More on The Alcoholism Revolution
Dr. James R. Milam
The greatest of all infidelities is the fear that the truth will be bad. — Herbert Spencer
As many readers will remember, “The Alcoholism Revolution” was published as a special feature in the August 1992 issue of Professional Counselor.
This paper defined the polarity in the field of addictions: the
conflict between two irreconcilable points of view, the psychogenic and
the biogenic. Virtually all of the responses to that article have
ranged from moderately to enthusiastically positive.
Copies
have been spreading among readers in the general public, in top levels
of the three branches of state and national governments, and in
scientific and professional communities. There are already indications
that it may significantly influence pending healthcare and criminal
justice reforms.
Briefly,
the psychogenic model is based on the nearly universal belief that
alcoholism is a symptom or consequence of an underlying character
defect, a self-destructive response to psychological and social
problems, a learned behavior. The biogenic model recognizes that
alcoholism is a primary addictive response to alcohol in a biologically
susceptible drinker, regardless of character and personality, or of
cultural or psychosocial influences.
Overshadowed
by the multitude of researchers who were busy confirming that the
psychogenic paradigm is devoid of any legitimate data base, many others
were quietly compiling a massive amount of empirical evidence that
alcoholism is a primary, biogenic disorder. As all longitudinal studies
have verified, all of the psychopathology of alcoholism, as alcoholism,
is of neuropsychological origin. However, this fact is disguised
because alcoholism is never diagnosed until after character and
personality are distorted and normal emotions are neurologically
augmented to abnormal levels of chronic anguish, fear, resentment,
guilt, and depression. It is these distortions that clinically identify
alcoholism, not the original character and personality. The earlier
effects of trauma or abuse, or of being raised in a dysfunctional
alcoholic family, are complications — but not contributing causes — of
alcoholism. Most often alcoholism is hereditary, but many individuals
become chronic alcoholics through cross-addiction to other drugs
(prescription or illicit) or as the result of other brain or liver
insults.
Compromise attempts fail
Endless
attempts at compromise have failed because the two views are not
complementary, but mutually exclusive alternatives, like a perceptual
figure-ground reversal. Compromise was the fatal flaw in the Jellinek
“disease concept” of alcoholism. For all his helpful descriptions of
the progression of the disease, he endorsed the false belief that
alcohol is primarily a sedative drug and that alcoholism is caused by
excessive “relief drinking”, drinking to relieve psychosocial stress.
Thus, as secondary consequence or symptom, the biology of alcoholism
could be largely ignored by the establishment in its diligent search
for the presumed primary psychiatric cause of relief drinking.
Following Jellinek, many leading proponents of the disease concept
still try to have it both ways, to assimilate the fragments of the
biological knowledge within the lingering psychogenic hegemony. Some
still mindlessly refer to addiction as “substance abuse”. This
conformity necessarily condones the misinformation that continues to
tear the country to pieces and helps to delay the emergence of the
biogenic paradigm.
The Alcoholism Revolution
does make extraordinary demands on the reader. It presents an original
conceptualization without a preexisting frame of reference. Ordinarily,
scientific truth can exist only after it is confirmed through
procedures of qualified peer review and consensual validations. That
paper explained at length why the biogenic paradigm has had to make its
debut without the usual scientific pedigree or academic blessing. The
normal avenues of critique and authentication have not been available.
Historically,
these internal channels have been open to important outside
contributions, even revolutionary ideas, provided only that they met
high screening standards of scientific integrity and academic
scholarship. In recent decades these standards have been progressively
compromised in obeisance to the higher priorities of publish-or-perish,
grantsmanship, and, more noticeable recently, political correctness.
Shielded within this more general degradation, the circumscribed field
of chemical dependency witnessed the avenues of impartial review
gradually narrow as a result of discriminatory screening until finally,
during the early 1970s, the whole mechanism of consensual validations
was hijacked by a tiny band of extremists, and it remains their
captive.
Prof. Irving Maltzman's confirmatory paper,“The Winter of Scholarly Science Journals”, published in Professional Counselor
in October 1992, documents the capture of the academic peer review
procedure and its continued subversion to protect the otherwise
discredited psychogenic premise. It is this distortion of reality that
sustains both alcoholic denial and the delusion of recreational drug
use, thus perpetuating the drug epidemic.
Looking to the court of public opinion
Although
it was clearly by necessity and not by choice, the fact remains that
the biogenic paradigm was conceived and nurtured in alienation from the
scientific establishment and that it has been presented to the public
as a mandate for insurgent reform without first passing through the
naturalizing process of peer review. Therefore, although it has waited
in vain for an impartial assessment for more than 20 years, it may be
that the paradigm and its supportive evidence must continue to wait in
limbo pending scientific ethical reform. But for both principled and
urgently practical reasons this is not necessarily the case. Given the
widening distribution of enlightening information about the scientific
paradigm shift, the court of public opinion may at any time simply
preempt the corrupted lower institutional court of peer review and
initiate this cultural reform. To further enable and encourage this to
be done, the following examples and clarifications address what appear
to be the remaining veridical reservations and skepticisms about the
paradigm shift itself.
As
a first illustration, it was widely reported that upon returning home,
drug-using Vietnam veterans demonstrated that illicit drugs are
non-addictive by simply stopping their use on their own, without
addiction treatment or withdrawal reactions. Aside from the widely
accepted anecdotal reports, support for the argument has come from
studies involving unreported cross-addiction. To those who deny the
very existence of physical addiction, the idea of cross-addiction is
also meaningless, and thus neither reportable nor subject to
surveillance.
Cross-addiction at VA facilities
As
a local option, along with psychotherapy, many VA psychiatrists
routinely and unremarkably switched traumatized, addicted returning
veterans to cross-addicting prescription drugs — tranquilizers,
sedatives, and antidepressants, with methadone for heroin addicts. With
this unlimited largess, financial support, a disability pension in the
offing, and therefore ample money for alcohol, these now lawfully
addicted veterans could stop the use of illicit drugs “on their own,
without addiction treatment or withdrawal reactions.” However, over the
longer period of a decade or so, the subsidized poly-addiction produced
a familiar result.
A
normal brain processes trauma and grief, gradually disposing of them as
fading memories. A toxic brain cannot accomplish this work. On the
contrary, as addictive disease progresses, old hurts fester and become
ever more inflamed and unmanageable. In Vietnam veterans this iatropic
(therapist induced) exacerbation was not recognized or reported as
such; instead it was simply given a new name: Post-traumatic Stress
Syndrome. The new diagnosis played well to a guilty society whose
negative attitudes toward Vietnam veterans did in fact complicate and
slow their postwar healing.
By
thus ascribing the later inflammation to the earlier trauma and
negative social attitudes, and by not mentioning the prescription drugs
or alcohol, by default both illicit and prescription drugs were
exonerated as non-addictive. No one seemed to notice that while
drug-prescribed veterans were deteriorating into their post-traumatic
stress syndrome, equally traumatized and equally addicted veterans who
were effectively treated for their addiction, and taken off all drugs
and alcohol, recovered and got on with their lives.
Exploiting onset variabilities
A
second type of spurious evidence exploits the variabilities in the
onset of addiction. The strength of addiction is progressive, often
starting near zero and growing stronger at varying rates in different
individuals. Usually there is a threshold below which each user can and
will stop on his own, given a sufficient deterrent. Again, sans
physical addiction, there is no threshold to report. It has been easy
for these researchers to contrive samples of sub-threshold drug users
who simply quit on their own. And of course, drug “abusers” who
temporarily or permanently switch to alcohol can also be said to have
quit drugs on their own.
Third
is the illustration that although NIAAA is fostering more studies of
the biology of alcoholism, including some good quality studies of
heredity, they are still isolated and compromised by psychologized
explanations. A recent research report in the news confirmed that, as
with men, 60 percent of alcoholism in women could be accounted for by
heredity. Without hesitation or equivocation, the authors and all
respondents gratuitously assigned the 40 percent error variance to
presumed psychosocial causes, considered more important because “that's
the part we can do something about.”
Typically, there was no mention of the several obvious biological explanations for the error variance:
First:
the significant amount of error that inevitably flows from inadequacies
in the prevalent psychogenic DSM-IIIR and other commonly used
diagnostic criteria.
Second:
the errors stemming from imperfect diagnostic training, experience, and
skill, and limitations in research design and implementation, as well
as in subject availability and selection.
Third:
errors systematically produced by the fact that totally abstaining
alcoholic parents and offspring are commonly classified as
non-alcoholics, resulting in false negatives in the experimental
offspring controls.
Fourth:
through cross-addiction to prescription or other drugs, many of the
offspring of genetically non-alcoholic parents become alcoholics (more
false positives), while unknown numbers of genetic alcoholic offspring
switch from alcohol to addictive drugs (more false negatives).
Finally:
the errors produced by such other biological factors as liver and brain
diseases or injuries that affect both alcoholism susceptibility and
manifestation, and, of course, the usual uncertainties about paternity.
Disguising genetic effects
In
the fourth illustration, still wedded to the psychogenic paradigm,
NIAAA was constrained to devote much of the last winter issue of its
quarterly Alcohol and Research World magazine to still more studies of
occupational differences in alcoholism rates. The relatively small
differences were attributed to stress factors and job cultures. The
typical reader would see nothing unusual in this addiction to the flow
of trivia into the alcoholism literature because here the sin is one of
omission. Not mentioned were the differing racial representations among
groups, which earlier studies, long since purged from consideration,
have shown are the significant sources of variance in alcoholism rates
among occupational groups. Thus, disguised genetic effects are
spuriously assigned to job culture causes, with an appeal for more
alcoholism money to further analyze the latter. Similar strategies of
obscuring and misrepresenting genetic contributions to alcoholism rates
are employed in other epidemiological and demographic studies. The
common practice of lumping into categories, such as “white” or “Asian,”
cancels most of the extreme genetic variance.
Knowing
that, when controlled for heredity, cultural attitudes and practices
are not contributing causes but consequences of profoundly differing
historical experiences with alcoholism, some of the earlier legitimate
occupational studies are as amusing as they are instructive. American
clergymen of all faiths, with their mix of Irish, Blacks, Scandinavians
and other highly susceptible groups, have an alcoholism rate not 40
percent higher, nor four times as high (the typical range of
differences in the NIAAA occupational comparisons), but over 40 times
as high as members of the Italian Mafia. So much for stressful work
factors.
Native Americans: genocidal disaster
That
Native Americans have an extraordinarily high susceptibility to
alcoholism, conservatively above 80 percent of those who drink, in
itself is an unfortunate fact, like the fact that some groups can't
digest milk from cows (except that milk has high nutritional value and
the ability to digest it might with more justification be construed to
have survival value). Their high alcoholism susceptibility was
immediately evident while they still owned the country as a proud,
brave, highly developed people and the white man was still a tiny
minority along the eastern seaboard. Thus their severe alcoholism
problem is not caused by a native inability to cope with
discrimination, or poverty, unemployment, or battered self-respect, as
virtually every news story deploringly implies. It is their genetic
alcoholism that has exacerbated all of these problems and destroyed
their ability to surmount them.
Again,
it is iatrogenic circularity that has disenfranchised them, laid the
insanity of alcoholism on their character and culture, added egregious
insult to already fatal disease, and converted this limitation —
otherwise manageable through abstinence — into a genocidal disaster.
Incredibly, mental health specialists would now have us believe that
this profound inversion of reality should be the prototype for the
treatment of the many other “victim” groups.
Thus
we are advised that addiction treatment should focus on the special
“underlying” problems of being a woman, an African-American, a Chicano,
a homosexual, a victim of sexual abuse, or whatever. Nothing could be
more destructive. On the contrary, first restore them to sanity and
selfhood through thorough addiction treatment, emphasizing the
commonalities with other addicts. Only then can they be helped to
realistically address and cope with their special social and personal
problems.
Why psychosocial variables are excluded
The
fact that the biogenic paradigm excludes psychosocial variables as
causes of alcoholism does not make it extreme. They were excluded for
four very sound and mutually supportive reasons:
• First, no such causes have been verified for inclusion.
• Second, the new paradigm accounts for alcoholism without requiring such causes.
• Third, as illustrated above, it explains why so many such factors so
compellingly seem to be causes when in fact they are not.
• Fourth, it explains why the unwarranted inclusion of psychosocial
factors as causes only creates an iatrogenic psychiatric problem that
blocks recovery.
Really
extreme would be to continue to include such factors. Therefore there
is everything to gain and nothing to lose by taking the inevitable step
of abandoning the one paradigm for the other. Only then will it be
realized that any as yet unverifiable contributing psychosocial causes
would have a far better chance to be delineated and confirmed within
the new paradigm. Of course, because such factors are not needed to
fill any gaps, the assessment of their importance could not possibly
precede but only follow their discovery.
Encouraging news
The
most encouraging news from NIAAA is that the funding structure to
foster synthesis across biological disciplines is taking shape. The
many scattered precursors and markers will be gradually brought
together for interdisciplinary study. Apace, and destined to provide
the mutually authenticating window between this scientific integration
and clinical practice, The American Society of Addiction Medicine
(ASAM) is setting a legitimizing example for all other enlightened
organizations and individuals by strongly advising healthcare reformers
to classify addiction treatment as a separate, mandatory “core
benefit,” not as a subordinate part of some optional benefit, such as
mental health treatment.
(copyright 1993 by James R. Milam)
Reprinted from Professional Counselor Magazine, Vol. 8, No. 2, October 1993
# # #
Special Note with this reprint:
There is reason to hope that as copies of The Alcoholism Revolution
continue to circulate they will create a kind of critical mass of
enlightenment that will, through the communications media, explode into
public view.
To this end, please continue to distribute copies, especially to
government officials and community leaders who may influence the shape
of healthcare or judicial reform. And be sure to make copies available
to “multipliers”, those who will distribute even more copies. Please
feel free to also photocopy and distribute this paper at your
discretion. Just remember that it is a sequel to The Alcoholism Revolution, not a stand-alone substitute.