Monday, August 07, 2006

So is love a disease?

From today's Peoria Journal Star comes another textbook lesson in how the managers of alcoholism's public image have achieved cultural saturation with their so-called "disease model" of drinking (and substance abuse as a whole). In essence a glowing tribute to the recovery movement, the article by writer Jodi Mailander Farrell drips with phrasing that unquestioningly (and, I might add, very un-journalistically) buys into the notion of alcoholism as a bona fide "chronic disease that can be treated just like asthma or cancer." Farrell talks about how a "group of activists are hoping to end discrimination" against substance abusers through the same types of "public awareness campaigns that pushed breast cancer and AIDS onto the country's radar screen." (I could be wrong here, but I gotta believe that many folks who wear those pink breast cancer ribbons would be somewhat offended at being lumped into the same group with the guy around the corner who spends his evenings doing lines of coke.) She also speaks of people who have "learned to live with their addictions," as if the thing they're learning to live with isn't, to any degree, something they brought upon themselves. (Am I totally wrong to make the comparison to a convicted bank robber who's "learning to live with being in jail"?) Further, with no apparent sense of irony, the writer quotes sources who complain about the "moral stigma attached to this disease." I'm not saying there should be a moral stigma attached to alcoholism, necessarily. I'm asking whether a writer should write such a piece in a way that so totally disenfranchises segments who do hold drunks at least partly accountable for their predicament. Especially given the flimsiness of the evidence supporting the disease model.

You don't have to look very hard to find subsantial evidence that many of the things AA has told us* are suspect at best, false at worst. This should not come as a surprise, given that the storied founders of AA, Bill W. and Dr. Bob, basically pulled the program's dogma out of--I'll be polite here--a hat.

Think of some of the things we've been led to believe about addiction:

--Once an alcoholic, always an alcoholic. Suspect.
--An alcoholic can never revert to mere social drinking. Suspect, and likely false.
--An alcoholic needs help to quit...he can never do it on his own, cold turkey. Outright hogwash. In fact, the reliable, verifiable literature on the subject suggests that drinkers who go it alone actually have better odds of lasting success than those who turn to AA!

I'll concede that once a drinker is fully immersed in his drinking, he must often contend with a constellation of physical problems that can be considered a disease (or maybe syndrome is the better word): liver damage, heart damage, nerve damage and so forth. That has nothing to do with turning to booze in the first place, which--many will argue--is a decision. And if one is going to counter that people who are predisposed to drink or stuck in environments that tend to promote drinking do not bear personal responsibility for their fates... Well, couldn't the same be said of, say, inner-city drug dealers or gang members? Why do we hold them responsible?

What I find most interesting about Farrell's piece, however, is that despite her overwhelmingly sympathetic tone, she eventually gets around to making the same point I made in SHAM (a point that earned me more condemnation during my media tour than anything else I said in the book): She admits that "nobody knows exactly how many Americans have achieved [recovery]."

This begs two questions: 1. If we don't have a good handle on the efficacy of the very programs Farrell lauds in her piece, then why are we lauding those programs, and why are we steering people to them? 2. The government in 2000 estimated the aggregate national costs of alcoholism at $184 billion per year (surely above $200 billion by now). Given that, don't we need to know what works and what doesn't? Not just guess at it. Not just trust people's "good intentions." But know. For sure....?

Btw, credit for the title of this post goes to my son. When I told him what I was writing about, he said, "So then is love a disease? How can something be a disease if it's not tangible?" How, he wanted to know, do you quantify it?

Bravo, son. Couldn't have said it better myself. And while I'm in family mode, let me take this opportunity to offer posthumous birthday greetings to my father, who passed in 1978 at age 60. The skeptic in me isn't sure there's a heaven...but if there is, Dad's there.

* The verification here is way too complex and voluminous to furnish through links in this post. You might use relevant sections of SHAM as a road map to your own inquiry, should you choose to make one. And as always, reasonable dissent is more than welcome.


Anonymous said...

I liked the way you ended this comment. I didn't realize you had a tender side. :) I will say a prayer for your father.

Cosmic Connie said...

First let me answer your son, Steve. Yes, love is a disease, but, as Leonard Cohen said, "there ain't no cure" for it. Thank goodness. There, now that I got my LC quote in for the day, I'll address the topic of this post.

I consider myself a recovered alcoholic. Not a "recovering" alcoholic. Not "a drunk." Not a "sick puppy" (as some of the AA-ites love to describe themselves). But a RECOVERED alcoholic...that is, when I think of myself at all in those terms. I do not drink, and everyone I know accepts that. It's NBD.

I know enough about myself to believe it is better for me not to personally test any theories about the possibility of going back to drinking socially. But that doesn't mean I don't think it is possible for others who once abused alcohol to learn to drink responsibly.

I have to confess, though, that the disease model of alcoholism was helpful to me at the very beginning, when I was trying desperately to quit drinking. I felt guilty about drinking (even though I never harmed anyone but myself), and thinking of it as a disease helped me. AA was helpful too. I got support I needed, and somehow I got the message that even though it was a "disease" I still had the responsibility to control it. (I know that message often gets lost in translation in recovery programs.)

But after a very short time, I got tired of the "Big Book thumpers" and the recovery fundamentalists who insisted that I had to work the 12 steps exactly as instructed or I would, sooner or later, "go back out there" (start drinking again).

My own sponsor lectured me about not working the steps properly, and yet she ended up going back "out there" soon after.

I haven't been to an AA meeting since the late 80s, and I am still not drinking. That doesn't mean I am complacent about the fact that I don't drink. And it doesn't mean that I think AA and similar programs are worthless. I think the AA model for addressing addiction is helpful to a limited degree for many people, but I agree with Steve; we need to take a more honest look at the long-term effectiveness. AA and all the other "anonymous" programs simply don't seem to have a very good track record there.

Anonymous said...

I believe these posts are going to get personal. That's okay.

I grew up with an alcoholic father, and my grandparents, along with high school groups such as SADD -- of which I was a member -- feed me the rhetoric that alcoholism was genetic -- that I was predisposed (doomed, maybe) to tipping the bottle for more than pleasure.

The case, however, is much different. When I was attending college, my friends and I worshipped Jack Daniels and Jim Beam, chased'em with vodka. To pinch pennies, beer was our drink. But only imports -- Bud and Coors Light, to me, looked and smelt like piss.

We drank to celebrate everything, and sometimes nothing at all.

However, there was a time setting in a bar when I was faced with a decision. Take another drink, and become just like my father, or walk away.

I chose that latter, partly to spite my dad -- that's a different story for a different day.

(In fact, Steve, that's a topic you encouraged me to write on. I haven't yet -- although I've tried.)

That choice to walk away proved to me and subsequent choices later in life have convinced me that alcoholism is a choice usually rooted in self-pity, or self-annihilation.

We either choose to wallow in our self-absorbed pity and slowly destroy our body with alcohol in excess and allow our attitude to be controlled, or we control the substance. It's that simple.

Alcohol, like money, like fame, like sex can be controlled, or we allow it to control us. But even that's not the best way to describe it. More or less, if we choose to allow a substance to control us, we are, in fact, using it as an excuse to act out in a fashion we wouldn't act out under normal circumstances.

The substance gives us an excuse, a scapegoat. For example, my dad would never punch me if he was sober, but in a stooper. Once we faught to a bloody end. I carry a scare as proof. That's the man I never wanted to become.

Fortunately, back to the choice I made in a college bar. I sat at a table in a stooper and another bar patron kept bumping into me, making harrassing comments at me -- he was picking a fight.

When I was thoroughly pissed, I looked at my just-poured shot, thought to myself that shot would give me the courage to break that guys nose. (Mind you he was twice my size, and he'd probably break me). My fury was real, my conscious -- that quiter side of one's inner self -- told me that drinking that new shot and busting that guy in the chops would make me no better than my dad.

I would become that man I hated. (again another story for another day.)

After my parents moved, after my dad got a better job, after the stress of life, I guess, let up, my mom told me that my dad stopped drinking -- until he found her dead last February. She hung herself from the back of a bedroom door.

My father is drinking again, sometimes heavily. Do you blame him?

Choice. It's something we wrestle with. Sometimes we lose, sometimes we win. Always, we learn -- hopefully.

Steve Salerno said...

I much admire the personal component of these posts (this will not surprise Rodger, given his IU-bred knowledge of my many years of experience with the memoir as both writer and teacher). I compliment you, CosCon and Rodg, for bringing added depth and impact to this thread by introducing such intensely personal thoughts. For my money, this is blogging at its best--not because it's my blog, but because of what contributors like yourselves are bringing to it daily.

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RevRon's Rants said...

My name is Ron, and I used to be a junkie. I won't say that I am still an addict, because I haven't put a needle in my arm since 1970, and know that I never will again. Sure, at certain stressful times, I recall with some fondness the comfortable haze of being stoned out of my mind. But I also recall the agony of withdrawal, and the shame I felt at the knowledge that I would have done almost anything to make that agony go away. And I feel thankful that I never had to steal, kill, or otherwise further debase myself to get my fix. The loss of self-determination I felt was debasement enough.

But did I suffer from a disease? I don't believe so. I did suffer symptoms brought about by my own foolish choices. To ascribe those choices to some disease would be to abdicate responsibility for my own actions, which would, I feel, only reinforce my addiction. Perhaps, instead of being addicted to the perversely nurturing sensation offered by the drug, I might have transferred my addiction to a substitute drug or to the nurturing sensation offered by a group of people who had also lived within that haze. Such processes might work for others, but they weren't for me. As such, I can't say that the programs constitute a cure, but more of a transferrence, perhaps delaying or even aborting actual victory over addiction.

And if I sound dismissive of the AA model, it is only because I have known more participants who either returned to their former addiction or became lifelong "program junkies" than have actually moved beyond their addictions. Granted, the program junkies stayed away from the substances, but their lives became defined - and often, limited - by their participation in their group. Hardly a "cure," in my opinion.

While I have admittedly shirked personal responsibility in many ways throughout my life, the repercussions for those times were transitory and relatively benign. I knew that a failure to step up to the plate and beat my addiction would result in my eventual incarceration or hasten my death, and I could not accept a "cure" that merely placed me a step or two away from the shadow under which I had lived. And the only way for me to fully change my life was not to seek an external cure for my own behavior, but to eliminate that behavior from my existence.

I am glad for those who have been helped by the disease / cure model, but I would encourage them to take that 13th step and graduate. I know it can be done, for I live with and love someone who has succeeded. And the only real lingering effect of our addictions is our memories of times when we did foolish things.

Steve Salerno said...

Your final line, RevRon, much reminds me of a certain wistful point in my interview with Joe Jennings, former gang-banger/drug-runner who now does motivational speaking, mostly before inner-city high school audiences. (I talk about him, and others of similar backgrounds, in the SHAM chapter on "con-trepreneurs.") Though Jennings today preaches a quasi-spiritual, zero-tolerance message of doing the right thing and ONLY the right thing every hour of every day, I asked him whether he ever missed the good old days. He got quiet for a second and even though we were speaking long-distance, I could "hear" the smile on his face. "We had some times, no question about it," he said, among other things.

I often think that the guilty pleasure inherent in the memory of "those times" is what sustains the average Joe (all of them, not just Jennings) living his Thoreau-ian adult life of quiet desperation. We get older, we realize that to one degree or another we must conform in order to make our way in life--but we never quite give up the dangerous beauty of the days when we were young and crazy and--like that classic scene from Scarface (Pacino version)--the world, for a brief while, was ours. At least that's how we saw it.