How to Regulate a Demon Drug

Expanded version of a Presentation to the Rational Drug Regulation Conference, Brno, Czech Republic, Oct 4-6 2017

Bruce K. Alexander, Professor Emeritus, Simon Fraser University, Vancouver, Canada

We are here today because of a global drug addiction problem. We are failing to solve this problem everywhere. No matter what we do, it seems, more people are becoming dependent or addicted. I hope to show you today why we are not doing better. The primary reason is that almost all of our interventions are based on a very old and very popular narrative about drugs that has outlived its usefulness. I will propose a paradigm shift from this “old story” to a “new story.” I will concentrate on showing how the new story can help us to envision a productive future for Rational Drug Regulation, which is the topic of this conference. 

I assume that every one in this room has heard some version of the old story, because it is deeply rooted in Western Culture. The contemporary re-telling of the old story speaks of a drug with super-human, almost demonic power. It is so seductively pleasurable that once people have used it a few times, some or all of them lose their self-control, and spend the rest of their lives craving and pursuing it. Not only do they become addicted or dependent, but also they become depraved and violent in their pursuit of the demon drug.

Countless people in every country of the world, including a large number of treatment professionals, believe this old story in these simple terms, but there are literally hundreds of variations that make it seem more complicated. So, when I went to university to become a psychologist, I relearned the old demon drug story as it was being applied to heroin in the terms of the behaviourist theory of the 1950s and 1960s, which made it sound more scientific, although it was basically the same old story that I had initially learned from a “Batman” comic book and from my father. Later I learned to tell the old story in the languages of Alcoholics Anonymous, of Christian doctrine dating back to St. Augustine, and of the neuroscience of endorphins that was current in the 1970s (See White, 1998 for a historical survey). Still later I learned to tell it in the languages of today’s advanced genetics and epigenetics, today’s chronic brain disease model, and some meditation disciplines. 

The old story has been told about a great variety of drugs. Today it is mostly being told in Canada about prescription opioids (especially fentanyl), heroin, methamphetamine, and cocaine, but many other drugs have played the demon drug role in the story in various times and places, including alcohol in the 19th century (“demon rum”), marijuana in the 1930s (“assassin of youth”), barbiturates, benzodiazepines, and even, in the US in the 1970s, model airplane glue (Brecher, 1972, pp. 321-334)! 

Sometimes I call the old story “the myth of demon drugs” because it sounds so much like even older tales of people who lose their souls because they yield to the temptations of demons that are not related to drugs. These tales were told long before drugs became a widespread issue. Demon stories became culturally important in Early Modern England (Raiswell & Dendell, 2004).

One pre-drug demon story is about Faust and the demon, Mephistopheles. Faust makes a bargain with Mephistopheles to give him understanding and power in the world. But the bargain does not bring Faust the rewards he expects and it damns him to suffer in hell for all eternity.  

 

Fig. 1. Faust and Mephistopheles. 

Of course, there are also stories of virtuous people, who were able to “just say no” to demonic temptations. The include Jesus in the wilderness, who encountered Satan offering him acclaim and earthly riches. But he never yielded to the deadly temptation.

 

Fig. 2 Jesus and Satan

Here are the four basic elements of the old story as it has been applied to drugs in its current form:

1. Addictive Drugs are the main cause of the drug addiction problem.

2. Many individuals foolishly or wickedly use addictive drugs, disregarding the advice of older and wiser people.

3. Using addictive drugs takes away the will power of these unfortunate people, transforming them into addicts who are “out of control”.

4. Recovery from addiction is extremely difficult. To be even partly successful, it needs to be organized by expert medical or psychological professionals or by self-help groups, particularly 12-step groups.

Taken together, these four elements of the old story comprise today’s popular understanding of the word “addiction” as a chronic disease or disorder of drug use.

Some variations of the old story emphasize the evil power of the drugs, by putting the stress on elements 1 and 2. In these variations, the problem must be solved by removing the Demon Drugs from the face of the earth or by making people so afraid that they would never try one. These variations have served to justify cruel and futile Wars on Drugs in many countries. 

Other variations stress elements 3 and 4 of the old story, putting the emphasis on the enslaved addicts who must be helped to manage their cravings. Help can come from medicines, vaccines, psychological counselling, cognitive-behavioural therapy, existential therapy, self-help groups, religion, contemporary methods of casting out demons, meditation, harm reduction, hallucinogenic drugs, shamanistic rituals, acupuncture, dietary treatments, recovery groups, special housing projects, or many other sources. 

The good news is that the last fifty years has seen a movement from War-on-Drugs-oriented variations of the old story to the help-oriented variations in many places. Along with the conceptual movement, we have seen much of the world moving from a War on Drugs regime towards a more compassionate regime based on many forms of compassionate care, all of which have proven helpful to some addicted people. This has been a genuine triumph of humanism over violence and I am proud to have played a small role in advancing this movement in my own city and country -- even though, despite this shift, the same “old story” (with the emphasis on elements 3 and 4) is still the foundation of most of our thinking.

The bad news is that, despite the compassionate movement between variations of the old story, and despite the genuine amelioration of the harms that drug use and drug wars produce, the problem of drug addiction has not decreased and in many places seems to be increasing alarmingly. Other kinds of addiction seem to be increasing as well, particularly addictions to gambling, obesity, social media, pornography, wealth, consumerism, religious fanaticism, and many other pursuits. Even Portugal, with its wonderful life-saving advances in harm reduction provides little solid evidence of a reduction of drug addiction or of other kinds of addiction. But why is this so? 

My own city of Vancouver provides one of the most discouraging examples of the failure of the second set of variations of the old story to reduce the addiction problem. Even though our movement away from the war on drugs now has consistent support from government, the professional community, the media, and the public, we are currently suffering from an all time high number of overdose deaths due to opioid drugs, especially fentanyl. Many people fear for their children as they grow up. Fortunately, our governments are responding to the apparent crisis by increasing harm reduction and treatment services, rather than regressing to the War on Drugs. But the crisis persists. 

Vancouver also appears to be suffering from a rapid growth in Internet addiction: particularly on-line gambling, social media, pornography, and video games. Likewise we have tangible indications of growing addiction to unhealthy eating patterns: Obesity, anorexia, and type 2 diabetes. We have many other serious kinds of addiction as well and many seem to be trending upwards.

How could this be? Why have we not seen a better outcome from more humane solutions based on genuine advances in neuroscience, psychological theory, drug law, and the spread of compassionate spirituality? 

How can we decide on the best methods of Rational Drug Regulation when we do not yet have enough knowledge to keep our drug problems from worsening? And, if the old story is basically true, how can we ever hope to regulate a demon drug? Demons, by their very nature are not subject to regulations.

Today, I want to propose that the old story of the demon drugs is fundamentally wrong in both of its variations, and that we need an entirely new story to enable us to discover the best forms of drug regulation. I am proposing that the first, and most important, step in successfully regulating a demon drug is unmasking it, i.e., showing that it is not really a demon at all.

In the year 2017, more and more researchers are challenging one or more of the elements of the old story. In fact, some researchers are beginning to see that all four of them are wrong. The evidence is overwhelming, and I have summarized much of it in earlier writings. It comes from a great variety of sources, particularly clinical case studies, biography, history, anthropology, and neuroscience. For a review of this literature, which goes back many decades, please read my books (Alexander, 1990; Alexander, 2008/2010, chap. 8), visit my website (especially Alexander, 2014), or look at the writing of other critical neuroscientists, researchers, and therapists (e.g., Peele & Brodsky, 1975; Hart, 2013; Satel & Lilienfeld, 2013; Lewis, 2015; Heim et al., 2014; Vintiadis, 2017; Heather et al., 2017)

But I will not lay out evidence against the old story in detail today.  Instead, I base this presentation on the simple historical fact that the old story has gotten us nowhere after more than a century of being taken very seriously by drug addiction professionals, governments, and the public (White, 1998). Not only has the old story been unproductive, but there is also overwhelming evidence that the first variation is still used by unscrupulous politicians as a way to persecute large numbers of people in the racial and economic underclasses (Hart, 2013; Hari, 2015; Baum, 2016; Rodriques and Labate, 2016). 

We need a better story. So I will offer one today that is gaining ground everywhere, and is supported, at least in general terms, by some of today’s most inspiring global thinkers outside of the field of addiction. This story is well known in various corners of the field of drug addiction, although it only beginning to find a place in the mainstream centre, where policy is set.

A paradigm shift from the old to the new story will be a major event in cultural history. It will radically the focus of attention of people concerned with addiction from a narrowly defined problem to a much broader problem that is now usually overlooked. This kind of re-focussing can be illustrated with a shocking but amusing picture of some golfers in one of the western regions of Canada and the US that have been engulfed with forest fires for the last few summers. The fires are destroying huge amounts of forest that are vital animal habitats, carbon dioxide sinks, and workplaces for thousands of forest workers.

 

Fig. 3. When it is time to re-focus.

The gentlemen golfers in this picture are concentrating intensely on their game. They know that a good game of golf is an excellent way to improve quality of life for affluent people like themselves after a certain age, and that golf also helps the economy, because important business connections are made while golfing. Because playing golf well is extremely difficult, they must concentrate hard. But, if these people really want to improve the quality of their lives and their society, they are concentrating on the wrong problem. 

No matter how much these gentlemen sharpen their golf skills, their quality of life is endangered. They could become the best players in their league or even develop a brilliant new variation on the game of golf, without improving their quality of life or the economy. If they really want a better quality of life, they need to change their attention from a less important problem to the more important, flamingly obvious one. Not only is the fire alarmingly close, but the forest fires that are burning all over Western North America are doing huge environmental and economic damage, and many experts say that they are a manifestation of a much larger problem of global climate change. We could say these golfers need a “new story” about how to improve their lives or we could say that they need to join a “paradigm shift” that is already under way.

This golf picture is popular among people that I know right now. I believe that it is a powerful metaphor at a time when reformulations of many basic problems – paradigm shifts – are so urgently needed.  

The “new story” or “new paradigm” for dealing with the drug problem that I will propose is not historically new, but it has remained in the background of the field of addiction for the past century. 

The “new story” has many old sources, for example: 

Plato, Book 8 of the Republic (ca. 360 BC; Stephanus numbers 544a-575a) 

Folk Culture: Canadian Indian, Scottish

Sigmund Freud’s Civilization and Its Discontents (1929)

Modern Social Critique (e.g., Franz Kafka, Vaclav Havel, Naomi Klein, George Monbiot, Byung-Chul Han)

Theologians (Ignacio Martín-Baró, 1994; Pope Francis, 2013, 2015; Kent Dunnington, 2017) 

Rat Park (Alexander, 2010)

“Social Determinants of Health Perspective” emerging in the World Health Organization (see Davis & Gonzales 2016).

Rat Park. For the sake of time, I must confine today’s remarks about sources of the new story to the single source I personally know best: Rat Park. I have written more about the other sources elsewhere (e.g., Alexander, 2017).

I began studying addiction as a professional psychologist in 1971. I volunteered as a therapist at a local treatment agency in the heart of Vancouver’s heroin-using area, was given an office, and told to start helping heroin users who were receiving methadone maintenance to stop taking drugs altogether. It was a fascinating assignment for a young psychologist. Most of the addicted men and women who sat across that desk from me were only a little younger than me, but they were weary, battered, and miserable from living as “junkies” in a very hostile world. As they told their very different stories, a theme emerged that was totally unexpected. They did not think of themselves as “out of control!” Rather they saw themselves as having access to a drug – heroin – that reduced their pain and misery and they also described themselves as having a comprehensible purpose in an adventurous life. They spent most of their time desperately seeking enough money to pay for this drug, most often by trafficking, theft, or prostitution. They were brutally handled by the local police in the drug war of the day and had the scars to prove it (Alexander, 1990), but, along with the suffering and the pharmacological pain relief, they also gained an important identity and feeling of solidarity in the community of people who were also chasing heroin and being chased by the police. Contradicting the old story, they told me in a hundred ways that they were not “out of control” but living the most meaningful lives they could find construct, given their fears, their lack of education, and/or their membership in the underclass.

As a new university professor of psychology, I was eager to share these observations with my students, and to raise possibility that perhaps these addicted people were at least partly right, and that the old story that was the dogma of the day was at least partly wrong. 

Some of my students were very interested in exploring these possibilities, but others threw the old story back in my face. One student actually shouted his disagreement from the back row of a classroom: “Don’t you know about the rats?”

By “the rats” he meant the research on rats in “Skinner Boxes” that was headline news in the 1970s. He knew – everybody knew – that rats housed in Skinner Boxes consumed huge amounts of heroin and other addictive drugs, and were sometimes so absorbed in dosing themselves that they forgot to eat and died of starvation! This was interpreted in those days as scientific proof that drugs like heroin were so irresistible that a person – or any mammal, down to the lowly rat – which experimented with them would become lost forever. This seemed, in those days, like an irrefutably scientific argument for what I am calling the “old story.”

Figure 4. Rats in the Skinner Box experiments of the 1960s received an injection of heroin through the tube when they pressed the lever on the wall.

As the debate became continued, a small group of student and faculty researchers, myself included, became interested in exploring the possibility that the rat research in the Skinner Boxes was wrong. We knew that rats are highly social creatures and guessed that keeping them isolated in the Skinner Boxes as well as their solitary home cages amounted to a kind of torture. Perhaps giving them access to drugs like heroin, when nothing else was available, was like offering a soothing painkiller to a human being in prolonged solitary confinement! 

So eventually we built Rat Park…

 

Figure 5. Rat Park provided plenty of room for both socializing and meditation.

Figure 6. Female rats in Rat Park spent much of their time taking care of their pups. 

…and offered unlimited access morphine hydrochloride (which has virtually identical effects to heroin) both in rats in Rat Park, and to rats isolated individual cages that were no larger than Skinner Boxes. We recorded much more drug consumption in the isolated cages, suggesting that the earlier Skinner Box research provided no real evidence for the old story at all. The extraordinary consumption of drugs in the Skinner boxed rats appeared to be an artefact of an impoverished environment (Alexander, 2010). Now that the Rat Park research has become known around the world, it has helped to open the door for the new story that will eventually replace the worn out old story that is confusing the understanding of addiction today.

I will tell the new story in the language of history, rather than the language of the rat laboratory, or of any of the other predecessors of the new story that I mentioned earlier. Then I will discuss the implications of the new story for rational drug regulation.

The “New Story”

The new story contradicts and replaces all four elements of the old story and negates the narrow way of looking at addiction that is implicit in them. The essence of the new story is that the “drug addiction problem” is only one corner of a much larger problem of addiction, dependence, and self-destructive lifestyles that is built into modern society. The new story leads to the conclusion that the really important addiction problem is not merely “drug addiction”, but a great many severe, harmful forms of addiction and related problems – including drug and alcohol addiction, of course. The new story points to the daunting conclusion that these problems can only be solved by epochal changes in the emerging modern world society. The new story is as different from the old story as a forest fire is from a game of golf.

I have centered my representation of the new story on a portrait of Christopher Columbus, looking worried. I hope you will quickly see why Columbus should be the central image, and why he was right to worry.

Figure 4. The Modernity-Addiction Feedback Loop.

Of course, the modern age has spawned dangers that are even more terrifying than the rising tide of addiction, for example, nuclear devastation of the planet, environmental catastrophe, extreme income inequality, mass political apathy, and increasingly violent, mass resentment. This presentation focuses on addiction, because that is the topic that brings us here today. However, I also hope to show, that part of the reason that addiction is such a serious problem today is that it is intimately interwoven with other dangers of the modern age (See also Alexander, 2015).

“The modern age”, taken as the five centuries of western history since Columbus’ voyages, has long been a topic of intense study among historians, literary scholars, and social scientists. For a serviceable, compact description of how social scientists conceptualize the modern age, see Berman (1988, pp. 15-21). For more recent, but less compact, descriptions, see Mishra (2017), Monbiot (2017), or Han (2017). In this presentation I focus on four rapidly globalizing aspects of modernity:

1. Massive, interlinked, global markets. 

2. Enormously powerful, globally interconnected institutions like colonial governments, multinational corporations, financial markets, the World Bank, and the Internet.

3. Spectacular, all encompassing advances in science and technology, particularly the technology of controlling people.

4. (Paradoxically)…Relentless celebration of individual freedom and power.

Many great thinkers have described the psychological problems of modernity eloquently: Today, I am thinking especially of Fyodor Dostoyevsky, Charles Dickens, Franz Kafka, Aldous Huxley, George Orwell, Eduardo Galeano, and Byung-Chul Han for powerful nightmare critiques, and Vaclav Havel, Naomi Klein, George Monbiot, and Pope Francis for critical analyses that point towards a way out. 

As you contemplate the new story of addiction that I am discussing today, please keep in mind that showing that addiction is built into the modern age is not the same as proposing a return to the Stone Age. Every human era of the past has its characteristic achievements and successes as well as its unwanted side effects. Although the side effects of early modernity were obscured by its dazzling accomplishments and the wealth that it brought to many people, especially in Europe, today’s late modern society must face and rectify its dire side effects if it is to avoid catastrophe.

Please also keep in mind that to say that addiction is built into modernity, is not to deny that well-documented risk factors such as degrading poverty, early-life traumas, family dysfunction, depression, loneliness, racial prejudice, insidious advertising, perfectionism, predisposing genes, and deliberately-addicting social media, games, and gambling machines increase likelihood of addiction. Rather, the new story shows how the structure of modern society tilts the playing field in favour of addiction by increasing the likelihood that people are exposed to these risk factors, and others, as the consequence of social and economic forces beyond their control. Modern society also tilts the playing field by making it difficult for people who have acquired harmfully addictive lifestyles to find deeply satisfying alternative lifestyles. Under these conditions, quelling the flood of addictions in the modern world will require profound social and political change. Otherwise, the addiction problem will continue to increase no matter what kinds of therapeutic, harm reduction, or recovery group strategies are offered to drug-addicted people and no matter how resolutely drug use and other potentially addictive practices are controlled and policed.  

Fragmented Society

From the time of Christopher Columbus onward, Western European powers crushed pre-modern societies and aboriginal tribes around the globe by conquest, disease, enslavement, enticement, economic exploitation, forced religious conversion, and ecological devastation of their territories. This social fragmentation was made possible by modern advances in science and technology, like the ship’s compass, steam engines, heavy gunnery, mass production of cheap trade goods, and by powerful modern ideologies that brilliantly justified subduing the entire planet to increase the wealth and power of the civilized nations and the great corporations of the world. 

As the colonizing European nations fragmented societies overseas to magnify their national wealth and power, they also crushed and impoverished the rural subcultures of their own homelands, although with somewhat more restraint. Agricultural and industrial revolutions, which accompanied global colonization, devastated stable peasant farms and commons throughout Europe. Refugees from this domestic fragmentation were cruelly stigmatized and economically exploited in European slums or shipped abroad to populate the colonies.

Although it is sometimes overlooked now, European nations also fragmented their own upper crusts of the wealthy and powerful. Rich adventurers, manufacturers, and bankers competed relentlessly to maximize their individual wealth and glory and many wound up in ruins (Galeano, 1973, 22-28, 55-56). As Viennese scholar Karl Polanyi (1944, p. 128) described early modern England, “... the most obvious effect of the new institutional system was the destruction of the traditional character of settled populations and their transmutation into a new type of people, migratory, nomadic, lacking in self-respect and discipline—crude, callous beings of whom both labourer and capitalist were an example.” In the late modern age, countless works of philosophy, fiction, poetry, and song lament the fragmented lives of the affluent and well educated as well as the poor and exploited. Think, for example, of the fiction of Dostoyevsky or Kafka, or the poetry of T.S. Elliot and Allen Ginsberg.

The fragmentation of society that began in the early modern era still escalates in both rich and poor nations in the 21st century. This fragmentation has been shaped by different economic and political regimes in different times and places over the centuries of the modern era, but it is currently shaped primarily by the dominance of free-market capitalism, neoliberal politics, ecological devastation, consumerism, gross inequality, mind-bending social media, third world “development,” financialization with its periodic market crises, corporate culture, “enterprise culture,” “metacolonialism,” high-tech surveillance, high speed technical change, real estate bubbles and crashes, relentless efficiency in manufacturing and agribusiness, robotization, “ludocapitalism,” and continuing plunder of the remaining aboriginal territories. Today’s continuing global fragmentation is not only propagated by European nations, but also by the United States, and by other major powers, as they modernize along the lines that originated in Western Europe five centuries ago.

In my earlier writing, I focussed on free-market capitalism as the cause of modern fragmentation. I still see free-market capitalism as centrally important, especially in my own country, but broader historical thinkers have shown that the cause runs deeper, to the very roots of modernity itself. Christopher Columbus was not a capitalist, nor were Vladimir Lenin, Joseph Stalin, Fidel Castro, Deng Xiaoping, and Xi Jinping. But they have been vigorously and sometimes mercilessly modern. Christianity, Marxism, and free-market capitalism have all provided justifications for the fragmenting advance of modernity in different times and places.  

Modernity creates obvious economic and environmental fragmentation, but my focus today is on its devastating social destruction. Beneath the steamroller of modernity, extended families and communities are scattered; nuclear families become dysfunctional; local societies are pulverized; legitimate authority is toppled, religious certainties disappear; and cultural arts are reduced to trinkets sold in tourist shops. People and social groups that do not contribute to the advance of modernity are marginalized or exterminated.

Societal fragmentation has come to seem an inescapable consequence of the modern miracles that have enabled the earth to support seven billion people. But this miraculously modern, emerging world society is in deep – possibly terminal – trouble. Part of this trouble comes from the diverse side effects of fragmentation, most obviously environmental destruction, obscene inequalities of wealth and power, and the possibility of nuclear war. The most important of these threatening side effects for this presentation, however, are mass dislocation and, in its trail, mass addiction. 

Mass Dislocation of Individuals

I use the word “dislocation” to designate the individual psychological consequences that follow from societal fragmentation, as they manifest themselves in people’s everyday lives throughout the modern world. 

Dislocation has been described in many ways. For example, sociologists speak of the alienation and resentment of individuals in large bureaucratized societies that crush both community and economic structure. Psychologists speak of rapidly growing deficits of attachment, belonging, identity, meaning, and purpose leading to disorders such as anxiety and depression in the people they study. Christians speak of the poor in spirit or of idolatry of the secular world. Existentialists describe feelings of anxiety, dread, absurdity, despair, loneliness, and nothingness in people who inhabit a pointless bourgeois society. Evolutionary biologists speak of failure to satisfy the innate social needs of the human species in modern times. Dislocation has not yet been adequately described in the language of neuroscience – but it needs to be.

Dislocation is brutally obvious in the poor and homeless of today’s world, but it not confined to them. It afflicts every level of society. In richer societies, dislocation is devastating the affluent as well as the poor (e.g., Luthar, Barkin, & Crossman, 2013; Powell, 2016; Curran and Hill, 2017; Han, 2017).

One of heart-rending story about mass dislocation describes affluent Japanese people sometimes hire actors to stand-in for long lost spouses, friends, and relatives in everyday family events and in important rituals like weddings, funerals, and welcoming new babies into the world. These practices are documented in a recently published article (Morin, 2017).

Figure 8. “Renting Friends and Family in Japan” (Morin, 2017)

Mass dislocation has come to seem inevitable. The modern market system requires that individuals must perform competitively and efficiently, unimpeded by sentimental ties to families, friends, religious values, or norms of compassion. After all, “business is business” and we expect our politicians to produce “economic growth” and to “create jobs” at all costs. Stringent economic rationality is said to make the law of supply and demand function efficiently, and thus to “clear the markets” each day. China, India, Brazil and other nations that have joined the economic superpowers are paying the price in surging dislocation – and addiction. 

Seen in a positive light, individual dislocation can provide a space for initiative and creative freedom for people who have felt stifled by their societies (Han, 2017, chap 13; Bruder, 2017). However, prolonged, radical dislocation exacts a high price, because it ultimately generates misery in the form of anxiety, suicide, depression, disorientation, hopelessness, and resentful violence. In fact, prolonged dislocation is so unbearable that it has been imposed as an extreme punishment from ancient times to the present. Punishments like exile, ostracism, banishment, shunning, excommunication, and solitary confinement are, essentially, imposed dislocation. Radical social isolation, which is essentially imposed dislocation, is an indispensable part of today’s terrifyingly scientific technology of torture (Klein, 2007, chap. 1).

As a human experience, “dislocation” resists quantitative measurement. For example, psychologists like myself may speak of dislocation as the lack of attachment, belonging, identity, meaning, and purpose. But can a strong identity make up for a weak sense of purpose? Can a strong sense of attachment and belonging make up for other lacks? How are dislocation, attachment, belonging, identity, meaning, and purpose measured? Such questions cannot be answered precisely at this time. Nonetheless, dislocation – under its various names – has long been recognized by critical observers of the modern era. It is easy to overlook the importance of dislocation in an academic milieu that is dominated by empirical epistemology and reductionist ontology. Unfortunately however, empiricism and reductionism cannot legislate dislocation out of existence. They can only obscure it.

Flood of Addictions: Severe Addiction as an Adaptation to Dislocation

Just as dislocation historically follows fragmentation of a society, a flood of addiction problems historically follows dislocation. Extensive historical, anthropological, and clinical evidence documents this predictable sequence. 

I have spent decades studying the deadly outbreak in harmful addictions in the indigenous people in Western Canada that followed the fragmentation and consequent mass dislocation of their cultures imposed by British colonization (Alexander, 2008/2010, chaps. 5, 6). Unfortunately, the tragedy of modern colonial fragmentation and dislocation followed by mass addiction, is not restricted to Canada, but has been repeated among aboriginal people on every continent (Bayly, 2004; Mann, 2011).

Methamphetamine provides a more contemporary American example of the effects of fragmentation and dislocation on addiction. An American methamphetamine panic broke out in about 2000 in the US.  The surge in methamphetamine use and addiction was explained as the work of an irresistibly addictive drug. Some champions of the old story announced at the time that methamphetamine was the “most addictive drug on earth.” Then, historical research showed why methamphetamine was spreading so fast. Mass dislocation had emerged in the American farming states following legislation and immigration practices that destroyed what had remained of the traditional American family farm culture. Large numbers of dislocated former farmers and dislocated workers from the meatpacking industry appeared in a region with abundant farm chemicals that could be converted into methamphetamine. The result was a devastating increase in methamphetamine use and addiction in the American farm belt, which was, renamed “Methland” by one author (Reding, 2009).

Abundant clinical and biographical evidence reveals the reason why severe addictions track dislocation so closely. Addictions can provide dislocated people with some relief and compensation for bleak, empty lives, when nothing else works for them. Addictions can be adaptive in a fragmented, modern world because – in psychological terms – severely dislocated people can use addictions to obtain at least a taste of attachment, belonging, identity, meaning, and purpose, at least in the short term (Alexander 2008/2010: chaps. 6-8; Hart 2013: 74-95; Fetting 2016; Dunnington, 2017). Without their addictive identities and their connections in the addict subculture, many dislocated people would have terrifyingly little reason to live, and would risk incapacitating anxiety, depression, or suicide.

 For example, opioid drugs, including heroin as well as prescription drugs, provide real relief for the physical and psychological pain of dislocated people. It is not hard to understand why opioid drug use is more and more common in the modern, dislocated, stressed-out world. Although the great majority of users do not become severely addicted (Alexander, 2008/2010, chap. 8; Satel, 2018), the most dislocated drug users must endure intractable, crushing absence of attachment, belonging, identity, meaning, and purpose in their lives. For them, opioid addiction – not just opioid use – can provide a desperately needed substitute for what is missing. 

When opioid addicts wake up, at least they know who they are and what they must accomplish that day. Rather than being overwhelmed by unbearable emptiness, they keep frantically busy chasing drugs, and interacting with other drug chasers, within a loose community of other addicted people. At the same time, addiction can enhance their self-esteem by symbolically identifying with the fascinating lives and deaths of opioid-addicted celebrities like William S. Burroughs, Sid Vicious, Curt Cobain, Phillip Seymour Hoffman, Amy Winehouse, Michael Jackson, Robin Williams, Prince, or Carrie Fisher (Pryor, 2003; O’Donnell, 2018).

Other well studied examples of the adaptive value of severe addiction: Many dislocated people use horserace gambling addictively to colourize their otherwise bleak lives.  They exchange information and hunches at the track with a subculture of track habitués, and share a mythology of famous gamblers and legendary horses (Ryan, 2014a, b). Some people who gamble addictively on slot machines or the Internet do not seek human social interaction, but rather a “zone” of intense engagement with colourful gambling machines that have been ingeniously designed to be engaging and interactive, without having the threatening or annoying qualities of actual human beings (Schüll, 2012).

People who are not addicted to drugs or gambling, or who are addicted in a minor or temporary way, can use drugs or gamble without getting into serious difficulties. However, there are millions of people whose dislocation is so desperate that they build their lives around drugs or gambling or any of the countless other potentially addictive pursuits. When severely dislocated people find that an addictive lifestyle provides their best hope for enduring their existence, they seize it with the same iron grip that they would apply to a piece of floating junk in a stormy sea. Quite often, they seize more than one piece of junk and have multiple addictions.

Speaking of harmful addictions as adaptations is incompatible with the old story, because this new story does not imagine that people have lost their will power and are under the control of a demonic drug. Adaptation does not imply loss of control. Nor is adaptation simply a matter of free will or idiosyncratic choice. Adaptation by-passes the ancient, unresolvable dichotomy of free-will and determinism completely.

All of our ancestors successfully adapted to their environments behaviourally, as well as structurally and physiologically. We all survive by using the adaptive capacities that we inherited from them and the possibility of becoming intensely devoted or dedicated to a habit is one of these capacities for human beings. Addiction is one adaptive capacity we can use to respond to chronic dislocation (Alexander, 2008/2010, chaps. 6-8). When addictions are short-lived, as they most often are (Heyman, 2009, chap. 4), they can function to help people to endure bouts of dislocation and then move on to more socially integrated lives. Unfortunately, addiction is like some other forms of adaptation than can become harmful or fatal if worked to exhaustion when the individual is adapting to a long-term stressor (Selye, 1950; Angeli, Minetto, Dovio, and Paccotti, 2004).

Using the word “addiction” in this broad way further affronts the old story, because the old story essentially, or at least primarily, reserves the word “addiction” for drug use. However, the new story fits the fact that addictions to a very large number of habits, like gambling, overeating, sex, extreme sports, cult practices, religious fanaticism, social media, Internet usage – and countless more – can become as destructive as drug addiction when they are used to adapt to chronic dislocation. 

Thus, the new story fits with the traditional everyday use of the word “addiction” in the English language since the time of Shakespeare. The current online edition of the most authoritative dictionary of the English language (the Oxford English Dictionary) defines addiction in this traditional way as a state of: “…being dedicated or devoted to a thing, esp. an activity or occupation; adherence or attachment, esp. of an immoderate or compulsive kind…(definition 1a)”

Of course the word “addiction” is often defined today as a disease caused by drug use, in accordance with the old story, but this relatively recent, alternative definition did not appear in the Oxford English Dictionary until 1933 (definition 1b in the current edition), while the traditional definition, which is much older, remains as definition 1a. Unfortunately, the word “addiction” has been exported to the non-English-speaking world only in the sense of the drug-disease definition, rather than in the traditional definition. This has helped to the old story seem irrefutable in those places that have been influenced by English-language culture.

I will be using the traditional definition of the word “addiction” for the remainder of this talk. Using the traditional definition allows us to recognize that addiction is a kind of concentrated focus of energy and attention that can be adaptive and sometimes quite harmless. In fact, “addiction,” in traditional English usage, was often used to describe habits that are adaptive and admirable, such as addiction to scholarship or religious devotion (e.g., King James Edition of the Bible, 1 Corinthians, 16:15). The new story explains why a perfectly good adaptive capacity like addiction so often goes wrong in the modern era and becomes harmful or fatal. 

The individual utility of addiction in adapting to dislocation partially explains its dangerously high prevalence in a fragmented world of dislocated people. But addiction also has adaptive functions for modern society itself. The insatiable economy of the modern world requires overwork and overconsumption to keep the wheels of industry turning, the GDP growing, and the share prices rising. Therefore the addictions that favour economic growth and corporate profit, e.g., addictions to wealth, consuming, shopping, casino gambling, and overworking, are encouraged by modern culture and mainstream advertising. The individual and socially adaptive functions of addiction in the modern era go a long way towards explaining why addictions of every imaginable sort are as intrinsic to modernity as competitiveness, loneliness, and anxiety. 

An extensive literature review and meta-analysis by Sussman, Lisha, and Griffiths (2011) tried to use all the research on addiction in the United States in the last few decades to estimate the prevalence of 11 different kinds of severe addictions. The study was provocatively entitled, “Addiction: A problem of the majority or the minority”. Addiction was not defined as a drug problem as in the old story. Rather it was defined in accordance with the inclusive traditional definition, but limited to only those addictions that were actually harmful to addicted persons and/or their society.

Here are Sussman, Lisha, and Griffith’s estimated frequencies of harmful addictions in the United States in any twelve-month period:

“Based on the above review, we estimated the overall last 12-month prevalence of the 11 addictive behaviours among U.S. adults as follows: cigarettes—15%, alcohol—10%, illicit drug use—5%, eating—2%, gambling—2%, Internet—2%, love—3%, sex—3%, exercise—3%, work—10%, and shopping—6%”

These percentages add up to 61%. But, as Sussman, Lisha, and Griffiths point out, it would be wrong to conclude that 61% of Americans are harmfully addicted to something in any 12 month period, because many people are addicted to more than one habit. Their final conclusion, based on a set of simplifying assumptions, is that probably 47% of Americans are harmfully addicted to one or more habits in any 12-month period. Nearly half the population!

The adaptive functions of severe addiction in the modern world are often denied. Many severely addicted people deny that they live in a state of dislocation, because they feel embarrassed to think that they do not “have a life”. They may not know that most people in the modern world experience painful dislocation, at least some of the time. They may be unaware or ashamed of the adaptive functions of their own addiction. In moments of insight, however, severely addicted people can explain the functions of their addiction with surprising candour (Alexander, 2008/2010, pp. 158-160; Schüll, 2012; Pond & Palmer, 2016, pp. 21-22).

Mass media endlessly proclaim that addiction is a chronic brain disease caused by the effects of addictive drugs on the brains of people with a genetic predisposition to addiction, rather than an adaptation to dislocation in a fragmented world. Scientific authority and media dramatization bolster this contemporary version of the old story. It is lavishly funded and sponsored by the National Institute of Drug Abuse in the United States, despite its evident deficiencies.

Another complication that obscures the adaptive functions of severe addiction is that people may be addicted, especially for a short time and in a relatively mild way, for reasons that have nothing to do with dislocation. People may fit the traditional dictionary definition of addiction when they undertake a binge of work to finish an important project before a deadline and thereafter return to normal work habits. They may also fit the definition when they devote themselves to compassionate service and asceticism out of concern for suffering humanity, when they drink their way through a period of grief, or when they fall head-over-heels in love. The dislocation theory of addiction explains the high prevalence of harmful, long-lasting kinds of addiction in fragmented society, but less extreme, shorter-lived forms of addiction can serve quite different adaptive functions and often occur in situations where dislocation is minimal. For example, you don’t have to be dislocated to fall in love, but you do have to be dislocated to sacrifice your life addictively to a dysfunctional love relationship (Peele & Brodsky, 1975). 

I would like to raise the possibility today that the words “dedicated” or “devoted” – the key words in the traditional definition of addiction – describe two of the most important and admirable characteristics of our species. Not only are dedication and devotion understood as virtues, they are also adaptive. We human beings are able to solve the most difficult problems by marshalling our energy and concentration in a sustained way, i.e., by dedicating or devoting ourselves to finding the best solutions or to a way of thinking that will help us find the best solution. Of course these virtues can go horribly wrong when the dedication or devotion are misplaced or when dislocated people with no other options continue their addictions beyond the limits of their effectiveness. It is these harmful forms of addiction that are our concern today.  

Consequences of Severe Addiction: The Cycle Continues. 

Many people cling to severe addictions because they are indispensable adaptations to dislocation in an increasingly fragmented modern world. And some kinds of intense, prolonged addiction are encouraged and promoted by society because they help to maintain high levels of production and consumption. But there is still another important reason why severe addiction is intrinsic to the modern world. Long-term harmful consequences of severe addictions exacerbate the fragmentation of modern society, thereby increasing the dislocation that society causes. Increased dislocation leads to more addiction. The Modernity-Addiction Feedback Loop takes another turn. (See Figure 4).

  Consequences of addiction that exacerbate social fragmentation include: Environmental and social destruction mandated by wealth and power addicts pursuing profits in the executive suites of their multinational corporations, investment banks, and hedge funds; environmental and social destruction caused by wasteful addictive consumption of millions of more-and-less severely addicted customers; the fragmentation produced by all the talented people who are lost from healthy family functioning and productive work because of severe addiction, protracted recoveries, or overdose deaths; social insecurity produced in local communities by the overtly criminal street addicts supporting their drug habits; and elders who cannot contribute stabilizing wisdom to succeeding generations because they are addicted to television, bingo, Sudoku, prescription drugs, or whatever.

Because of its long-term socially fragmenting consequences, severe addiction is not only a downstream adaptation to societal fragmentation but also an upstream cause of it. Addiction is built into modern, global society structurally.

The vicious cycle that is built into modernity cannot continue indefinitely. Eventually the strain on the earth’s ecosystems and on human culture would become unsustainable, and modern civilization, like every civilization that has preceded it, would collapse (Toynbee, 1948). 

What does the New Story Tell Us about Rational Drug Regulation?

First, the new story helps us to understand that Rational Drug Regulation is possible. Obviously it is impossible to “regulate” a demon – including a demon drug – because demons are supernatural beings with magical powers. Demons might somehow be destroyed by heroic measures, but they cannot be regulated. 

However, the new story confirms that drugs and the other things to which people get addicted do not have magical, demonic powers after all. Therefore the new story takes the mystery out of what has been so loosely called the “drug addiction problem.” It is not caused by mysteriously demonic drugs but is part of a much larger problem that can be brought under control by epochal changes in modern culture that are already being envisioned by the luminary thinkers of our times.

Second, Rational Drug Regulation is necessary. People will continue to use drugs in the foreseeable future, along with all the other technology that modernity has brought. Since mass dislocation will also continue in the near future, severe addiction to drugs, as well as countless other habits and pursuits, will continue. This means that people must be helped to use drugs in the safest possible way, and rational drug regulation of psychoactive drugs is an important part of that task. Since it is not only addicted or dependent people who use drugs, it is important that drug regulation both minimizes the dangers for people who might use drugs recklessly and maximizes the benefits for those who use them wisely. 

For example, opiate drugs must be regulated in a way that both minimizes addiction and overdose and, at the same time, insures that the people who need opiates for relief of severe physical and psychological pain are not needlessly left in agony as they have been at some times in the past (Alexander, 1990, pp. 47-49), and are still today in many underdeveloped countries (McNeil, 2017). 

In the case of opiates, they must be widely available because they are the best means that many people can find to reduce their intense suffering from unbearable physical and psychological pain. Unfortunately, prescribing, even by the most enlightened doctors, cannot be an effective form of regulation. Doctors can give patients valuable information and advice about opioids, but there is no way for a physician to judge whether or not a person’s pain is unbearable. They will inevitably make errors in both directions. 

There is ample historical precedent for making opiates widely available in local markets – with prudent regulation of quality and dose. For example, opiates were freely available in the English speaking countries throughout most of the 19the century. They were sold in grocery stores and local pharmacies in dilute solutions that made overdosing very difficult. Most people who used these opiate solutions used them wisely, to relieve suffering – or at least harmlessly. Some people did become addicted, but the problem was considered minor and there were no “epidemics” of opiate addiction or overdose of a size or virulence of those that have broken out regularly since these substances were banned (Brecher, 1972, chap. 1; Courtwright, 1982; Berridge & Edwards, 1987). There was some harmful use and addiction of course, but social controls emerged among doctors, pharmacists, and concerned citizens that kept these at a low level (Courtwright, 2015). 

Rational drug regulation of opiates today would mean making them available in a low-potency form that minimizes accidents. Rational regulation would also entail giving clear warnings to drug users about the hazards of more potent forms that will remain available illegally and cautioning users about society’s disapproval of reckless and addictive use. 

In many places rational drug regulation of this sort seems impossible, because the demon drug story has become entrenched. But in places where it is possible, opiates should be made available, not through prescriptions, but through dispensaries for medical opiates, or perhaps through ordinary pharmacies. This kind of dispensing must not, of course, be forced on localities where people are still too terrified by the old story to contemplate this rational change of policy.

I think cannabis and stimulants can be dispensed with the same philosophy of availability that applies to opiates and with the same sensitivity to local issues and prudence. This is happening currently in Canada with respect to cannabis. Medical marijuana dispensaries are multiplying in Canada. The requirement that a purchaser must have a medical condition that requires cannabis as a medication is being interpreted very loosely in some places – particularly in Vancouver – and more literally in other places. This allows local norms to control access, and it allows different localities to learn from each other’s experiences about how cannabis can be best regulated. Local differences in policy will probably lead in the long run to evolution of more uniform regulations and a normalization of regulated cannabis availability. Alcohol regulation in Canada has been evolving in just this way since the nineteenth century (See Alexander, 2008/2010, pp. 379-382).  

I think the recent appearance of both certified organic and officially kosher marijuana in Canada (Baker, 2016; Greencamp News, 2017) is a very good sign, because it helps to normalize the dispensation of cannabis, which was once universally regarded as a demon drug in Canada. 

Figure 5. Organic Marijuana in Canada as reported by the Canadian Broadcasting Association.

 

Figure 6. The announcement of kosher marijuana is greeted with good humour by Canadian media.

There are even recent indications that Jesus, who played an important role in the imagery of the old story (See Fig. 2 above), can be part of the normalization of cannabis in Canada. Here is the cover of a recent Canadian book, which is, I think meant both to be humorous and part of the normalization process. 

Figure 7. A recent, popular Canadian book (Struthers, 2017).

The door is open to a regime of legalization and prudent regulation in Canada and the Canadian government is giving every indication that it will go through that door. More legislation is planned for 2018. 

Questions that the New Story raises about Regulation

There are several questions that I wanted to take on in this presentation but did not have the time to thoroughly research. I leave them with you in case you agree with me that they deserve to be answered. I hope you will send the answers to me when you find them.

1. Is it as important to make stimulants available for legitimate use as it is to make opiates available? It seems to me that opiate availability – with careful regulation – cannot be avoided because depriving suffering people of essential painkillers is too horrible a price to pay to avoid illegitimate use. But can the same be said about stimulants?

Certainly stimulants can serve as effective anti-depressants. And, certainly nobody who has no other recourse to control incapacitating depression should be deprived of pharmaceutical anti-depressants. However, there are other pharmaceutical anti-depressants that are not stimulants and therefore do not carry as great a risk of overdose or addiction. For me this question remains open.

2. If stimulants are to be made available and regulated, should methamphetamine be left out of the program, on the grounds of having greater neurotoxicity than other stimulants? Certainly making stimulants other than methamphetamine available and regulated could have the effect of reducing demand for the stimulant with the greater neurotoxicity.

3. What else should be regulated besides drugs? The new story, and the research evidence, shows that there are countless habits that are potentially as addictive as drug use (Sussman, Lisha, and Griffiths, 2011). Dangerously addictive forms of some of these habits are so widespread that, despite the limitations that have been imposed on our thinking by the old story, society is recognizing that they can turn into severe and dangerous addictions. These habits include gambling, pornography viewing, social media, shopping, hoarding, gluttony, and many, many more. The argument for regulating these habits seems to me exactly the same – and as strong – as the argument for regulating opiates and other drugs. And reasonable regulations are not difficult to imagine, especially, for example, in the case of gambling machines, which can lead to devastating addictions. 

But at what point does regulation become more burdensome to society than it is worth? Is overregulation any less of a problem than under regulation?  

The Need to Go Beyond Rational Regulation

The fact that our methods of dealing with drugs have improved dramatically in the past half-century but our results are no better makes no sense within the framework of the old story, which implies that both the War on Drugs and the more compassionate treatment-oriented regime should have substantially reduced the addiction problem.

However, the fact that addiction continues to expand makes perfect sense within the new story. Fragmentation and dislocation of a society cannot be reduced by any substantial amount by better drug laws and regulations, no matter how enlightened they may become or how rigidly they are enforced. Nor can introducing more compassionate or more effective therapies for people who are addicted to drugs reduce a society’s fragmentation or dislocation. Because fragmentation and dislocation cannot be reduced in these ways, neither can the rate of creation of new addictions, nor the rate of relapsing to existing addictions.

Moreover, drug addictions comprise less than half of serious drug addiction problems. Nothing we do about drugs will have any substantial effect on the majority of serious addiction problems! In fact, dislocated people who do not become drug addicted are very likely to become addicted in other ways. Very high levels of gambling and gambling addiction among the population of Singapore, which has been able to control drug addiction through draconian measures concentrated in a very small area, may provide an example (Chin, 2014).

The causes of fragmentation and dislocation are global. They are built into the economic and social structure of the late modern age. They can only be changed by epochal changes in society on a global level. 

It is vitally important that world society get serious enough about addiction to really do something about it. This means finding a way to reconcile the modern age with satisfaction of people’s basic social, psychological, and spiritual needs. We know that this can be done, because it is being done with reasonable success in some very modern small countries, including the Nordic countries in Europe, Costa Rica, and Singapore (Buettner, 2017). But I can only guess now at how long this may take to be actualized on a global level, or what the eventual alternative to current form of modernity will look like.

 I turn for reassurance that society can change in epochal ways in larger countries to people wiser than myself, some of whom I have already mentioned in this presentation. My single favourite thinker on this topic is a man who actually did change the world at the time of the fall of the Soviet Union – in collaboration with many other courageous thinkers of that era. I speak of the Czech intellectual and politician, Vaclav Havel. 

Havel posed a question in his essay, “The Power of the Powerless”: Where do ordinary people get the power to change enormous systems in both the communist and the democratic countries? (Amazingly, he had the wisdom to see that the problem that confronted his country in eastern Europe was not simply the all-powerful Soviet Union, but modernity as established in the western world as well as in the east (Havel, 1978, Section XXI). Havel’s deceptively simple answer to the question that he posed was “living within the truth”. 

Havel spent the four years in prison after writing “The Power of the Powerless”, while his words inspired revolutions in Eastern Europe.  He was elected president of the newly independent Czechoslovakia in 1989, and later President of the Czech Republic. I cherish his concept of “living within the truth” because I can see how it applies directly within my own field of drug addiction and in my own life. Havel does not pretend to know what society will look like on a global level after the modern age, but he does give us a powerful sense of what our individual roles might be in getting there. 

An example of “living within the truth”, as Havel conceptualized it, would be the brave policemen who spoke out at the height of the drug war in several countries, including Canada. They tried to tell the public that there was no way that the police could arrest or punish society’s way out of the drug problem, because it was a different kind of a problem than that (LEAP, 2017). These policemen refused to accept the old story at a time when it was universally believed and they denounced the lie that the drug problem can be eliminated if dealers and users are punished enough. For “living within the truth”, many of these policemen faced professional censure and some lost their jobs, but people also listened, and the world is different now, in part because of them.

I think that addiction professionals have a uniquely important role to play in getting rid of the old story and, thus, focussing attention on the defragmentation of world society that will be necessary to bring addiction and other crucial problems under control. For addiction professionals, I believe that this means going beyond the compassionate support, treatment, and harm reduction measures that we currently provide to addicted people – and should continue to provide, because they can be extremely helpful to some people. Politicians and the popular media today are pinning the public’s hope on a treatment breakthrough – a new vaccine, a new more spiritual approach to therapy, a new form of cognitive behavioural therapy, a new drug that somehow reduces cravings, a “non-addictive pain-killer”, deletion of a gene for addiction, new restrictions on prescribing, a newly rediscovered eastern spiritual practice, vast increases in the budget for existing treatments, a regime rational drug regulations, etc. (Obama, 2016; Pond & Parker, 2016). Often these are touted as if there was not a long history of innovative medical treatments, spiritual discoveries and re-discoveries, and new regimes of drug control extending back well into the 19th century (White, 1998). This simplistic rhetoric, based on the fourth element of the old story, needs to be challenged. I think we addiction professionals can best interrupt it by emulating the brave policemen who I have mentioned. 

Just like the police of the past who had been burned out by the war on drugs spoke out to inform the world that we cannot punish our way out of the addiction problem no matter how much money is poured into enforcement, treatment professionals need to say that we cannot treat our way out of the addiction problem no matter how many of us there are or how much money you give us. We also need to say that no matter how many research grants you give us, we are not going to discover a single, controllable gene for addiction or a widely effective medication or form of psychotherapy that will bring it under control. Of course our treatments do help some people and provide comfort to many others, but they can never be the basis for a full solution to the addiction problem or other human problems built into modernity. Modernity itself must be changed, and it can be. A few brave treatment professionals are speaking this way already (Pipher, 2013). 

One of Havel’s most illuminating conclusions is that living within the truth is not only informative, it is contagious, and that once the contagion takes hold, enormous social changes can take place and previously unimaginable new worlds can grow up.  I think our field can live up to the standard that Havel established and that the world will be a better place when we do, because society will be able to direct more of its attention on the underlying causes of addiction and other problems.

For Havel, living within the truth was not only, or even primarily, the work of a few brave individuals, but a work of organization. He described communities organized around the purpose of achieving a flourishing social life within the stultified rituals of the Soviet Bloc in the 1970s. These purposeful community organizations, he thought, could gradually facilitate the breakdown of the system that, for all its powers of surveillance and policing, could no longer sustain itself (Havel, 1978, section XXII). It would seem that his hope was achieved in the “Velvet Revolution” of 1989.

Addiction is a different sort of a problem than the one described by the old story, and we addiction professionals need to say so, loud and clear, both a individuals and as part of organizations that deal with addiction in a radically different way. To not speak out is to foster the comforting illusion that there is a quick fix to the problem of addiction and that we can eventually provide it…although we haven’t quite got there yet. I think many more addiction professionals and professional groups will be publicly rejecting this illusion in the future and that they will be justifiably proud of responding to the full breadth and importance of the addiction problem in the modern world. 

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