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Diseasing of America

Addiction Treatment Out of Control

by
Stanton Peele

Reviewed by Mira de Vries
1989


Sadly, this book is still at least as timely today as when it was written, and well worth the read.

Peele disparages the current politically correct concept of addiction as a hereditary disease over which the addict has no control. Its roots go back to the temperance movement in the US, which in reality advocated not temperance but total abstinence. This movement led, albeit temporarily, to prohibition. Shortly after the repeal of prohibition, Alcoholics Anonymous (AA) was formed, borrowing on values from the earlier temperance movement.

Peele does not deny that AA has helped many people attain and maintain sobriety. Rather, he questions the widespread belief today that sobriety can be obtained only through AA, or that it is the best or most reliable method. In fact, far more former alcoholics achieve and maintain sobriety totally on their own, hence without AA or professional assistance. Furthermore, AA provides an undesirable trade-off: it convinces recovering alcoholics that alcoholism is an illness over which they are powerless, and that they will never be able to drink moderately. This doctrine encourages drinkers to turn every minor transgression into a major binge, while people who have successfully overcome excessive drinking on their own are more likely to reduce their alcohol intake to acceptable levels without either total abstinence or drunken excesses.

In the first chapter, Peele makes a small digression to discuss the much debated definition of disease. He points out that in modern medicine it is largely defined by identifiable and combatable microorganisms. Yet this reductionist view of disease is not the whole story, as the major killer diseases in the US today, heart disease, cancer, and stroke, are not caused by microbes, but are associated with individual habits. (This may be partly true, but it is unfair to people of exemplary habits who are none-the-less plagued by these diseases, and overlooks people of poor habits who are not. While it is clear that addiction is caused by behavior, the same is not unequivocally true for heart disease, cancer, or stroke. Behavior can at most be considered a risk factor.)

The AA model of alcoholism as a disease has spilled over into other areas of life, so that now practically every bad habit or feeling is considered a disease. Overeating, destructive romantic liaisons, gambling, promiscuity, violence, depression, shopping, obsessive-compulsive behavior, and myriad other behaviors are squeezed into the addiction/disease model. The person involved in these behaviors is taught that he is helpless to change them without therapy. Furthermore, people are brainwashed into seeing themselves as alcoholics or drug addicts when they simply aren’t, for instance, when they are social drinkers, or use drugs incidentally, or in the case of adolescents, when they are suspected of using drugs by their parents.

Naturally, this attitude is a boon to the therapy market. Little wonder that professionals systematically endorse and expand the disease category, even when contradicted by evidence. Massive state and federal $$$ spent on statistically useless addiction therapies benefit the disease industry. Each successive administration in the White House has raised spending on these matters, while the conditions they purport to remedy increase rather than abate. (Peele does not mention the role of the pharmaceutical companies in promoting disease models of behavior.)

What is the real solution to addiction problems? To Peele, it is the social community. Most addictive behaviors occur in underprivileged environments such as ghettos, which are beset by a host of social problems like poverty and hopelessness. (Peele does not say how urban poverty can be alleviated.)  Alcohol and drug use is actually dropping among the middle class, though other addictive behaviors are on the rise, e.g. childhood obesity and domestic violence. Here he faults the increasing tendency of families to live in isolation, failing to build durable contacts in the community at large. Children sit watching TV instead of playing outdoors with other children, and adults are not subjected to the scrutinizing eye that family friends could provide. (Peele’s theory fails to explain why most child couch potatoes remain thin, and most isolated middle-class families remain free of violence.)

How did people used to deal with social problems? Peele points to life in the pre-US colonies where community support was strong. Neighbors helped each other when the going got tough, caring for the sick, providing for the needy, taking in the homeless, comforting the bereaved, and so forth.
 
Here Peele comes just short of putting his finger on the sore spot: professionalism, buttressed by state recognition and funding, teaches us to believe that professionals are uniquely equipped to deal with social problems, while lay people should not involve themselves. This is a reversal of the colonial community spirit which Peele endorses. To be sure, there were outcasts and outlaws in colonial times as well, which Peele fails to mention. Dismantling professionalism will not solve all of society’s ills, but it will go a long way toward restoring personal freedom, reestablishing communal bonds, fostering feelings of responsibility for ourselves and each other, and diminishing the vast gap between the extremities of the socio-economic spectrum.

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