Treatment & Recovery

The 2008 report of Scotland’s Futures Forum[i] indicates that Scottish policy makers are prepared to move in a new direction, seeking to reduce harms associated with drugs and alcohol, rather than vainly striving to eliminate these substances from the face of the earth.

The report’s “systems approach” indicates that every dimension of modern society must be taken into consideration in this quest. I congratulate all of you who contributed to developing these compelling themes.

I will hope today to contribute something of my own to your further deliberations. To this end, I will ask you, for the next 40 minutes, to focus your attention specifically on the topic of addiction, in the sense of an overwhelming and destructive involvement with some habit or pursuit.[ii] I believe that a clear comprehension of the psychology of addiction can shed much light on the policy debate, without obscuring the importance of other harms that are associated with drugs and alcohol, but not necessarily with addiction.

At the outset, I will ask you to reflect on the most severely addicted people you know, no matter what their addiction may be. Beyond having overwhelming involvements with one or more habits, they are apt to be self-absorbed, socially irresponsible, self-destructive, blind to some of their own problems, and quite possibly dangerous at times. I propose that formulating effective policy requires solving the psychological mystery of why so many people are in this tragic, addictive trap today.

I also propose that this mystery can now be solved on the basis of historical scholarship that is not usually considered in the field of addiction, in conjunction with more familiar kinds of quantitative and clinical evidence. Finally, I propose that solving the mystery of addiction provides new inspiration for policy decisions, especially if policy makers are willing to go “up the down staircase”. I will explain this staircase metaphor as the presentation proceeds.

I. The view of addiction promulgated by today’s mainstream media and official rhetoric is seriously deficient.

Addiction can be construed as an individual, progressive, relapsing disease caused by drug use that can only be controlled by professional treatment. This view has long been promulgated by the mainstream media, by political rhetoric, and by some very highly-placed academics and doctors, giving it a seemingly unassailable, official quality.[iii] Although details and emphases have changed over time, the essence of this official view has prevailed throughout most of the 20^th century. The official view remains implicit -- and as dogmatic as ever -- in rhetoric supporting new, draconian drug legislation in the 21^st century and in sensational accounts of individual addictions in the newspapers.[iv]

However, most addiction counselors and community workers, as well as most drug historians and social scientists, recognize that the official view of addiction is not adequate for coping with the rising flood of addiction in the 21^st century. I will only have space today to review a few pebbles of the mountain of evidence that I have gathered up in my recent book, The Globalisation of Addiction: A study in poverty of the spirit (Oxford Univ. Press, 2008). Because the book[v] provides a more comprehensive review of this evidence, the endnotes to the written version of this talk generally refer to it, except in cases of evidence that has come to my attention since the book was published.

The official view of addiction has many different aspects, but I have stripped it to its basics for this presentation. The blue circles in Figure 1 refer to the key elements in the official view: a non-addicted person, an addictive drug, and the same person after being transformed by the drug into an addict.

According to this official view, certain drugs have the power to rob people who use them, once or a few times, of their ability to stop. Sooner or later, users are transformed into addicts and thereafter comprise serious dangers to themselves and to the larger society. The dangers that are usually linked to addiction appear on the extreme right side of Fig. 1.

In the older forms of this official view any person will be immediately transformed by the addictive drug into a personally and socially destructive addict. In the newer forms, particular combinations of genes, past experiences, and personalities make some people more vulnerable to this transformation. Newer forms of the official view do not identify the most vulnerable people in advance, but imply that addictive drugs will eventually cause addiction in virtually everybody. The drugs for which this transformative power has been claimed have changed over the last two centuries, beginning with alcohol in the mid-19^th century, and later including opium, morphine, cocaine, heroin, marijuana, amphetamine, barbiturates, meprobamate (Miltown), industrial solvents and glue, benzodiazepines, crack (i.e., cocaine again), and crystal meth (i.e., amphetamine again).

This official view is summarized in its most modern, authoritative form in a recent American book and television series entitled Addiction: Why don’t they just stop?.[vi] This book includes quotations from many of the most highly placed specialists in addiction medicine, including Nora Volkow, the head of the American National Institute on Drug Abuse. It is important to read this book because it says explicitly and authoritatively what is assumed implicitly elsewhere.

Just as the supposedly addictive drugs change over time, so do the mechanisms by which they are said to transform people into addicts. For example, in older forms of the official view of addiction as applied to heroin, individuals were said to be transformed into addicts by the irresistible euphoria that heroin supposedly produces, or by the unbearable withdrawal symptoms that it causes, or by the pharmacological tolerance which increases the amount of heroin that is necessary to produce the same effect, or by its crippling of the brain’s ability to produce endorphins.

In the newest form of the official view, heroin, along with other addictive drugs, are said to transform the brain so that the person is unable to experience normal pleasures associated with moderate release of dopamine. Moreover, heroin and the others are said to cripple those parts of the brain which are normally charged with inhibiting destructive behaviours.

Here are some of the reasons that the official view of addiction is inadequate for the 21^st century:

1. Although it bases its claims on impartial science, the deepest roots of the official view do not lie in science at all, but in the religious temperance movements of the 19^th century, which spoke of “demon rum” in the same sense that medieval Christians had spoken of demon possession. Deeper roots of this way of thinking about addiction were laid out, in religious terms, in the writing of St. Augustine, from around 400 AD.[vii]

Today, the official theory is most often dressed up in avant garde neurological terminology and illustrated with the brilliant images from brain scans, products of a technology that people who are not neuroscientists barely understand.[viii] Nonetheless, it remains a statement of a philosophical position that was ancient before modern neuroscience appeared. You do not need a PhD in neuroscience to make up your mind about it. It can be evaluated with a normal understanding of the rules of evidence and the facts of history

2. Most people who use any of the “addictive drugs” (or engage in any other activities that can be addicting) have no addiction problem with them. In fact, there are many cases of life-long use of one of the supposedly addictive drugs by eminent people whose lives were unblemished by the problems that inevitably associated with addiction in the official view.[ix] The Guardian newspaper on 13 June 2009 re-discovered a 14-year old World Health Organization study on cocaine, which shows that large numbers of people all over the world use cocaine and crack for very long periods of their lives without addiction, self-destruction, or anti-social behaviour.[x] Although this was the most global study of cocaine use ever conducted, with data reported from 22 sites in 19 different countries, it has been officially ignored everywhere and its publication politically suppressed. I can elaborate on that study today, if you like, since I was Principle Investigator for it at the Vancouver site. I can make the written report from the Vancouver site, which was accepted for inclusion in the report that was never published, available to anybody who would like to study it in detail. Moreover, other, published data showing that people can use addictive drugs for very long periods without being addicted are available. Some of the best was produced by the admirable researchers of Glasgow Caledonian University.[xi]

3. Professional treatment is neither necessary nor particularly effective. Most people who become addicted recover without any need for specialized treatment. The source of recovery for people who recover without treatment is no mystery. It lies in establishing stronger relations with their community, or creating a new life in another one.[xii] Where recovery can be measured, the recovery rate for people who undergo treatment for addiction is only marginally higher than for those who do not undergo treatment.[xiii]

4. Addiction is not an individual disease, but an aspect of a much larger problem that can be looked at socially or spiritually.[xiv] This is confirmed by historical research, risk factor research, concurrent disorder research, and clinical interviews,[xv] even though addicted people sometimes carefully conceal their prior and concurrent problems.

5. Addiction is not limited to drugs. It is easy to imagine that a drug that most people have never taken, like heroin of crystal methamphetamine, takes away the will power of its users, by altering their neurochemistry. However, the larger number of severe addictions are to habits and pursuits that cannot be understood this way: gambling, sex, video games, food, money, ideological involvement, and so forth.[xvi] Most of us know from personal experience that habits and pursuits like these do not have the demonic powers that have been attributed to the so-called “addictive drugs”.[xvii]

6. The biggest problem of all is that the official theory has got us nowhere in controlling addiction in more than a century of diligent and well-funded application. Even treatment programs based on the official view that are supported with unlimited funds succeed only in a minority of cases. No matter how wealthy you are, you can’t buy your way out of addiction, even at the Betty Ford Center.

7. Many people are tempted to defend the official view of addiction on the grounds that it is an alternative to an older, moralistic view of addiction as a wilful sin, worthy of serious punishment. This is a slim defence at best. The old, moralistic analysis of addiction has become indefensible in view of the misery that serious addiction brings. Who would wilfully chose to subsist in the streets, despised and miserable, if they could avoid it? Instead of an alternative to an obsolete moralistic view, the official view is the basis for the moralism of the war on drugs. Since dealers, importers, and growers of drugs are, by the logic of the official view, guilty of causing mass misery and snaring the innocent into lifelong addiction, no punishment can be too severe for them. The official view distorts people’s thinking in other ways as well, since it provides such an effective smokescreen for the real causes of addiction.

Despite overwhelming counterevidence, the official view of addiction has been defended fiercely by the institutions of mainstream society for over a century now. The political suppression of the WHO cocaine study for 14 years has been mentioned. This summer’s news includes a new book by a Harvard University Professor who challenged the official view on addiction. The North American press responded to this with exaggerated shock, as if this was the first time the official view was ever challenged[xviii] and various mainstream experts expressed wonderment that the esteemed Harvard University Press could even publish such a book.[xix] The mainstream view of addiction is authoritatively bolstered in more or less the same way as the mathematical models that proved – up to a year ago – that the market for subprime, securitized mortgages would not collapse.

None of this proves that the official view of addiction should be completely discarded. In fact, it still serves as a useful doctrine in some therapeutic situations, including 12-step programs. However, it is not an adequate basis for theory or policy in the face of the unique and threatening addiction problem of the 21^st century.

II. Contrary to the official view, the source of today’s flood of addiction lies in the dislocation of entire populations from their communities and cultures in globalizing, post-modern society.

A radically different view of addiction is coming to the fore. It is spreading upwards in the field of addiction, rather than from the top down. It comes primarily from the addiction counselors and social workers who have to respond pragmatically to people who have serious addiction problems. It also comes from the testimony of many seriously addicted individuals. Within academia, support for the dislocation view comes primarily from historians and social scientists, rather than from the more prestigious physicians and neurochemists. High-ranking members of the media, governmental, medical, and academic hierarchies may be the last to detect this radical shift in the understanding of addiction.[xx] This bottom-up paradigm shift is one reason for the subtitle of this presentation, “Climbing up the down stairway”. Another, reason remains to be discussed.

I will explain the new paradigm, which I call the dislocation theory of addiction, in a schematic form first. Then I will summarize some fragments of the voluminous evidence that supports it. Although I will refer to some quantitative and clinical evidence today, I will reserve most of my time for historical evidence, which I find most persuasive. I would be very happy to give you a much more comprehensive review, but for that, you will have to invite me back to make a longer presentation or, better yet, you will need to read my book.[xxi]

By contrast with the official view, the dislocation theory of addiction shown in Figure 2 does not begin with single individuals or addictive drugs, but rather with entire societies and the full range of addictions.

It is first of all intended to explain the flood of addiction that is enveloping the modern world at an ever increasing pace. Each addicted individual has his or her unique story to tell of course, but the dislocation view focuses first on the social context of a flood of addiction, within which specific cases can be more easily understood.

The dislocation view of addiction easily comprehends each of the facts that perplex the official view of addiction, as summarized in the previous part of the talk.

The word “dislocation”, in this view of addiction, refers to the absence of sustaining connections between a person and his or her family, friends, society, traditions, nation, and gods. Dislocation does not necessarily imply geographic separation. Rather, it denotes a psychological and social separation that can befall people who never leave home, as well as those who are continents away. I have described dislocation in social terms, but it has crucial psychological aspects too, including the disconnection of people from their identities, values, feelings of personal power, overall sense of well-being, and sense of spirituality.

Severe, prolonged dislocation entails unbearable despair, shame, emotional anguish, and bewilderment. It regularly precipitates suicide,[xxii] depression, and less direct forms of self-destruction.[xxiii] This is why forced dislocation, in the form of ostracism, excommunication, exile, and solitary confinement, has been a dreaded punishment from ancient times until the present. Solitary confinement is an essential component of the modern technology of torture.[xxiv]

As depicted in Figure 2, people who are suffering from dislocation not only feel badly, but act badly as well. In fact, they display most of the behaviours that are seen as signs of addiction in the official view, except, of course, those that are tied to specific pharmacological effects, such as withdrawal symptoms or cirrhosis of the liver.

Poverty frequently accompanies dislocation, but it is definitely not the same thing. Although poverty can crush the spirit of isolated individuals and families, it can be borne with dignity by people who face it together as an integrated society. On the other hand, dislocated people are demoralized and degraded even if they are wealthy. Neither food, nor shelter, nor amassing riches can restore their well-being. Only psychosocial integration with their community can.[xxv] In contrast to material poverty, dislocation could be called “poverty of the spirit”.[xxvi] This phrase is suggested by the words of the Christian Beatitudes, “Blessed are the poor in spirit, for theirs is the kingdom of heaven”.[xxvii] These ancient words did not promise material wealth to the demoralized and degraded Galileans whose society had been crushed by the Roman empire, but rather a spiritual community to which they could truly belong, for it was “theirs”.[xxviii]

Dislocation can have many causes. For example, it can arise from an earthquake that destroys a village or from an individual idiosyncrasy that a society cannot tolerate. It can be inflicted violently by abusing a child, ostracizing an adult, or destroying a culture. It can be inflicted with the best of intentions, by inculcating an unrealistic sense of superiority that makes a child insufferable to others or by flooding a local society with cheap manufactured products that destroy its economic integrity and independence. It can be voluntarily chosen if a person is drawn from social life into the single-minded pursuit of wealth in a “gold rush” or a “window of opportunity”. Most importantly for today’s presentation, dislocation can become the norm if a society systematically curtails psychosocial integration in all of its members.

If the dislocation view of addiction is correct, there are billions of severely dislocated people in today’s world, because dislocation is an inevitable by-product of the free-market society that is being globalised. The historical connection between globalization and mass dislocation can only be documented with a single example today, but it is documented at length in my book.[xxix]

Many forms of addiction, including but not limited to drug addiction, follow from dislocation. This is because addiction is a way of adapting to severe dislocation. When people do not have a life or an identity, addiction provides a compensation, a substitute for “having a life”. Addiction is not the life that people foresaw for themselves, or that society foresaw for them, but it at least provides a degree of belonging, meaning, and identity. This is why people cling to their addictions with such desperation. Without them, they would have terrifyingly little reason to live.

Addiction is a cause as well as an effect of dislocation, as indicated by the feedback arrow in Figure 2. As addiction worsens, people commit further affronts to their already strained community ties and become more dislocated. Thus, addiction becomes self propagating.

Although the dislocation view of addiction puts primary emphasis on social antecedents of addiction, it does not deny that addiction and recovery also involve individual moral struggles. Nor does it minimize the courage and fortitude of those who overcome addictions through their individual struggles. The more dislocated an individual is, however, the more difficult it is to win these struggles and the more likely a person will lapse, or relapse, into addiction.

The next three sections of this presentation summarize some bits of the extensive evidence that supports this dislocation view of addiction.

III. The "Rat Park" experiments showed that drug consumption increases dramatically when laboratory animals are dislocated from their natural groups.

In the early 1960s, devices were perfected that allowed laboratory animals to inject themselves with drugs by pressing a lever in what was called a “Skinner box”. By the end of the 1970s, hundreds of experiments with this apparatus had shown that rats, and occasionally mice and monkeys, would self-inject large doses of heroin, cocaine, amphetamines, and other drugs.[xxx]

These animal experiments provided highly publicized support for the official view of addiction in that era. If animals inject drugs avidly and to the detriment of their health, as they did in Skinner boxes under some experimental regimes, does it not follow that these drugs instill a need for addictive consumption that transcends culture and species? By this logic, the official view of addiction is simply a tragic fact of mammalian destiny. Eminent American scientist Avram Goldstein put it this way in 1979:

If a monkey is provided with a lever, which he can press to self-inject heroin, he establishes a regular pattern of heroin use – a true addiction – that takes priority over the normal activities of his life.… Since this behaviour is seen in several other animal species (primarily rats), I have to infer that if heroin were easily available to everyone, and if there were no social pressure of any kind to discourage heroin use, a very large number of people would become heroin addicts.[xxxi]

Although many scholars still accept this conclusion, it does not fit with human history, because in cultures where heroin and morphine are freely available, only a tiny percentage of people became addicted. It does not fit with current reports of moderate, non-addictive use of heroin over long periods. Nor does it fit with observations of people who are given relatively free access to supposedly addicting drugs either by prescription or by so-called “patient controlled analgesia” machines in hospitals after surgery.[xxxii]

Soon critical scholars suggested that opioid ingestion by laboratory animals also could be understood as a way that the animals cope with social and sensory isolation that was imposed by the Skinner box itself. Laboratory rats are gregarious, curious, active creatures. Their ancestors, wild Norway rats, are intensely social and, despite generations of laboratory breeding, their albino descendants retain many of their social instincts. Therefore, it is conceivable that rats may self-administer powerful drugs simply as a response to stress when they are housed in isolated metal cages, subjected to surgical implantations, and tethered to a self-injection apparatus by a canula implanted in their jugular veins. The results of self-injection experiments may show nothing more than that severely distressed animals, like severely distressed people,[xxxiii] will seek pharmacological relief if they can find it.

To determine whether the self-injection of opioids in these experiments could be something other than a sign of addiction, my colleagues Barry Beyerstein, Robert Coambs, and Patricia Hadaway and I carried out a series of experiments beginning in the late 1970s. Albino rats served as subjects. Morphine – which is interchangeable with heroin for most human addicts – was the experimental drug. We put one group of rats in the most natural environment for rats that we could contrive in the laboratory. “Rat Park”, as it came to be called, was airy and spacious, with about 200 times the square footage of a standard laboratory cage. It was also scenic, with a peaceful, British Columbia forest painted on the plywood walls. It was rat-friendly, with empty tins, wood scraps, and other desiderata strewn about the floor. Finally, relative to the standard laboratory housing of its day, it was a psychosocial paradise, with 16-20 rats of both sexes in residence at once.

We compared the morphine consumption of Rat Park rats with that of rats housed in individual cages. For the individually caged rats, we fastened two drinking bottles, one containing a morphine solution and one containing water, on each cage and weighed them daily. In Rat Park, we built a short tunnel leading out of the residential area that was just large enough to accommodate one rat at a time. At the far end of the tunnel, the rats could release a fluid from either of two drop dispensers. One dispenser contained a morphine solution and the other an inert solution. The dispenser recorded how much each rat drank of each fluid.

A number of experiments were performed in this way,[xxxiv] most of which indicated that rats living in Rat Park had little appetite for morphine compared to the rats housed in isolation. In some experiments, we forced the rats in both groups to consume morphine for weeks before allowing them to choose, so that there could be no doubt that they had consumed enough morphine to be addicted according to the official view. In other experiments, we made the morphine solution so sweet that no rat could resist it, but we still found much less appetite for the morphine solution in the animals housed in Rat Park. Under some conditions, the rats in the cages consumed nearly 20 times as much morphine as those in Rat Park. Nothing that we tried instilled a strong appetite for morphine or produced anything that looked to us like addiction in the rats that were housed in our approximation of a normal rat environment. These results were subsequently replicated, extended, and analyzed by other psychologists.[xxxv]

Therefore, the intense appetite of isolated experimental animals for opioid drugs in self-injection experiments cannot be taken as proof that opioid drugs have an irresistibly addictive quality. Beyond driving another coffin nail into the official theory of addiction, the Rat Park studies suggested that integration into an intact society protects rats from addiction. Could this also be true of human beings?

IV. Historical research shows that mass addiction tracks mass dislocation in human society.

It is a fact of history, that when societies or civilizations collapse, dislocating all of their members, mass addiction follows.

The most familiar example, for Canadians, is that the collapse of the many aboriginal societies that occupied the land before their colonization by European settlers was followed by a plague of native alcoholism. The same thing happened on every continent in the 1700s and 1800s, wherever aboriginal people were “civilized” by the various colonial powers.[xxxvi] And the same thing is happening today to people who are not necessarily aboriginal, wherever societies are crushed and people are dislocated by the political and economic steamrollers of the modern world. I believe that this is as evident in Scotland as anywhere else.

The tragic plague of addiction that struck aboriginal populations is particularly important because the native people had virtually no history of addiction before their societies were crushed by European colonization. The testimony of elders, myths, and anthropologists all agree on this fact. Although native tribes had all kinds of problems, including incessant warfare, slavery, and occasional insanity, they had virtually no addiction before their societies were annihilated.[xxxvii]

Most Canadians believed at one time that the plague of alcoholism that struck the Canadian aboriginal population was because of a genetic weakness for alcohol – a variation on the official view of addiction. But natives societies that were not crushed, particularly fur trading societies, were able to control their use of trade alcohol without serious difficulty.[xxxviii] Moreover, dislocated natives are vulnerable to a multitude of other addictions from crack cocaine to heroin to Bingo television to sex to addictive overeating, just like dislocated people of all races. A genetic weakness for alcohol cannot explain the historical facts.

The story of the destruction of native societies is probably well known to this audience. Native lands were seized, with or without treaties and natives forced onto reserves that were tiny in comparison to the vast lands and ocean spaces that their cultures were based upon. Leaders were discredited and humiliated by the superior power of the invaders. Sacred native practices, such as spirit dancing and the potlatch in British Columbia were prohibited and subject to severe penalties. Generations of native children were seized and imprisoned in residential schools were they were not allowed to speak their languages, practice their customs, or keep in touch with the members of their bands.

When the history is examined in finer detail, it becomes evident that the most important cause of addiction was the breakdown of native society itself, rather than the economic exploitation or sexual abuse. Today I will illustrate this vital fact with a single historical case study: the Tseshaht people of central Vancouver Island.

In 1868, Gilbert Malcolm Sproat, an amazing Scotsman, published the memoirs of his service to the British Empire in the colony on Vancouver island, not too far from my home in Vancouver. Sproat was born in Kircudbright, near Solway Firth in 1834 and was educated at Dumfries and Kings College, London. He lived close to the native people from 1860-1865 near present-day Port Alberni. He served as leader of a settlement that worked a steam driven sawmill and as colonial magistrate for the area. He left his name behind on the map, attached to the Sproat River and Sproat Lake.

Sproat’s was the first sustained European settlement on the West Coast of Vancouver Island. His memoir was entitled, The Nootka: Scenes and Studies of Savage Life.[xxxix] It is obvious from the title that Sproat used the ethnocentric language of his day. However, in the context of this presentation on addiction, it is important not to be too distracted by his ethnocentrism, but rather to recognize that Sproat was also a careful scholar, a sympathetic observer, and an authoritative writer.[xl]

Sproat the scholar never undermined the program of Sproat the colonial administrator. Sproat the administrator drove the Tseshaht people from a long-established village site where he wanted to establish his sawmill by terrifying them with a cannonade from his ship. He welcomed them back to their land later, as colonial subjects rather than owners. Having destroyed the authority of their native leaders, who fled before his cannon, he next inadvertently destroyed the native economy, which was based on food, handmade blankets, and traditional redistribution of wealth through potlatches. This inadvertent destruction entailed introducing cheap flour and potatoes that made native food gathering methods superfluous, introducing mass-produced English trade blankets that made the handmade native blankets worthless, and requiring that all transactions be made by buying and selling in the style of a free-market economy which broke down traditional systems of redistribution. As magistrate, he imposed punishments on young native men when they broke English laws they did not understand.

Sproat the administrator was not a cruel man, but simply a product of his time and station. He was horrified by the rapid deterioration of morale and health that he witnessed and documented among the Tseshaht people near his settlement, and believed that they would soon be extinct. Here are two descriptions, one general and one very specific, of the degradation that he observed among his colonial subjects:

I will now further remark on the effect [that our invasion]produced on the Indians themselves. It is a lamentable spectacle, and I do not wonder that kindly men, who witness the result of such intercourse, are more in the mood for declamation than for observation and argument. The effect is this: the Indian loses the motives for exertion that he had, and gets no new ones in their place. The harpoon, bow, canoe chisel, and whatever other simple instruments he may possess, are laid aside, and he no longer seeks praise among his own people for their skilful use. Without inclination or inducement to work, or to seek personal distinction – having given up, and being now averse to his old life – bewildered and dulled by the new life around him for which he is unfitted — the unfortunate savage becomes more than ever a creature of instinct, and approaches the condition of an animal. He frequently lays aside his blanket and wears coat and trousers, acquires perhaps a word or two of English, assumes a quickness of speech and gesture which, in him, is unbecoming, and imitates generally the habits and acts of the colonists. The attempt to improve the Indian is most beset with difficulty at this stage of his change from barbarism; for it is a change not to civilization, but to that abased civilization which is, in reality, worse than barbarism itself. He is a vain, idle, offensive creature, from whom one turns away with a preference for the thorough savage in his isolated condition.[xli]

Crab-apples are [traditionally] wrapped in leaves and preserved in bags for the winter. The method of cooking them, when freshly plucked, is by simply boiling the apples…The natives are as careful of their crab-apples as we are of our orchards, and it is a sure sign of their losing heart before intruding whites when, in the neighbourhood of settlements, they sullenly cut down their crab-apple trees, in order to gather the fruit for the last time without trouble, as the tree lies on the ground. (Sproat, 1868/1987, op. cit., p. 43).

Sproat knew that the destruction of the Tseshaht culture was not due to alcohol or any other drug problem, because the unique geographical circumstances of his colony cut it off from outside commerce except through the lengthy Alberni Inlet, which was completely controlled by the British navy, which was willing to enforce his alcohol prohibition. This made it possible for Sproat to impose prohibition of alcohol not only on the Indians, but on the white settlers as well!

The use of intoxicating liquors was forbidden to everyone in my employment, and although it was impossible altogether to exclude ardent spirits…I was able to make the settlement as nearly a temperance settlement as any village of two hundred colonists of English descent could be made…Taken as a whole, the settlement probably was one in connection with which the Indians, not being compelled to abandon their old ways of life, enjoyed nearly all the advantages of a neighbouring civilization with a comparative exemption from the distressing evils which are supposed necessarily to attend it.

What was the effect on the aborigenes of the presence of this settlement? At first no particular effect was observable; the natives seemed, if anything, to have benefited by the change in their circumstances. They worked occasionally as labourers, and with their wages bought new blankets and planks for their houses…They acquired a taste for flour, rice, potatoes, and other articles of food that were sold to them at low prices, and thus, on the whole, probably spent the first winter after the arrival of the colonists more comfortably than usual. It was only after a considerable time that symptoms of a change, amongst the Indians living nearest to the white settlement, could be noticed…that a few sharp-witted young natives had become what I can only call offensively European, and that the mass of the Indians no longer visited the settlement in their former free independent way, but live listlessly in the villages, brooding seemingly over heavy thoughts…

The steady brightness of civilized life seemed to dim and extinguish the flickering light of savageism, as the rays of the sun put out a common fire. (Sproat (1868/1987, pp. 185-187).

In spite of his limited vision of the crushing effect of his invasion on native society and psychology, however,[xlii] Sproat saw something that later settlers forgot. The psychological downfall of the people occurred even though they had little or no access to alcohol! He recognized the existence of alcoholic frenzy when he saw it in other settlements but he knew that it was not the primary cause of the fatal change that was occurring to the Tseshaht people, although he recognized that they would fall prey to alcohol when it did become available eventually. Sproat’s account shows, as clearly as any single study can, that dislocation precedes vulnerability to addiction, as the dislocation theory of addiction stipulates.

In other colonies, however, Sproat recognized that alcohol quickly became part of the problem. He put it this way:

It is during this time of change, immediately after the arrival of intruding settlers, that the aborigines in our colonies are exposed, for the first time, to the temptations of strong drink. The effect upon Indians of the excessive use of the description of ardent spirits which they generally get, is such as no one who has not seen can conceive. The appearance of an Englishman in a state of intoxication gives no idea of the effect of drink upon a savage (p. 191)

And why were the natives so reckless in drunkenness? Sproat offered three explanations: (1) The trade liquor is of poor quality, (2) the natives have not learned how to handle it, and: (3) “some unknown circumstance of their habitual contact with a superior people render the bodily system of savages especially subject to disease”.

We now know that good quality alcoholic drinks are every bit as intoxicating and addicting as the bad trade spirits of Sproat’s day. We also now know that, despite their lack of experience, native people in localities where the destruction of their culture was postponed were able to drink with moderation and dignity, or to abstain as long as their cultures were essentially intact. Thus, we know that the “unknown circumstance of their habitual contact” with colonialists was the destruction of indigenous culture. In the language of this presentation, addiction to alcohol became universal among indigenous people because they were universally dislocated.

V. Clinical research shows that people use addiction as a way of adapting to the misery of dislocation if they cannot find a way to achieve or restore normal psychosocial integration.

So far in this presentation, the dislocation view of addiction has been stated in abstract or historical terms. However, the anguish of dislocation and the use of addiction to cope with it is fully evident in individual addicts of all sorts.[xliii] Here is a single example from a vast clinical and biographical literature. This quotation from an drug addict in a California prison contemplating his future.

“It’s very difficult [for me to not use drugs]…The first problem is the physical addiction. That can be hard to beat. And if you beat that, there’s still the memory of how good it feels. Even though I’ve been clean now all these years in prison if you put drugs in front of me right now I’d want to take them, just so I could feel that good again. But these problems are nothing compared to the emotional addiction. So much of my identity has been wrapped up in drugs. Drugs became who I am. Without them I was nothing. But even kicking the emotional addiction still isn’t the hardest part. It’s all of my relationships. My wife and I used together—that was all bound up in our courtship, in our sex-life, in our daily activities. And she still uses. What am I supposed to do when I get out? Not only do I have to give up this thing that makes me feel so very good—or at least I think it makes me feel good—and not only do I have to step away from this thing that’s been my identity for most of my life, but I’ll have to change my whole web of friendships, and maybe even my family. I’m facing a third strike if I get caught again, which means I’d be in forever, but even facing that I just don’t know if I can give up so much.”[xliv]

VI. Implications of the dislocation theory for drug and alcohol policy.

If dislocation is the root cause of the flood of addiction in the globalizing world, and if dislocation is a predictable side-effect of the globalization of free-market economics, then how can society hope to do anything about it? I believe that the dislocation theory of addiction leads to the realization that we can do a great deal more than we do at present. This final section discusses some specific actions that can be derived from the dislocation theory, if only in a preliminary way. Because the dislocation theory guides my own informal counseling and community work, I may overstress these levels of intervention, but I will consider other levels as well.

For me, the most impressive aspect of the Scotland’s Futures Forum 2008 report[xlv] is the bold inversion of the normal way in which the alcohol and drugs landscape is envisioned. The report argues that the usual way of describing the landscape in 2008 put the “substance culture” atop the hierarchy of attention, and then descends, in turn, to governance, enforcement, intervention and recovery, public health, community, and research and evidence, in that order. The report then boldly proposes inverting the order.

Hear, hear! Indeed, start with research and evidence so that we know what we are doing and then proceed first and foremost to the issue of community, because that is where the most relevant work can be done. Go next to public health, which is the most powerful of the existing professions for restoring community well-being, and so on up the staircase that people concerned with addiction have been coming down all these years. This is the primary meaning of the “up the down staircase” metaphor that is the subtitle of my talk.

1. Evidence and Research. I have placed primary emphasis on evidence and research in this presentation. I tried to show that existing historical, quantitative, and clinical research proves the necessity of shifting from the official view to a dislocation view of addiction.

I hasten to add that, to be useful, research and evidence need to be stripped of their affectations. I make no claim to totally value-free, objective science. In fact, I think such claims are indefensible, since all research is based on working assumptions and assumptions are invariably influenced by the values and cultural background of the investigator. I think we must be skeptical about claims of perfect objectivity and even more skeptical of evidence and quantitative analysis that is so complex that the audience cannot hope to understand how it was produced and what it really means. Although we cannot operate without working assumptions, we can be scrupulously accurate about the facts as well as clear and straightforward with those who must judge our arguments.

2. Community. Addicted people are ultimately struggling to adapt to dislocation. They do not experience membership in a socially acceptable community that sustains their well-being, their identity, their grasp of reality, or their sense of the divine. They turn to addiction in a desperate attempt to “get a life”. It is in the community, first and foremost, that their psychosocial integration can be restored.

After devoting decades to gathering evidence and research as a university professor, I am now more and more concerned with community participation. I cannot claim more than a fragmentary acquaintance with present-day Scotland, so I will speak in terms of my own experience in Canada, in the hope that some parts of my explorations may be useful here.

For me, community participation starts with trying to be a good neighbour, joining in neighbourhood functions, supporting community art and theatre, and carrying out economic activities through local cooperatives and social enterprises that enhance psychosocial integration. For many people, now including myself, this kind of community participation proceeds to collectively creating new community organizations where there is a need. In my area of Vancouver, my neighbours and I seem to have succeeded in bringing an informal educational cooperative called “A Community Aware” into being.

To involve oneself in active community participation is to be part of a burgeoning world-wide growth of grassroots politics,[xlvi] cooperatives and social enterprises,[xlvii] and community-based arts[xlviii] that can replace the tottering institutional structure based on neoliberal politics, rapacious corporations, and commercialized pop culture. After the world-wide economic debacle that began in 2007, the failure of the old institutional structure has become impossible to conceal. The final chapter of my book provides many examples of community-building activities, some of which are already prospering, and some of which still exist only in my imagination.[xlix]

Building and maintaining healthy communities that maintain the psychosocial integration of their members is first of all the responsibility of the community itself. But outer forces can crush communities, overwhelming the capacity of community members to defend themselves. If we are serious about doing something about dislocation and, hence, addiction, we must not only enhance protect and enhance our own communities but our neighbours’ as well.

This provides a unique opportunity to members of the psychological and social service professions. As individual professionals, we try to help individuals develop their power and resiliency. When we can, we support community’s efforts to grow, to flourish, and to look out for their members who have lost their bearings for a time. But there is something more that we could do.

Organized professions of experts have influence in the corridors of power. We can use our authority as experts to demand the support of government in sparing vulnerable communities from the most onerous demands of the market place and of geopolitics. We can show authoritatively that while the government’s right hand provides treatment services for addiction, its left hand often simultaneously introduces economic initiatives that break down communities, thereby increasing dislocation and addiction. Although communities by themselves are often defenseless before the streamrollers of free-market society, professionals who understand their importance can use their real political influence to help protect them. I believe that this line of intervention is still seriously underutilized by members of the helping professions.

Is it realistic to propose revitalizing communities in the modern world to bring dislocation, and thus addiction, under control? I say absolutely yes, for several reasons. First, because the intolerable depredations of dislocation are becoming more and more obvious to more and more people. Second, because this is a time of cascading crises on a global level. Fundamental change in free market society must come if the world is not to be overcome by environmental destruction, intolerable social inequality, and political upheaval. When civilization moves toward chaos, fundamental change is not only desirable, but inescapable.

Finally, it occurs to me that it may be more reasonable to think of fundamental change in Scotland than in many other countries right now, because the new Scottish parliament affords a golden opportunity to revitalize communities at the time at which revitalization is most needed. Of course community building in Scotland is different than community building in Canada. It must draw from ancient Scottish realities and collective memories that are unknown to me, but not to you.

3. Public Health. Many of the miracles attributed to modern medicine were achieved primarily through large scale environmental interventions undertaken by public health authorities. A major principle of public health in recent times is that individual health is in large measure determined by social factors as well as sanitation and other aspects of the physical environment that have been the more familiar workshops of public health in the past.[l] Since public health institutions are simultaneously academic, administrative, and service entities, they can organize large scale interventions with governmental support and effective research components. Public health measures are now being brought to bear on addiction problems on a large scale.

For example, the Mental Health Commission of Canada is now implementing a major study of homelessness and mental illness. Beyond its research component, this study will provide housing over an extended period for 1325 currently homeless individuals, and will provide supporting services, but not housing, for another 900.[li] The Vancouver component of this study, under the direction of Principle Investigators Julian Somers and Michael Krausz, will target homeless people who struggle with substance abuse and addiction. One aim of the study in Vancouver is to determine the effectiveness of adequate housing in reducing the problem of drug addiction in comparison with services other than housing. Moreover, it is likely that this project will ameliorate the problem of addiction in other cities by providing housing and other services that reduce dislocation for individuals and families who do not suffer from visible addiction problems at the outset. Much can be gained by complex quantitative analysis of the results of large scale public health interventions of this sort as well as the services that are provided to addicted people in the course of carrying out the research.

4. Intervention and Recovery. I definitely find that the dislocation theory informs and improves my own informal work as an addiction counselor. However, I have difficulty articulating why. Therefore, I asked some friends who are addiction counselors to help me articulate principles that they draw from the dislocation view when they do counseling work. I also asked a client – a long-term methamphetamine addict now recovering – about what he felt was lacking in the counseling that he had received. This section is based on their responses.

a. Tracking clients. The recovering methamphetamine addict asserted that counselors could improve their effectiveness by “tracking” their clients more consistently. This surprised me at first, because addicts are not people who normally like to have their privacy invaded. However, they feel the need, during their encounters with diverse treatment specialists in a departmentalized social services system, for a single counselor who cares enough to keep track of what is happening in the long run. People who are leaving addictions behind are agonizingly alone – that is why they became addicted in the first place. Perhaps the biggest service that the counselor can provide is to really care about the client.

b. Drugs are not the primary issue. It is impossible to control addiction without controlling dislocation. If people are cut off from their addiction of choice, they will search out another addictive lifestyle, which may or may not involve drugs, unless their dislocation has been substantially reduced. Moving people from a fatal drug addiction to a less than fatal addiction to something other than a drug can be an important achievement, but it is not enough. Ultimately addiction entails the loss of a meaningful life, whether drugs are involved or not.

The primary problem for psychotherapists who work with addicted clients, even when drugs are their primary addiction, is severe dislocation from social, cognitive, and spiritual connections. Some addicted people become dislocated in the historical way the Tseshaht people were, others are dislocated because they have immigrated into a strange and unwelcoming culture, others because of powerful anxieties that grow up in dysfunctional families, and still others because they have been so deeply immersed in commercial culture that they do not know how to connect with real, human society. In each case the primary problem for the psychotherapist is dislocation.

The ultimate problem that I have encountered as a therapist is that dislocation is so painful and shameful that many addicted people will not admit to it until after they have overcome their addiction. For a person to admit to dislocation is to say I do not belong, I have no friends, I am a loser, even my parents don’t love me, the best reason for living that I have is my pitiful “life” as an addict to … whatever. If I can listen for a long time in a relaxed atmosphere people often confront their own dislocation, but this process cannot occur very well under the pressure of mandated treatment with an unremitting focus on drug use as the key problem.

c. The value of the addictive life style should not be denied. People need to be able to tell their counselor not only what was harmful and destructive about their addiction, but what their addictive life style did for them. For a counselor to deny the benefits of a person’s addictive life, is simply to rule out an honest discussion with them. More important, discussing what a person gets out of their addiction helps to clarify what they are missing in life and how their life must change to provide some non-destructive way of achieving what they most urgently need. The counselor must never be afraid to the truth, including the fact that there were probably some aspects of the addiction that were wonderful to the addicted person.

d. The hardships of modern society should not be denied. Modern society is unwelcoming to many people, but dislocated and addicted people have usually gotten an especially bad deal. Their childhood, adolescent, and adult environments were often bizarrely dysfunctional, either inside or outside their family, or both. To acknowledge this is simply to give compassion and sympathy where it is due, and to affirm a person's accurate perception of the today's world.

Recognizing the causal role of dysfunctional society does not negate an addicted person's responsibility for their actions. Nor does this recognition, in itself, solve their problems. Society is not going to apologize and make everything right for the addicted person. Addicted people must find the solution to a problem that they did not entirely cause, because nobody else can do it for them.

As they recover, addicted clients may well discover that the society they re-join is in many ways as materialistic, vacuous, and hypocritical as they thought it was when they originally lapsed into addiction. Perceptions like these should not be explained away by counselors, because lots of extremely intelligent people with few addiction problems see the same picture. On the larger stage of human affairs, many people in today's world are trying hard to throw off a system of domination and false values that has been in place for a long time and recovering clients are fully qualified to join this progressive movement if they want to. Counselors can join it too.

e. Addicted people are not much different from everybody else. This is a society in which everyone is forced to adapt to some greater or lesser degree of painful dislocation, and so everybody experiences the temptation of sliding away from their responsibilities into addiction. Many people who do not have severe, visible addiction problems have smaller, concealable ones. We are all in the addiction mess together. There is no basis for self-righteousness by anybody and there is much to be gained by accepting our common humanity and social condition.

Because addicted people are not unique, they have a lot to gain by discussing their problems with their good friends and asking for advice. Their friends are apt to be sympathetic and to have relevant experiences to share. Moreover, there is no reason to think that psychotherapist have any particular monopoly on good ideas about coping with addiction. As well, sharing problems is an important part of feeling a sense of belonging in society.

f. Psychotherapists have only a little power to help individual clients. Therapy does help to a measurable degree, but the treatment outcome statistics are anything but reassuring. It is only reasonable for therapists to have moderate expectations, and not to feel too surprised when their interventions have little or no effect. It is important to continue to do all that is possible, remembering that support and solace are precious gifts to suffering people, even when the desired changes in lifestyle do not follow.

5. Enforcement. For the past century, police have been burdened with the impossible assignment of eliminating crime by stopping the flow of “addictive” drugs. The worldwide War on Drugs proved that no amount of imprisonment, flogging, or capital punishment of people for drug crimes could eliminate either drugs or crime. There was never any hope that the drug wars could have a major impact on addiction because most addictions are to habits other than drug use. Terrorizing people out of one kind of addiction inevitably increases the attractiveness of other kinds. The dislocation theory of addiction implies that the prevalence of severe addiction would remain essentially unchanged if every single “addictive” drug were miraculously expunged from the face of the earth.

Striving to enforce an unachievable and pointless abstinence has done great harm. Spectacular, highly publicized seizures of drugs by police around the world and billion-dollar campaigns that kill and terrorize peasant producers of poppies and coca in the third world have no measurable impact on the supply of drugs to illicit users. They do not even drive up the price! Arrests and violent searches of drug users in Vancouver over the decades have injured many people and killed some, with no apparent benefit. Moreover, police have been called upon to bring anti-drug scare tactics to classrooms, making themselves objects of ridicule to many students by the time they reach university.[lii]

On the other hand, LEAP (Law Enforcement Against Prohibition) is an organization of police professionals who are willing to speak out publicly against the futility and harmfulness of the drug war in which they have served as foot soldiers.[liii] Yet sweeping, punitive drug laws remain in place in most countries.

Many police are now concentrating their attention on functions that are more constructive. For example, police can carefully enforce closing-hour laws, drunk-serving laws, and age restrictions for bars and can manage after-hours crowds to reduce the mayhem.[liv] Police can publicize drug information that is strictly accurate, but still cautionary, when contaminated drugs are found on the street. As genuine authority figures, police can give stern, but sympathetic advice to young people who they see becoming addicted to street drugs. Police can use existing drugs laws judiciously to get sick street addicts into prison where they will be well fed and allowed to recover their health for a time.

Perhaps most important, police can take the time to seriously investigate and prosecute the blight of small-scale burglaries and car thefts that blight our cities. “Petty crime” is anything but petty to economically overstressed families who must make up the losses. If a family car, even one with little market value, is stolen, how do the parents get themselves to work and the kids to hockey practice? Petty crime is a cause as well as an effect of dislocation. Yet, the sort of glamourless, painstaking police work that can control petty crime is scarcely being pursued in the residential areas of my city now.[lv]

6. Governance. Governments have tried for more than a century to find a quick fix to the problem of addiction. In the process, they have obscured and minimized a devastating addiction problem by convincing the public that it is limited to drugs and alcohol and that it can be overcome by drug wars, draconian punishment, mandated treatment, and perfecting drug laws.

Of course wise drug laws and compassionate interventions can ameliorate problems of drug and alcohol to some extent, and it is imperative that they continue to be improved. In the end, however, government must take the lead in facing the reality that no set of drug laws or individual interventions can ever bring the rising flood of addiction under control. Addiction can only be controlled in a healthy, psychosocially integrated society. The best thing that governments can do to reduce the addiction problem is to find ways to govern well, in the interest of the people. In my opinion, this starts with defying the neoliberal dogma of leaving all problems to the mercy of merciless markets and salving all wounds with the balm of affluence, real or imagined. This dogma has had its run in the last few decades, leaving vast destruction, including mass addiction, in its trail. Governments and the public will eventually be forced to wean themselves from the dream of quick fixes and to face the deeper nature of the problems that face modern society. Why not now?

Facing reality means, at a minimum, that ways must be found to provide homes for the homeless, childcare for the women who must work away from home, legal protections for unions and cooperatives, elimination of the huge discrepancies of wealth and power, and so forth. But the minimum is not enough. The welfare state alone is not a sufficient response to the problem of dislocation and addiction. Governments must find bold new ways to support the souls of their communities and their nations as well as their material needs. This means support and protection for the arts and for cultural traditions and it means supporting the development of cultural innovations that will address the unforeseeable needs of the future. Governments will have to respond to problems that have not yet arisen, in a way that is based, in part, on a clear comprehension of the problem of dislocation and addiction.

VII. Conclusion

I will leave you today with my hope that Scotland will find the best possible ways to care for itself in a tumultuous 21^st century. I will dare to hope and dream that this beautiful, tradition-rich country, the home of my own Scottish ancestors, can become a model of benevolent self-government that engages its citizens in their national affairs as much as their communities and their families. I will hope and dream that, as a natural corollary, it will bring dislocation, addiction, and the other psychological ravages of globalizing modernity under control.