An Open Letter To All Concerned With The Drug-Crime Epidemic:
From Dr. James R. Milam
Since its publication (some 30,000 original circulation) copies of The Alcoholism Revolution
are continuing to spread, and there is now clear evidence that this
definitive statement is transforming scientific and professional
understanding of addiction, inspiring cleanup of the peer review
scandal, and profoundly influencing pending healthcare and criminal
justice reforms. Major media stories are already reflecting the more
positive attitudes toward treatment and recovery.
Meanwhile,
with only stop-gap measures available to address the social and fiscal
crises of our time, there is a continuing urgency for this rectifying
information to be more widely available in its present form. So I have
mailed evolving versions of this letter with its enclosures to
scientists, professionals, government officials, media members and
others who by their cumulative actions and influence will help to
finally put a stop to this cultural calamity. To this end, I ask that
you read this information thoughtfully, and share it with still others.
As early responses indicate (in More On The Alcoholism Revolution), The Alcoholism Revolution
speaks eloquently for itself, but it is also necessary to address what
may otherwise still seem to be an insurmountable obstacle to the more
general dissemination for this “heretical” material. Some members of
the broader scientific and professional community have been
constrained, without substantive comment, to hold the paper in abeyance
as extreme, or premature. The reason is as obvious as it is absolute.
Everything in the paper is anathema to the long established peer review
consensus in alcoholism. There is no interdisciplinary mechanism of
substantive appeal, no higher scientific authority, and it is
unthinkable for official scientific spokesperson to violate the
sacrosanct hegemony of an intradisciplinary peer review procedure.
Neither they nor the communications media have had any way to know that
in the field of addiction research this obstacle has been more apparent
than real. Thus the fact that the peer review process has long been
corrupted and subverted is a necessary part of the story of the
alcoholism revolution.
About
25 years ago Mark and Linda Sobell began publishing research reports
alleging that controlled drinking was a viable treatment option for
alcoholics because, having trained 20 to do so, “many engaged in
limited, non-problem drinking throughout the follow-up period.” The
Maltzman, Pendery, and West investigations (from The Winter of Scholarly Scientific Journals)
found that both during the Sobell follow-up and continuing through
1981, with the exception of one patient whose initial diagnosis was
questioned, all had been drinking alcoholically, with multiple
hospitalizations and incarcerations. Four had died of alcohol-related
causes, another had disappeared while drinking, and six had resorted to
programs of total abstinence. None had been drinking
non-problematically.
Peer
review then denied relevant journal access to Maltzman and the other
whistleblowers, as an “investigative” panel of Sobell cohorts
castigated the critics and absolved the Sobells, characterizing their
research reports as “perhaps too enthusiastic”. The Sobells were
defended on the ground that the control group, instructed by the
Sobells to abstain, fared no better than those taught to moderate their
drinking. This diversionary point is, of course, irrelevant to the fact
that the Sobells blatantly falsified their critically important data.
It
would be hard to overstate the enormous impact of the Sobells'
“demonstration” on both science and public policy. It was insider
knowledge — that all other attempts to justify the denial of physical addiction had instead confirmed it —
that put such heavy pressure on the Sobells to falsify their data, and
that made their bogus reports the most widely cited and most
influential in shaping the academic addiction literature through the
1970s and '80s.
In
parallel, by the 1970s the academic chorus of denial, with Timothy
Leary singing lead, had successfully promoted marijuana as a completely
harmless, non-addictive recreational drug with no physical
consequences. There was then a sharp rise in cocaine use. At the first
sign of public alarm President Carter's drug czar, psychiatrist Peter
Bourne, quelled the concern with a reassuring White House bulletin:
“Don't worry about cocaine. It's among the most benign of all drugs in
widespread use.”
Herbert Fingarette's 1988 book, Heavy Drinking,
was pivotal in the abrupt national regression from the emphasis on
intervention and treatment of addicts to almost complete reliance on
condemnation and punishment of “abusers”. Echoing psychiatrist Morris
Chafetz, the founding Director of the National Institute on Alcohol
Abuse and Alcoholism, he cited the Sobells' reports 20 times in his
argument that there is no such thing as physical addiction, that
abstinence treatment is both unnecessary and ineffective. Since it had
been scientifically proven that alcoholics can learn to drink
moderately, society should demand that they do so, and punish them if
they don't. Thus his primary contribution was to elevate the big lie to
public prominence and respectability, supporting Stanton Peele's
raucous sound-bite presentation of it in the media. Incredibly,
Fingarette has been the US representative on addictions to the United
Nations, which explains the global ignorance of the scientific paradigm
shift that has occurred behind the scenes of denial in this country,
and our meager distorted information about how other countries are
coping with the drug crisis.
Fingarette's
gullibility was one thing, but why was society so ready and willing to
be duped? The answer was in the changing composition of society. By
1988 members of the aging baby-boom generation were ascending to
society's levers of control. Under the cover of legitimate social
protest, reared within an academically sanctioned world of drug
addiction and denial, the diabolic spawn of the older moralistic
ignorance of addiction, theirs was the first generation ever to mistake
adolescent rebellion for a sophisticated new adult lifestyle. They were
programmed to believe that theirs was the enlightened view, and from
the beginning consensual validation had precluded any concern with
evidence. In flipping society back into its old moralisms, the task was
not so much to persuade as merely to pander to the mind set of this
rising majority — denial imbedded in ignorance. Never mind that
Fingarette's evidence and argument were specious. Who but a
cross-threaded voiceless minority could know?
Although
never mentioned in the long lists of psychosocial risk factors blamed
for the growing problem of “drug-abuse”, clearly all such factors are
preempted by this big lie — the denial of physical addiction — the
seminal crime in the drug-crime epidemic. This deception alone, the
cultural message that drugs are non-addictive, and harmless when not
being abused, fully accounts for the drug epidemic. Absent the truth,
freedom of choice is counterfeit, freedom of speech a mockery, and
support for the proposal to decriminalize drugs a capitulation to the
hoax that generates the problem.
It
is naïve to suppose that a decisive battle will ever be won on the
streets. Street level drug activity couldn't operate a week without a
high level umbrella of money and protection. It is inconceivable that
for so many years, so many hundreds of billions of dollars generated by
this deadly cash trade could be laundered and distributed without the
participation or cognizance of many otherwise respectable people in all
high places — the media, academia, banking, government funding
agencies, major professions and others. To the participants it must be
worth well placed millions to lubricate the trade and to ease the
public conscience by keeping in place the belief that their products
are really non-addictive and harmless, when used recreationally and not
abused. Damn the “abusers”, not the drugs. How else to explain the
fanatic denial of reality and the betrayal of scientific and public
trust (Maltzman).
So
where are all the investigative reporters when we need them for a
really serious problem, one that is destroying the country? Answer:
Many of these boomers are also dupes, and either using drugs or
condoning it in their peers. The enlightened ones are waiting for a
legitimizing platform. Who can they quote or cite as an authoritative
source? Who in high places can and will go first? Where is the Dr. Koop
of street drugs? Whoever the lead authoritative spokesperson, they must
be backed by a strong consortium supported by a constituency, and all
such candidates are paralyzed by the awareness that so far no such
organized platform exists.
And
don't look to the major professions or government drug and alcohol
agencies. They are the source of the problem. Bill Wilson in his later
years lamented the fact, confirmed repeatedly by research, that without
prior treatment only about 1 in 18 alcoholics is able to start recovery
successfully in AA without multiple relapses. Research also has shown
repeatedly that treatment without Twelve Step continuation yields near
zero recoveries. For over 25 years research has shown that it is only
the full sequence of detox, inpatient treatment, outpatient follow-up,
and Twelve Step continuation, with no substitute drugs or
contraindicating therapies, that can yield a recovery rate of
three-fourths or better on first treatment. NIAAA has just recently
acknowledged this decades old research evidence in their quarterly
magazine, but they presented it as a “new” discovery, thereby avoiding
any criticism for having ignored this readily available information for
so long. Their belated acknowledgement was accompanied by the
announcement that research would now be funded to see which components
of treatment works best, while searching for a drug to ease the
craving. (Cars run well, but they are expensive. Let's see how well
they run without the fuel system, the ignition system, or the
transmission.) Of course it will take many years to again test all of
the components this way. (Our sound-bite response might well be, “It's
the sequence, stupid.”)
The
primary reason the funding agencies are stalling is because they are
ill prepared to participate in the biogenic model they have
categorically suppressed for so long. There is no one in academia to
teach the teachers, never mind reeducating the tens of thousands of
professionals already out in practice. Theirs is the old rock and a
hard place dilemma. Is it better to let the drug/crime epidemic run
unchecked for a few more years while we try to save face and educate
ourselves? Or should we immediately go public with the validity of the
“new” paradigm, thereby revealing that, locked in the old, we have been
the source of the drug/crime problem and the major obstacle to its
resolution? In the latter case, tens of thousands of shocked and
embarrassed practitioners, feeling betrayed, would have to refer half
their patients out while they sheepishly (angrily?) tried to learn
(from whom?), or seek more suitable employment. Citing the failure of
alcohol prohibition, blaming the current crime epidemic on the fact
that drugs are illicit, is as disingenuous as citing the psychosocial
risk factors. While cocaine and other such drugs were legal up through
the first decade of this century there was a major drug epidemic.
Finally realizing that the drugs were destructively addictive for most
users, the public rallied in full support of the Harrison Act,
outlawing the drugs, and the epidemic subsided. According to historian
David Musto, “Drug prohibition was a complete success.” The difference
was that smirking members of academia and a huge entertainment industry
were not flouting the law and, through a misinformed press, continuing
to promote recreational use of drugs. On the other hand, one major
reason alcohol prohibition failed is that for nine out of ten drinkers,
regardless of how, why, how much or how long they might choose to
drink, alcohol is not an addictive drug, and for them moderate
recreational drinking truly is a valid option.
No,
psychosocial “risk factors” are not causes of addiction. Along with the
big lie, they help to determine exposure, but the cause is the
addictive chemical in a biologically susceptible individual, and most
drugs users are addicted. It is not just the acute drug effect or the
illicit drug seeking that are a problem. They are just the beguiling
visible tips of the massive addiction-crime connection. Note that
tendencies toward violent behavior have always been with us, and that
psychosocial factors have always been precipitating causes. As
explained in The Alcoholism Revolution,
persisting even after drugs have cleared the bloodstream, the chronic
brain syndrome of untreated addiction increases (neurologically
augments) all destructive response tendencies, thus escalating both the
frequency and intensity of overt expression of these normally more
controlled impulses. Rates of suicide and homicide and all other crimes
and excesses are greatly increased regardless of the ready availability
of drugs or alcohol. But with addiction commonly excluded from the
consideration of causes, and drug use and “abuse” viewed as incidental
symptoms, the cause of the whole inflamed response is attributed to the
person and to the familiar psychosocial triggers, as though age old
sexual tension, domestic conflict and social injustice somehow in
recent generations have become extremely provocative of destructively
insane behavior.
Alternately,
it seems that a failed morality has unleashed this abusive torrent,
when in fact, naively thrust to the decoy front in this quixotic war,
morality has been blindsided and savaged by the camouflaged foe of
addiction. Unable to account for the pandemic destructive behaviors,
the media can only describe them, as weird, strange, out of character,
irrational, bizarre and mysterious.
The
familiar comes to seem normal, but the cumulative loss of civilities
and moral sensibilities has been devastating as for three decades the
whole of society has been contagiously coarsened to accommodate this
misattribution of the insanity of addiction. Through screaming music
the nihilistic effluvium of toxic brains has been imprinted as social
commentary on the brains of each new generation of innocents, the
maudlin agonizing of dying brain cells has been flatteringly mistaken
for existential angst, senseless violence has been viewed as social
protest, and peeing on cultural icons has been hailed as an avant-garde
art form.
And
it is through this denial and misattribution that society has
unwittingly subsidized and enabled addiction by guiltily trying to
assuage its abusive consequences instead of demanding and enabling
clean and sober recoveries. Predictably, insane behavior, crime, and
poverty have increased in proportion to ever increasing expenditures
devoted to their reduction. Thus did the drug culture of denial and
misattribution assure that all of the heroic social engineering and
fiscal gymnastics intended to create the great society would instead
produce the great alibi society, this blundering bankrupt world of
psychobabble and victimhood.
And
no, informing the addict that he has a disease does not let him off the
hook for his bad behavior, as widely proclaimed. On the contrary, it is
the only convincing way to put him on the proper moral hook, the
enforceable imperative to do whatever it takes to get clean and sober,
and stay that way, as the only way to heal the brain syndrome that
produces the destructive behavior. When coerced into treatment, once
detoxified and returned to sanity and selfhood virtually all patients
gratefully accept this truth and its moral obligation — if presented
unequivocally and explained thoroughly — and become self-motivated.
Most fully recover, even many of the “hopeless”. None recover when
their psychosocial alibis and complications are mistaken for causes.
By
1988 the lucrative exploitation of the addiction treatment industry by
the “substance abuse” mentality had burgeoned out of control, and it
was easy to contrive the public backlash against the “rip-off
industry”. Contrived, because it was the same Sobell alliance that
fostered the exploitation and then orchestrated the media blitz. They
focused the attack not on their own zero recovery psychogenic programs,
but exclusively against the “disease concept”. During the two decades
of peer review subversion, scientific evidence proving the high
cost/effectiveness of the abstinence oriented programs had been purged
from view. Bereft of scientific legitimacy, they were helpless to
differentiate themselves or to defend against the attack, and the voice
of recovery disappeared from the national dialogue. Well over half of
the better private inpatient programs, ranging downward from eight
thousand dollars per treatment sequence and yielding full recovery
rates of some two-thirds, have been forced to close, and most of their
financially starved public funded counterparts have been compromised to
become cheap but extremely costly revolving doors. Meanwhile, at some
$25,000 per inmate, per year, the prisons are bulging with alcoholics
and drug addicts whose predictably recurrent crimes and incarcerations
are secondary to the insanity of unrecognized or wrongly treated
addiction.
The
surviving treatment programs remain impotent pending public disclosure
of the truth, and in their silence we hear the loud replay of the
hostile code words of the truly failed psychogenic strategies of the
1970s, “We need to try alternative treatments.” The 44 of these highly
varied “alternative” programs in the notorious Rand follow-up study
(including anger management, harm reduction, and dual diagnosis
treatments) cruelly provided temporary diversions, but uniformly
yielded zero recoveries from this progressively fatal disease. Their
future failures are predictable because in their inverted view of cause
and effect, addiction doesn't cause dysfunctional behavior,
dysfunctional behavior causes substance abuse (John Bradshaw). If we
learned anything from the 1970s it was that increased funding of this
wrong premise in whatever guise only produces more colossal failures.
So keep your eye on the really big money and its diversionary
deployments, the “dual-diagnosis” replay, and the other Trojan Horses —
the “harm reduction” and “moderation management” programs — that
smuggle the alcoholics' old alibis back in as causes. “It isn't the
drugs, it's the abusers that are the problem.”
Alas,
in a face-saving stall some members of the old guard are now attempting
to trivialize the biogenic model by equating addiction with the
nerve-transmitter effects of heavy drinking, the normal effects also
produced by heavy drinking in non-alcoholics, and similar to the
effects of excessive running or stamp collecting. But this denial of
genetic susceptibility to addiction will not long prevail because
enlightenment is spreading too fast, and government alcoholism and drug
funding priorities are already shifting to support remedial
professional education and training in the disease of addiction.
Of
course, the broader default position is still psychogenic. Even with
unlikely retractions by the Sobells and their cohorts or published
repudiations, it could take many years to glean enough valid
information from the chaff comprising the vast inverted “substance
abuse” literature to assemble the biogenic paradigm. On the other hand,
as growing awareness of the true gestalt reaches a kind of critical
mass, in an edifying figure-ground reversal, the whole academic
literature can be quickly flipped right side up.
Take
heart from many signs that the revolution is under way, and gaining
momentum. In an historic preemptive move, early in 1994, the principal
culprits in the subversion of peer review were visibly hooked off the
academic center stage into the wings. Confronted with the ensuing
disarray, top officials of the American Psychological Association then
suspended their campaign to subordinate addiction to mental health,
appealed to their biologically oriented members to assert new
leadership in this area (APA Monitor, July, 1994), and began a
reassessment of peer review procedures. To the same end, top government
agencies have just announced prophylactic peer review changes required
for future research funding.
In
a most promising parallel development, the American Bar Association
Task Force on the Drug Crisis has recently discovered and adopted the
biogenic model. It is also evident that the broader public pendulum has
started to return from its extreme swing to interdiction and
punishment. Drug courts are proliferating, and growing numbers of
reformers are discovering the hard data confirming the enormous
reduction in crime and healthcare costs following comparatively small
investments in effective addiction treatment. So now the really huge
question is this: To what will the pendulum return? Will selected
addicts merely escape the revolving prison doors to join the throng
still cycling in the traditional zero recovery healthcare and welfare
caseloads, and the financially compromised revolving door programs? Or
will there be a substantial reduction of all caseloads through
enlightened leadership and rigorous measures of prevention,
intervention and treatment of the core problem, addiction? Heaven help
us if we merely continue to follow the advice attributed to Yogi Berra,
“If you come to a fork in the road, take it.”
# # #
To read Maltzman's The Winter of Scholarly Scientific Journals click here.