|
|
An Open Letter To All Concerned With the
Drug-Crime Epidemic:
From Dr. James R. Milam
Since it’s publication (some 30,000 original circulation) copies of
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 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 (in More On The Alcoholism Revolution),
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 for 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 spokesperson 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.
About twenty five 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, non-problem drinking throughout the
follow-up period." The Maltzman, Pendery, and West investigations
(from The Winter of Scholarly Scientific Journals) found that both
during the Sobell follow-up and continuing through 1981, with the
exception of one patient whose initial diagnosis was questioned, all
had been drinking alcoholically, 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 whistleblowers, 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 falsified 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 lead, had successfully promoted marijuana as a
completely harmless, non-addictive 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." Echoing psychiatrist Morris Chafetz, the
founding Director of the National Institute on Alcohol Abuse and
Alcoholism, 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. Under the cover of
legitimate social protest, reared within an academically sanctioned
world of drug addiction and denial, the diabolic spawn of the older
moralistic ignorance of addiction, theirs was the first generation
ever to mistake adolescent rebellion for a sophisticated new adult
lifestyle. 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 non-addictive, 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.
It is naďve to suppose that a decisive battle will ever be won on the
streets. Street level drug activity couldn’t operate a week without a
high level umbrella of money and protection. It is inconceivable that
for so many years so many hundreds of billions of dollars generated by
this deadly cash trade could be laundered and distributed without the
participation or cognizance of many otherwise respectable people in
all high places—the media, academia, banking, government funding
agencies, major professions and others. To the participants it must be
worth well placed millions to lubricate the trade and to ease the
public conscience by keeping in place the belief that their products
are really non-addictive and harmless, when used recreationally and
not abused. Damn the "abusers," not the drugs. How else to explain the
fanatic denial of reality and the betrayal of scientific and public
trust (Maltzman).
So where are all the investigative reporters when we need them for a
really serious problem, one that is destroying the country? Answer:
Many of these boomers are also dupes, and either using drugs or
condoning it in their peers. The enlightened ones are waiting for a
legitimizing platform. Who can they quote or cite as an authoritative
source? Who in high places can and will go first? Where is the Dr.
Koop of street drugs? Whoever the lead authoritative spokesperson,
they must be backed by a strong consortium supported by a
constituency, and all such candidates are paralyzed by the awareness
that so far no such organized platform exists.
And don’t look to the major professions or government drug and alcohol
agencies. They are the source of the problem. Bill Wilson in his later
years lamented the fact, confirmed repeatedly by research, that
without prior treatment only about 1 in 18 alcoholics is able to start
their recovery successfully in AA without multiple relapses. Research
also has shown repeatedly that treatment without Twelve Step
continuation yields near zero recoveries. For over 25 years research
has shown that it is only the full sequence of detox, inpatient
treatment, outpatient follow-up, and Twelve Step continuation, with no
substitute drugs or contraindicating therapies, that can yield a
recovery rate of three fourths or better on first treatment. NIAAA has
just recently acknowledged this decades old research evidence in their
quarterly magazine, but they presented it as a "new" discovery,
thereby avoiding any criticism for having ignored this readily
available information for so long. Their belated acknowledgement was
accompanied by the announcement that research would now be funded to
see which components of treatment works best, while searching for a
drug to ease the craving. (Cars run well, but they are expensive.
Let’s see how well they run without the fuel system, the ignition
system, or the transmission.) Of course it will take many years to
again test all of the components this way. (Our sound-bite response
might well be, "It’s the sequence, stupid.")
The primary reason the funding agencies are stalling is because they
are ill prepared to participate in the biogenic model they have
categorically suppressed for so long. There is no one in academia to
teach the teachers, never mind reeducating the tens of thousands of
professionals already out in practice. Theirs is the old rock and a
hard place dilemma. Is it better to let the drug/crime epidemic run
unchecked for a few more years while we try to save face and educate
ourselves? Or should we immediately go public with the validity of the
"new" paradigm, thereby revealing that, locked in the old, we have
been the source of the drug/crime problem and the major obstacle to
its resolution? In the latter case, tens of thousands of shocked and
embarrassed practitioners, feeling betrayed , would have to refer half
their patients out while they sheepishly (angrily?) tried to learn
(from whom?), or seek more suitable employment.
Citing the failure of alcohol prohibition, blaming the current crime
epidemic on the fact that drugs are illicit, is as disingenuous as
citing 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 misinformed 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 drugs 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 bloodstream, 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 blindsided 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 denial and 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 the "rip-off
industry." Contrived, because it was the same Sobell alliance that
fostered the exploitation and then orchestrated the media blitz. They
focused 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 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 follow-up
study (including anger management, harm reduction, and dual diagnosis
treatments) cruelly provided temporary diversions, but uniformly
yielded zero recoveries from this progressively 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 and its diversionary
deployments, the "dual-diagnosis" replay, and the other Trojan
Horses—the "harm reduction" and "moderation management" programs—that
smuggle the alcoholics’ old alibis back in as causes. "It isn’t the
drugs, it’s the abusers that are the problem."
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 non-alcoholics, 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.
Take heart from many signs that the revolution is under way, and
gaining momentum. In an historic preemptive move, early in 1994, the
principal culprits in the subversion of peer review were visibly
hooked off the academic center stage into the wings. Confronted with
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.
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."
James R. Milam, PhD.
Note: updated versions of this letter are now available at the
following Internet address: Out From Under,
http://aaw.com
It now appears that the mission proposed for the Biogenic Addiction
Institute (last page of The Alcoholism Revolution) will best be
accomplished by a combination of the Washington State organization,
the Alliance for Recovery, and computer networking with the growing
number of clinical and research organizations and individuals on-line.
(Find the Alliance at
http://aaw.com). Major professional organizations and government
agencies are already finding ways to help and, as they discover the
effective programs and become familiar with the biogenic approach, can
be expected to gradually emerge in their proper leadership roles.
Meanwhile, this (information) provides the rationale for truly
effective reform in addiction prevention, intervention, treatment and
rehabilitation which will be so essential to the success of any
healthcare or judicial reform. As the nation moves in this direction,
enlightened national, state and local organizations and individuals
are available to provide information and assistance in program design
and implementation. For convenience, listed below are three key
organizations that work closely with all of the others. They can
immediately provide vital information and assistance while assuring
the wider coordination.
National Council on Alcoholism & Drug Dependence (NCADD)
20 Exchange Place, Suite 2902
New York, NY 10005
(212) 269-7797 - fax (212) 269-7510
www.ncadd.org
American Society of Addiction Medicine (ASAM)
4601 North Park Ave, Arcade Suite 101
Chevy Chase, MD 20815
(301) 656-3920 - fax (301) 656-3815
www.asam.org
|
|
