“Everything You Thought You Knew About Addiction is Wrong” April 5, 2020 Dr. Roger Ray, pastor
Bruce Alexander: “Global society is drowning in addiction to drug use and a thousand other habits. This is because people around the world, rich and poor alike, are being torn from the close ties to family, culture, and traditional spirituality that constituted the normal fabric of life in pre-modern times. This kind of global society subjects people to unrelenting pressures towards individualism and competition, dislocating them from social life.
People adapt to this dislocation by concocting the best substitutes that they can for a sustaining social, cultural and spiritual wholeness, and addiction provides this substitute for more and more of us.”
My mother, who was the travel agent for guilt trips, could write a pretty mean letter when she was in the mood to do it. The worst one I ever received came after they had visited me in the church where I worked in Louisville, KY. Several of us went out to church after the service and I bought my dad a beer to go with our tacos. My mother, I’m certain, came to America on the Mayflower in the company of some hard-assed Puritans. For her, drinking a beer was the same as trying to drink all of the beer in the world. There was no line between occasional or moderate alcohol use and full-blown alcoholism.
In fact, a year or so after my mother had died, my dad told me that he bought a six pack of beer and put it in his refrigerator but, he said, every time he opened the refrigerator door and saw it, he could swear that he heard Helen crying behind him, so he eventually just threw it away. Needless to say, I grew up in a home that was so dry it was a fire hazard.
My first encounter with an alcoholic was in my student church in Russellville, KY. My attempts to help that man led me to attending AA meetings with him and eventually doing my master’s thesis in the treatment of alcoholism. During my 
doctoral work, I took my Clinical Pastoral Education working as a chaplain in the Veterans’ Hospital’s addiction treatment center in Nashville, TN. I became a huge fan of the 12-Step recovery program which, almost like my mother had written the literature, taught that the cure for addiction was to embrace a life of absolute abstinence.
In that understanding of addiction, there were people who were not addicts, who could drink or not drink, and there were alcoholics, whom we protected from even using after shave or mouth wash that contained alcohol. And I still don’t want to throw any shade on the AA program. It has worked for more people than any other treatment program in its century of admirable work.
But over my years of work with both drug and alcohol addiction, I have realized that this binary view of addiction is totally nuts. There are people who drink to the point of intoxication every day, but they never have blackouts, hangovers, and they never miss work but to say that they are not alcoholics misses the point. They are still emotionally unavailable parents and partners and they are chemically dependent.
I want to talk about substance use and abuse today, in large part because the whole world is being confined to their homes, faced with domestic tension and boredom, complicated with feelings of anxiety and depression . . . a powder keg for potential addiction and abuse issues. Bruce Alexander has written about the fact that historically speaking, cultures can go for generations with fairly low levels of substance abuse, and then circumstances change, and it becomes nearly universal. Honestly, I worry about that now during our months of quarantine.
Especially since, right now, AA meetings are not happening in person, so many people who have depended on daily or regular meetings to maintain their sobriety are having to rely on phone calls and video conferencing and, as we all know by now, even from our virtual church, it is not the same.
Moderate drinkers can become alcohol abusers, and those who use Xanax and other panic and anxiety medications can begin to abuse their prescription drugs, and, under our current circumstances, I worry about those who take Adderall the most. I’m going to leave some of the more clinical, researched based part of this to my friend, Dr. Paul Thomlinson, but I want to speak about this personally.
After leaving my parents’ home, alcohol became a part of my life. In college, it was typically a matter of occasional pizza and beer. In grad school, I fell into the habit of having either wine or beer before bed to help me go to sleep for the three or four hours a night that I got to sleep.
After graduation, it became a part of social life. You got a beer with your friends after a run, a tennis match, or a white-water rafting event. As I got older, especially when I had an “empty nest,” I started going out to hear live music with friends, which almost always happens in a bar where, lo and behold, they serve alcohol.
I never drank alcoholically. I never had a blackout, never had a DUI, never had a hangover or a headache, but my doctor, responding to my frustration about not losing weight, especially as I have been threatened with high cholesterol and type-2 diabetes, has suggested cutting alcohol out of my diet. To placate him, I would cut back but never stop until about six weeks ago.
Realizing that my health demanded some serious action, I just stopped drinking . . . before Covid-19 was a big deal. I immediately started to lose weight faster than ever before. And, ironically, I also found that I went to sleep easily at the end of the day and slept through the night without any issues. And when the world was still going out to bars to hear bands, I found that I could drink water or tea and though no one around me pressured me to drink, I noticed how alcohol was affecting the people I hang out with and I didn’t like what I saw. In fact, I fear that I have lost a close friend simply from being sober while he was plastered.
And about a month later, I donated blood and saw from the lab test that for the first time in 20 years my cholesterol was normal, my blood sugar is down, and my jeans are three sizes smaller. I have not sworn off all alcohol forever, I would have a drink if I wanted to, but, realizing what my instincts would have led me to do when I am trapped alone in my home for days at a time with a liquor cabinet full of tasty anesthesia, I don’t want to drink.
I have known for years that alcohol can be dangerous because of alcoholism, but cirrhosis of the liver or drunk driving are not the only ways that alcohol can kill you. There is also diabetes, heart disease, obesity, and, what I might call, episodic insanity.
I have always loved the famous Ben Franklin quote: Beer is proof that God loves us and wants us to be happy.” But like so many popular Ben Franklin quotes, he never said it and evidently didn’t much care for beer. However, rather more poetically, he did make a similar sentiment known in a letter to a friend about wine. He wrote:
“Behold the rain which descends from heaven upon our vineyards, and which incorporates itself with the grapes to be changed into wine; a constant proof that God loves us, and loves to see us happy!” But, as Franklin, during his years as the American diplomat in France, became known for giving up state secrets to a prostitute with a bottle of wine, spirits can gladden the heart and lubricate some social settings but drinking doesn’t make you smart and it reduces your inhibitions, probably below the level of your normal informed self-control.
Again, I am not saying that I have taken up my mother’s mantle. I will have a drink from time to time. But not very often, and probably not at all during the Covid-19 quarantine because it is just too easy to fall into the habit of coping through self-medication . . . and that goes double for Xanax and Adderall. Just because you have a prescription doesn’t mean that you should take too much.
Allow me to remind you, I am a doctor, maybe not the kind you might wish, but, I have the sheepskin to prove it: I prescribe long walks in the sunshine, meditation, reading, hot baths, conversation, and exposure to art and nature. We’re going to get through this. I just want all of you to emerge from quarantine more healthy than you were when Covid-19 showed up in this neck of the woods.
Everything You Thought You Knew About Addiction is Wrong
Paul Thomlinson, Ph.D.
April 5, 2020
(Slide 1) Everything you know or thought you knew about addiction is wrong? Well, that may be a tad bit hyperbolic, so let’s say, maybe not everything, and for everyone—and maybe not so much wrong, as incomplete. In using that title, similar to Johann Hari’s TED talk (Slide 2) we recognize and affirm the lived experience of those who have struggled with addictions like alcoholism, and we recognize that the lived experience of some may differ or be contradictory to what we are sharing today. We do not seek to condescend to anyone in our remarks. But I can pretty much guarantee that what we are saying today, the perspectives and evidence, differs greatly from what most people in our culture have been taught, and what they have believed or “known.” By the way, alcoholism is sort of our tracer condition for these talks today—but everything we are saying pretty much applies to all substances of choice with addictive properties.
I also want to begin with a the assertion that I believe we need to be clear eyed and unafraid of the truth about human beings and our seemingly universal impulse to alter our state of consciousness. You want evidence of this? The historical and anthropological record is clear—humans have always consumed substances for the express purpose of altering consciousness, and have found value in doing so. There seems to be a drive in us to experiment with ways of changing how we feel. (Slide 3) Witness every child ever, spinning in circles until they are dizzy as evidence of this drive, and how much we seem to enjoy it…and witness those same children falling on the concrete patio and breaking out a tooth as evidence of the harmful consequences that can ensue from altering our headspace too much.
This brings me to another important point…our ambivalence toward substances like alcohol. Most of us feel at least two ways about it at the very same time. I earned my Ph.D. at Southern Miss, in their APA accredited psychology program, where I took my first graduate course in addictions…that’s where I heard my favorite and best illustration of this ambivalence. I lost it for years, but I finally found it for this talk. (Slide 4) Judge Noah “Soggy” Sweat, gave his so-called whiskey speech as a state representative on the floor of the Mississippi state legislature in 1952, when prohibition of alcoholic liquor was still in effect in that state. And it goes a little something like this:
“… I want you to know that I do not shun controversy. On the contrary, I will take a stand on any issue at any time, regardless of how fraught with controversy it might be. You have asked me how I feel about whiskey. All right, this is how I feel about whiskey:
If when you say whiskey you mean the devil's brew, the poison scourge, the bloody monster, that defiles innocence, dethrones reason, destroys the home, creates misery and poverty, yea, literally takes the bread from the mouths of little children; if you mean the evil drink that topples the Christian man and woman from the pinnacle of righteous, gracious living into the bottomless pit of degradation, and despair, and shame and helplessness, and hopelessness, then certainly I am against it.
But, if when you say whiskey you mean the oil of conversation, the philosophic wine, the ale that is consumed when good fellows get together, that puts a song in their hearts and laughter on their lips, and the warm glow of contentment in their eyes; if you mean Christmas cheer; if you mean the stimulating drink that puts the spring in the old gentleman's step on a frosty, crispy morning; if you mean the drink which enables a man to magnify his joy, and his happiness, and to forget, if only for a little while, life's great tragedies, and heartaches, and sorrows; if you mean that drink, the sale of which pours into our treasuries untold millions of dollars, which are used to provide tender care for our little crippled children, our blind, our deaf, our dumb, our pitiful aged and infirm; to build highways and hospitals and schools, then certainly I am for it.
This is my stand. I will not retreat from it. I will not compromise.”
Are you convinced that we, as a culture, are still at least as ambivalent about whiskey, and a host of other mind and mood altering substances today, nearly 70 years later? I am. As Roger shared, a binary view of alcoholism has never been widely accepted scientifically speaking, but yet, it has prevailed in the treatment world, and in popular culture for generations. So, what have we learned that’s worth sharing? What is worth knowing about some of the new ways thinking about addiction?
We all know that there has been a concerted effort, going back to at least the 1930’s to assert that substance use is a crime that deserves the most severe of punishment, an idea rooted in a very limited view of addiction and one that makes it primarily about stigmatizing those with addictions as morally flawed and weak. If you’ve ever really known someone struggling mightily against addiction, you have to know they are neither. But that prevailing view made it’s way to the so-called public health campaigns of the 80’s and 90’s: (Slide 5) just say no, this is your brain on drugs, etc. The underlying assumption here is that there are “chemical hooks” in substances of abuse and if you have the moral failing of trying it once, you will be hooked and well, you deserve everything that this brings upon you.
But if the “chemical hooks” hypothesis is correct, (Slide 6) then shouldn’t everyone who’s had nicotine patches or Nicorette gum be able to quit smoking cigarettes as a delivery system for nicotine? We know that these marvelous products can easily maintain the levels of nicotine in the bloodstream at the same levels as produced by heavy smoking…and yet, the quit rates for smoking even with these nicotine replacements are abysmal. So, there must be other explanations for why people continue to consume substances that are dangerous and even deadly.
Well, those war on drugs propaganda messages in the 1980’s included one PSA, based on studies from the 1960’s, showing rats in a cage dying from consuming heroin. (Slide 7) You see, in those studies scientists put rats in cages with two water bottles. One bottle had water; the other bottle had water laced with either cocaine or heroin. In virtually every case, in this free choice situation, the rats would keep going back to the drug-laced water bottle and fairly quickly die of an overdose. The conclusions are clear, right? Drugs are addictive and will kill you.
Kind of ironically, those messages and the underlying studies became an inspiration for a psychology researcher named Dr. Bruce Alexander at Simon Fraser University. This clever psychologist wondered, what else is going on here, and maybe it’s not really the drugs themselves that explain what’s happening. He wondered if it might be the cage, the environment in which these rats were placed—a bleak and solitary existence in which they only thing there was to do was…drink water or take drugs. So, Alexander repeated the experiments, but rather than putting one rat in a small cage, he created what he called “rat park.” (Slide 8) Famously now, this cage was filled with lots of good things to eat, other rats for socialization and plenty of sex, and toys and colored balls for recreation. Rat park also had two water bottles: one with water, and one with drugged water. The rats tried both, but given the choice between good food, sex, and playful friends, none of the rats became addicted or overdosed. Not a single death by overdose. They, in fact, didn’t like the drugged water.
Does this study have any relevance to humans? Of course it does. Pesky research ethics prevent us from putting humans in cages for extended periods of time with ad libitum drug consumption…but as Johann Hari beautifully describes in his book Chasing the Scream, in the Vietnam War and it’s aftermath, we have something of a natural human experiment that illustrates the principles very well. At one point, a huge number, upwards of ten percent of American soldiers stationed in a miserable jungle, where they didn’t want to be and where they might be killed at any moment, were using heroin. It was feared that when these soldiers came home, we would have hoards of vacant-eyed heroin addicts roaming our streets—but that’s not what happened, thankfully. When they were removed from their virtual rat cages in the jungles of Vietnam, and were able to come home to the embrace of family, the meaningful activities of employment and school, most were no longer interested in heroin and simply quit. They were not criminal nor physically addicted. They just changed their cages.
(Slide 9) As the great Hungarian born, Canadian physician Dr. Gabor Mate has put it, “All substances of abuse will either treat pain or distract from pain. So the question is not, why the addiction, but why the pain?” This question is a haunting one…it is what we must answer if we are to make long-term, sustainable recovery possible for our brothers and sisters who are addicted. The sources of the pain that humans treat with whiskey and Oxycontin, with cocaine and benzodiazapines, are many—chronic physical pain from injuries and illnesses, for sure. But I’m convinced it is much more likely to include psychic pain from trauma (either in childhood or later), from interpersonal alienation from primary relationships, from family disconnection and conflict, from shame and guilt heaped upon us by heavy handed religion, from abject loneliness, from having not found a guiding passion or a meaningful purpose for one’s life. These are the real sources of pain that lead so many to find connection with alcohol or other drugs. These are the sources of pain that lead to self-medication. These are the sources of pain we can and must find ways and means of treating.
I’ll conclude with an all-too-obvious application of all this to our current circumstances, the COVID-19 crisis. (Slide 10) Under quarantine, we may all begin to feel like rats in cages, right? What if our cage is feeling pretty desolate, and we have two bottles from which to choose? We might begin to choose the whiskey bottle, or the bottle of pills, rather than the healthier water bottle if we don’t take care to enrich our environment. Rat park was an enriched environment that included, not insignificantly, other rats with whom to play, socialize, have sex…be close to. So we need to enrich our environments by bringing our offline supports online through regular phone calls, FaceTime, Zoom, syncing up Netflix accounts. Getting and/or staying connected with others is really the most important thing we can do for ourselves right now. We need to enrich our environments by refusing to drink from the firehose and restricting the flow of bad news and misinformation—make sure we are getting good information, and balance it with stories of human kindness and resilience. We need to enrich our environments by developing and demonstrating mastery—learn something new or practice something old. To be most helpful and hopeful, make sure it is something that provides meaning and purpose to life—some way of adding beauty to your own life or those of others, some way of contributing joy to someone who may desperately need your light. Let’s all enrich these cages we are living in, together.
