Health Education Review, 2:423-432, 1987.
We're Too Frightened to Deal with the Real Issues in Adolescent Substance Abuse
Contemporary America is obsessed with self destructive drug and alcohol use. However, our policies are based entirely on erroneous epidemiological, pharmacological and clinical beliefs about drug use and alcoholism. Adolescents are special targets for our anti-drug efforts, since they are a high-risk group both for substance abuse and for other kinds of self-destructive behavior. Nonetheless, our main prevention effortsto instill more fear of drugs and alcoholseem not to have persuaded most young people to avoid drug and alcohol intoxication or to have prevented the small group of potential addicts from their immersion in lives built around drugs. Rather than dealing with what in fact underlies such behavior, we are preoccupied with seeking biological explanations for our personal and social sense of loss and searching for medical cures for our cultural failures and existential malaise. This elaborate social defense mechanism, which at times achieves the level of psychosis, masks and ultimately exacerbates our deepest fears that we cannot cope with our worlds.
When US college basketball star Len Bias died in 1986 while inhaling cocaine, cries went out for increased surveillance against drug use. In fact, the University of Maryland athletic program of which Bias was a part already had a model drug-testing program in place. Obviously, Bias circumvented this program while he regularly took massive amounts of cocaine. However, a reliable indicator was readily available that Bias was not fully engaged in university lifehe didn't pass a single course in his last year of college.1
Bias's behavior and death contrast with the experiences of the large number of cocaine users in American universities. In 1985, 17% of American college students used cocaine and most students said the drug was fairly easy to obtain. Yet only 0.1% of students (or 1 in 170 of those who used cocaine) used it daily for as long as a month (Johnston et al., 1986). Apparently, most students resist the addictive lure of cocaine, even after having sampled the drug, because school obligations and other values they hold prevent them from consistently savoring the drug's effects. It would seem that drug addiction is best resisted through an involvement in activities and valuessuch as achievement at schoolthat are incompatible with continued drug intoxication.
However, American society has not been able to inculcate such values adequately, particularly in certain key high-risk groups of people. Bias actually represents a class of people with similar problems. Bias's basketball coach, Lefty Driesell (who was removed as coach but became assistant athletic director at the University after Bias's death), noted about the athletic conference Maryland participated in: 'Cocaine has been a continuing problem among Atlantic Coast Conference players and former players. Five of the best players we've ever had have all admitted having drug problems: Bias, David Thompson, John Lucas, Phil Ford, and Walter Davis.' Meanwhile, "asked if he had been made a scapegoat for Bias's death (by Maryland), Driesell ducked the question with a smile, 'I'm still being paid by that school' " (Driesell reflects, 1987).2
Driesell called David Thompson 'the best player I ever saw in the conference'. Thompson, after having been investigated for cocaine use and for beating his wife while he was a professional basketball player, has since retired and was recently sentenced to jail for criminal assault (Woes for Thompson, 1987). Thompson played for a college team that emphasized God and community spirit (although this team was banned from tournament play because of violations it committed in recruiting Thompson from high school), and Thompson was thought to be a model citizen in college. Bias, too, was from an extremely religious family. Driesell said about Bias, 'He was one of the nicest young men I have ever known . . . I didn't even think he drank beer'. Bias's mother currently lectures around the US on the dangers of drugs. All of the five men Driesell discussed were blacks who came from rural sections of the southern US and from extremely abstemious backgrounds.3
Driesell and others seemed to have mistaken the kinds of values and preparation that are necessary to prevent self-destructive drug use. A dedication to abstemiousness and God does not seem adequate for the job. In common with most Americans, Driesell conceives of drug abuse as an external force that surprises otherwise good young people. The solution, of course, is to avoid any contact with drugs. Once someone uses drugs, in this view, anything can happen (no matter what the user's previous disposition). For those stricken with the 'disease' of drug abuse, medical treatment emphasizes biological causation but recommends something very much like religious conversion to keep the individual away from drugs however tenuous the person's self-control and however ready for relapse the person remains as long as he or she lives.
Facing the Facts
It is not true that several decades of widespread drug use in the United States have made us more aware of the facts about, and nature of, drug use. Rather, the contrary has occurred, and totally unsupportable assertions about drugs are made and accepted without question. We have witnessed in the United States a gradual growth in recreational drug use until more high school seniors nationwide have tried illicit drugs than have not done so (Johnston et al., 1986). In many areas and among many groups, such drug use is a norm, and not to use drugs is abnormal. Such statistics are, of course, horribly alarming to parents and others. Nonetheless, as indicated in the 1985 college student cocaine use data, the rather large majority of young drug users are casual or occasional users. Less well known is that even those young people who use drugs heavily will generally desist or cut back this use before the age of 30, even when the drug in question is heroin (O'Donnell et al., 1976).
The American reaction to data indicating that many young people have used drugs has been increasingly alarmist (Clymer, 1986), even though there have not been clear indications that abusive drug use has grown. For example, daily marijuana use declined among high school seniors in the mid-1980s (Johnston et al., 1986), even while marijuana continued to be widely available and most adolescents have used the drug by the time they enter college. The one sign of regular drug intoxication among the young occurs in the case of alcohol. Fifty-nine percent of 1985 male college students (along with 34% of female students) reported having had five drinks or more in one sitting in the previous two weeks.
Anti-drug and anti-alcohol propaganda have exploded in America in the 1980s. This represents more of a change in the case of alcohol than it does for drug use, which, despite some claims that drug use became acceptable in the US, has been portrayed in continuously negative tones since drug experimentation first appeared on college campuses in the 1960s. Even so, anti-drug campaigns have been stepped up along with anti-drinking programs in recent years, including now regular celebrity anti-drug and anti-alcohol messages, testimonials from former drug abusers and alcoholics, anti-drug and anti-alcohol school programs, and widespread advertising by and for private treatment centers.
These campaigns seem to have inspired fear in many young people (drugs were the number one concern of elementary children polled by the Weekly Reader). In the case or declining daily marijuana use, this approach might seem to be quite effective. However, drug use continues at extremely high levels in the US, compared with other Western nations and with pre-1970 levels. Cocaine use has risen among young people (although it involves far fewer users than marijuana). Overall, it is hard to imagine the circumstances that would return the United States to pre-1970 drug usage levels. At the time when President Nixon announced Operation Intercept in 1969 (the first in a series of massive US government drug interception programs), perhaps 15 million Americans had used marijuana. By 1982, 22 million had taken cocaine and 80 million had used marijuana (Miller et al., 1984). Following President Reagan's 1982 War on Drugs, tailored specifically for cocaine, use of that drug did not decline (Peele, 1987a).
As new generations of drug-using students graduate, we have a population that has largely been exposed to drugs, and somewhat higher levels of drug use throughout the life cycle (considering most people quit or reduce drug use in adulthood). Along with these continued high levels of drug use, we also display greater official concern and more negative public attitudes toward drugs. It may be that those who heed dire drug warnings are those least likely to become problematic users under any circumstances. At the same time, many young people describe drug use as dangerous while continuing to use drugs. Most young people, in fact, continue to ignore messages that they should never take a drug or get drunk. They apparently reject anti-drug messages because these messages deny the multifarious types of drug use they observe around them.
The most important question is how our scare tactics affect the small minority that uses drugs regularly and the smaller minority still whose drug use totally dominates their lives. Heavy drug users may have the same negative beliefs about drugs as their peers and still persist in taking drugs. They are likely to misuse a whole host of substances at the same time; those who smoke cigarettes have the highest probability of smoking marijuana regularly and using cocaine (Clayton, 1985). These young people are those least involved in school and other achievement and pro-social activities (Peele, 1987b). On the one hand, this describes a small but intractable minority of children from middle-class backgrounds. On the other, it characterizes a larger group of inner-city and minority youths. In this way, substance abuse problems grow out of social problems like an evolving underclass with which the US has been unable to come to grips, and which may be growing worse.
Our inability to engage many youngsters in meaningful achievement activity or to provide a large number with a minimal degree of social integration vitiates our drug education programs for the groups we are most concerned to reach. National news programs in the States carried the story on June 8, 1987 of First Lady Nancy Reagan's visit to a Swedish program that induces young mothers to desist from drug use. This intensive residential program teaches mothers coping and child-care skills in highly supervised homes, and costs the Swedish government $75,000 per client. Staff of the Swedish program rightly point out that this investment is repaid if it reorients children's and mothers' lives. Unfortunately, the sheer number of children and mothers such programs would need to reach in New York City and elsewhere in the US makes such cost prohibitive. While Sweden reports 18,000 addicts nationwide (mainly amphetamine users) in its homogeneous population, New York City alone (with a population slightly smaller than Sweden's) claims 200,000 addicts (Lohr, 1987). As a result, we need to ask what comparable public health and social policies might be adopted at a lower cost that will help high-risk groups develop constructive values, activities and skills.
The Treatment Trap
I must confess that I am discouraged when our First Lady endorses the Swedish program with a seeming lack of awareness of the basic conditions of drug use in her home country. In hearing Mrs Reagan enthuse that ghetto children and others should 'Just Say No' to drugs and sex, I cannot help but think of Marie Antoinette explaining that those without bread should simply eat cake. One erroneous deduction Mrs Reagan and other observers made from the contrast between US and Swedish policies is that the US does not spend nearly enough on this problem. Although in their far smaller country Swedes spend twice as much per capita on drug programs as the US, American expenditures in this area are fantastically high and growing: they have doubled since 1981 to 3 billion dollars. This does not take into account astronomical costs for drug law enforcement and interdiction efforts, large expenditures for alcoholism, and far higher expenditures by the private sector for treatment than occur in European countries.
Sweden's drug program is entirely non-medical in nature and is government-funded, while in the US alcohol and drug programs are nearly always under private medical supervision. Growth in American private sector treatment accelerated in the mid-1970s, when the federal government encouraged private contractors to care for alcoholics and addicts, and as third-party (insurance) reimbursement for such treatment grew. This expansion has accelerated in the 1980s; for example, the hospitalization of teenagers has more than quadrupled since 1980 (Peele, 1986). A few large organizations such as CompCare dominate the treatment industry, engage in hostile takeovers of smaller centers, and mount aggressive marketing efforts to engage clients and their families in treatment. At the same time, the courts and corporate Employee Assistance Programs have become the largest sources of clients for the private treatment system (Weisner, 1987).
This situation differs dramatically from Britain and most other European nations. In the case of alcoholism, according to British psychiatrist Robin Murray (1986), Dean of the Bethlem Royal and Maudsley Hospitals' Institute of Psychiatry, 'British clinicians have shown that the effect of treatment is only marginal, and, in contrast to their American counterparts, have decided against a major expansion of in-patient treatment facilities'. At the same time, Murray remarks, 'It is perhaps worth noting that whether or not alcoholism is considered a disease, and how much treatment is offered, has no bearing on the remuneration of British doctors'. In Britain, Murray notes, 'Even R.E. Kendall, one of the British psychiatrists most interested in categorical diagnostic systems, states that for alcoholism it is increasingly clear that most of the assumptions of the 'disease model' are unjustified and act as a barrier to a more intelligent and effective approach to the problem'.
American hospital treatment has demonstrated no greater success than that found in the UK, and remission rates for outpatient counseling in the US are typically at least as good as those resulting from hospital stays (Miller and Hester, 1986). As Murray indicates, the tremendous emphasis on medical treatment and insurer payments in the face of unmeasurable treatment benefits is closely tied to the economics of the private enterprise medical system in America. Having established for insurers and in public opinion that alcoholism is a treatable disease, the American alcoholism movement now draws more and more individuals into treatment. These alcoholics are freshly discovered; that is, street inebriates are no more attractive as patients than they have ever been. Instead, well-placed and financially secure alcoholics, often women with rather mild drinking problems combined with reliance on sedatives (epitomized by former First Lady Betty Ford) now fill fancy psychiatric and other private facilities for one-month stays that can cost as much as $25,000.
Young people provide the other major areas of growth for treatment in what is termed 'chemical dependence' (both alcohol and drug abuse). CompCare and other organizations frequently present school staffs and parents with the frightening specter of the results of the untreated diseases of alcohol and drug abuse. Such organizations contract to teach school counseling staffs to conduct 'interventions' in which suspected drug users are confronted by friends, teaching and school counseling staff, and family members who together insist the student immediately enter treatment. Families may be encouraged to sell their houses in order to raise funds to ensure their children receive such treatment, without which, they may be convinced, their children will die. In the treatment setting itself, if the child should claim not to be chemically dependent, counselors attribute this to denialan inescapable Catch-22.
The American political and social system has been dramatically affected by the current drug scare. That is, convinced we are in the throes of a drug epidemic, frightened that we cannot control the effects of drugs that are everywhere around us and are regularly consumed, Americans rely increasingly on drug-testing and other unAmerican invasions of privacy (Clymer, 1986) and on involuntary treatment of those found to have been using drugs. Any degree of police intervention is justified since drugs are destroying our society, any degree of medical intervention is justified on the grounds that the drug user has a disease that would result in death if left untreated. Drug-treatment advocates like Gold (1984) unabashedly argue for greater freedom for involuntary commitments, such as that allowed for by a model Connecticut law whereby 'a relative or police official who believes that a person is drug dependent may petition a court for compulsory treatment' (p.70).
Of course, who is to be involuntarily treated on the grounds of being chemically dependent turns out to be quite vague. Star baseball player Dwight Gooden tested positive for cocaine use and was instantaneously spirited off to a hospital program. After he was released, Gooden indicated that he was not actually addicted and that he never took the drug while pitching. 'When he was asked how he could regulate the use of cocaine after taking it in the winter, he said: 'I wasn't addicted, so I was able to lay off it during the baseball season. But once you take it the first time, you're starting to be addicted' " (Gooden tells of cocaine use, 1987). For what was Dwight Gooden being treatedstarting to be addicted? In this way, in an horrific Orwellian atmosphere, people are tested for drugs, declared drug dependent if discovered to have used one, and compelled into treatment from which they may be released only when the treatment center finds they have passed muster. In Gooden's words: 'I cried a lot before I went to bed at night. It was embarrassing because whether you had a problem or not, you're there'.
Those who object to the CompCare-type approach or the treatment of people like Gooden (who, after all, accepted his fate as a necessity for his return to baseball) are not well-received in the US today. After a national television news program revealed CompCare's conduct described above, an unrepentant Vice-President of that company declared to the investigators: 'I don't know why you think that when you're done, the mafia, NORML and all those supporting drug abuse in the world won't have you . . . as their champions'. This man noted that parents weren't concerned 'about treatment professionals doing something wrong with their child. They are worried about their kid dying because of lack of professional help' (Adolescent treatment debate rages, 1986).
If drugs are killing our young, then anyone found to be insufficiently negative toward drugs, or who questions the indiscriminate hospitalization of young drug users, is in danger of being branded as insensitive or, worse, an abettor of drug smugglers or a killer. When rational discourse about a topic that is so much on our minds becomes impossible, and to weigh the pros and cons of different courses of action becomes an invitation to personal attack, we surely do have a problem! If children do come to view drugs as having magical powers to corrupt and control, they will have learned this from the general social environment. And those young people least adept at making informed decisions and beneficial discriminations in their lives (that is, those who most closely mirror the general social irrationality) will be those most liable to drug abuse.
The Blind Leading Sighted
Betty Ford has become the poster woman for the new age of treatment for alcoholism and chemical dependence. When she initially was promoted to First Lady, Mrs Ford offhandedly announced that she used tranquilizers several times daily. This announcement was printed throughout the American press without comment. But when Mrs Ford learned through intensive medical therapy that she wasn't using tranquilizers wisely (even though they were prescribed by her physician) but was actually addicted to them, she stopped all drug use and drinking, and now lectures as a drug addiction and alcoholism expert. Yet, one might be most struck in Mrs Ford's history by how utterly unable she has been from the first to come to grips with the emotional meaning of her use of drugs and alcohol.
I participated in a television program with Monica Wright, who now directs a New York treatment center and who described her 20 years of alcoholism. Ms. Wright's alcoholic drinking coincided with her raising six children, four of whom became substance abusers and the other two of whom entered treatment as children of an alcoholic. Ms. Wright and the moderator were not in the least abashed by this information, for the program claimed Monica had inherited her alcoholism from her father. Today, based on theories that alcoholism and addiction are biologically and genetically caused, addicts are presented as passive victims of their disease. Who is better qualified to discuss the nature and side-effects of the disease? Thus Betty Ford is relied on equally as much for her insights into tranquilizer addiction as into the experience of breast cancer, because she has suffered from both of these medical problems.
The careers of Monica Wright and Betty Ford are simply two examples of the reliance on people who abused drugs and alcohol as instructors on drugs and alcohol. For instance, school children regularly hear from Alcoholics Anonymous members or young drug abusers about the effect of drugs and alcohol and the nature of drinking and drug-taking behavior. What would happen if someone suggested instead that basketball star Kareem Abdul Jabbar talk about his drug use? Jabbar revealed in his autobiography that he sampled psychedelic drugs while he was in college but gradually abandoned the habit as his professional basketball career, family and spiritual life took the forefront for him. Indeed, most young people have taken drugs and drink without becoming addicted, leading us to wonder what they should learn from those less successful than they at managing their lives.
The idea that we should seek knowledge about addictive substances from addicts grows from the temperance lecture, a popular nineteenth-century stage entertainment in the United States and the UK. Now, claiming the mantle of science, the sinner who has seen the light has come to be a moral instructor cum addiction expert. How Mrs Ford, Ms Wright, and other alcoholics or addicts have become models for children and others, while we ignore people who have drunk and lived moderately, is quite a remarkable phenomenon. Is our society undergoing a psychotic episode, where failure is conceived as success, where loss of control is thought to be the path to control, and where we are so unconcerned about wrongdoing that we make drug-abusing criminals (the majority of felons) our heroes? The New York Times reported (October 14, 1986, p. 30):
Thomas (Hollywood) Henderson, the former Dallas Cowboy linebacker who has been jailed in California since 1984 on sex charges involving two teenage girls, will be released this week and has already been scheduled for a paid speaking tour to talk against drug and alcohol abuse. Henderson was an admitted drug user.
Abusing the Youthful Drug Abuser
The same system that elevates out-of-control people to positions of prestige and command victimizes others. The most common victims are the young.
Programs intended to 'resocialize' troubled or troubling youth sometimes have resorted to holding youth incommunicado, refusing to allow them to wear street clothes, keeping them in isolation for prolonged periods of time, or forcing them to wear self-derogatory signs, engage in other humiliation rituals, or submit to intense and prolonged group confrontation.
Such 'treatments', which have been all too common in juvenile justice and substance abuse programs, are based on dubious psychological theory . . . attempts to strip away a supposedly 'missocialized' or antisocial character structure through intense confrontation or humiliation may destroy the youngster's already fragile self-esteem. The effects of such treatment are thus much more likely to be iatrogenic than ameliorative (Melton and Davidson, 1987, p. 174).
This article argues that children need to be protected from therapy and government agencies!
The fundamental model for drug education programs in the US is the lecture by the recovered addict who indicates that anyone who takes drugs will follow the same route to perdition as the addict. The body of the lecture (as was the case in the temperance lecture) is devoted to recounting the horrors of the addiction, the addict's misbehavior, and especially the addict's lack of self-control. The lectures, from temperance to the modern drug scare program, are completely noninteractive. Both in form and content, the program assails the audience, impressing especially those whose self-management and self-image are already weak. Although these programs dominate the American scene, they have been shown to be ineffective. According to the chief of the prevention research branch of the National Institute on Drug Abuse: 'Those programs that use scare tactics, moralizing and information alone may actually have put children at increased risk' (Some school drug efforts faulted, 1986).
Why do such programs remain so popular? They are no doubt very self-gratifying for the lecturer, and they give vent to the anxieties of parents and authorities who wish nothing so much as to act forcefully, even without assessing the consequences. The goal seems most clearly to be to have the audience admire and emulate the speaker. A favorite program of this type for combatting crime in the US has been the so-called 'Lifer's Juvenile Awareness Program', in which recidivist criminals are allowed a free hand in lecturing youngsters (who may or may not have already committed offenses themselves) about the fruits of crime. A film entitled Scared Straight! (which won a special Academy Award) depicted criminals screaming at and threatening children, who often then break down. A follow-up of the program entitled Scared Straight! Ten Years Later, recently shown on American television, advertized as follows: 'If you resist, you will be raped. If you report us, they'll put you in solitary. If they let you out, we'll kill you'.
The original film and the follow-up made outlandish claims of success for the program (90 - 95 % of the children are typically said never to have engaged in further delinquent or criminal activities). In fact, nearly every evaluation of the Lifer's (or similar) programs has failed to show their efficacy. Indeed, several comparisons of children sent through prison 'awareness' programs and those not sent found outcomes that favored the control group. In one systematic comparison of a treated and untreated group, twice as many delinquent children who went through the program committed a crime in the following six months as did those in a comparable group who did not receive the training. Even a study favorable to the program indicated that 85% of participants committed delinquent acts afterwards [for a review see Finckenauer (1982)].
Nonetheless, the popularity of the Lifer's program remains high nationwide. The 1987 follow-up Scared Straight! film interviewed participants in the program, all of whom reported they had really been impressed by it. Why is the program such a failure and yet Pollyanna results such as these are accepted so uncritically? Convicts physically intimidating children is really more of the same of what got them where they are, while to the extent they impress children, these children are most likely to emulate the convicts' hyper-aggressiveness and brutishness. Meanwhile, the audience masks its own feelings of ineffectuality with a moralistic faith that deterrence works and browbeating children will bring them to their senses, even though most such supporters could never imagine acting this way toward children they knew personally. Do the film's on-screen stars (Peter Falk and Whoopie Goldberg) and producers humiliate and threaten to maim their own children when their youngsters do something wrong?
Albert Stunkard and his colleagues (1986) have recently claimed in investigations of adopted children that obesity is largely inherited. This result seemed to contradict work Stunkard conducted as part of the famous Midtown Manhattan study, research that indicated lower socioeconomic status (SES) girls were nine times as likely to be obese by age 6 as upper SES girls (Goldblatt et al., 1956). Overall, Stunkard in that research found SES was a powerful predictor of obesity, so much so that when people changed social classes their weights approximated the norm of the group they entered (Stunkard et al., 1972). A British group replicated Stunkard's several decades of work by claiming both that obesity was largely genetic and depended on social class. In this study, permanent obesity appeared in people's 20s rather than childhood. Nonetheless, the onset of obesity was linked to poor education and lower SES, and people often changed their physiques when they rose in social class (Braddon et al., 1986).
Assertions that obesity is largely genetic, is greatly influenced by social class, and changes with changing life circumstances are confusing. Should people worry about their weight and should we try to do something about obesity, or should we just accept it? The question is especially crucial because in the US, childhood obesity is rampant and growing distinctly worse. 'Data from four national surveys indicate pronounced increases in the prevalence of pediatric obesity in the United States . . . (including, since the mid-1960s) a 54% increase in the prevalence of obesity among children 6-11 years old and 98% increase in the prevalence of superobesity' (Gortmaker et al., 1987). Whatever role genes play in obesity, this role seems to have been overridden by a general trend toward fatness in America. What is more, this trend has appeared despite a preoccupation with physical fitness that has overtaken American society.
Why should obesity be increasing so rapidly and why do our science and our public policies and popular attitudes have so little positive effect on the problem? One strong relationship with childhood obesity is television viewing, a positive correlation that withstands statistical controls for prior obesity, race, SES, region and a variety of family variables. Dietz and Gortmaker (1985) reported: 'We have shown that the association of television viewing and obesity in children fulfills the criteria necessary to establish a causal association. These criteria include . . . that television viewing precedes obesity, even when controlled for confounding variables, that the relationship is unidirectional, that a dose-response effect occurs, and that a mechanism exists by which this association can be explained' (p. 811).
An obvious connection between television viewing and obesity is that television is a passive, sedentary activity (a description that fits drug taking and drinking as well). However, since 'television viewing precedes obesity', another variable must account for differences in amount of television children watch in the first place. One candidate is another factor strongly associated with television viewing: fear. Heavy television viewers overestimate the number of crimes and the danger in their environments (Gerbner and Gross, 1976). Television emphasizes antisocial conduct that not only encourages violent behavior, but makes the viewer more fearful. Is our world more dangerous today than 20 years ago? Certainly, our awareness of child abuse, drugs, kidnapping, crime and violence has been exacerbated in the last 20 years. Regardless of whether these events are actually more common, television has made them seem so.
Is a more dangerous world, or a world we consider more dangerous, a root cause of obesity, and while we're at it, of the drug use patterns that have developed since the 1960s (cf. Zinberg, 1972)? In this analysis, we need to consider the possibility that fear precedes excessive television viewing and thus obesity, along with drug and alcohol excess. The link is that fear prevents the child from experiencing his or her environment directly, thereby encouraging alternate, 'safer' (i.e. less challenging) means of modifying experience. If fear fosters television viewing and substance abuse, we would need, in order to combat obesity and other addictions, both to create a safer society and to help Americans get control of fears about their environments which, in many cases, have run amok. Consider, for example, the idea that a child should never speak to a stranger. In this view, the bulk of humanity are to be feared as hostile agents who would harm one if only they had the opportunity!
At the same time that we, as parents and a society, must control our irrational fears, we need to make our children less afraid and more capable of facing their environments. This, too, is a formidable task, and one on which we seem to be losing ground rather than making progress. After all, we constantly strive to make children more afraid of drugs (among a number of other things). In this, we simply reflect our own fears. In the US today, we have given up the ghost that children (and adults) can be counted on to regulate their consumption of drugs, and instead dedicate ourselves to an escalating war to eliminate all exposure to drugs. If our goal were to create people competent to deal with their environments and content enough to resist self-destructive temptations, our current efforts would prove we have already lost the war on drugs.
The disease theory of alcoholism and addiction is an elaborate defense mechanism to prevent us from examining those things that, individually and as a society, we fear too much and do not believe we can deal with (Fingarette, 1985). Unfortunately, as in the classic addiction syndrome, relying on this disease fantasy exacerbates the very problems from which we recoil. Put simply, we don't have the courage to confront the dilemma that addiction is transmitted through fundamental family and societal processes (including such daily socially sanctioned activities as television viewing), and cannot be eradicated without examining and seeing the beast within. If we cannot create a world worth living in, and people who want to live in this world, then the disease of addiction will continue to typify our age.
Nevertheless, we and our children are not so helpless as we make out. Most of the young and we ourselves have already resisted a host of potential addictions to which we have been exposed. Most ghetto young people have avoided addiction under quite remarkable circumstances of deprivation and environmental assault. What we mean to do by falsely convincing ourselves that we are at the mercy of every new drug that comes down the pike is beyond me. As I argued in The Meaning of Addiction:
Our conventional view of addiction, aided and abetted by science, does nothing so much as convince people of their vulnerability. It is one more element in a pervasive sense of loss of control that is the major contributor to drug and alcohol abuse, along with a host of other maladies of our age. We feel we must warn people against the dangers of the substances our society has banned, or attempted to curtail, but cannot eradicate. This book argues that our best hope is to convey these dangers realistically, by rationally pointing out the dangers of excess and, more importantly, by convincing people of the benefits of health and positive life experience.
Afterword (November, 1996):
For the only time in my life, the editors sent out something I had written to the authorities whom I criticized to get their reactions. In the Editors' Notes that follow, the University of Maryland justifies why Len Bias was still permitted to complete university despite having ceased attending classes, why Bias's coach Lefty Driesell was smugly still employed by the Universitythough he had been demoted, and why all the cocaine addicts discovered in the Atlantic Coast Conference were black scholarship students from less well-off economically but religious backgrounds. Interestingly, I have more than once seen the editor who invited my article and who got the University's response, John Davies, speak about the insidious role of institutions in controlling academic content.
- Since reviewing this paper, we have become aware that the interpretation of these facts is in some dispute. A source at the University of Maryland informs us that although Bias did not complete his University course, he was academically successful and completed his eligibility for the University as far as his final year. At this point Bias apparently joined a professional basketball team; a not uncommon occurrence amongst college 'stars'. The implication that his failure to graduate was entirely due to drug problems is disputed.
- A source at the University of Maryland points out that Driesell had recently signed a ten year contract. Consequently although he was demoted, his appointment could not be terminated.
- Again, we are informed by a source at the University of Maryland that Bias himself did not accord with this description. Bias apparently lived in a lower-middle-class urban environment approximately one mile from the University.
Adolescent treatment debate rages. (1986, June) U.S. Journal of Drug and Alcohol Dependence, pp. 4, 16.
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Driesell reflects. (1987, June 8) New York Times, p. C2.
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Fingarette, H. (1985) In Martin, M.W. (ed.), Self-Deception and Self-Understanding. University of Kansas, Lawrence, KS, pp. 52 -67.
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Gooden tells of cocaine use. (1987, June 26) New York Times, p. D17.
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