If the world were a perfect place, our efforts to understand ourselves would be based on reason, experience, and evidence, and free of the poisoning influence of politics. Alas, the world of addiction is just as beholden to political tradewinds as other fields.
Every field of inquiry is burdened by politics to some degree. But when people who are in positions of authority and power hold onto their views despite reason, experience and evidence, the result is that new knowledge, and the people who espouse it, are suppressed. This act, of clinging to outdated dogma, is where politics fights against progress.
Recently I read Nobel laureate Paul Krugman’s book “End This Depression Now!” Before describing his views, I must make a disclaimer: my own education in economics began and ended with a single college course I took 40 years ago. So I’m not writing to endorse or refute Professor Krugman’s views, but to underline his description of his field. He writes that in recent decades, macroeconomics became divided into two great factions described as Keynesians and non-Keynesians (after the economist John Maynard Keynes). The non-Keynesians, he writes, “Soon got carried away, bringing to their project a sort of messianic zeal that would not take no for an answer… [a leader of this group predicted] in 1980 that participants in seminars would start to whisper and giggle whenever anyone presented Keynesian ideas. Keynes, and anyone who invoked Keynes, was banned from many classrooms and professional journals… [non-Keynesians developed] quasi-religious certainty that has only grown stronger as the evidence has challenged the One True Faith.”
Anyone familiar with the addiction field will recognize this description immediately. But unlike economics, in addiction we have two sets of overconfident whisperers with a history of ignoring or suppressing other views. One of these groups are the followers of the “chronic brain disease” idea – a notion that has been repeatedly shown to be false (see other posts in this blog) yet still remains the official view of the National Institute on Drug Abuse and the American Academy of Addiction Medicine. The influence of this group has led many professional addiction journals to avoid publishing any contrary views for many years running. In fact, a recent review I conducted of all the major addiction journals for the past three years turned up no discussions at all of the psychology of addiction. (This isn’t because there were no articles submitted; my own paper describing the limits of both neurobiological and psychological views, which was published in a respected peer-reviewed journal in the United Kingdom, was turned down by every addiction journal in the US, because, I was explicitly told, it did not fit the editors’ narrow view of what was correct.)
The other powerful group is of course AA, and its 12-step brethren. Anyone who has tried to criticize the 12-step approach knows full well the hostile reception this produces from devoted members. In fact, because of my position as an independent voice in addiction, I have often heard from counselors working in addiction treatment programs around the country who tell me they are afraid to challenge the 12-step model for fear of losing their jobs.
Addiction deserves better. One online addiction website, The Fix, recently published my guest piece taking a critical look at both the official description of addiction in the new edition of the Psychiatry Diagnostic and Statistical Manual (DSM-5), and the brain chemistry people at NIDA. The Fix is a wide-ranging site that publishes a variety of views, some of which I don’t agree with, but that’s the point: like Psychology Today, it is a rare forum for contrasting ideas and discussion. We desperately need more open-minded resources like this, and a new national addiction conversation that doesn’t reflexively strangle dissent.