The Stanton Peele Addiction Web Site, March 19, 2015.
Recovery Narratives at War in the New York Times
Before turning to the event that brings the war over recovery into the open, a word on “recovery” and its sister concept, “sobriety.” Neither of these words now has its literal meaning. That is, sober doesn’t mean sober, as in non-intoxicated. It means abstinent.
And being in recovery doesn’t mean that you have recovered from an illness. It means that you are part of The Recovery Movement and are holding on trepidatiously to your sobriety as a member of a 12-step group like AA.
These matters are relevant to a review of Johann Hari’s book, Chasing the Scream: The First and Last Days of the War on Drugs, by Seth Mnookin, in the Times’s Sunday Book Review. In brief, Hari—a journalist—takes on both the addiction-as-disease establishment (i.e., The Recovery Movement) and the drug war, linking and attacking both through research Hari highlights and dramatic stories he tells about addicts.
Hari’s answer to both the disease theory and the drug war is harm reduction, meaning non-abstinent solutions to problems with drugs—for instance, replacing an addiction to heroin with a marijuana habit, since the latter is less dangerous. Harm reduction does not meet the criteria of “sobriety” and The Recovery Movement will never accept it.
Mnookin begins his review by dismissing Hari with an ad hominem attack on Hari’s life, which has some blemishes. Yet, in what for me is a deep irony, Mnookin endorses Hari’s basic message: “While each man (researchers Hari cites) pushes his conclusions to extremes unsupported by data, their underlying message — that harm reduction is the most rational and humane approach to drug use and abuse — is, in fact, backed by copious research.”
Let me identify the characters in this drama, and my relationship to some of them. I know the chief researcher Hari bases his ideas on, Bruce Alexander, and have stood with him for decades in refuting the disease theory of addiction. Bruce does so based on his Rat Park experiments, “which demonstrate that rats in stimulating, social environments would not become addicted to morphine while rats in cramped, metal cages would.”
Hari and I both make much of this, but Mnookin dismisses Alexander: “Hari explains why Alexander’s views have not been universally embraced by making the preposterous assertion that ‘when we think about recovery from addiction, we see it through only one lens — the individual.’” We don't find out what Mnookin himself thinks about the Rat Park research or why he believes Hari's statement about "the individual" is "preposterous" (which it isn't necessarily).
Meanwhile, Mnookin attacks another of Hari’s heroes, Gabor Mate, for his view that “the roots of addiction (and lots of other things to boot) can almost always be found in childhood trauma.” Mnookin notes that there is “a significant body of work demonstrating” the shortcomings of “Mate’s reductionistic approach.”
I am not in a good position to come to Hari’s defense here, because I also know Mate, but my relationship with him is less propitious. That is, I am one of the chief critics of Mate’s reducing everything to childhood trauma.
But what most puzzles me is that Mnookin, while finding Hari’s underlying approach critically beneficial for dealing with addiction, is so intent on discounting Hari’s presentation of these ideas in his book. After all, Hari is a journalist who tells dramatic stories (a skill Mnookin compliments Hari for in his review). Isn’t it important to get this message out there in a popular book like Hari’s?
Not so, Mnookin argues: “Hari acts as if a rigid, deterministic model of addiction as a purely physical disease is almost universally accepted; if anything, the opposite is true.”
I don’t think so! Recently, the world’s most prestigious scientific publication, Nature, definitively declared in the opening line in an editorial: “Drug addiction is a disease” which it forcefully relates to “images of the brains of addicts.” You can’t find the impact of Rat Park in a brain image. It is not enough to say it hasn’t been done—it can’t be done, as I discuss while noting how dominant the disease model has become through the work of Nora Volkow, the head of America’s National Institute on Drug Abuse. The times calls Volkow a “General in the Drug War”—which proves Hari’s point.
This pitched battle has been waged for many decades, as evidenced by my 1983 review in the Times of Harvard psychiatrist George Vaillant’s tribute to the disease theory despite results of a long-term study Vaillant conducted that found exactly the opposite.
- As someone who seemingly agrees with Mnookin on the best approach to addiction, I find Hari’s brilliant, popular and appealing work critical for reversing our last century, as Hari shows, of wrong-headed thinking about drugs and addiction.