For Most, Values Trump Addiction

Thursday, October 02, 2014

Although the analysis is somewhat deterministic, I found an article by Maia Szalavitz titled "Most People With Addiction Simply Grow Out of It: Why Is This Widely Denied?" to be a vast improvement on the conventional wisdom about substance abuse and recovery. Two points particularly stood out.

First, Szalavitz reveals a thinking error that lends credibility to one popular myth about addiction:

Why do so many people still see addiction as hopeless? One reason is a phenomenon known as "the clinician's error," which could also be known as the "journalist's error" because it is so frequently replicated in reporting on drugs. That is, journalists and rehabs tend to see the extremes: Given the expensive and often harsh nature of treatment, if you can quit on your own you probably will. And it will be hard for journalists or treatment providers to find you.

Similarly, if your only knowledge of alcohol came from working in an ER on Saturday nights, you might start thinking that prohibition is a good idea. All you would see are overdoses, DTs, or car crash, rape or assault victims. You wouldn't be aware of the patients whose alcohol use wasn't causing problems. And so, although the overwhelming majority of alcohol users drink responsibly, your "clinical" picture of what the drug does would be distorted by the source of your sample of drinkers.

Treatment providers get a similarly skewed view of addicts: The people who keep coming back aren't typical--they're simply the ones who need the most help. Basing your concept of addiction only on people who chronically relapse creates an overly pessimistic picture. [links dropped]
Szalavitz is correct to question the pessimism, but does not really get away from the notion that addiction is a disease. That said, her article still offers useful information for those of us who disagree with that idea entirely.

Thus, the second thing that stands out about this article is what it has to say about the recovery process and how treatment might be improved:
To better understand recovery and how to teach it, then, we need to look to the strengths and tactics of people who quit without treatment--and not merely focus on clinical samples. Common threads in stories of recovery without treatment include finding a new passion (whether in work, hobbies, religion or a person), moving from a less structured environment like college into a more constraining one like 9 to 5 employment, and realizing that heavy use stands in the way of achieving important life goals. People who recover without treatment also tend not to see themselves as addicts, according to the research in this area.

While treatment can often support the principles of natural recovery, too often it does the opposite. For example, many programs interfere with healthy family and romantic relationships by isolating patients. Some threaten employment and education, suggesting or even requiring that people quit jobs or school to "focus on recovery," when doing so might do more harm than good. Others pay too much attention to getting people to take on an addict identity--rather than on harm related to drug use--when, in fact, looking at other facets of the self may be more helpful. [bold added]
This discussion reminds me of Ayn Rand's discussion of the relationship between life and values, particularly the following:
The standard of value of the Objectivist ethics--the standard by which one judges what is good or evil--is man's life, or: that which is required for man's survival qua man.

Since reason is man's basic means of survival, that which is proper to the life of a rational being is the good; that which negates, opposes or destroys it is the evil. [emphasis in original]
Of course, without volition, none of this is relevant to the problem at hand. That said, not only do some recovery stories give good evidence of the role of volition in changing a life-threatening habit, it is plain that recovery from addiction hinges on two things: (1) a realization on some level that the addiction stands in the way of some value (or at least something the individual considers a value), and (2) a decision to choose the threatened value over the addiction.

-- CAV


Steve D said...

Michael J. Hurd says a lot of the same things.

Coincidentally, I just read an interesting book by Jack Trimpey on my kindle called; "The Triumph of Addiction Recovery in the Breakdown of the Bicameral, Addictive Voice or, Who killed Julian Jaynes." which made almost exactly the same points, especially hammering on the issue of free will. He states that the vast majority of people who recover from addiction do so on their own without clinical or outside help but their experiences are always similar. However, he is emphatic that addiction is NOT a disease but a choice and that contrary to what AA claims, addiction is one day at a time but recovery is forever. He also skewers the standard treatments for much the same reasons; such as the isolation of patients and the claims by other recovering addicts that ‘your family won’t understand you.’

I am not sure of Trimpey’s philosophical ideas but his psychology and his writing both have a very pronounced Randian sense of life and a tremendous respect for human beings. I just checked Amazon. He’s written a number of books on ‘Addictive Voice recognition technique.

He goes on to discuss addiction in the context of Jaynes theory of consciousness; that addiction is caused by a pre-conscious, almost instinctive survival mechanism which comes to dominate at the expense of the addict’s operational conscious free will. This is less certain in my mind but still a very interesting book.

Steve D said...

Although the analysis is somewhat deterministic

I agree. In fact, her title uses the deterministic phrase; 'grow out of it' suggesting people almost get bored of their addictions whereas Trimpey says it's not quite that easy; you have to make a choice, and undertake a struggle but it's one that most people win.

Gus Van Horn said...


The book you cite sounds like a mixed bag, much like this article.

I was once, very long ago, enamored of Jaynes's theory of consciousness and may even still own the book, but I regard it as a very appealing idea that is nevertheless probably wrong. Based on that, that book sounds much like this article: better than the CW, but with problems of its own.


Steve D said...

Yes, it’s a mixed bag. Still, it is probably useful since it confirms that the vast majority of drug addicts correct themselves which would be highly unlikely if it was a real disease. For instance, how many people spontaneously recover from cancer? The book also provides what might be a useful tool for alcoholics. I view the addictive voice as a useful metaphor, while Trimpey views it as a real manifestation from the right side of your brain; but the technique probably does not require Jaynes’ theory to be correct. Unfortunately, I would have to become an alcoholic to test this and that would be too expensive and time consuming :)

As far as Jaynes is concerned, his theory seems almost impossible to test or falsify; which of course doesn’t make it wrong, just difficult to address scientifically. That said, I haven’t been able to come up with a clear reason why in principle Jaynes has to be wrong. Of course, many appealing and even ingenious theories turn out to be wrong or in some cases just partly wrong.

However, when I read his book I was struck by the similarities between Jaynes’ theory of consciousness and Rand’s theory of reason, most notably in the critical role of language (and also in the insistence on free will). In ‘Introduction of Objectivist Epistemology’ and other works, Rand taught that spoken language is critical for thinking (reason) and so its role in communication becomes almost a side benefit. She went on to describe how concepts are formed and how this process is only made complete by the designation of a word to represent the concept. Jaynes on the other hand believes that spoken language is necessary for consciousness and crucially it occurred as a result of metaphorical speech and the metal feedback loop that created. I started to wonder if reason and consciousness are connected; if you might have to be conscious to reason. It many ways it seems surprising to me that consciousness and free will are even possible in our universe; something more is going on than the shuffle of chemicals and language and metaphor might just bridge the gap between mind and matter.

From my reading on human evolution, it is pretty clear that just after 50,000 years ago anatomically modern humans underwent an enormous change in behavior and there is paleontological and molecular evidence that language might have developed at that time. If this is the case, then hominids before this period could not be Aristotle’s ‘rational animal’; they would not reason as Rand understood it.

One of my main problems with Jaynes is the late date he assigns to the development of consciousness. I particularly reject the notion that the Odyssey was written by an unconscious man. It is too modern in its outlook and theme and could have almost come out of Hollywood. Jaynes uses the lack of introspective language in early literature (Iliad, Bible etc.) as evidence but I think this is more likely explained by cultural factors rather than an inability to introspect. A good example of this is the Koran. However, if you accept his hypothesis about the role of language (and possibly metaphorical speech) but reject the bicameral part of it and all that stuff about idols, oracles and the Iliad, it still remains possible that operational or self consciousness might have developed alongside language and the ability to reason shortly after 50, 000 BC. This theory is probably even more untestable that Jaynes’ theory yet it seems much more reasonable to me.

Gus Van Horn said...


Many of the problems you have with Jaynes's theory are fairly similar to mine, and to many a critique of the theory I read many years ago brought up. But, yes, the late date of the transition he posits is a biggie.


Snedcat said...

Yo, Gus, you write, "I was once, very long ago, enamored of Jaynes's theory of consciousness and may even still own the book, but I regard it as a very appealing idea that is nevertheless probably wrong." From the reviews I've read of it, Jaynes's book sounds like one of those that sets off a red flag: Everybody says that the part falling within his own specialty is clearly wrong, but the rest of it is very intriguing. That is common among popular science books. (One book that doesn't raise a red flag in that way, in case anyone's curious, is Terrence Deacon's The Symbolic Species: The Co-Evolution of Language and the Brain. The linguistic aspects of the book are quite good.)

In any case, a book well worth reading about the addiction-as-disease industry is Herbert Fingarette's Heavy Drinking. It's a bit old and is restricted to criticizing AA and such programs, but it's still thought-provoking.

(Amusing note: I encountered this book at the used bookstore I used to work at and picked it up because I knew Fingarette, a philosopher, from his work on Chinese philosophy. The book has since been praised by Diana Hsieh. It's sadly amusing to read the responses to her Amazon review: most are negative, and all the negative ones attack her for praising such an awful, inhumane book because it refuses to recognize that addiction is an incurable illness that they, the reviewers, are not responsible for. Ooh, touched a nerve there, guys!)

Steve D wrote, "In ‘Introduction of Objectivist Epistemology’ and other works, Rand taught that spoken language is critical for thinking (reason) and so its role in communication becomes almost a side benefit." However, Noam Chomsky holds the same position: If language can be said to have one basic or underlying purpose, it's to facilitate thought, not communication. It's only one of many possible points of similarity in one's view of epistemology.

Gus Van Horn said...


You may have mentioned to me what you noticed about Jaynes's book before, but thanks for mentioning it again. Perhaps looking for reviews by specialists of interdisciplinary best-sellers is a very good way to avoid wasting time on many of them, or at least to be aware of their possible limitations...

Interestingly, in this day and age, the kind of anger Fingarette's book drew might be a prima facie indication of merit.