I've never received so many letters as those concerning the Newsweek article (February 12, 2001) on drug policy reform and the film "Traffic," which was referenced heavily in the Newsweek piece. Following are some of these questions.
What do you think of the film "Traffic" and other recent developments?
I've long been impressed by your perspectives on addiction.
I'd be interested in seeing your response to some of the material cited in the latest article on addiction in Newsweek. That article cites supposed latest research which suggests that the use of addictive substances causes permanent, or at least persistent, changes in brain chemistry and/or physiology, particularly regarding the brain's use of dopamine, which makes addiction and the urge to abuse near-intractable (and permanent?) difficulties for addicts.
Are you familiar with this literature and these studies? What's your take on the article in Newsweek? And does the research have any substantial impact on your own views on the physiological component of addiction or the necessity of permanent abstinence from the substance (or experience) to which one is addicted?
I noticed that despite all this supposed new research, in the main, the therapies which Newsweek claimed had been documented to work in combating addiction continue to be those which give the addict a reason to live and life structures which are more rewarding than continued abuse of the addictive substance or experience...in short, the same kind of principles you detail in your Life Process model.
What do you make of all this?
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Of late, drug warriors have taken to saying that law enforcement is a necessary component of our drug policy, because of the "proven" benefits of coerced treatment. I've read in your books that forced treatment is ineffective, but the drug warriors insist that time in treatment is the best indicator of success, and it doesn't matter if this time is enforced under threat of prison or if it is voluntary. On what research are they basing this claim, and what is your opinion of this research?
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I saw the movie "Traffic" last night, and groaned when I saw the ending the would-have-been drug czar at a twelve step meeting supporting his daughter.
I waited the entire movie for some indication that someone in high places was becoming aware that the disease model of substance abuse promoted by the 12-step and recovery industry has lost any validity it might have had.
To me, it is the basis of the misguided drug policy in the US and Canada.
I went to AA for almost 30 years, all the time feeling this wasn't the answer and avoiding the steps.
I received any number of letters about the Newsweek article. Actually, Time and Newsweek have both in the past trumpeted supposed breakthrough discoveries in addiction that signaled the beginning of our triumph over this age-old bugaboo. The last time this was front-page news was when endorphins the endogenous opioids produced by the body were discovered. My favorite rendition of the idea that this discovery meant we had licked addiction appeared in the now-defunct Saturday Review, where neurologist Richard Restak gushed:
So far, researchers have carefully avoided hyperbole in their descriptions of the endorphins. But it's hard to leave out the exclamation points when you are talking about a veritable philosopher's stone a group of substances that hold out the promise of alleviating, or even eliminating, such age-old medical bugaboos as pain, drug addiction, and, among other mental illnesses, schizophrenia.
A quarter century after this triumphant announcement, addiction and mental illness are still holding their own. There is simply no penalty to announcing that we are on the verge of curing addiction or mental illness the press and public will eat this type of thing up forever. Indeed, Richard Blum has announced that he has already found the genetic source of addiction a decade ago, and that addiction keeps cropping up in no way hinders his marketing of his discovery or his vitamin bromides for curing cocaine addiction, obesity, and whatever else ails you.
That people who stay in treatment longer fare better has always been a finding in evaluation studies, beginning with Charles Winick's assessment of the success of Therapeutic Communities. As Winick pointed out and as continues to be true in all such research if you only count those who enter any form of treatment who stick with it in your outcomes, the treatment looks great. If you count all those who enter, however, including those who drop out, you find results no better than and actually often worse than not receiving treatment. I write about this phenomenon in regards to an evaluation of the State of Texas's prison/probation drug treatment program in an article for Reason:
Two explanations could account for such findings. One possibility is that, while treatment and non-treatment groups are equally likely to be recidivist, those who quit treatment are those who were more likely to relapse anyway. Thus, counting only those who remain in treatment and aftercare is cherry-picking those who were most likely to succeed in the first place. The other possibility, which would scandalize AA zealots, is that those who have a negative reaction to AA and its 12-step approach are actually driven to relapse by the experience.
Meanwhile, a distinguished group of 15 economists, criminologists, and psychiatrists assembled by the National Research Council, an arm of the National Academy of Sciences, declined to endorse the recent rush to replace enforcement with treatment ("Drug Research Inadequate, White House Panel Finds," New York Times, March 30, 2001): "studies of whether drug treatment works and whether it is more cost-effective than enforcement are flawed because they do not use the scientific method of comparing randomized groups for example, comparing one group of prison inmates who have participated in a treatment program with another group of inmates who have not."
As for "Traffic"'s position on 12-step treatment, that was unclear. That is, the youthful high school girl whom the film tracked originally went to what looked to be a standard 12-step program, where she clearly didn't fit in with the other older, longer-abusing clients. The girl mentioned during her group "sharing," almost apologetically, that she didn't consider herself an alcoholic, because drinking had not been a special problem for her. And then, in the film, she quickly relapsed back to the street. At the end of the film, she was shown in a family-type program, which was at the least more age-appropriate. Whether that kind of program has any better track record than the program she had earlier failed in may not be so clear.
The massive impact of both "Traffic" and the Newsweek article, and just the general fomenting go on about whether we're doing the right thing in our drug policy (very few people not employed by the government give an unqualified "yes" to that one) and whether we can treat drug problems successfully prompted me to write a full response to these claims.