Nora Volkow, director of the American National Institute on Drug Abuse, a cornerstone representative of the model of addiction as a chronic brain disease (see Nature, 2014), presents addiction as a “chronic relapsing brain disease” that vitiates free will through its effects on the brain. Drugs would disrupt the circuits that enable to exert free will and, as a consequence, for addicts, it is no longer a choice to consume the drug: they are wired for!
Stanton Peele, an American psychologistand researcher, denounces and warns against the perverse consequences of such medical model. Indeed, without being clearly said, according to this dominant neuroscientific paradigm of addiction, the possibility to self-cure and manage to consume with moderation after several years of abuse is impossible or, at least, poorly acknowledged. According to Stanton Peele, this hidden core message is preoccupying in a least two ways. First, the conceptual and treatment goal of eliminating choice in addiction and recovery is not only futile, but also and worryingly iatrogenic. Ironically, the brain disease model’s ascendance in the U.S. corresponds with a sharp increase in overdose deaths (labeled drug-related-deaths, cf. Rudd et al., 2016), a decline in natural recovery rates (Dawson et al., 2005) and a sharp increase in AUDs (Grant et al., 2015). Second, the message conveyed by this neuroscientific paradigm of addiction is deeply preoccupying in the sense that it counteracts both clinical facts and epidemiological data (Peele, 2015). Studies like the one of the Department Of Health and Human Services (2002) show that quitting an addiction can happen, and frequently happen, even after a tortuous journey and after an uncountable number of relapses. Thus, the idea that people are irreversibly stuck in drug dependence and no effort of will can extricate them as proven to be wrong by several research studies that directly test this belief.
To prove the extent to which the message conveyed by the medical model can be wrong, Stanton Peele recalls the results obtained by two renowned studies. One of them is the treatment study led by Charles O’Brien, a member of the prestigious pharmacologically-based research center in the United States. This study attempted to establish the benefits of “pharmacogenetic matching” in the case of Naltrexone treatment (NTX) for alcoholism (Oslin et al., 2015). To do this, the effects of NTX were compared to those of a placebo treatment over an experimental period of 12 weeks and genetics analyses were done (two opioid receptor alleles were targeted here).Were measured the intensity of craving during the course of the treatment, the percent days of any drinking and the number of drinks per drinking day. As a result, “molecularly” speaking, placebo outcomes for reduced drinking were identical to those created by NTX. Moreover, tremendous brain molecular changes were observed for both groups and these change benefits in reduced drinking were observed almost instantly, at the very outset of the trial. As for the other renowned study, Stanton Peele cited the landmark clinical trial of psychotherapy for alcoholism treatment, the Project MATCH. This project showed that : (1) minimal or no treatment produces similar outcomes than those produced by standard treatments, (2) patient self-motivation is far more important than treatment type or intensity for recovery and (3) reduced drinking, more than abstinence, is the most common outcome for alcohol-dependent individuals (Peele, 1997). In a nutshell, the MATCH data showed a poor impact of the treatment in the recovery process compared to the person’s own ability to come to grips with their addiction.
To conclude, the purpose of Stanton Peele’s argumentation is to deliver a message to health professionals and current addicts. The one that change in addictive behavior is self-initiated and self-propelled. Against the medical model views of humans beings as biological automatons who must passively wait for and rely on modern medical miracle, Stanton Peele says that the most important ingredients in quitting addictions are the addicts’ belief that they can and their commitment to doing so. These elements are inescapable aspects of overcoming addiction in the long run and they cannot be injected or ingested in drug form. As such, even a massive and well-intentioned program that do not recognizing this truth will do more harm than good.
Research digest of the following article:
Peele, S. (2016). No matter how much the “chronic brain disease model of addiction indicates otherwise, we know that people can quit addictions – with special reference to harm reduction and mindfulness. Addictive Behaviors, 4:97-101.
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– Peele, S. (1997). Bait and switch in project MATCH: What NIAAA research actually shows about alcohol treatment. PsychNews International (Available at http://www.peele.net/lib/projmach.html, May-June).
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5 words that I have learned:
– jettison [sth] = jeter à la mer, par-dessus bord.
– awed (adj) = impressionné, émerveillé
– cloak (v) = cacher, dissimuler
– nigh-on (adv) = presque
– ironclad (adj) = invulnérable