Note: The Fifth Column is a regular, independent column
written by Jeffrey A. Schaler, Ph.D.

For this issue, Dr. Schaler has invited his colleague
Prof. David J. Essex, to contribute to the PsychNews as
guest columnist.

Opinions and comments are invited. Please send them to
the PsychNews Int'l mailbox: pni@badlands.nodak.edu



                          David J. Essex

     If it were not so appallingly vicious, the dominance of a
nonsensical paradigm over current consideration of "addictions"
might well be the stuff of high comedy.  Perhaps sometime in the
distant future, smug comedic pieces will be constructed around
the quaintness of beliefs which seem to that age as silly as the
notions of egocentrism, alchemy, and witch-fear do to ours.
But unless those who know better now challenge the shibboleths of
the addictionologists vigorously and courageously, that day will
be regrettably postponed, and come to after much needless
suffering.  Plainly today, political demagogues, professional
opportunists and religious zealots have decided there are
demonic substances in the world which steal souls through a black
sacrament, through mere contact, and they have decided
against this Satanic evil, the deployment of many lesser evils is
necessary to effect a mythical good.  Primary among these
necessary evils is the compartmentalizing of the
addictionologists' dogma, its insulation from the logic, method
and critique which distinguish science from scientism, which
distinguish sense from nonsense.  The demons of addiction, our
putative leaders seem to feel, are so dangerous that we merely
err on the side of caution if we misrepresent and overstate the
menace.  This is a dangerous mistake.

     It has long been axiomatic in medicine that what an
individual believes about the effect of a drug will often change
the effect of the drug.  So basic is this assumption that double-
blind (even triple-blind) testing is the standard procedure for
determination of a new drug's efficacy.  Under this model, neither
patient nor researcher knows which of the subjects is getting
the drug under review and which is getting a placebo.  This
ensures the actual effects of the drug, if any, will be
distinguished from the psychological effects of the placebo.
So scrupulous are the testers, that the administrating researcher
is not even permitted to know who gets the placebo, lest his
nonverbal cues clue to the subject and skew the differentiation
of results.  Given this apparently sound and prudent practice
is almost universally accepted in the medical community (save in
the rare case of immediate and desperate need for new treatments)
it seems surprising the principle is not translated to our
policies regarding hypnotic, narcotic or recreational drugs,
legal and otherwise.  Here, well-credentialed practitioners are
allowed, or even required, to make from the highest professional
pulpits pronouncements of "fact" about drugs which are untested,
or discredited, scientifically absurd, or emptily tautological.
We ought to wonder, mightn't they be doing grave harm by
promoting false beliefs in the trusting citizenry?

     Foremost among the shibboleths of the American medical
community, at least as it speaks to the general populace, is the
disease model of addiction.  This paradigm, as it might be handed
down to a sophisticated lay person, might be summarized thus:
it is the notion that addiction, a compulsive resort to certain
self-destructive practices, is manifestation of a lifelong,
incurable disease, acquired through repeated exposure to certain
sorts of substances or stimuli, perhaps in conjunction with or
through a genetic predisposition to that disease.  A chief symptom
or consequence of the disease is the moral decay of the afflicted
individual, his or her devaluation as parent, citizen, employee
or consumer.

     I'll not attempt a scientific refutation of the disease
model here; most people who believe in it do so either, like the
majority of Americans, in the ignorant belief that it is
established scientific fact, or in faith, in willful disregard of
the evidence, akin to that of the educated Creationist.  Most of
my readers here, I assume, are acquainted with the real terms of
the debate over the paradigm and are not likely to be persuaded
by such review of the research as I could muster here.  Doctors
Peele, Schaler and Szasz have, in various media, made the case
against this model much more strongly and thoroughly than I
could.  But I would like to invite consideration of how this
concept has been compartmentalized, insulated from the sort of
revision which other assumptions and practices in our society
have undergone in recent years.

     To the layman the most impressive argument for the
scientific validity of the disease model is the most esoteric
one: the idea that addiction, especially alcoholism, is
genetically caused.  The average citizen is utterly unaware that
that there is considerable debate about the validity of such
claims.  Indoctrinated by the popular organs like _Parade_
magazine, daytime talkshows, and recovery posterpersons, the
citizen often regards genetic causation as settled scientific
fact.  Now it's quite probable that, though the links are not
clearly established, our heredity has an influence on our
temperament; the more surprising claim would be that one's
genetic makeup has nothing to do with out behavior.  Still, even
if one's abusive behavior has some biological or genetic
component (which is really only to say it isn't
metaphysically produced by the fates or devils), this does not
necessarily make it a disease.  Many people postulate biological
bases for such things as left-handedness, musical talent,
athletic ability, various forms of intelligence, but we do not
therefore regard these as pathological.  A biological
predisposition isn't sufficient for disease classification;
obviously some harm or risk to the predisposed must also inhere.
Some studies suggest that the left-handed have significantly
shorter average life-span, so some risk may be assumed there, but
we don't regard left-handedness as thing to be treated these

     Less trivially, we might look at a contrast in actual
policies.  The American Medical Association (AMA) defines
addiction as a disease, possibly in view of its alleged
biological basis, but that professional organization may thus
classify in view of the economic and public-relations interests
of its constituents.  Note that the AMA is quite ready to ignore
very similar, if similarly inconclusive, evidence for the
biological basis of homosexuality, which was removed from the
roster of diseases in 1973.  Clearly the doctors are able to
separate the risks of (particularly male) homosexual practice
from the actual diseases which today constitute those risks,
perhaps because it is not anymore so politically safe or
profitable to sell gay people, in virtue of their sexualities, on
a diseased self-image.  In this instance the doctors have wisely
advised modifying risky behaviors, with some success; but they
have not channeled gay people into quack treatments, and a
lifetime of recovery from their incurable nature.  Would that this
were so with respect to the "addict."

     Receiving his prejudices from the mass-media, the average
citizen, insofar as he thinks about it at all, wrongly believes
four things about the sort of drug treatment an American is
_likely_ to get.  He or she believes, (1) treatment is necessary,
(2) treatment works, (3) this treatment will be secular, (4) and
it will entail or produce lifelong abstinence from the object of
addiction.  For their own reasons, people in the treatment
industry would like to make universal the belief that one needs
help to drop any habit, and they spend big money to promote that
misconception.  Epitomal is an ad placed in a local paper by the
drug-treatment wing of my local community hospital.  Its photo
depicts a mans hand crushing a pack of Tareyton 100's; beside it
is the headline "Quitting is easy, I've done it many times."
Underneath that headline, the following text runs:

     You've tried everything.  Now try the smoking cessation
     program that really works.  Studies have shown that only
     about 1% of smokers who try to quit alone are
     successful.  At Nicotine Services, the long-term
     success rate is 40-60% -- a rate much higher than
     similar programs.  Why are we so successful? There are
     many reasons.
        We follow a 12-step program and limit our classes to
     small groups.  Each of the seven classes is based on
     proven techniques, focusing on personal growth and the
     development of a healthy, smoke-free lifestyle.  The
     program is under the direction of a Medical Director
     who is a trained Addiction Specialist, and a free, on
     going support group helps ensure lasting abstinence.
     All these things work for you, to provide you with the
     best resources to help you quit smoking -- for good.
     References available.

I truly wonder about that study that "shows" how only about 1% of
us have been able to quite smoking alone.  That claim would
probably surprise many of the tens of millions of American who
have managed to quit cigarettes without benefit of Nicotine
Services.  The fact is, insofar as their habits are
problematical, most people most people "mature out" of those
habits without any professional help.  The opposite impression is
given not only by the treaters, but also by the law enforcers,
for reasons having to do with their own prejudices, and again in
view of their employment security.  And the mass media promote the
idea that people must be saved from their addictions for the
simple reason that it's more dramatic than the truth.  That people
often grow tired of the costs and liabilities of their
indulgences and moderate or give them up without much struggle is
not news, precisely _because_ it is the most usual the case; it's
a dog-bites-man story.  Much better to have a recovering athlete
or celebrity tell his story of sin and redemption, the miraculous
clinical intervention, and the recent "personal growth" which
allowed him to get whatever monkey off his back.

     It is of course to be hoped that counseling and support
would hasten one's maturing out of a harmful habit, but it is by
no means certain they will.  Moreover, there is no evidence
whatsoever the monolithically predominant mode of
"treatment," or counseling and support, Nicotine Services' "12
step program" (based in Alcoholics Anonymous' famous program of
recovery), is the most effective.  Indeed, some say there is
no evidence of _any_ efficacy of 12 Step treatment.  True, people
do sometimes "get better" in the course of these "treatments" but
then again they were quite possibly going to get better anyway.
Even Dr.  George Vaillant, one of the nation's most famous
addictionologists, and inexplicably a leading proponent of 12-
Step treatment, has said of the method, that for the alcoholics
he treated, it yielded results "...  no better than the natural
history of the disease."

     Consider this finding as possible evidence of a
compartmentalization necessary to the pseudoscience of
addictionology, an instance where medical logic and scientific
practice are given a pass in service of prejudice.  If in one of
the aforementioned double-blind tests, the action of the test-
drug is shown to be "no better than the natural history of the
disease" that drug is most assuredly not certified for treatment
of that condition.  Nonetheless, in most areas of America,
ineffective 12-Step treatment is not only the most prevalent
type, it is the _only_ type of drug treatment available.  Once,
having pointed out this and other inconsistencies in drug
treatment policy to a counselor I was asked, "So what's the down
side; if people are going to get better anyway what harm does it

     Twelve Step dogma and the "treatment" which springs from it,
are immensely harmful in many ways.  Most obviously this form of
treatment sucks up billions of health-care dollars which might
be better used, perhaps even used on more efficacious forms of
counseling for people with troublesome habits.  More generally
the 12 Step believers degrade the public discourse on drug issues
by injecting into it, and selling a great many people on, a lot
of fervently held nonsense.  Unfortunately some of this nonsense
is falling into that category the late Karl Popper called the
"Oedipus effect," that is to say, a prophecy which fulfills
itself.  Thus the claims of the 12 Step addictionologist might be
not descriptive of reality, or even predictive, but prescriptive
of reality.  Recall that with respect to drug action the belief
of the user can be influential; might it not be, in a sense,
counterproductive to tell people that they have a one-percent
chance of managing their habits on their own.  Mightn't it also be
harmful to tell people that because they have a lifelong
incurable disease, any future indulgence of their forbidden
tastes will lead to disasters that they will be powerless to
control? If the first claim brought the sufferer to a counselor
who convinced him of the second with such thoroughness that he or
she did in fact abstain for life, some net benefit might ensue.
But that's not the way it works down here on the ground.  A lot
of people are in fact convinced they _are_ to some degree
powerless over their drug habits, that they can't manage them or
their lives without help, so they're not going to try too much,
until that far off day when a post opens up in a free clinic,
when they're really scared, when they can or must finally submit
(declaring Moral Chapter 11) to the radical cure of total,
penitential abstinence.  Thus the dominant preconceptions about
drug habits, promulgated by 12 Step believers may actually erode
people's inclination to improve their behavior.  Perhaps, 12 Step
treatments and dogma constitute a problem masquerading as a

      There is evidence that 12 Step treatment, once undertaken,
actually makes some people worse.  A good friend of mine spent
several years working for the state as a counselor of young
people with drug histories, most usually alcohol problems.  He
grew very disillusioned with the standard practice, complained
he and his colleagues were "confusing the kids more than
anything".  He found particularly regrettable the observed
tendency to take quite literally the beloved "One drink equals
one drunk" mantra of the group.  His charges sometimes made that
prophecy self-fulfilling, reporting things like, "Well, Friday I
found myself with a beer in my hand, and I thought 'it's off to
the races now' and next thing I know it's Tuesday and I'm at
juvie hall again...."  My friend left the field and became a

     Another 12 Step alcohol counselor reported to me something
she seemed to feel was axiomatic in her field, that people who
don't fully "get it," i.e.  become totally abstinent, "...get
worse after treatment."  (She said this, I might add, with a
strange sort of glee.)  The few such studies as have been done,
and there doesn't seem to be a lot of money or future in bringing
this kind of news, suggest drunk drivers who are referred to
treatment actually are more likely than the untreated to repeat
the offense.  So perhaps our dominant mode of "treatment" ought
to go on the medical scrap heap along with phlebotomy, lobotomy
and aversion therapy.

     It might not really seem surprising the 12-Step
treatment does more harm than good, if one looks at real nature
and its typical method.  The average citizen takes his or her
notion of the 12 step program from the mass media; perhaps he or
she sees Michael Keaton or Meg Ryan making a cinematic recovery
in a tough-loving 12 Step group.  But what the citizen doesn't
see, what is carefully airbrushed out, is the atavistic, faith-
healing fundamentalism which is integral to all such programs.
The first principles of the fundamental 12 Step dogma are never,
but might well be, explicitly stated, "Your addiction is a
disease from which only God can save you," and "God helps those
who abase themselves before the faithful."  Most citizens don't
know that six of the  twelve famous steps invoke God, and that
treatment based on that liturgy is a catechism, a doctrinal
preparation, and a march through a series of sacraments intended
to bring one into a state of grace, that is, "recovery."  This, I
think partly explains the American dominance of 12 Step treatment
despite its dismal efficacy.  Americans have a sort of a
sentimental fondness for religion, in the abstract.  At a rate
unmatched in the western nations we claim to believe in God,
though that claim doesn't correlate, as often as elsewhere, with
any religious practice.  A great many Americans seem to think a
little old time religion is just what sinners other than
themselves need more of these days, so they're not concerned if
those drunks and addicts get a whiff of God in with their
supposed medicine.  Still, many American grow rather incensed
these days at the idea of prayer or Creation "Science" in the
classroom, and they might grow even more incensed if they
realized what religious idiocies were foisted on the politically
powerless in the name of treatment.

     In the first sacrament of a 12 Step program, we admit that
we are powerless over (drug of choice) and that our lives have
become unmanageable.  This is a preparing of the heart so that,
in later steps we can "turn our will and lives over to the care
God" so that He can "restore us to sanity." What this means
practically is that at some point early in treatment the
"patient" will be asked to break through "denial" and confess
before the group that he or she is an addict or alcoholic.  The
administration of this sacrament can be fearsome to behold.  I
once saw a man who had been brought the point of "making first
step" before his group.  His history, as he'd been relating it to
the group in previous weeks was this: he was a worker on a local
assembly line and had been for thirteen years.  He was married and
a father.  He smoked marijuana on rare occasions, and he'd done so
at a party shortly before his number came up in his employer's
occasional random drug screen.  His urine showed positive; the
employer suspended him until he completed "drug treatment," at
which time he might or might not get his job back.  Apart from a
few puffs of pot, this fellow seemed about as normal and decent a
person as a Republican could conjure up in a stump speech.

     On his big day he brought a sort of prepared statement, a
little confessional speech.  In it, he said he'd been reckless,
that he saw now how drugs had put his family's security in
jeopardy and, which was just crazy, for that he was heartily
sorry.  This sounded sensible enough but it wasn't nearly enough
for the group leader.  She kept asking him questions like, "What
kind of person takes such chances?" And the young man kept
hedging, "A confused person...  a person with a problem." He knew
what she wanted to hear but stammered around trying not to say it
for fear, I think, that if he said it, it might somehow become
true.  Finally, with the counselor silently mouthing the words in
accompaniment, the man, fear and trembling in his voice, said, "I
guess that makes me a drug addict."

     The counselor was elated; another of her wards had made that
first step on the road to recovery from infrequent marijuana use.
If the man kept making such progress he might he allowed to
remain with the program and perhaps get his job back, restored to
sanity.  She regarded it as unfortunate when the man dropped out
of the group several days later, and presumably went looking,
sans reference, for another job.

     Why, we might wonder, when enlightened people nowadays call
disabled people "challenged" and we otherwise regard pigeonholing
by pathology as perhaps cruel, counterproductive and at least
disempowering, do we think it therapeutic to get the merely
self-indulgent to adopt a diseased self-image? Once again the
normal principles don't seem to apply to addictionology.  All of
this self-flagellation and repentance might be fine if one comes
to it freely, but a great many people are forced into this type
of treatment by the courts, their employers, their parent or
spouses.  Because he wants his license back, her sentence
shortened, needs a job, or wants a spouse, a citizen may be
forced to assent fervently to any number of propositions she or
he disbelieves or perhaps doesn't even understand.  Moreover,
because the counselor who monitors compliance with the program is
listening to the citizen's declarations with an ear for the
subtle nuances of sincerity, the confessor must screw himself
into a sort of salesman's convenient belief in his spiel.  This
maximizes the compromise, minimizes the chance he'll be able
to blithely go through the motions, whether he originally
believed any of the stuff the counselor wants to hear or not.
Also, he'll be in a group, there expected to help browbeat other
people into making the same sort of dubious declarations he has.
Here is a common result: the citizen who came into treatment
thinking himself perhaps a bit of a fool, leaves after his public
confessions and other mummeries thinking himself perhaps
diseased, but knowing himself a liar, a hypocrite, a coward, and
a bully.  Thus demoralized, is it any wonder he sometimes seeks
deeper oblivion.  A fellow writer made this sweeping, but not
altogether insensible, generality, "A defeated people is a drunk
people; look at the Soviets, the Irish, the American Indians."  I
can think of few things more likely to inculcate a sense of
defeat than being forced into "spiritual awakening," as the
twelfth step calls it, on someone else's terms.

     It seems to me then, this type of "treatment," is not
only of questionable practical value, but worse, is morally flat
wrong.  We recognize many decisions cannot be rightly made
under duress.  For instance, no matter how blissfully happy I know
I could make my student, it would be ethically wrong for me
to attempt to romance her.  The moral turpitude stems from the
fact I have power over her, which compromises her whole
freedom  to give uncoerced consent.  Why does this moral principle
not apply to the spiritual progress of the so-called addict?
Surely to all those very spiritual people in the 12 Step
fellowship, matters spiritual are more sacrosanct than matters
sexual.  Why then aren't these personally growing people outraged
at the grotesque travesty of true, free spiritual "awakenings"
which takes place under their auspices?  Could it be that like so
many zealots -- know them sometimes by the strangely menacing
smile, the body-snatched modulation of their voices -- they have
parted company with the examined life and with ethical
reflection? Perhaps they have traded these responsibilities for
bumper sticker principles: "the Big Book says it, they believe
it, that settles it." Perhaps too this breach of ethics is just
another of those little evils necessary to the war on Big Evil.

     As it gets translated into public policy, the belief most
fundamental to addictionology is this: There are certain
substances which certain individuals are powerless to resist,
and some substances which almost all of us are powerless to
resist.  These things are true only to the extent the user
believes in them; most of us show them to be false every day.  In
fact, the belief in this powerlessness is merely bad science in
service of religion and authority, as egocentrism was bad science
in service of the church and the supposedly divine rights of
Europe's rulers.  The direct logical extension of this false
premise is prohibition, the notion the authorities must,
acting _in loco parentis_, protect us, the infantilized
citizenry, from exposure to those things we are powerless to
resist.  The government will lift this impossible responsibility
from us; of course it must take freedoms from us to do the job
properly.  That this notion is completely inimical to democracy,
to the notion that each adult citizen rightfully has the power to
regulate his own existence, seems all but lost on our citizens.
This is because our discourse has become, thanks to the zeal
of the Disease Cult, so frightened, sanctimonious and

     Sir Karl Popper was quite skeptical about psychoanalysis; he
didn't think Freud's claims were really scientific assertions.  I
share that skepticism but still like the related analytical style
we have grown comfortable with in the humanities.  Thus I
really sometimes believe nothing is so self-disclosing as
the devils we project onto the world.  So I find it wholly fitting
that perhaps the last possible heresy in America is the
criticizing of addictionology and its armed offshoot, the War on
Drugs.  This tells us something about the national dementia.

     A friend of mine once oracled darkly, "Drugs are American as
Coca-Cola." We had been pondering what a strange inversion is our
national mania for addiction busting; in the War on Drugs we have
truly, as Walt Kelly said, "met the enemy and he is us." Our
society is now predicated upon the idea of continued progress,
sustained growth; we're going to invent a technological fix for
the liabilities of technology, and we're going to grow the
economy out of its deficit.  But looked at from another angle,
sustained growth (Edward Abbey regarded it as the "ideology of a
cancer cell") is really just "escalating dependence," complete
with the consequent moral decay imputed to the dope-fiend.  In  a
society dedicated to sustained growth, coveting thy neighbor's
goods is a virtue and conspicuous consumption is a patriotic
duty.  We call this, in a phrase which should have resonance for
addictionologists, "keeping up with the Joneses," and we are
called to it at every turn by the advertisers whose job it is to
see that the registers keep ringing so the assembly lines
can keep turning.  One's life is incomplete without this or that
thing, they tell us constantly, adding, happiness is just a
purchase away.  In a culture sponsored by this mode of thinking,
which promises a material fix for everything (for a fee you can
even make an Addiction Specialist responsible for your self
control), can we be surprised that people use drugs
irresponsibly? So it is deeply telling and ironic that the
Advertising Council (mostly tobacconists and distillers) feels
called upon to sponsor its inane and often mendacious series of
anti-drug ads.  This is the moral equivalent of pimps preaching on
the street corners about the evils of masturbation.

David J. Essex is assistant professor of English at the
College of William & Mary, Williamsburg, VA, where he teaches
creative writing, contemporary literature and film. He is a
writer and documentary filmmaker. He is currently developing
_Medicine Show_, a documentary about drugs, drug-use, and drug
issues as depicted in the American popular media.
His e-mail is: djesse@facstaff.wm.edu