From Abracadabra to Zombies
reader comments: substance abuse treatment
18 Feb 2004
Hi, I enjoy your site very much since years. Still, it seems to me that the sheer mention of a "Higher Power" does warrant your ire only if harm is done - We know only that many compulsive people think that if they "shift" their "focus" from themselves to some Higher Power "as you understand it" (as Non-existent focal point for instance you may call it) they may heal (and from then on instead of bingeing and dying and abusing they can support their families)- plus: there is no guru or sect-leader either - well, then maybe you may as well let them live with it. Isn't there some clear difference between the horrendous crimes committed by most sects and gurus and quack cults you mention (that do cause tragedies and do kill people and even children) and a non-centralized group that is able to help some compulsives (which is a disease, a psychological disease) to restrain themselves?
Or am I totally misunderstanding you? Maybe I am wary of any kind of totalism [?] or perfectionism: after all I was raised in a state (in former Soviet-satellite Hungary) where to mention "God" was taboo and for a time was even punished by prison and later just by sacking from ones job) and skepticism was state religion.
I value highly your job on misunderstandings around any kind of superstition. I even agree that maybe the basic texts of these groups are sometimes not stressing clearly enough that "Power as you understand it" is not a real entity, just a figure of speech, like in the expression: "I painted a picture due to my "creativity" /I became sober due to my Creativity (which happens to be my Higher Power...as you probably know the Hebrew name YHVH - pronounce: yehoweh- means Creator, /or rather: Be-er, make-be-er/ and is simply a form - active participle - of the verb "to be" as Moses expresis verbis mentions it when asked about this forces name at that famous burning bush...Or I am allowed to say things like I became sober due to my Scepticism /which is my Higher Power since I doubt the psychological views on addiction for instance. I enjoy your work on strange beliefs... But I can't grasp the point of mentioning Twelve Step groups among cannibals [?]. Except of course maybe it's fun for you to see people get upset about it.
reply: See the next letter.
20 Feb 2004
As a recent visitor to your website, I applaud you and your stance on substance abuse treatment and Alcoholics Anonymous. After spending nearly 10 years in that “cult”, I have come to see that AA and the addiction treatment community is ineffectual, and it is probably the most damaging thing you can do to yourself. I absolutely agree with your statement; “Those familiar with AA will recognize that the “disease” model of substance abuse contradicts the AA model of the weak-willed sinner who needs a “Higher Power” (which can mean anything from the AA group itself to the God of the Bible) to conquer the mighty forces of satanic booze. These clashing metaphors of the victim and the sinner are contradictory”. It was this contradiction (although in AA, it is called a “paradox”) that fueled my search for something better, and to finally discover that everything I thought I knew about alcoholism was built on a house of cards.
The dismal effectiveness of a 12-step program and the addiction treatment industry is perhaps its most glaring weakness. But even this failure is attributed to the “cunning, baffling…” nature of the “disease”. It is in fact expected. It is even called the “disease of relapse”. It’s truly a rare animal in AA to see someone with any length of sobriety. And of course, anyone who fails to stay sober is the one who “wasn’t honest with themselves”, or who “must not have wanted it bad enough”, (there’s that crazy paradox again!!) or any of a number of thought stopping slogans that keep members from facing the harsh reality, that they really have no clue as to why one person stays sober and the other doesn’t. But I think the most damaging statistic I have read comes form AA’s own literature. Their Triennial Membership Survey of 1989 stating that only 5% are consistently abstinent after 5 years of attendance. And in the AA “Grapevine” of May 2001, they stated that over 60% of all successful recoveries occur without the use of recovery groups, counseling or other professional treatment. Hello!! Can anyone see the emperor’s new cloths!?!?! And based on what I experienced in AA, these two facts are not too far off the mark.
AA and the 12-step program is overwhelmingly the only option available if you enter a “treatment” program or get in to trouble with the law. (The “two-hatters’ you mentioned have taken care of that and have a vested interest in maintaining the status quo. And trust me, there is nobody more pious or revered, than a two-hatter with power). The process of disclosure, inventory, meditation, prayer, amends, etc.. have very little to do with staying abstinent. And any success in sobriety is created to God, (I mean your higher power) and all your failures are blamed on the disease. You are left somewhere in the middle. With this type of dynamic, is it any wonder recovery through self-improvement is so tenuous?
Addiction is a choice. Call it a sin or whatever, but everyone has the ability to stop. They just forgot how. AA will not remind you. It will enslave you in a dance that, if you’re lucky, will condemn a person to a lifetime of one-day-at a-time sobriety. But most likely, will set the stage for your expected, frequent flyer status in and out of abstinence. You must continue to speak out against AA and the addiction treatment industry. This sacred cow needs to be lead to slaughter.
02 Feb 2004
I was reading through some of the topics covered in the Skeptic's Dictionary and was very disappointed in what I understood as your conclusions about Alcoholics Anonymous. I suspect that due to a lack of complete, in depth research, and sources of misinformation, your take on what AA offers is not only based in contempt prior to thorough investigation but in stereotypical thinking about alcoholics and recovery by common society. I suspect you are of the mind that faith, logical or not, is without power for the individual.
I propose to you that it is faith itself that has helped me maintain 15 years of abstinence from all mind and mood altering substances. I also propose to you that AA promises nothing except an introduction to a "Higher Power" that is only understood by the individual who chooses to believe in said power.
It is my opinion, based on personal experience, that believing that one is a "sinner" has nothing to do with effective and long term changes in individual behavior from that of the addict or alcoholic who's consumption puts them in grave jeopardy. Acknowledging one's own character faults and working to change those behavior patterns is what has been the cornerstone of change in my life, thus facilitating my "recovery" from alcoholism. Disease or not, that description puts the personal problems of addictive behavior into an understandable light for the members I has spoken to about this in my 15 years of abstinence and taking the “12 steps” as a outline for how to maintain personal betterment
And to what seems to be your unfounded skepticism of AA’s 12 steps and the structure of thinking therein, I truly wish that deeper research had been done into the groups’ literature that is available at no profit to AA. Besides, AA has been more successful than any other group or process or set of principals in recorded history at treating the hopeless drunk.
I don’t know if my words fall on deaf ears. I hope my words are not taken in any personal way. And as a cynic I clearly see logic in being wary of cultism and brainwashing. AA is a re-programming and admittedly so. There are no secrets kept about what it is. It is effective and helpful for those who choose to believe it will be and are desperate enough to make that choice.
There is far more work required for genuine redemption by the description provided in the 12 steps than simply turning one’s will and life over to an individually chosen higher power. There are nine more actions one must take to achieve any kind of true redemption.
I humbly ask that you please look deeper into what AA is about and present a clearer picture about what is to be found in your skeptic’s dictionary. Once again, these are only the opinions of one person based on their personal experience within AA and NA. I could be completely inaccurate with my opinions and ideas. I may have misunderstood the portions I read online. Nevertheless I ask that you consider my words.
David B., Agnostic
reply: You say that your faith is what keeps you sober. George W. Bush says the same thing. I think you have a quorum but what does it mean? Whatever it means, it has nothing to do with the claims I make about substance abuse treatment and the philosophy behind the 12-step program. I don't know why some people read this entry and think I am saying that religion or faith can't help people. That's not my point but I'm not going to try to explain it again.
7 Nov 2003
First of all, let me say how much I have and will continue to enjoy the skeptic s dictionary. Having dangled the carrot I m sure you sense a stick in the future.
I have just read your piece on substance abuse treatment. I do agree
with a lot of what you said. Pseudoscience, quackery, and any lame-ass way
of parting people from their money have no place in our world as I see it. I
must however speak out in defense of Alcoholics Anonymous. For indeed, noble
is the purpose. AA requires no dues, fees, pledges, or names, and
declarations of alcoholism are not required. All that is required is a
desire to stop drinking. The problem most people have is not being
weak-willed or a sinner. Unless your sponsor is a sadist or a control freak
(AA is full of all kinds of people, just like the rest of the world) you are
not required to say these things. The problem most have is too much will! It
s like trying not to think about a yo-yo. People in AA are encouraged to
give in and think about the yo-yo, integrate it into their lives, let it go.
I was disappointed to see the phrase it seems like in your bit about 12 step
programs. Didn't you look deeply enough to get past it seems like to what it
is? It seems like skepticism may have gotten the best of the skeptic. As far
as the disease aspect, well, my personal jury is still out on that one & And
of course people seek different methods. And they work. Don't be a jackass
just for the sake of it. AA is the first to admit that their method isn't
for everyone. It just works for them. Ever actually read the book? And,
right in the big book, it says if a man should find another way to sobriety
than our own, let him go and wish him well. At the time AA was founded,
there wasn't much else, pal. Those people were looking for a way out. Like I
said before-disease? Who knows. But it s pretty obvious that you fell down
hard on this one. Misinformed skepticism is as bad as blind faith.
Substitute psychological awakening or something for religious conversion, if
it makes you feel better. It does help people, a lot of them, lead better
reply: I don't deny the noble purpose of AA. Nor do I deny that many people have been helped to sobriety by AA. But I am still waiting for Liam or anyone else to explain to me how alcoholism can be both a disease and a matter of a weak will.
8 Nov 2003
Your answer to 'Liam:' "I am still waiting for Liam or anyone else to explain to me how alcoholism can be both a disease and a matter of a weak will."
Ignores one of Liam's chief points: "The problem most have is too much will!"
Liam was pointing out the distance between AA (anarchic, egalitarian, free from financial interest) and the 'Spin-Dry,' 'Recovery,' and 'Self-Help' industries. If 'will power' was the answer to alcoholism, the ranks of alcoholics would be completely different. No one has more will power than a drinking alcoholic, struggling to keep afloat while preserving his drinking.
As a skeptical, atheist AA member (sober 15 years) I can assure readers that AA does NOT impose any theological constraints on its members. This does not mean that you won't hear a lot of 'spiritual' nonsense in meetings. In the long run, though, the old AA saying 'check your religion at the door,' is more honored than any particular enthusiasm.
AA cannot change its history (Oxford group, Bill Wilson's weirder ideas etc.) but the fellowship is made up of its members. If you are an atheist, repelled by the smarmy 'god talk,' look around, you are not alone.
16 May 2000
As one of those professionals (social worker) who works to provide lifestyle alternatives to suffering addicts and alcoholics (however you choose to define them). I maintain a bit of skepticism myself regarding the motivations and methods of many treatment programs, and my experiences regarding mental health professionals is that a large number of them are working their own issues out on others, especially their clients. This, however, does not excuse your misdirection, disingenuousness and downright dishonesty in your diatribe regarding alcoholism. The problem with your writing is, although you present some valid points, you disqualify yourself by your either dishonesty or misunderstanding.
Here are just a few:
1. AA does not regard alcoholics as victims. Quite the opposite. What is said is that it's not their "fault" they have a "disease," but they are absolutely responsible for all their actions.
2. There are indeed other "diseases" which are similar to alcoholism in that others need to provide the diagnosis...how about schizophrenia, or other mental illnesses where denial is an essential component. You do believe that denial as an ego defense mechanism exists, don't you?
3. I'm not sure whether or not alcoholism is a disease, and don't much care. When I see someone doing something compulsively (i.e.: they can't seem to stop even if they want to), I know that help will often need to come from others. Is spontaneous remission possible...of course....just like with any other malady or "disease."
4. AA says that alcoholics are powerless over alcohol, not everything. This is in terms of taking that first drink and then going off on a binge, etc. Maybe none of it is really so, but AA says that they aren't bad people getting good, but sick people getting well. They also make it clear that, despite their common belief in a God (of some kind), it's not required for membership.
5. AA is not alone in believing in spiritual power...the power of God. In fact, probably most of the people in the world believe in it...what's wrong with that?
I could go on and on. I've witnessed good treatment and bad treatment, and I think most of it is bad. I think AA works for some and not others. I have no investment in any of this crap, but it irks me when dishonest people masquerade as "skeptics." Unless you are just remarkably ignorant...which is, I'll admit, what I think is really the case.
By the way, we don't diagnose alcoholism by how much or how often one drinks. Check out your DSM IV (if you have one). The criteria are pretty much behavioral. And, by the way, your implication that interventions are in the employ of sleazy treatment programs is also a misdirection....most of them aren't, and there are other models of intervention which don't ambush the "client."
For you to maintain that you'll only consider your perspective and what supports that is so bizarrely anti-honesty that I can't believe anyone really takes you seriously. Frankly, I suspect that those who truly believe your obviously biased half-truths are really not interested in reality anyway.
I'm not even sure why I've wasted my time with this, other than I'm bored with nothing to do for a few minutes.
James Sandel, MSW
reply: You probably just felt the need to vent. Social workers need social workers to help with the stress of dealing on a daily basis with desperate people, people who won't or can't help themselves, people in trouble through no fault of their own, mentally ill people who self-medicate with alcohol, cocaine, heroin, crack, crank, etc., to the point where nobody can tell what their problem really is.
If someone I know and love called me dishonest, I'd be hurt, but when a total stranger calls me dishonest, I start thinking of my college psychology professor's lecture on projection and defense mechanisms.
Calling alcoholism a "disease" and comparing it to schizophrenia or obsessive-compulsive disorder is about as useful as calling crime a disease. Choice is the key difference here, not denial. The mentally ill don't choose to be neurochemically imbalanced. The alcoholic and the criminal choose their behaviors. (By the way, just because someone is mentally ill, does not mean one has no choice in what one thinks or does. Many mentally ill people know what they are doing, do things they know are right or wrong, and can control their behavior. I think the model used by our courts, which forces a decision 'sane or insane', is mistaken. I think there are degrees of insanity and degrees of responsibility for insane persons. I would not give a person a "do anything and never go to jail" card simply because he or she was mentally ill.) And even if it is true that alcoholics have a genetic tendency to abuse alcohol, it doesn't follow that they don't choose their behavior any more than it would follow that a genetic predisposition toward pedophilia would imply that pedophiles don't choose to act on their desires. It may be more difficult for a genetically predisposed person to overcome their desires than for someone not so predisposed, but that only implies that people who don't have a predisposition to abuse children or alcohol don't deserve any special praise for being so virtuous. A genetic predisposition to behave badly does not mean you cannot be a bad person for making the choices you make.
Just because the alcoholic or drug addict has a pathological dependence on booze or other drugs doesn't make them 'sick'. The psychologists and psychiatrists, the authors of the DSM IV [Diagnostic and Statistical Manual of Mental Disorders], have co-opted the language and with each new edition have created more 'illnesses' for them to treat. Just because they call homosexuality an illness, doesn't make it one (as they did in the second edition of the DSM). On the other hand, I don't agree with those who think that alcoholism and schizophrenia are not diseases because there is no agreed upon physical test or symptom for identifying the disease, as there is with things like measles or cancer. I think it is absurd to argue, as some have, that mental disorders are not diseases because they are defined by behaviors that others disapprove of or are annoyed by and are therefore nothing but value judgments.
Despite the claim by some experts that there is no evidence for a biological or genetic cause of any mental illness, there does seem to be such evidence. For example, about one percent of the population in America suffers from schizophrenia, yet the chances of being schizophrenic double if you have a cousin who is schizophrenic. The chances quadruple if you have an aunt or uncle who is schizophrenic. If a sibling is schizophrenic, the chances increase ninefold. If a parent is schizophrenic, there is a 13 percent chance that his or her child will have the disease. And if one identical twin is schizophrenic, there is a 50 percent chance that the other one is too. Does the data support a significant genetic causal factor here? I think it does.
Even so, I don't claim that only physical disorders can be called illnesses or diseases just because traditionally physicians have treated illnesses and they define them by their physical causes or symptoms. A person is more than a body with moving parts. I see no reason why it would be intrinsically inappropriate to speak of mental, psychological or emotional illness or disease. An illness or a disease is a malfunction of an organism. We may not know exactly what consciousness is but we do know that there is a relationship to the human organism's ability to function and its physiological response to emotional trauma, for example. We don't necessarily have to treat a traumatized person with drugs or tell them to wait for two weeks and the symptoms will subside. Dealing with the emotions by a variety of psychological interventions may in fact restore the organism's vitality. To refuse to call the person ill because the cause of their dysfunction was not physical seems to be mere quibbling.
But if the cause of a person's dysfunction is a chosen behavior such as abuse of drugs or alcohol, there seems to be something screwy about calling the tendency to make such a choice an illness itself. Using alcohol is not dysfunctional. Abusing alcohol renders one dysfunctional. Helping a person change the way they use alcohol is more like helping a person break a habit than it is like curing a person of a disease.
I may be wrong about this, but that's my honest opinion.
19 Aug 1999
Hi there. Very nice entry. It reminds me of my own experiences. Nearly 20 years ago I had developed a moderately severe drinking problem, one that ultimately resulted in my being expelled from college. Not long afterward, a friend brought me to an AA meeting. For the short term, it worked. But once I was back on an even keel, I started to see AA as a monumental waste of my time. Then there was the religious angle, which as an atheist I found difficult to swallow. So I stopped going. I went back to school, and managed to go through it (and get my degree) without touching a drop of alcohol -- all without AA support.
Now, AA's chapter-and-verse will tell you "once an alcoholic, always an alcoholic", and that even if one has been sober for years, one drink will bring all of that success crashing down. I can tell you that this is, at least for my experience, a load of crap. Not long after I finished school, I had a drink. As in, one drink, after which I switched to soda.
Nearly 20 years later, I have been able to keep that same pattern: have one (two, on rare occasions) drink, then change to something non-alcoholic. The last time I got drunk was about a week before that first AA meeting. Sounds to me like I've managed to cure my problem.
17 Aug 1999
First, thanks for creating this site-it's enjoyable and informative.
One of AA's traditions: "The only requirement for membership is a desire to stop drinking."
I joined AA out of desperation-my drinking was out of control and destructive-DWIs, job loss, physical problems.
I might have sought AA's help sooner, if not for the mistaken belief that it was a Christian organization that required a belief in the Christian God. It was certainly founded by Christians, and there's a lot of "God" in the literature, but it's evolved to a much more inclusive program where all who desire to stop drinking are welcome. I think you do a disservice in suggesting that AA says it's necessary to substitute "God-addiction" for alcohol addiction in order to recover.
I'm a skeptic in the God arena, but a believer in the power of shared experience in AA meetings. This, I think, is the real power of AA-to know that you're not alone, and that others have to stop drinking and find serenity.
Thanks for listening.
reply: Not all AA groups are created equal. Some are obviously less forceful than others regarding belief in God as a necessary condition to get sober. There are, however, alternatives to AA, which eliminate the need to find out whether religion is going to be an issue in seeking sobriety with a particular group.
25 May 99
Interesting book, although I sometimes think you fall into a kind of Randian Ubermenschy trip here & there, but we're all allowed our little flaws.
I thought I'd share a bit about my AA/Al-Anon (more the latter) experiences, 'cos I think you're tarring them a bit too heavily with the theism brush here. Experiences vary, obviously, but my experience with Al Anon is that their idea of God isn't exactly theistic. I knew one Al Anon group that was largely atheists.
My general experience has been that Al-Anon and AA see god as a metaphor. There's a tendency for alcoholics and their families to start to see everything in a hugely imbalanced, fairly control-freaky fashion. Everything that happens is perceived as a personal fault & judgement. Mom's drinking is your fault, wars in Bosnia are your fault, messy rooms are your fault and so on. It can really wrench a person internally, and one of the things you have to learn to do is differentiate between what's your fault (and responsibility) and what you can't do anything about. I've seen a lot of satires of Al-anon where it's described largely as a blaming group. My experience has been that one of the things you have to learn to do is stop worrying about problems that aren't connected to you.
Enter God. God's more or less a convenient place to hang problems that you can't really touch, and worrying about those problems doesn't do me (or anyone else) much good. God's job is to take care of the bigger problems so I can concern myself with my own. For example, I can't do much about an alcoholic's drinking, I can hide booze, but that isn't going to fix the problem. If the alcoholic's going to do something about it, it's going to have to be his decision. Interventions, in that context, are largely useless. In AA parlance, there's a term called 'dry', which refers to an alcoholic who is basically between drinks. Dry people aren't a pleasure to be around, since they're basically alcoholics who've gotten religion. There's a distinction between dry and sober, and it's one that most people who haven't been through it themselves have a bit of trouble grasping. If you've ever been around anyone who is on a diet and makes you change your eating habits, you've got the gist. What interventions, court ordered detox programs and the like tend to do is irritate the alcoholic, which doesn't really solve the problem. You might get 'em dry, but sobriety is a matter of personal choice. Which is a large part of the paradox - alcoholics have to make a decision to become sober, and it's not really something that comes easily. Whether it's a Saul Of Damascus experience or not, I really can't say, I've heard people talk about moments of clarity, but I also know people who just eased into it over the years.
I guess the thing that surprises me the most (and you may want to pursue the
literature in and out of AA on this), is that the organization is markedly different from,
say Syanon or one of those culty groups. My experience with Al-anon is one of a marked
lack of ego - AA is similarly goal oriented. The major focus of both organizations
is to help folks (drunks or the families of drunks) to get on their psychological feet and
get on with their lives. If you can do it without AA, fine with them, most of the AA folks
I've known really don't care how you get to sobriety, as long as you eventually get there.
I know culty, and these organizations really aren't culty - either that or I was too cheap
to buy the photocopied promotional material. (Actually, promotional material isn't the
right word. I've never actually seen Al Anon boost anything. Guidebooks is probably a
18 Nov 1998
Let me start by telling you that I am a member of AA. I am the oldest child of a UCC minister, who pretty much rejected a GOD by the time I was sixteen, not uncommon for the offspring of ministers. At fifteen I started drinking alcohol and experienced my first blackout, if you have never had one they are a strange experience, it was not until I turned 18 that I was able to drink legally and thus as often as I wanted, before that it consisted of whenever we were lucky enough to get some beer.
I experienced blackouts pretty regularly at that point, with no consequences in my life, until at age 24 I got my first drunk driving, I swore that I would never do that again, but of course did, with in the next three years I would be arrested two times more before realizing that I could not drink successfully.
In your treatise you state that an alcoholic is defined by a number of factors,
when , how much etc. While this may be how treatment centers define it, it is not how AA
defines it. In the big book of AA an alcoholic is defined as what happens after you take
the first drink.
reply: I don't see any inconsistency here.
This rang true with my experience of drinking. Once I had taken the first drink I might stop there, or I might not stop for a day, I never knew, and once having taken that first drink had no control. If you are not an alcoholic this is probably difficult to believe, but it was my experience.
The AA big book differentiates between people who may drink a lot, by whatever scale you want to use to measure that and people who lose control of their drinking after taking the first drink.
The intervention practice you wrote about also goes against AA philosophy and is one that I have many problems with in the end a lot of times it does do more harm then good. The AA traditions are explicit about the program being one of attraction rather then promotion and at no time should anyone be forced to take the program.
reply: True. And by the same token, non-theists ought to be aware that just because the 12-step plan works for some people does not mean it is the best for them.
The steps of AA work for some reason that I cannot explain, I do not feel that they are in any way demeaning and the concept that AA tells people that they are worthless and need to tell the world that has not been my experience. Human beings are emotional as well as logical people, the steps in my experience are designed to help identify those areas of emotional/spiritual pain, without that knowledge one cannot fix the problem, you would not renovate a house with out first checking out what needed to be fixed , the steps work in the same way with the human psyche. As well there is nothing new in the AA program which was pretty much borrowed from traditional organized religions. The real difference in AA is the fact that it is one alcoholic relating to another.
I thank you for your time and listening to me, also for the efforts you have taken
in your work. I hope that what I have written makes some sense.
12 Mar 1997
I read your article on Substance Abuse Treatment. I can't disagree with anything in it, and your points about being skeptical about the disease paradigm of alcoholism and the treatment process, as well as your point about "all alcoholics not being equal", are well taken. With all due respect, however, there were places where I thought the article might benefit from editing or rewriting:
reply: Somehow, I knew this was coming!
1. If you are going to include Tim's story, I did want to know about the end of the story. Did he quit drinking? Did he not even need to? Did he get a divorce? Did he live happily ever after?
reply: Tim's story is here to illustrate the dangers of good-willed interventionism, pseudoscientific therapies for substance abuse, and greed. Obviously, Tim's wife believed he needed to quit drinking. Tim says he "sometimes abuses alcohol." They're still married, thought the interventionist/clinic experience has left a bitter aftertaste which has not diminished much in three years. As for living happily ever after....well, the point of the illustration was not to show that his life had been ruined or improved by the experience, nor was it to support the claim that SAT in general ruins or helps lives, so, whether Tim lives happily ever after or not will have to remain a great mystery known only to Tim.
2. About Tim's story: do you think that it presents your point about SAT well? It seemed to veer off into a criticism of Tim's experience. I had three problems with it:
a. It was a single anecdote. I am skeptical of the inclusion of anecdotes in critical articles. I won't say that it was a waste of space but ...
b. Even as an anecdote, it didn't really make a good point. Was it the fuzziness of the "disease" definition, or was it the inappropriateness of his "treatment", or was it the expense, or the damage to Tim's ego or another part of the anecdote that was the point?
reply: The point of the
illustration is described above. Sorry it's use wasn't clearer to you. It is an
anecdote, but it is used to illustrate not to prove anything. It was there to vivify the
material, not to validate my critical comments. I hope other readers don't find it quite
as useless or fuzzy as you do.
c. We don't really know the whole story about Tim. It was told from his point of view to an unknown observer. There may (or may not!) be another point of view that presents more details that leave the reader with an entirely different impression.
reply: Exactly. That is why the article is not primarily about Tim and his
drinking problem and how he worked it out and is now living happily ever after. As I
indicate in the article, I have only Tim's subjective impression that his drinking was not
as serious a problem as others thought it was. So I make no claims about whether his
impressions or that of his wife were more accurate. It should not require too strenuous an
effort to infer from the article that there were quite a few people who had a very
different view of Tim's drinking than Tim's own view. And I'm sure the interventionist
does not see herself primarily as someone paid to deliver a live patient to the clinic. I
think most readers will figure out these things and that the staff at the clinic would
have a different point of view from either Tim's or mine.
Finally, alcoholism and substance abuse in general are pretty subtle phenomena. I think they deserve, perhaps, a bit finer brush than you were using.
reply: The article is not really about alcoholism or substance abuse, but about
treatment for alcoholism and substance abuse. Even so, your point is well-taken.
The issue could be, and deserves to be, explored in great depth by someone whose art of
criticism and depiction is much greater than mine. I suggest you read some of the sources
mentioned in the "further reading" section below.
Please don't take this as a reaction objecting to your inclusion of the article; it's more a reaction to coming away with an impression that the article wasn't up to the quality of the rest of the dictionary.
reply: I appreciate the criticism and will take your final remark as a backhanded compliment meant to inspire me to greater heights.
20 Mar 1997
I just read your article in the Skeptics Dictionary about Substance Abuse Treatment. I also think the emphasis on religious content in these programs is unwarranted. However, what I wanted to share with you is this - I am an astronomer, and teach part-time at Baldwin-Wallace College in Ohio. When looking with my students through the telescope, I sometimes find that the magnification is insufficient. It is only then that I get some satisfaction from appealing to a "higher power."
Dr. Dale C. Ferguson
09 Apr 1997
I have been greatly enjoying your skeptic's dictionary, and I was particularly interested in the entry on substance abuse treatment. I agree with virtually everything you said in it, however, there was one section which may be weak. here it is:
If alcoholism is a disease, it is the strangest disease there is. What other disease is there which
requires coercive teamwork to convince the sick person that he or she is ill? If I have kidney
disease, for example, I expect a certain kind of evidence to be produced to verify that I have such a
disease. A few bits of medical evidence ought to suffice. I sure wouldn't need a team of
interventionists to coerce me into seeing that I have kidney disease.
Though some people question whether mental illnesses are diseases, many of them easily fall into the category of diseases that require coercion in order for the sick person to accept that s/he is ill. this is often due merely to the general lack of knowledge about mental illness in our society, but at other times may be caused by the illness itself. For example, very few people with paranoid schizophrenia will admit that they have a disease. Though I question the veracity of many mental illnesses as being true diseases, I have little doubt that schizophrenia is an illness, or at the very least a developmental aberration. Simply put, schizophrenics have different brains than non-schizophrenics. Exactly what causes schizophrenia is a mystery, but it has been shown that there are differences in the mass of certain brain regions in schizophrenics and "normal" people. Bipolar disorder (manic depression) is another mental illness which is organic, and which is often denied by those who suffer from it. This may be due to misunderstanding of the disease, fear of stigmatization, or any of a million other reasons. Bipolar disorder and schizophrenia are the only mental illnesses which have medications to treat them that are proven to be effective. The effectiveness of antidepressants is generally no greater than that of psychotherapy without medication. Certainly not everyone with a mental illness refuses to admit it, but some do, and there are quite valid reasons for not admitting to something like this. It's really a minor point, but it harms your argument that alcoholism is not a disease.
reply: I don't think it is a minor point. The analogy between brain disorders and alcohol abuse is a stretch. Some people do have problems metabolizing alcohol and cannot drink without having problems. Such people are not brain damaged and should be able to understand the medical evidence presented to them. Even the genetic argument--that some people inherit a genetic tendency to alcohol abuse--does not amount to more than a claim to a tendency. In any case, it does not involve the notion that one's brain can't function properly. The only medication given for alcohol or drug abuse are either more drugs which can be abused (such as methadone for heroin users) or drugs which make one physically ill if one drinks alcohol. Such treatment is trivially analogous to treating schizophrenia: both involve prescribing a drug. On the significant issue of brain or other physical dysfunction or damage, there is no strong analogy. In alcohol abuse the most noticeable physical elements are effects of the abuse; in schizophrenia and other diseases, the significant physical elements are causes.
One would expect that a disease which significantly affects the brain, whatever that disease, could be of such a nature that the affected person would not be capable of rational evaluation of evidence, including evidence of their own disease. There are people who have drunk so much that they have caused themselves significant brain damage, but that is a far cry from identifying all people who abuse alcohol as having a diseased brain.
Additionally, I'd just like to suggest that you might include as an
entry the D.A.R.E. (drug abuse resistance education) program that has become ridiculously
popular in this country despite being utterly ineffective. There is a wonderful source of
information about it at http://www.dare.org despite the
name, this site is in absolutely no way affiliated with the dare program. It is a very
impressive site. [note: Reader John P. Brockus alerted us to the
fact that D.A.R.E. has taken over the site and it is no longer a parody of
the program many have criticized
as a scam.]