their kids - intoxication. Despite claims by the Drug Czar and other government officials that we have put the bite on illicit drug use, American 15-year-olds are fifth (31%) in having used marijuana, and third (14%) in regular use. Worse, although HBSC does not measure use of pharmaceuticals, there is every reason to suspect that American kids are at the top of the list in this category.

The good news is that the U.S. is near the bottom of the list of drunkenness for 15-year-olds - 36th (Greece and Israel are two of the four nations with lower rates). The problem here is that, while America's distinctive efforts to ban underage drinking seem to result in delayed drunkenness, American youth frequently get drunk by their late teens, when about 40% binge drink regularly.

Worse, at the age of 21, half of American young people binge regularly. Amazingly, according to the U.S. National Survey on Drug Use and Health, fully a quarter of Americans of this age are classifiable as suffering from substance (mostly alcohol) abuse or dependence. So, delaying drunkenness seems only to mean that kids start binge drinking with a vengeance in late adolescence.

I believe the only solution for this aberrant drinking - and many other addictive behaviors American youths display - is to prepare them with the values, skills, and outlooks that prevent addiction altogether.

Okay, now the most disturbing news about kids' health in our country. Among 11-year-olds, the U.S. ranked third worst in kids rating their health as fair or poor (22%); among 13-year-olds, there is a jump to 29% of American girls rating their health this way; at 15 years of age, American youths are still in the top ten among Western nations in fair-poor health ratings (including 28% of girls). Among 11-year-olds, Americans rank sixth in terms of kids reporting multiple health complaints; among 15-year-olds, they are seventh in such complaints.

Despite our preoccupation with diet, exercise, and health care, American kids are consistently at the bottom of countries in overall health - and this includes Bulgaria, Slovakia, Croatia, Scotland and many other nations considerably less wealthy than we are and reputed to have poor national health conditions. Money and school programs cannot create a healthy nation.

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

June 17, 2008

A Psychological Profile of Tim Russert

Tim Russert's death last Friday at the age of 58 produced the greatest national outpouring of grief for a single "civilian" since John Lennon was killed in 1980. Russert's memory has been honored by virtually every prominent newsperson and public figure in the United States. His numerous qualities - his faith, devotion to family, skill as an interviewer, impartiality, dedication, hard work, kindness, support of colleagues - have been praised by the leading figures in journalism and government. But some of Russert's fundamental attributes, at least those a psychologist would note, have not been given their share of attention.

Russert described his upbringing in his 2004 best-selling book, Big Russ and Me. Russert paid tribute to his quiet, unassuming father, who worked two jobs - as a sanitation worker and newspaper truck driver - to support his family. Russert attended a small Catholic college in Ohio, following which he obtained a law degree at Cleveland-Marshall. He then worked on New York Democrat Daniel Patrick Moynihan's successful senatorial campaign in 1976. Before the age of 30, Russert became Moynihan's chief of staff. In 1984, he left politics to work for NBC, where he became both Washington Bureau Chief and moderator of Meet the Press, as well as leading election coverage for the network.

Obviously, Russert was smart. But he wouldn't be called brilliant, certainly in terms of his academic background. Commentators spoke of his common touch and awareness of mainstream Americans' concerns. But there are many people with working class backgrounds, even those who go to college, who don't rise to Russert's heights. What, exactly, enabled him to become America's pre-eminent political commentator? I don't know enough about either the workings of TV journalism or Russert's skills to identify the source of his political insight and genius. But I can say something about the psychological traits that enabled his attainments.

Russert was achievement oriented and ambitious. He spoke often of his blue-collar, working-class origins, to which he and others credited his work ethic. But Russert did more than work incredibly hard. Russert took on the most demanding jobs and was prepared to be the best at them. It was not only personal achievement he sought, but the betterment of the organizations for which he worked. He assumed, fresh from law school, increasingly commanding positions in Moynihan's campaign and Senate office. He switched from a successful career as a political operative into broadcast news. He took on hosting Meet the Press after he already held the powerful and demanding job of NBC's principal bureau chief. Tim Russert, for all of his lack of pretension, was dedicated to achievement.

A need for social affiliation is usually contrasted with achievement motivation on the one hand, and the need for power on the other. Leaders often manage by relying on their status and on sheer power. But Russert led by friendship - he dealt with new situations and people by making friends. Gregarious and considerate, Russert's memory inspired co-worker after co-worker to tears as they related the personal kindness and generosity he consistently displayed. Mary Matalin described how Russert was as concerned about the success of those he worked with as with his own. Other colleagues talked about his never wanting credit for suggestions he made that gave them a leg up on stories or interviews.

Finally, Russert was self-confident. This trait is submerged - along with his achievement motivation - by his image as a down-home guy who could just as easily have been a teacher or a lawyer in Buffalo. When Russert first went to work for Moynihan, who had been a brilliant Harvard professor, he was intimidated by the brainpower of his boss and other Harvard alums who worked for him. But Russert recovered his equilibrium quickly and, as chief of staff, readily offered advice and direction to many smart people. You have to be confident to make pronouncements - like declaring Barack Obama the winner of the Democratic presidential nomination - in front of millions of television viewers. And Russert never backed down from confronting the nation's power brokers, including presidents. You have to believe in yourself to do that.

Where did a Buffalo sanitation worker's son from a small-college background get this kind of chutzpah (pardon the technical jargon)? Understanding that might require an entire psychobiography. One hint research offers is that being the only boy with three sisters tends to boost a person's self-esteem. But it took much more than this to create the combination of psychological dispositions that enabled Tim Russert to assume the unique position in American life he did.

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

June 14, 2008

Dying of Medicine

Let's work our way up from the bottom of the list of drugs that killed people in Florida in 2007. Florida has 15 million adults. Marijuana killed none of them in 2007. Methamphetamines, 25 people. Heroin, 110. Alcohol, 466. Cocaine, 843.

Tranquilizers actually caused slightly fewer deaths than cocaine - 743 - although more than alcohol and heroin added together. Vicodin/OxyContin - 2,328. And prescription drug fatalities have been growing steadily and are increasing far more rapidly than illicit drug use and fatalities.

Although prescription addiction is more upscale (witness Cindy McCain), it has been more common than addiction to herbal drugs for decades. And Florida is the capital of pharmaceutical abuse, addiction, and death. Anna Nicole Smith died in Florida of prescription drug misuse. The former governor's daughter (and niece of the president), Noelle Bush, has been treated for her addiction to medications. And Rush Limbaugh cruised the streets of Palm Beach (actually, he had his maid do it) scoring OxyContin.

We're worried about the wrong things. After years of being afraid of bugaboos like heroin, cocaine, and meth, and thinking we were public health experts by imagining that alcohol was the most lethal substance of all, we discover that those medical substances we take to allay our poor, troubled souls are killing us at ever increasing rates. And young people are far more likely to use these drugs than older generations, so the future of death by medicine is even bleaker.

If the government allocated its resources against substances strictly on their likelihood of being abused and causing death, the NIDA would change its name to the National Institute on Pharmaceutical Abuse. Addiction has always been a bludgeon used to fend off foreign drugs. Drug education is about continuing to scare kids about illegal drugs and alcohol.

Addiction and dangerous drug use are not about illicit substances - they are at the heart of the American experience.

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

June 13, 2008

McCain (and Cindy) On Drugs

Much has been made of allegations of youthful use of illegal drugs by Democratic presidential candidate Barack Obama. Meanwhile, his GOP opponent, Arizona Sen. John McCain, has admitted that his wife not only illegally used drugs but walked away from criminal charges. The McCains have worked to make Cindy McCain's addiction into a political asset-despite the fact that she stole the drugs from a charity she directed and used them while mothering four young children.

In 1994, Mrs. McCain admitted that she had solicited prescriptions for painkillers from physicians who worked for an international charity that she founded, the American Voluntary Medical Team. She then filled the prescriptions in the names of her staff.

There are two ways to react to this behavior. According to the Betty Ford model, people can sympathetically respond to the oppressed and ignored wife of a busy politician who has bravely come forward to admit her overpowering addiction. Mrs. McCain took this posture when she first tearfully confessed her addiction. She and her husband repeated this performance in October, 2000, on the NBC program "Dateline."

The other possible public reaction is one of anger. Americans are prosecuted every day for such drug use. While most drug abusers purchase their drugs from street dealers, Mrs. McCain used her status as a charity director and senator's wife to cajole the drugs she wanted.

In fact, Mrs. McCain was investigated by the Drug Enforcement Administration after the agency was approached by a former staff member of her charity. The investigation resulted in no charges or prison time for her, and she entered a diversion program. While these records were not made public at the time, Mrs. McCain eventually confessed her drug use when she learned that a reporter was investigating the story.

Is Mrs. McCain to be judged as a pitiable victim or as a criminal felon? This debate is at the heart of the discussion of American drug policy. Should we deal with illicit drug users as victims or as criminals?

Let's examine Mrs. McCain's position in these terms. She is the privileged daughter of a wealthy family and spouse of an important politician, a person who had her own position of prestige and power. Should she not be held at least as accountable for her actions as an uneducated inner-city drug user? After all, she could enter drug treatment at any time she chose, unlike many drug users who find themselves in prison.

Moreover, Mrs. McCain was violating a position of trust by stealing from a charitable organization, using its money and medical expertise to fuel her drug use. Is this not morally more reprehensible than simply purchasing drugs illegally?

Finally, Mrs. McCain was the mother of four children at the time she admits to using drugs-between 1989 and 1992. Her children were born in 1984, 1986, 1988 and 1991. In other words, Cindy McCain was using drugs while raising small children, one of whom she adopted while she was an addict. In most states, family services will remove children from a woman who is known to be an active drug addict, and she would certainly not be allowed to adopt a child while addicted.

John McCain is a hawk in the drug war. He advocates stricter drug laws, penalties and enforcement against drug sellers. He has had nothing to say about redressing our punitive approach toward drug users. Of course, McCain also supports family values. Yet if John and Cindy McCain were not well-off and influential, they might not have a family at all. McCain's lack of concern for street drug users contrasts sharply with the support and understanding his wife received. It's the old American double standard. For "straight-shooter" McCain, charity begins at home-and ends there.

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

June 6, 2008

Drinking around the world

This spring, I have had a chance to observe alcohol consumption in three very distinctive cultural settings - First Nation (Canada), Irish, and Iberian (Portugal/Spain). Alcohol use - and consequences - could not have been more different in these three places.

While our evolutionary psychology colleagues emphasize that humans behave the same throughout history and around the globe, my slant could not be more different. The drinking in these three places was worlds apart - almost as though the people were from different species.

In upper British Columbia, I found native people living in shabby circumstances in a transcendentally beautiful valley. Virtually no family is unaffected by alcohol (and drug) abuse - it typifies the challenges faced by First Nation People. Even the most assimilated educator described to me siblings whose lives have been wrecked by addiction.

Worst, and most puzzling, even when - as in the case of this woman - the older generation has succeeded in the white world, her kids were overcome by addiction. Sometimes, the cultural chasm with broader Western society seems unbridgeable - yet total separation is also impossible, even more so in the modern electronic era. In this setting, the only alternative to addiction is presented as being total abstinence. I never had - or was offered - a drink while there.

In Ireland, change was also afoot. Modern pub life continues, but it has been modified - for better and for worse. Although, to an American, pubs are everywhere, long-time natives describe them as being in decline. In urban centers, they are becoming entertainment centers - with video screens all around - in order to appeal to young weekend consumers.

Irish drinking is deeply ambivalent. The Irish see drinking as a time out from ordinary life, when they can let loose and forget daily concerns. At the writers' conference I attended, the pubs were filled late into the night with noisy conviviality.

But there are consequences. For a feminist writer, one who drank beer herself, those who sit in a pub all night are leaving a wife and family alone. At the same time my driver could report having quit drinking, he recalled with terrific fondness endless evenings together with neighbors and cronies at the local pub. He could recognize the prevalence of alcoholism in Ireland, at the same time that he saw drinking and pub life as the glue holding Ireland together. A remarkable number of Ireland's leading politicians own pubs.

Finally, in Portugal and Spain, alcohol was a ubiquitous, accepted, pleasurable, well-managed facet in all social life. To decline a drink with a meal - generally wine or a liqueur - was an incomprehensible aberration. This extended even to teenagers. Unlike in either the First Nation locales or Ireland, I never observed or heard of people drinking to excess - gathering specifically and exclusively for the purpose of drinking is alien in this world.

What does this tell us about alcohol, drugs, substance abuse and humans? Attitudes and comportment towards even the most potent substances are virtually infinitely malleable. Ways of thinking and being in the face of substance use that seem ordained by nature and God in one place are unfathomable in another.

Human beings are not good at imagining ways of being other than their own. And, to paraphrase George Bernard Shaw, it is the barbarian who mistakes the customs of his peculiar island for universal laws.

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

June 4, 2008

New York Times Assault on Sobriety!

Fox News regularly accuses the New York Times of being pro-gay, anti-Bush, and anti-American involvement in Iraq. But it is now clear that the Times is, more than anything, pro-alcohol.

In the first place, the Times has had a regular wine column for decades, begun by Frank J. Prial, and more recently continued by Eric Asimov.

(At least Asimov wrote, when he was preparing to introduce his son to the addictive pleasures of wine, that his wife forbad him, after hearing an alarming lecture at the kid's school that this would make him an alcoholic. Thank God we are not pursuing here in the U.S. the madness that prevails in southern European countries. )

But the June 4 issue of the newspaper went totally beyond the pale, starting with a front page article expanding the madness that alcohol is good for you ("New Hints Seen that Red Wine May Slow Aging"). Yeah, sure - just ask the wino on the street how his health is.

Of course, the Dining In section led with an Asimov column (called "The Pour") on Burgundy wines - have I mentioned - just tell the wino on the street how well a good Burgundy goes with a meal.

But it is actually in The Arts section that the full bias in favor of alcohol becomes apparent. On the first Arts page (are you keeping track - this now includes the front page, the first dining page, and now the arts page in a single issue of the newspaper), Dwight Garner applauds a collection of Kingsley Amis' extensive writings on drinking in a review titled: "Toasting the Joys of Imbibing Properly."

In the first place, Amis was obviously an alcoholic - why else would he publish three books about booze: "On Drink," Everyday Drinking," and "How's Your Glass?" Just consider Amis' notable quotes: a diet is good so long as it doesn't reduce "your alcoholic intake by the smallest degree."

In fact, the review notes, Amis did lose some of his intellectual acuity by the end of his life. But the reviewer than affirms Amis' biographer's belief "that it [alcohol] added more to his life than it took away." Clearly, the biographer and reviewer are two more alcoholics in denial.

To sum it up, the reviewer notes with favor Amis' alcoholic viewpoint: "The human race has not devised any way of dissolving barriers, getting to know the other chap fast, breaking the ice, that is one-tenth as handy and efficient as letting you and the other chap, or chaps, cease to be totally sober at about the same rate."

Shocking! Scandalous! And this in America's leading newspaper!

But the Times is not done. On the same page on which the Amis review continues, the Times includes a review of Spanish musical performances. The title? "Sun, Sherry, Castanets: Musical Postcards from Spain."

Obviously, this is one more subliminal suggestion to Americans that drinking is pleasurable. No wonder we can't eliminate underage drinking, so long as people under the age of 21 can read the Times. I suggest we place the Times behind the desk in libraries, insist that young people show proper identification (just as if they were at a bar) before being allowed to purchase the paper, and force the Times to run countering articles to each one that portrays drinking in a positive light.

Either that, or change the name of the gray lady to "The Alcoholic Review."

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

June 3, 2008

So, you think we're going to end addiction soon?

Returning from Ireland, I read Barbara Tuchman's 1978 best selling history, A Distant Mirror: The Calamitous 14th Century. The 14th Century included the Black Death, which killed between a third and two-thirds of Europeans. Authorities could not address the epidemic because they didn't know microbes caused disease. So, instead of improving sewage treatment, people slaughtered Jews.

Before we laugh or cry over our benighted forbearers, we should reflect on our own inability to stem a number of tides. The one I am chiefly interested in is addiction. Ireland is currently revising its drug policy. Everyone agrees substance abuse is worse now than when the policy was introduced. But just as clearly as that policy failed, the new policy will contain the same principal ingredients.

American policy is worse. The Irish are steeped in prohibitionism and zero-tolerance, as we are. More recently, some efforts have been made to incorporate harm reduction. But the Irish - like Americans - see addiction as an alien force invading our society (like the Jews poisoning wells to create the black plague), and that the task is to eradicate the invading scourge, in this case through eliminating drugs and drug use.

Here are the five chief reasons this approach is impossible, will never succeed, and yet will be continued ad infinitum:

1. The myths of addiction. Addiction is not a drug side-effect. People seek experiences from drug and non-drug involvements that they require and cannot otherwise obtain, and become irrationally and dysfunctionally attached to them - i.e., addicted. But in the drug area, the Bush Administration's aversion to the fact-based world is widely shared by leading scientists. Thus, the National Institute on Drug Abuse pursues a research agenda based on erroneous ideas - that some drugs are inevitably addictive (fewer than 10 percent of regular cocaine, heroin, and crack users become addicted), that addiction is irreversible (a much larger majority of heroin, crack, and alcohol addicts quit on their own than smokers), and that addiction to drugs is a qualitatively different experience from other addictions (so that, for instance, the AMA was forced to beat off an onslaught from distraught parents inquiring about kids' addictions to video games).

2. Fear and loathing of drugs. In ways it is impossible to reverse, Americans and the Irish have come to hate and fear drugs (and, in a more ambivalent way, alcohol) as a malignant, magical, uncontrollable force in their midst. Thus everyone believes that the mission of the NIDA and Irish drug task force should be to abolish these things - or, in the case of alcohol, at least abolish drinking by kids. This has been the policy for many decades in both countries with results around for all to see - leading both countries to redouble their futile efforts.

3. Addiction is mainstream. When we say we want to eliminate drugs, of course we mean illicit drugs. We are foisting, happily, more and more powerful psychoactive drugs on our kids. Concerta is as addictive a stimulant as amphetamines (Adderall IS an amphetamine). The fastest growing drug use among adolescents is of prescription pain killers. American adolescents are the fattest in the world and the cumulative health consequences of their obesity and food addictions are far greater than they suffer from illicit substances. We are self-addicting, and becoming more so all the time.

4. We cannot comprehend the forces causing addiction. Americans protect their kids more than any kids have been protected in history. We try to keep them away from drugs and everything that will hurt them. Yet they are less capable of taking care of themselves than kids have ever been, more prone to addiction, and less content than even the miserable generations (like us) that preceded them. And we cannot reverse these trends - when confronted with childhood misery, we strive to take away more freedom and self-control from children, creating more hair-of-the-dog.

5. Liberals hate drugs like conservatives, and are more likely to believe in diseases. While conservatives rail against drugs (at the same time as Jeb Bush's daughter, Cindy McCain, conservative commentator Rush Limbaugh, et al. have had major prescription drug joneses) liberals' own views are worse. For instance, liberal icon Bill Moyers (and his son William Cope Moyers) are two of the most ardent purveyors of drug-addiction-as-disease-requiring-spiritual-redemption narratives - because calling what used to be a sin a disease seems so humane, even though the same thinking underlies both sin and disease.

The solution? As I outline in Addiction-Proof Your Child, it involves recognizing substance use as a regular, necessary part of contemporary human existence and producing young people able to cope with it, along with all of the other addictive experiences to which they will be exposed. Impossible? Right you are. So the Irish - and Americans - will be having the identical drug problems and debates fifty years from today that they are having now.

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

May 30, 2008

I'm in Brigadoon--Irish Drinking and Irish Pubs

In the Alan Lerner musical, Brigadoon (fictionally located in Scotland, another Gaelic nation), a small village comes alive every hundred years. I feel that way writing from Listowel, speaking at its annual Writers' Week.

Of course, Listowel is alive at all times, even if I only come here once a year. But it is one of the last remaining Irish local towns that an American might visit, due to this conference. In this place of 5,000 inhabitants, I stay at the Listowel Arms. From the rear of the hotel you look over a river and bridge leading to the large grass horseracing track. From the front you see the small town square, and beyond the church steeple, grassy hills.

(A note on cultural differences. One PT blogger insists there are no significant difference among world cultures. Everything I am interested in is impacted by culture.)

If God were designing a way of drinking, it wouldn't be the Irish way. The Irish have the lowest rate of daily drinking (2% of men) and the highest rate of binge drinking.(half of men) in Europe. Low levels of daily drinking prolong life and intellectual acuity; binge drinking accomplishes the reverse.

When you are introduced as an addiction expert in Ireland, people immediately begin reciting their alcoholic relations ("five of my uncles" . . . etc.). And the Irish are capable of being almost - I say almost - as Puritianical about alcohol as Americans (for example, Ireland is the only European nation where there are serious discussions about raising the drinking age to 21).

At the same time, drinking is mythical, prodigious, and acclaimed in Ireland - at a reading by Nobel-Prize winning poet Seamus Heaney last evening, my hosts asked if I wanted something to drink and brought me a beer while I listened with pleasure - an experience I have never had at a public reading in the U.S.

Writers' Week was begun by John B. Keane - a well-known Irish playwright and writer. Listowel's low-slung downtown is filled with pubs - and one of them was owned by Keane, and is still run by his family. I went there last night with his daughter. The place - like all the other pubs - was packed. And everyone there was smiling and talking. People came in groups, but strangers were also welcomed and quickly assimilated.

You can't buy that kind of social support, and the psychological and physical health it encourages, in the U.S.

How to combine the good and the bad elements of Irish drinking? Keane's daughter told me, "My father introduced us to beer (like the Italians and Spanish introduce their children to wine), and my mother refused to serve anyone who was intoxicated or misbehaving."

Ah, I shall miss Brigadoon when I return to the U.S.

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

May 28, 2008

We're getting unhealthier, no matter how much we spend

Among Ted Kennedy's notable legislative initiatives is insurance parity for emotional disorders. Like many noble efforts, this cost will be borne by private insurers and public payors, which means ordinary people will pay for them. Yet almost fifty million taxpayers already can't afford health insurance.

The solution for the issue of the uninsured from Democratic candidates is universal coverage, like that offered in other civilized nations. Universal health care is, as Kennedy notes, a fundamental right. We can only recoil when Fox News commentators bloviate that there is no need to change the American health care system, since they and other well-off people already have access to the best doctors and medical facilities.

But, again, someone will have to pay for it, and the someone is us. I live in a bellwether state, New Jersey, which is at the top of national rankings for property taxes, indebtedness, and cranky citizens. Governor Jon Corzine, who has proposed several ways to address our multi billions of financial obligations, has record low approval ratings.

Among the true but unpopular things Corzine has announced is: "Frankly, New Jersey has a government its people can't afford." So Corzine is withdrawing support for local hospitals. Of course, this means that they will pass their expenses along to insurance companies, Medicare, and whichever poor idiots they can get to pay for their own health care - that is, we all must pay this bill.

In this monumental game of pass the buck - or rather, pass the hat - we never address Americans' appetites. These are taken for granted. Americans are not healthy - older Americans have more of every major illness and health condition than the English (even our wealthy are roughly comparable to their poor) despite our paying twice the per capita health care costs of the UK. And the British are the unhealthiest people in Western Europe!

The primary example of unhealthy plentitude is that American teens are the fattest in the world. (This remains true despite recent signs that youth obesity is leveling off.) Alarmed public health authorities are predicting an actual downturn in life span when this generation achieves adulthood. Belated and ineffectual responses cannot remedy that young Americans luxuriate in unhealthy diets, inactivity, and a sense that they require more attention than they are already receiving in our child-centered culture. This also makes them addiction-prone, as I detail in Addiction-Proof Your Child.

Which brings us to bipolar and other epidemic emotional disorders among the young, treated by massive and ever-increasing doses of psychiatric medications. American kids, despite all their privileges, aren't happy. And the American response is to offer them something to put in their mouths - not to make them happy - but at least to reduce their bitter complaints.

The surest way to incur Americans' wrath is to suggest that they can't have everything they want all the time without delay. When any suggestion is made that we curb our appetites - or simply wait in line - like managed health care and HMOs, Americans rise as one to protest. Michael Moore's film, "Sicko," simply demands more health care instantaneously without addressing the underlying imbalances in American lives.

The very demands Americans are making for more health care, more medications, fewer bills is actually a sign that we are emotionally and physically drained, rather than offering realistic ways to improve our health. Our increasing crankiness and ineffectuality, coming at a time when the country is facing stunning belt-tightening economic realities, predicts that our emotional and physical health will continue to decline.

This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.