Gregory E. Pence

Overcoming Addiction

Seven Imperfect Solutions and the End of America's Greatest Epidemic

• Broschiertes Buch

Produktbeschreibung

Leading bioethicist Gregory Pence demystifies seven foundational theories of addiction to reveal how they must work together to build more comprehensive solutions. Concerned citizens, individuals suffering from addiction, their families, and those who devote their lives to fighting addiction will find this new perspective a hopeful call to arms.

Produktdetails

• Verlag: Rowman & Littlefield Publishers
• Seitenzahl: 208
• Erscheinungstermin: 25. Juni 2022
• Englisch
• Abmessung: 229mm x 152mm x 12mm
• Gewicht: 346g
• ISBN-13: 9781538168097
• ISBN-10: 153816809X
• Artikelnr.: 66010758

Autorenporträt

By Gregory E. Pence

Inhaltsangabe

Preface
Acknowledgments
1 America's Unsolved Epidemic
2 What Are We Getting Wrong?
3 Follow the Money
4 A Medical Disease
5 Chemicals and Electrical Impulses
6 Poor Choices
7 Avoiding the Worst Outcomes
8 Written in the DNA
9 Bad Ways of Coping
10 Beyond the Individual
11 The Seven Approaches and Super Pot
12 Ten Insights for Fighting our Epidemics
Notes
Index
Preface
Almost every day, newspapers or television describe deaths from overdoses.
Educated people understand that addiction and alcoholism raise some of the
most pressing questions of our times: what causes them, how should they
best be treated, how much is the alcoholic or addicted person responsible
for his or her condition, and can victims actually overcome these diseases?
What people don't realize is that these questions not only raise factual
issues but also deeply philosophical ones.
In 2016, Surgeon General, Vivek Murthy, MD, in an essay in the New England
Journal of Medicine decried "American's escalating opioid epidemic."[i] He
wrote that, "more than 2 million people in the United States are addicted
to prescription opioids," and that "we estimate that more than 1 million
people who need treatment lack access to it." Some would call our situation
in America a pandemic of addiction and of abuse of alcohol. Some scholars
estimate that 1 American family in 3 suffers personal experience with
addition or severe alcoholism.
At the same time as the number of deaths grows each year from overdoses,
various clinics and therapists claim to know the true cause of addiction
and the way to cure it. They write books, start residential treatment
centers, and charge substantial fees. Starting with Alcoholics Anonymous in
1935 and ending with insights from brain imaging in the last decade,
families and addicts hear conflicting claims about addiction and how to
treat it.
In all this noise, it may surprise people that real understanding addiction
may be as much a philosophical problem as a scientific one, that we really
need to understand the foundational commitments of researchers and
counselors. Just hearing one scientist pitch her views, without comment
from other views, dooms listeners to an incomplete understanding. Getting
to the bottom of addiction, and its twin, alcoholism, requires both
philosophical acumen and hard-nosed facts. Getting to the bottom also
requires exposing the many hidden ethical issues in competing claims about
treating addiction, such as how Google can make $187 every time someone
clicks on one of its ads for a a rehab center.
Take one recent theoretical battle over treating addiction. A bitter,
sustained debate occurred in 2018 in the normally boring New England
Journal of Medicine. One famous physician- researcher claimed that
addiction was an "acquired disease of the brain" and should be treated as
such. An opposing researcher awhile later opposed that claim, arguing that
addiction was learned behavior that could not be treated solely as a
disease-of-the-brain. In turn, both thought the approach of Alcoholics
Anonymous/Narcotics Anonymous, was simplistic and outdated. And in turn
again, all these theories thought Kant's view of addiction and alcoholism,
as a series of free choices for which people are responsible, was wrong and
primitive (although many ordinary people and parents agreed with Kant.)
Not understanding the philosophical conflict behind conflicting theories
dooms each researcher, each family, to falsely believing that their
approach is true view, while seeing other approaches as besot with
ignorance or bigotry, just as many Christians, Muslims, Hindus or Jews
believe that they grew up in the true religion and, sorry!, but all other
religions are false.
Each addiction specialist believes that he or she has discovered the true
theory for treating alcoholism and addictions, but unlike theories of human
nature defended by long-dead philosophers-these living specialists push
their theories with take-no-prisoners zeal. The ferociousness of this
debate will surprise readers, but sadly, it is an ongoing fact. Indeed, as
a physician or PhD writing a book about alcoholism or addiction, it seems a
prerequisite that one be recovering from one of these conditions (Paul
Thomas, Leslie Jamison, Ann Johnston, Annie Grace, Judy Griesel, Marc
Lewis, Maia Szalawitz, et al.) Yet the same passion that these writers
bring to their subject narrows their focus to the theory that worked for
them instead of the broader focus on what might work for other, different
people.
And that's important. If addiction and alcoholism are not all-or-nothing
conditions, but spectrums, and if different people arrive at the same place
on these spectrums for different reasons, then a one-sized approach won't
fit all.
Tolerance of other views and impartiality are rare virtues. In the author's
reading about alcoholism and addiction over decades, he has never come
across a writer who admits, "Every one of the other theories contains some
truth." Instead, each writer vilifies the other approaches, accusing them
of ignorance, greed, and lack of evidence.
This book discusses the seven leading theories of addiction:
Alcoholics/Narcotics Anonymous, Neuroscience, Kant, Genetics, Learning
Theory, Harm Reduction, and Structuralism. An introductory chapter sketches
the history and nature of our epidemic of substance abuse, while another
gives an overview of theorizing about alcoholism and addiction. The latter
discusses how theories might be usefully compared and evaluated. Seven core
chapters, each covering one theory, follow the two introductory chapters.
As the book progresses, each theory is subjected to criticisms by other
theories. A concluding chapter offers some conclusions and suggests avenues
of further inquiry.
This book also emphasizes practical applications of the theories, empirical
tie-ins, and actual cases. Every chapter on a theory also contains a
summary of the theory's explanation of addiction, its proposed cure or
treatment, its explanation of why other theories are mistaken, its view of
money matters, its view of whether addicts are responsible for their
behavior and, its advice for families of affected relatives.
Although much has been written about addiction and although billions of
dollars fund research into treating addiction, many physicians and educated
laymen do not realize how much the definition of addiction, as well as its
treatment, stems from underlying philosophical assumptions. Ignorance about
these assumptions contributes to our ongoing controversies about treating
addiction and our ongoing villainization of opposing views. As Socrates
said, the first step to wisdom is understanding what you don't know, as
well as questioning whether your unstated assumptions are correct.
Moreover, one of the most famous issues in the history of philosophy has
been free will, paralleled by its companion issues of personal
responsibility and blame. Addiction makes resolution of such issues a
national crisis, especially for families of those affected by chronic
users, who are often told they should not blame their son because he has a
medical disease. Yet hardly any philosopher discusses the free will or
responsibility of the addict.
The business of treating addiction is a lucrative one. Two of my former
students, both psychiatrists, run groups every weeknight for addicted
dentists, nurses, anesthesiologists, surgeons, and others. Each night, each
person must provide a urine sample and $100 bill (no insurance taken). Each
person must do so to retain the right to continue employment in their
practice or hospital.
The Surgeon General noted that "the Mental Health Parity and Addiction
Equality Act of 2008 was a major step forward in ensuring that health
insurance plans treat substance use disorders the same way they treat other
medical conditions ... ." It also unleased billions of dollars of insurance
money for treating addiction, setting off scads of problems. This book also
follows the money in discussing many ethical issues surrounding reimbursing
those who treat addiction.
Prestigious groups, such as the editorial board of the New York Times and
Surgeon General Vivek Murthy, push for more funding for treatment of
addiction.[ii] But how are we know which treatment to fund without a
thorough understanding of the strengths and weaknesses of different
theories? Should we fund theories whose therapists refuse to submit their
results to impartial observers? Whose counselors cannot provide objective
evidence of success? If we throw gobs of money at scammers, won't we just
waste it?
Some last personal remarks: I realize that some families, upon reading this
book, may realize that the money they've spent for a relative in rehab may
have been wasted. If so, I apologize for their hurt feelings. It is also
possible that reading this book may save other families from wasting money
on methods that don't fit their child.
I have no monetary or personal stake in any theory described in this book.
Also, I donate a portion of the royalties from this book to evidence-based
treatments of alcoholism and addiction.
I also realize that some recovering alcoholics and some people recovering
from addiction may be inflamed by my description of a theory that has
worked for them. If a particular theory such as Alcoholics Anonymous has
worked for someone, he or she often generalizes it to be the only theory
that can work for everyone. Such people may not believe that other theories
can work for others or that some people recovered on their own, without
accepting any over-arching theory. Again, I apologize if you think I've
short-changed your favorite theory or not done it justice.
The literature and studies of alcoholism and addiction are vast,
encompassing dozens and dozens of journals in many different fields. I do
not claim to have read or mastered all these studies: I do not see how
anyone could. But I do claim to know about the theoretical orientations
that emerge from this literature and how those theories often conflict with
each other.
In reading the many memoirs and books of recovering alcoholics and people
with addictions, I get the sense sometimes that these authors feel that
only one who has experienced these syndromes is qualified to write about
them. If you haven't "walked the walk," they imply you can't credibly "talk
the talk." I understand those feelings and I do not want to take anything
away from the many authors who've courageously recovered and written about
their journey to recovery.
At the same time, an impartial observer can be valuable and add
understanding to the issues. Because each profession seems to compete to be
the Master of Addiction Treatment, counselors and writers from each theory
only write from their orientation. Ideally, relatives and people affected
need an impartial survey of all the theories and their strengths and
weaknesses. In that way, everyone can decide which theory, or which
combination of theories, works best for him, her, or their child.
[i] Vivek Murthy, "Ending the Opioid Epidemic - A Call to Action," New
England Journal of Medicine, December 22, 2016, 375: 25, pp. 2413-2415.
[ii] Vivek Murthy, "Ending the Opioid Epidemic - A Call to Action," New
England Journal of Medicine, December 22, 2016, 375: 25, pp. 2413-2415;
"Breaking America's Opioid Addiction," Editorial, New York Times, October
1, p. SR8.