David Brooks, after writing a paean to AA, is publishing a book about the wonders of modern neuro-cognitive research - he loves them both. What is their relationship, how much success have they had individually and together, how will he respond to their joint failures?

 

The Stanton Peele Addiction Website, February 6, 2011. This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

Identity Politics in Addiction - David Brooks' Unconscious

David Brooks is the hard-headed conservative New York Times columnist. Brooks is a star-struck worshipper of cognitive and brain research, which he hopes will explain humankind. How could it fail to - it's so, so scientific. In the New Yorker, "David Brooks writes about how the new sciences of human nature can help make sense of a life . His new book, The Social Animal, will be published by Random House in March."

Make sense of life! Fabulous! Brooks' key insight:

"We are living in the middle of a revolution in consciousness. Over the past few decades, geneticists, neuroscientists, psychologists, sociologists, economists, and others have made great strides in understanding the inner working of the human mind. . .  precisely those things about which our culture has least to say. Brain science helps fill the hole left by the atrophy of theology and philosophy. A core finding of this work is that we are not primarily the products of our conscious thinking."

We are not primarily the products of our conscious thinking!  Where have I heard that before?

This post analyzes Brooks' unconscious.

Just a few months ago, Brooks wrote a scintillating paean to AA. In his simultaneous prayerfulness at the feet of AA and of futuristic brain research, Brooks joins a long line of worthies - this unwieldy conflation includes Ken Blum's 1991 Addictive Brain that kisses up to AA while simultaneously claiming that in 1989 he discovered the gene for alcoholism ; Bill Moyers' 1998 five-part PBS series on addiction which was divided between plaudits for 12-step groups and state-of-the-art NIDA neuroscience (Bill's son got cleaned up, and now works, at Hazelden); Benoit Denizet-Lewis' 2006 article for the New York Times magazine and subsequent work in which he sleeps with the same two odd bedfellows; etc.

Why throughout the United States do we still need a spiritual program to cure the disease of addiction if we have made such promising biological discoveries over the last 20 years? Why haven't we found the cure for addiction and why don't we treat addicts like Charlie Sheen and Lindsay Lohan with it?

"Oh," you say, "we need more than two decades to accomplish something this monumental."  Well, let's tune back a little farther.  Beginning in the 1980s, Newsweek, Time, Scientific American et al. regularly cycled through cover stories about the amazing progress being made with the neurochemistry of addiction - replete with brain diagrams and PET scans claiming to show its underlying mechanism. Often, the exact same illustrations appeared a few years apart in the same magazines with identical claims being made about what they show and how they unlock the key to addiction.

Let's go back a little farther. Here's what a leading neurologist, Richard Restak, wrote in 1977 :

So far, researchers have carefully avoided hyperbole in their descriptions of the endorphins. But it's hard to leave out the exclamation points when you are talking about a veritable philosopher's stone-a group of substances that hold out the promise of alleviating, or even eliminating, such age-old medical bugaboos as pain, drug addiction, and, among other mental illnesses, schizophrenia.

Remember endorphins? But what's 35 years when we're talking about a cure for addiction?  More to the point are these questions: What unifies AA and biomedical approaches, and why does the absence of success with either, or both together, do nothing to discourage their worship?

Here's what the two have in common: Both see addiction as a deus ex machina created by irresistible universal forces - God, the absence of God, yet-to-be discovered genes, a brain mechanism we are just about to pinpoint in an MRI. In the view of neither must human beings change their lives aside from addressing their addictions per se - nor must society make any changes to lower addict rates. It's an inherent disease.

So it is surprising to read Thomas McLellan 's discontent in 2009 with current addiction treatment, and where he sees such treatment going.

We've also got to intervene earlier in ways that aren't quite as threatening, that enable people to take control of an issue that they may not be able to understand is hurting their quality of life. I'm very interested in, and this office is very interested in, screening and brief interventions. ... The other thing, without question is, we've got to develop much more attractive, engaging, enduring treatments. If this is largely, at least today, about lifestyle management, that's what treatment really is.

What a non-disease Luddite! But McLellan comes from the heart of the addiction research braintrust - he along with Charles O'Brien and Nora Volkow have been the most forceful proponents of the modern medical model of the disease of addiction (the one gerryrigged on top of AA's disease and, prior to that, Benjamin Rush's - Rush, a Colonial physician and signatory of the Declaration of Independence, originated the American disease notion of alcoholism). And McLellan is married to a recovering addict and had a son who died due to an overdose. Oh ye of little faith.

What's most surprising about Brooks' faith based on a baffling combination of medicine and AA utopianism is that he is a community-oriented conservative - someone who often points to the failures in the mechanics and the fiber of American society that lead to all sorts of problems. So why is he simultaneously so happy about the success of AA and so optimistic about its replacement with not-quite-yet-discovered scientific cures?

Here are a half-dozen questions for Mr. Brooks:

  • If AA is so good, why do we need to add to it futuristic brain and cognitive research results? Will this research replace AA?
  • Has the addiction rate declined since 1935, when AA was invented (it wasn't really invented then - it is mainly repackaged elements of the Rush and Temperance notions of the disease of alcoholism).
  • Do you believe there will be less, more, or the same amount of addiction in 25 years?
  • What is the numero uno treatment created by the modern revolution in neuro-cognitive science?
  • What do you envision will be the most groundbreaking, ameliorating discovery that will arise from this work, and what time frame do you see for it? 
  • If this dream doesn't materialize in this time frame, will you be in any way discouraged from your optimism?

I know the answer to the last question: NOT.

The reason is identity politics. You know, where Republicans say our health care system is great, never proposed any reformation of it when they were in power, then objected strenuously to the Democrats' reform of the system and proposed instead to return to free-market health care.  Because they don't care a whit about the efficacy of the system - their votes are an assertion of their true belief.  Just like people must believe addiction is a disease, no matter how nonexistent the past, present, and future benefits yielded by such a belief.

Moyers, Denizet-Lewis, and Brooks are all about the faith that addiction is a unitary, irreducible disease - whether spiritual and God-based or biological and medical - and no amount of failure to improve the incidence, prevalence, and prognosis for addiction in America will ever convince them otherwise.