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Addiction Notes

[1] See: Drug Use is NOT Abuse 

[2] See: Deter and Cohen 

[3] Dr. S. Peele in Addiction Research, 8:599-607, 2000 

Also see: Cohen 

[4] See: Heroin 

This should be self evident from the fact that most addicts must produce high levels of income while evading arrest. 

We also have innumerable examples, many from the work of Edward Brecher on the period when drugs were legal in "Licit and Illicit Drugs." And, what do we make of the early years of President Bush (43) and the travails of Rush Limbaugh ? Peele cites the case of writer Stephen Gaghan: 

Gaghan is a recovering addict who himself recognizes that his experience is singular among his peers: "I wasn't much different from my peers. Except where they could stop drinking after three or six or ten drinks, I couldn't stop and wouldn't stop until I had progressed through marijuana, cocaine, heroin and, finally, crack and freebase. . ." 

Still, Gaghan does not exactly conform with popular notions of addiction: in Newsweek he revealed that, "I won an Emmy for an episode of 'NYPD Blue' composed while on heroin," after years of serious drug use. 

[5] See: Science note 2 

[6] See: Lincoln on Addiction

[7] Dr. Stanton Peele 

Dr. Peele has long been an iconoclast in the addiction field, beginning with the publication in 1975 of his classic work, "Love and Addiction.

He challenges the idea of addiction as a disease, 12-Step orthodoxy and the concept of the "high jacked brain." 

He is both a psychologist and an attorney. In his various articles and books such as "Diseasing of America", "Meaning of Addiction", "The Truth About Addiction and Recovery", and, with co-authors Archie Brodsky and Charles Bufe, "Resisting 12-Step Coercion", he has explored how most drug users do not become addicted, how most addicts recover without treatment, how addictive patterns characterize many compulsions aside from drug use, how treatment in America is often more about moralism and zero-tolerance than about actually improving the lives of substance users and addicts. 

Those interested in addiction should be aware of his contrarian views, their growing acceptance and the evidence he presents. 

An original article written for DPFT is at Dr. Peele Article

His work can be explored in more detail below and at his website.

Dr. Peele views addiction as a general pattern of behavior that nearly everyone experiences in varying degrees at one time or another. 

Viewed in this context, addiction is not unusual, although it can grow to overwhelming and life-defeating dimensions. It is not essentially a medical problem, but a problem of life. It is frequently encountered and very often overcome in people's lives - the failure to overcome addictions is the exception. It occurs for people who learn drug use or other destructive patterns as a way of gaining satisfaction in the absence of more functional ways of dealing with the world. Therefore, maturity, improved coping skills, and better self-management and self-regard all contribute to overcoming and preventing addiction. 

 Excerpts from "The Surprising Truth About Addiction

Psychology Today, May-June 2004, pp. 43-46, by Stanton Peele. 

 Summary: More people quit addictions than maintain them, and they do so on their own. That's not to say it happens overnight. People succeed when they recognize that the addiction interferes with something they value and when they develop the confidence that they can change. 

Change is natural. You no doubt act very differently in many areas of your life now compared with how you did when you were a teenager. Likewise, over time you will probably overcome or ameliorate certain behaviors: a short temper, crippling insecurity. 

For some reason, we exempt addiction from our beliefs about change. In both popular and scientific models, addiction is seen as locking you into an inescapable pattern of behavior. Both folk wisdom, as represented by Alcoholics Anonymous, and modern neuroscience regard addiction as a virtually permanent brain disease. No matter how many years ago your uncle Joe had his last drink, he is still considered an alcoholic. The very word addict confers an identity that admits no other possibilities. It incorporates the assumption that you can't, or won't, change. 

Smoking is at the top of the charts in terms of difficulty of quitting. But the majority of ex-smokers quit without any aid neither nicotine patches nor gum, Smoke enders groups nor hypnotism. (Don't take my word for it; at your next social gathering, ask how many people have quit smoking on their own.) In fact, as many cigarette smokers quit on their own, an even higher percentage of heroin and cocaine addicts and alcoholics quit without treatment. It is simply more difficult to keep these habits going through adulthood. It's hard to go to Disney World with your family while you are shooting heroin. Addicts who quit on their own typically report that they did so in order to achieve normalcy. 

This is not to say that treatment can't be useful. But the most successful treatments are non-confrontational approaches that allow self-propelled change. Psychologists at the University of New Mexico led by William Miller tabulated every controlled study of alcoholism treatment they could find. They concluded that the leading therapy was barely a therapy at all but a quick encounter between patient and health-care worker in an ordinary medical setting. The intervention is sometimes as brief as a doctor looking at the results of liver-function tests and telling a patient to cut down on his drinking. Many patients then decide to cut back and do! 

These findings square with what we know about change in other areas of life: People change when they want it badly enough and when they feel strong enough to face the challenge, not when they're humiliated or coerced. An approach that empowers and offers positive reinforcement is preferable to one that strips the individual of agency. These techniques are most likely to elicit real changes, however short of perfect and hard-won they may be. 

(This summer, Dr. Peele's latest book, "7 Tools to Beat Addiction" will be published by Random House/Three Rivers Press.)

[8]Dr. Andrew Byrne 

Extracts only. For more, see www.AddictInTheFamily.org Just because a teenager uses cannabis occasionally or takes an ecstasy tablet does not mean they are destined to turn into a heroin addict. The vast majority of such young people never develop a problem with drugs at all. From the medical point of view it is probably more worrying to find that one's child is smoking tobacco than to learn of occasional cannabis use. 

Whether legal or illegal, most adults use a variety of drugs in a controlled way and only a minority get into difficulties. 

When necessary, most addicts can wean themselves down to a low dose of their drug-of-choice. From this point some can spontaneously cease drug use altogether. 

Occasionally, one meets a user who states frankly: 'No, I do not want to give up. Heroin makes me feel good. It gives me energy to go out and do a day's work and helps me relax in the evenings. I pay for it myself and I do not cause anyone else any trouble.' It is difficult to argue against such assertions from informed adults. 

Lives are lost frequently in the drug using population, and very often it is not the victim's drug-of-choice which kills them. Substitute drugs, harmful additives and unknown concentrations or alternative routes of administration are all possible causes of death. 

Only a minority of these patients [who died] fit the 'junkie' stereotype and some are very young, emphasizing the tragedy of these largely preventable deaths. 

[9] Methadone [extracts from Dr. Byrne] 

The miracle of methadone has to be witnessed to be understood. The change in the addict is often sudden and dramatic. The appearance, attitude, general health and social functioning may return to normal almost overnight. 

Dole's team [Dr Vincent P. Dole in New York in 1963 , his psychiatrist wife, Marie Nyswander] found the transformation to be rapid and radical, with most of his patients returning to a normal way of life in all observable respects. Education was resumed, families reunited, employment found and, most importantly, the patients largely curtailed their use of injected heroin while taking daily doses of oral methadone. 

Large numbers of patients successfully complete methadone treatment every year. The average length of time in treatment is between one and two years. 

Following months or even years of illicit drug use, it is important to have a substantial period of stability on methadone before considering dose reductions. It has been shown repeatedly that those remaining in treatment longer have a better likelihood of long term abstinence from narcotics. 

It would be as useful as saying to an overweight person to 'if you eat a bit less every day you will cure your obesity'. Of course, it is true, but to recite it is patronizing, unhelpful and shows an ignorance of the human condition. 

But gradual reductions do work in certain instances. Usually over quite extended periods, they should be initiated by the patient themselves in a climate of stability and control. ... we now know that the longer it takes, the more likely it is to result in long term abstinence. 

What is important from our standpoint is that such people are productive members of society at the same time as using large quantities of opioid drugs. Most of them only use drugs for limited periods but some consume their drugs regularly over many years.

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