Stanton Peele, Ph.D., and Archie Brodsky with Mary Arnold (1992), The Truth About Addiction and Recovery. N.Y.: Simon & Schuster, Inc., pp. 9–16.
The growth of addiction treatment in the United States, predicated on the idea that alcoholism and addictions of all kinds are diseases, is a public-relations triumph, and not a triumph of reason or science. The idea that modern addiction treatment—like that provided at private alcoholism hospitals—is eminently successful is a myth. More people quit alcoholism and addiction on their own than do so through treatment, and evidence is that in many cases people trying to quit an addiction (such as smoking) are better off attempting it without the help of typical treatment programs. There are therapies that work better than disease-oriented alcoholism clinics or nicotine gum therapies for smokers, but you would be hard-pressed to find such treatment if you tried. That’s why we developed the Life Process Program.
We believe that many people want an open-minded, realistic way to understand and deal with addictions—their own, their spouses’, their children’s, their friends’ and employees’. This book is a response to that need. It begins by making clear what addiction is and what it is not. Addiction is an ingrained habit that undermines your health, your work, your relationships, your self-respect, but that you feel you cannot change. Addictions are difficult to change, because you have relied on them—in many cases for years or decades—as ways of getting through life, of gaining satisfaction, of spending time, and even of defining who you are. Whereas some addictions involve drugs (like smoking or problem drinking), some do not (like shopping, or eating, or sex). It is impossible, therefore, to relate addiction to one chemical or biological process or another.
Because of the distinctive approach we take, you will find guidance here that in most cases you cannot get elsewhere. That is, we do not regard addiction of any kind as a disease. Thus, we do not recommend that you see a doctor or join a twelvestep group organized for one disease or another as a way of dealing with addiction. These approaches, we believe, have already been shown to be less effective than others that are available. The same is true if you are concerned that your children and their friends are using alcohol and drugs—the common practice of putting them in a hospital will usually do more harm than good. Our approach, called the Life Process Program for changing destructive habits, is instead rooted in common sense and people’s actual experience.
This approach is more empowering—and therefore more effective—than conventional treatment or self-help methods. Because our approach differs so drastically from the messages you get constantly in public-service announcements and advertisements for alcoholism centers, we review a great deal of evidence to show you that the conventional notion of addiction as an uncontrollable “disease” is baseless. It doesn’t get at what causes people to be addicted and it is ineffective for most people as a method of treatment or self-help.
It is disturbing that an approach to addiction that is widely claimed to be scientific is actually false and is more often harmful than beneficial. The good news is that many people are beginning to question how accurate or helpful it is to think of addiction as a “disease.” These may be people with substance-abuse problems whose needs are not met by twelve-step support groups. Or they may be people who don’t buy the claim of the alcoholism movement that announcing you are powerless helps you change. They may be researchers who find that the evidence doesn’t back up the personal testimony of addicts who tell us incessantly in the media that conventional treatment works. They may be individuals who have been exposed to the treatment system—because their children used drugs or because they were arrested for drunk driving—and who were appalled by its coerciveness and irrationality. They may be especially mystified that anyone wants to weigh adolescents down with the message: “Because you have been drinking or using drugs, or because your father or mother did, you have a disease you can never overcome.”
Sometimes people with questions like these stumble upon the best-kept secret in the addiction treatment industry—that many more people give up addictions on their own than through treatment, without taking on the stigma that they suffer from a disease. TV talk-show host Oprah Winfrey, for example, discussed her struggle to lose (and keep off) weight on a show she did on the disease theory of alcoholism. She remarked that she could accept the disease theory “intellectually,” but that she just didn’t see how believing she was forever “powerless” could possibly help her with her weight problem. What Oprah and others like her should know is that calling addiction a “disease” is just as wrong “intellectually” as it is unhelpful.
Indeed, what about all the people who are so uncomfortable with twelve-step groups that they can’t bring themselves to attend one or don’t stick with it if they do attend? Are these people all, like Oprah, really in “denial”? As a result of such “failures,” many people mistakenly think they can never overcome their addictions. Wouldn’t they benefit from knowing that the great majority of people with addictive habits—particularly young people—can outgrow them without entering a hospital program or following a twelve-step regimen? They may be able to do it on their own. Or they may benefit from the kind of treatment represented by the Life Process Program—treatment that builds on people’s own strengths, values, and confidence in themselves and on their existing ties with friends and family, while improving how they deal with their lives.
In 1990, American Health magazine published a study that finally told the public just that. According to a Gallup Poll of a cross-section of the American population, people are about ten times as likely to change on their own as with the help of doctors, therapists, or self-help groups. Among the survey’s surprising findings were these:
Professional help has surprisingly little to do with important life changes, even health-related ones. Doctors helped people change only 3% of the time—while psychologists and psychiatrists, selfhelp groups and religious counselors got the credit even less often. Support was much more likely to come from friends (14%) parents, children, or siblings (21%), or a spouse, boyfriend or girlfriend (29%). And 30% of the time, people simply did what they had to do on their own, often with striking success.
In other words, the support that is most crucial comes not from specialized treatments and support groups, but from the people one already knows. And sometimes people simply change when they realize that the time has come. The survey found this to be true even for giving up such tough addictions as smoking or excessive drinking—a majority of respondents described quitting as something they did naturally, on their own.
Positive feelings and desires more often motivated people to change than negative ones. These positive feelings fed on themselves: healthy habits become more secure over time. “Fully 86% of the time,” the survey found, people reported that “as time goes on, my new habits become easier to keep up—they make me feel good.” Not only were positive changes self-maintaining, but they sparked other beneficial changes as the person’s self-image and self-confidence improved.
One part of the survey focused on eating and nutrition. Again, common sense and life-style evolution won out over Overeaters Anonymous, Weight Watchers, or other groups or therapies. The techniques people used to lose weight were very straightforward. These typical Americans revealed that the methods they relied on most to lose weight successfully were cutting out snacks and desserts (42 percent), eating less altogether (37 percent), exercising more (32 percent), and cutting down on fat (32 percent). The ones they least often used successfully were weight-loss groups (9 percent), special diet foods such as protein powders (3 percent), and diet books (1 percent). The lesson seems to be: If you want to succeed, do what you know you have to do. You can’t rely on any intermediary to do it for you.
You cannot reconcile the American Health survey findings with the doom-saying of the twelvestep movement and the addiction establishment that people are out of control of the inevitable progression of their addictions. Still, these uplifting survey findings about real people tell only part of the story. Even if more than half the people surveyed were able to accomplish significant changes, a sizable minority were not, and many of those may have wanted to.
If this has been your experience, a more concerted approach to habit change may be called for. The positive changes reported in the survey were made by people whose lives were basically intact, but who let a single habit such as overeating or smoking get out of hand. But destructive habits may reflect deeper problems in a person’s emotional or family life or social environment. In these cases, change must involve the total context of a person’s life. To give up a bad habit, you may need to transform the life situation that supports the habit into one that discourages it. The Life Process Program is designed to help you do just that.
During the past couple of decades, researchers have discovered effective, nontraditional ways of understanding and attacking addiction. Sociologists have discovered large numbers of individuals who have given up addictions without going into treatment or to support groups. Psychologists have studied the personal techniques people develop on their own for initiating and maintaining behavior change. Alcoholism experts such as Harold Mulford of the University of Iowa have begun to explain how the natural paths a person takes into and out of addiction are woven into the fabric of the person’s life. But these perspectives are little known to the public in the United States, which is still fed the simple-minded ideology of the disease movement. As a result, the most enlightened guidance on addiction has not been available to the many people it could help.
The aim of this book, therefore, is to put together the components of a workable approach to addiction into a practical framework for your use. Many people think of behavior therapy as an artificial system of rewards and punishments that are more effective in the laboratory than in life. In many cases, they are right. They aren’t aware, however, that the single treatment proven most successful with severely alcoholic individuals—called the Community Reinforcement Approach—applies behavioral techniques to help people reshape their entire environments. This approach is used in other countries and has been adopted by some therapeutic communities in the United States. What we have done in this book is to adapt the concepts involved in such research and therapy to enable you to apply them in your own everyday life.
We have seen the need for such an integrated approach ever since we wrote Love and Addiction. Because we emphasized quitting addiction as a part of an integrated life change, many addicted persons (alcoholics and addicted drug users, overeaters, smokers, gamblers, shoppers, as well as those addicted to love) have said that that book talks directly to their needs. Now, based on this growing understanding of what addiction is really about, we will show how you can develop a self-tailored path out of addiction.
The disease model of addiction does more harm than good because it does not give people enough credit for their resilience and capacity to change. It underestimates people’s ability to figure out what is good for them and to adapt to challenging environments. At the same time, it disempowers people, because it fails to hold them accountable for acting irresponsibly while under the influence of alcohol or drugs, or for excessive behaviors ranging from shopping to gambling. The disease theory of addiction can even serve to perpetuate addiction and to excuse repeated relapses. Our approach, in contrast, respects every person’s capacity to make positive choices, even in the case of the most compulsive behaviors. Instead of undermining your integrity, we give you credit for being a responsible adult capable of self-management.
The Life Process Program takes us far from the frightening assumption that a compulsive behavior is a disease that you will have to live with forever. It brings us into the practical human realm of individual self-assessment, planning, and action. As you will see, the myths of addiction and the realities with which we contrast them offer radically different ways of freeing yourself from addictions ranging from overeating and smoking to alcohol and drugs. They also have different implications for how you deal with heavy drinking or drug use in a spouse or lover, a child, a friend, or an employee. The Life Process Program and the disease model also give you different messages about what it means if you come from a family with a history of some addictive problem, like alcoholism.
Finally, the two different approaches point in different directions concerning the social problems and public-policy issues that we confront, such as drunk driving, drug testing, and widespread drug abuse and drug-related violence in the ghetto. Popular attitudes about addiction, instead of locking people into their addictive dependencies, can instead encourage individual and community strength and autonomy. For although this book is mainly about overcoming addiction as individuals, the crux of the struggle against addiction lies in the social and cultural environments we create. The widespread failure to realize this holds more danger for our civilization than does crack or alcohol or any international drug cartel.
The key to giving up addiction is to mobilize the necessary motivation, values, skills, and environmental supports. In most cases, you already have these things. Our emphasis, therefore, is on kindling your desire to stop harming yourself and others and your belief that you can do so. We never tell you that you are powerless. When you feel strongly enough the urge to change your life in a healthful direction, you can often develop the means for stopping unhealthy addictions quite naturally.
Thus, instead of a single, prepackaged program for recovery, we provide the highlights of successful self-cures and successful therapy for you to use as signposts for change. You must then see how they fit into the rhythms of your own life. The Life Process Program, while it makes the experiences of others accessible to you, remains something you create for yourself out of your own experience and personal values.
Our approach has no gimmicks. It is grounded in the reality of the numerous studies we cite and the many personal accounts we relate. Whatever solution proves right for you, it is unlikely that you will succeed by working on the addiction in isolation from the rest of your life. Indeed, as the Life Process Program shows you, you cannot escape addiction without dealing with your entire world, including your family, your community, and society as a whole.