By James R. Milam, Ph.D.
November 17, 1995
“In my opinion, interdisciplinary work does not mean the meeting of specialists in different disciplines, but rather the meeting of different disciplines in the same individual–an adventure that our system discourages, when it does not absolutely forbid it.” – LUCIEN ISRAËL, Conquering Cancer (1978)
Since its publication (some 30,000 original circulation) copies of the enclosed paper, The Alcoholism Revolution, are continuing to spread, and there is now clear evidence that this definitive statement is transforming scientific and professional understanding of addiction, inspiring a cleanup of the peer review scandal, and profoundly influencing pending healthcare and criminal justice reforms. Major media stories are already reflecting the more positive attitudes toward treatment and recovery.
Meanwhile, with only stop-gap measures available to address the social and fiscal crises of our time, there is a continuing urgency for this rectifying information to be more widely available in its present form. So I have mailed evolving versions of this letter with its enclosures to scientists, professionals, government officials, media members and others who by their cumulative actions and influence will help to finally put a stop to this cultural calamity. To this end, I ask that you read this information thoughtfully, and share it with still others.
As early responses indicate, The Alcoholism Revolution speaks eloquently for itself, but it is also necessary to address what may otherwise still seem to be an insurmountable obstacle to the more general dissemination of this “heretical” material. Some members of the broader scientific and professional community have been constrained, without substantive comment, to hold the paper in abeyance as extreme, or premature. The reason is as obvious as it is absolute. Everything in the paper is anathema to the long established peer review consensus in alcoholism. There is no interdisciplinary mechanism of substantive appeal, no higher scientific authority, and it is unthinkable for official scientific spokespersons to violate the sacrosanct hegemony of an intradisciplinary peer review procedure. Neither they nor the communications media have had any way to know that in the field of addiction research this obstacle has been more apparent than real. Thus the fact that the peer review process has long been corrupted and subverted is a necessary part of the story of the alcoholism revolution.
Over twenty years ago Mark and Linda Sobell began publishing research reports alleging that controlled drinking was a viable treatment option for alcoholics because having trained twenty to do so, “…many engaged in limited, nonproblem drinking throughout the followup period.” The Maltzman, Pendery, and West investigations (The Winter of Scholarly Science Journals, enclosed) found that both during the Sobell followup and continuing through 1981, with the exception of one patient whose initial diagnosis was questioned, all had been drinking alcoholicly, with multiple hospitalizations and incarcerations. Four had died of alcohol related causes, another had disappeared while drinking, and six had resorted to programs of total abstinence. None had been drinking non-problematically.
Peer review then denied relevant journal access to Maltzman and the other whistle-blowers, as an “investigative” panel of Sobell cohorts castigated the critics and absolved the Sobells, characterizing their research reports as “perhaps too enthusiastic.” The Sobells were defended on the ground that the control group, instructed by the Sobells to abstain, fared no better than those taught to moderate their drinking. This diversionary point is, of course, irrelevant to the fact that the Sobells blatantly lied about their critically important data.
It would be hard to overstate the enormous impact of the Sobells’ “demonstration” on both science and public policy. It was insider knowledge that all other attempts to justify the denial of physical addiction had instead confirmed it that put such heavy pressure on the Sobells to falsify their data, and that made their bogus reports the most widely cited and most influential in shaping the academic addiction literature through the 1970s and ‘80s.
In parallel, by the 1970s the academic chorus of denial, with Timothy Leary singing the lead, had successfully promoted marijuana as a completely harmless, nonaddictive recreational drug with no physical consequences. There was then a sharp rise in cocaine use. At the first sign of public alarm President Carter’s drug czar, psychiatrist Peter Bourne, quelled the concern with a reassuring White House bulletin: “Don’t worry about cocaine. It’s among the most benign of all drugs in widespread use.”
Herbert Fingarette’s 1988 book, Heavy Drinking, was pivotal in the abrupt national regression from the emphasis on intervention and treatment of addicts to almost complete reliance on condemnation and punishment of “abusers.” He cited the Sobells’ reports twenty times in his argument that there is no such thing as physical addiction, that abstinence treatment is both unnecessary and ineffective. Since it had been scientifically proven that alcoholics can learn to drink moderately, society should demand that they do so, and punish them if they don’t. Thus his primary contribution was to elevate the big lie to public prominence and respectability, supporting Stanton Peele’s raucous sound-bite presentation of it in the media. Incredibly, Fingarette has been the US representative on addictions to the United Nations, which explains the global ignorance of the scientific paradigm shift that has occurred behind the scenes of denial in this country, and our meager distorted information about how other countries are coping with the drug crisis.
Fingarette’s gullibility was one thing, but why was society so ready and willing to be duped? The answer was in the changing composition of society. By 1988 members of the aging baby-boom generation were ascending to society’s levers of control. Reared within the academically sanctioned drug culture of denial of addiction—the diabolic spawn of the older moralistic ignorance of addiction—they were programmed to believe that theirs was the enlightened view, and from the beginning consensual validation had precluded any concern with evidence. In flipping society back into its old moralisms, the task was not so much to persuade as merely to pander to the mind set of this rising majority—denial imbedded in ignorance. Never mind that Fingarette’s evidence and argument were specious. Who but a cross-threaded voiceless minority could know?
Although never mentioned in the long lists of psychosocial risk factors blamed for the growing problem of “drug-abuse,” clearly all such factors are preempted by this big lie—the denial of physical addiction—the seminal crime in the drug-crime epidemic. This deception alone, the cultural message that drugs are nonaddictive, and harmless when not being abused, fully accounts for the drug epidemic. Absent the truth freedom of choice is counterfeit, freedom of speech a mockery, and support for the proposal to decriminalize drugs a capitulation to the hoax that generates the problem.
Citing the failure of alcohol prohibition, blaming the current crime epidemic on the fact that drugs are illicit, is as disingenuous as reciting the psychosocial risk factors. While cocaine and other such drugs were legal up through the first decade of this century there was a major drug epidemic. Finally realizing that the drugs were destructively addictive for most users, the public rallied in full support of the Harrison Act, outlawing the drugs, and the epidemic subsided. According to historian David Musto, “Drug prohibition was a complete success.” The difference was that smirking members of academia and a huge entertainment industry were not flouting the law and, through a disinformed press, continuing to promote recreational use of drugs. On the other hand, one major reason alcohol prohibition failed is that for nine out of ten drinkers, regardless of how, why, how much or how long they might choose to drink, alcohol is not an addictive drug, and for them moderate recreational drinking truly is a valid option.
No, psychosocial “risk factors” are not causes of addiction. Along with the big lie, they help to determine exposure, but the cause is the addictive chemical in a biologically susceptible individual, and most drug users are addicted. It is not just the acute drug effect or the illicit drug seeking that are a problem. They are just the beguiling visible tips of the massive addiction-crime connection. Note that tendencies toward violent behavior have always been with us, and that psychosocial factors have always been precipitating causes. As explained in The Alcoholism Revolution, persisting even after drugs have cleared the blood stream, the chronic brain syndrome of untreated addiction increases (neurologically augments) all destructive response tendencies, thus escalating both the frequency and intensity of overt expression of these normally more controlled impulses. Rates of suicide and homicide and all other crimes and excesses are greatly increased regardless of the ready availability of drugs or alcohol. But with addiction commonly excluded from the consideration of causes, and drug use and “abuse” viewed as incidental symptoms, the cause of the whole inflamed response is attributed to the person and to the familiar psychosocial triggers, as though age old sexual tension, domestic conflict and social injustice somehow in recent generations have become extremely provocative of destructively insane behavior. Alternately, it seems that a failed morality has unleashed this abusive torrent, when in fact, naively thrust to the decoy front in this quixotic war, morality has been blind sided and savaged by the camouflaged foe of addiction. Unable to account for the pandemic destructive behaviors, the media can only describe them, as weird, strange, out of character, irrational, bizarre and mysterious.
The familiar comes to seem normal, but the cumulative loss of civilities and moral sensibilities has been devastating as for three decades the whole of society has been contagiously coarsened to accommodate this misattribution of the insanity of addiction. Through screaming music the nihilistic effluvium of toxic brains has been imprinted as social commentary on the brains of each new generation of innocents, the maudlin agonizing of dying brain cells has been flatteringly mistaken for existential angst, senseless violence has been viewed as social protest, and peeing on cultural icons has been hailed as an avant-garde art form.
And it is through this misattribution that society has unwittingly subsidized and enabled addiction by guiltily trying to assuage its abusive consequences instead of demanding and enabling clean and sober recoveries. Predictably, insane behavior, crime, and poverty have increased in proportion to ever increasing expenditures devoted to their reduction. Thus did the drug culture of denial and misattribution assure that all of the heroic social engineering and fiscal gymnastics intended to create the great society would instead produce the great alibi society, this blundering bankrupt world of psychobabble and victimhood.
And no, informing the addict that he has a disease does not let him off the hook for his bad behavior, as widely proclaimed. On the contrary, it is the only convincing way to put him on the proper moral hook, the enforceable imperative to do whatever it takes to get clean and sober, and stay that way, as the only way to heal the brain syndrome that produces the destructive behavior. When coerced into treatment, once detoxified and returned to sanity and selfhood virtually all patients gratefully accept this truth and its moral obligation—if presented unequivocally and explained thoroughly—and become self-motivated. Most fully recover, even many of the “hopeless.” None recover when their psychosocial alibis and complications are mistaken for causes.
By 1988 the lucrative exploitation of the addiction treatment industry by the “substance abuse” mentality had burgeoned out of control, and it was easy to contrive the public backlash against this “rip-off industry.” Contrived, because it was the same Sobell alliance that fostered the exploitation and then orchestrated the media blitz. They focussed the attack not on their own zero recovery psychogenic programs, but exclusively against the “disease concept.” During the two decades of peer review subversion, scientific evidence proving the high cost/effectiveness of the abstinence oriented programs had been purged from public view. Bereft of scientific legitimacy, they were helpless to differentiate themselves or to defend against the attack, and the voice of recovery disappeared from the national dialogue. Well over half of the better private inpatient programs, ranging downward from eight thousand dollars per treatment sequence and yielding full recovery rates of some two-thirds, have been forced to close, and most of their financially starved public funded counterparts have been compromised to become cheap but extremely costly revolving doors. Meanwhile, at some $25,000 per inmate, per year, the prisons are bulging with alcoholics and drug addicts whose predictably recurrent crimes and incarcerations are secondary to the insanity of unrecognized or wrongly treated addiction.
The surviving treatment programs remain impotent pending public disclosure of the truth, and in their silence we hear the loud replay of the hostile code words of the truly failed psychogenic strategies of the 1970s, “We need to try alternative treatments.” The 44 of these highly varied “alternative” programs in the notorious Rand followup study (including anger management, harm reduction, and dual diagnosis treatments) cruelly provided temporary diversions, but uniformly yielded zero recoveries from this progressive fatal disease. Their future failures are predictable because in their inverted view of cause and effect, addiction doesn’t cause dysfunctional behavior, dysfunctional behavior causes substance abuse (John Bradshaw). If we learned anything from the 1970s it was that increased funding of this wrong premise in whatever guise only produces more colossal failures. So keep your eye on the really big money, in the “dual-diagnosis” replay, and the other Trojan Horses–the “harm reduction” and “moderation management” programs that also smuggle the alcoholics’ old alibis back in as causes.
But enough already of the 50-year obsession with alternatives to what works–the cosmetic tweaking and fiddling within the failed paradigm. As sincere curiosity and respect replace programmed ignorance and contempt, academics can discover and help improve, and multiply, the effective abstinence programs. Just honest scientific validation replacing dishonest disparagement will significantly increase patient confidence and therefore treatment effectiveness.
Take heart from the many signs that the revolution is under way, and gaining momentum. In a historic preemptive move, early in 1994 the principal culprits in the subversion of peer review were very visibly hooked off the academic center stage into the wings. Confronting the ensuing disarray, top officials of the American Psychological Association then suspended their campaign to subordinate addiction to mental health, appealed to their biologically oriented members to assert new leadership in this area (APA Monitor, July, 1994), and began a reassessment of peer review procedures. To the same end, top government agencies have just announced prophylactic peer review changes required for future research funding.
Alas, in a face-saving stall some members of the old guard are now attempting to trivialize the biogenic model by equating addiction with the nerve-transmitter effects of heavy drinking, the normal effects also produced by heavy drinking in nonalcoholics, and similar to the effects of excessive running or stamp collecting. But this denial of genetic susceptibility to addiction will not long prevail because enlightenment is spreading too fast, and government alcoholism and drug funding priorities are already shifting to support remedial professional education and training in the disease of addiction. Of course, the broader default position is still psychogenic. Even with unlikely retractions by the Sobells and their cohorts or published repudiations, it could take many years to glean enough valid information from the chaff comprising the vast inverted “substance abuse” literature to assemble the biogenic paradigm. On the other hand, as growing awareness of the true gestalt reaches a kind of critical mass, in an edifying figure-ground reversal the whole academic literature can be quickly flipped right side up.
In a most promising parallel development, the American Bar Association Task Force on the Drug Crisis has recently discovered and adopted the biogenic model.
It is also evident that the broader public pendulum has started to return from its extreme swing to interdiction and punishment. Drug courts are proliferating, and growing numbers of reformers are discovering the hard data confirming the enormous reduction in crime and healthcare costs following comparatively small investments in effective addiction treatment. So now the really huge question is this: To what will the pendulum return? Will selected addicts merely escape the revolving prison doors to join the throng still cycling in the traditional zero recovery healthcare and welfare caseloads, and the financially compromised revolving door programs? Or will there be a substantial reduction of all caseloads through enlightened leadership and rigorous measures of prevention, intervention and treatment of the core problem, addiction? Heaven help us if we merely continue to follow the advice attributed to Yogi Berra, “If you come to a fork in the road, take it.”
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