Everything you believe about drugs/addiction is wrong. EVERYTHING. It matters.
I. Drug Overdose
Tom Petty died from, according to the New York Times headline, an “Accidental Drug Overdose.”
Here’s the coroner’s list of the drugs found in Petty’s system: fentanyl, oxycodone, temazepam, alprazolam, citalopram, acetyl fentanyl and despropionyl fentanyl.
Petty’s death is not accurately classified as an overdose. He died due to a dangerous mixture of opioid drugs. Such drug intake, often classified as “chaotic” drug use, is the source of over 90% of deaths involving drugs, so much so that the CDC now classifies these deaths as “drug poisonings” rather than as “overdoses.”
I have been making this case for a few decades (see “The Persistent, Dangerous Myth of Heroin Overdose”). The main case against the overdose myth was made initially by the New York Medical Examiner, as presented by Edward Brecher in his remarkable Consumer Reports volume, “Licit and Illicit Drugs.”
Among the data Brecher and the New York ME present that should have forever jettisoned the overdose concept:
Drug overdoses became a “thing” in the 1960s as street use became popular in New York City and drug supplies were regularly adulterated with whatever came to hand.
Pioneering heroin researchers at Jefferson Medical College early in the last century, Light and Torrance, administered pharmaceutical heroin orders of magnitude more concentrated than addicts’ usual doses, without the addicts even noticing the change in the purity of the drug in their systems.
Dead heroin users examined by the NYME showed no differences in the presence of narcotics than did fellow users taking the same drug at the same time who walked away.
Of course, the myth persists, amplified by popular media. Writing for the National Reviewin 1994 about the front page New York Times too-pure heroin hysteria story of China Cat, I pointed out that the Times, in articles buried ever deeper in the newspaper, was forced to slowly retract the story, since among the claimed victims of “Cat,”
a majority hadn’t consumed heroin at all
more had consumed cocaine
but, in general, the dead men were characterized by multiple drug and alcohol use
Why it matters. People often balance their heroin use with other drugs (including now often benzodiazepines) — exactly the wrong approach to using drugs. If Petty had a reliable adviser (one who might have also saved the 12-step acolyte, Carrie Fisher), the helper would say, “You can take whatever drugs you wish—one at a time.”
II. The Prescribed Drug Addict/Overdose Victim
A media colleague of mine wrote me, apropos of Petty: “If a guy with this much cash can’t manage to have a doctor who gets it straight, what about everyone else?”
I replied, “In defense of doctors, I believe he was out fishing for drugs through personal connections. NO doctor would prescribe this list for a patient — if only because they’d remove his license inside a month (the days of Elvis, like Elvis himself, are dead).”
(In particular, the drug acetyl fentanyl in Petty’s system is made by street chemists, never prescribed by doctors.)
Where is this fable of unscrupulous, ignorant doctor prescribers going? When Chris Christie left the governorship of New Jersey this month, deeply unpopular, his successor, Democrat Phil Murphy, picked up for approval only one part of the Christie platform — Christie’s ubiquitous Reach NJ program encouraging people to seek treatment for their disease of drug addiction.
Here’s how the media described the imperative that Murphy adopt the Christie project:
Christie made the opioids crisis the hallmark of his final year in office, and it will now be up to Murphy to follow through on state efforts to tackle it.
Murphy praised Christie’s efforts during his inaugural address, and has vowed to continue the fight, which included more money for treatment and an effort by the state attorney general’s office to sue drug dealers and pharmaceutical companies, and charge doctors for unscrupulous overprescription of the addictive drugs.
The problems with the second part of this policy attacking “unscrupulous overprescription of the addictive drugs” include these:
opioid prescriptions have been declining for years
during this same period, in New Jersey and elsewhere, drug deaths have risen precipitously (a 50% rise in 2016 over 2015, a trend that is seemingly continuing
Why it matters. The narrative that best fits these data is that users, forced off their prescriptions by new medical restrictions, are increasingly turning to the street for their drugs. And such unregulated drug use is the fundamental cause of increasing drug deaths.
III. Drug Use = Addiction, Death
The basis for the idea that people taking painkillers long term inevitably leads many to become addicted, and some proportion to die, is based on the fundamental addiction myth: narcotic drugs = addiction.
Of course, the very prevalence of opioid painkillers in the American experience makes clear that this concept is a myth: in 2015, the latest year for which data were available, 93 million Americans — 38% of the adult population — took a painkiller.
How many became addicted? Fewer than 1%. A recent study of insurance records found that, among people taking prescribed opiates,
0.6% of the entire sample wound up “misusing” opioids — meaning they became dependent on the drugs, abused them, or had an overdose
rates of misuse increased over the course of the study, but were still virtually nil (from 183 cases for every 100,000 person-years in 2009 to 269 cases per 100,000 person-years in 2016)
the prescription rate for opioids declined over the course of the study — over the years, doctors prescribed lower doses of painkillers and longer periods between administration
Why this matters. The narrative fitting these data is that constraining the use of prescribed opiates led to greater rates of misuse of the drugs and deaths, even only including their legal use, let alone those turning to outside sources to supplement their diminished supplies. That is, the policy recommended by all parties in New Jersey and across the U.S. has been shown empirically to create more, rather than fewer, problems.
IV. Treatment Will Solve the Problem
New Jersey now budgets $1 billion in public funds for addiction treatment. This doesn’t include private treatment, which entails multiple times the expenditures of public funds. And how well is this going?
The simple equation is that greater expenditure on treatment has accompanied precipitous rises in drug problems, up to and including death, even as there are no clear signs that drug use and addiction themselves are increasing.
How is this possible? One narrative to account for this is the case of Delray Beach*, Florida, a haven for drug treatment in which many rehab graduates choose to remain as they cycle in and out of treatment. But their relapses (which are readily explained by the rehabs as being due to the incurable nature of their disease) aren’t a problem for providers.
Rather, drug testing, relapses and “overdoses,” are accepted and billed at extravagant costs to insurers, who are increasingly required to pay for them by law (including Obamacare). In other words, providers make out like bandits, even if — especially if — treatment fails.
*”Unlike other places in the United States that have been clobbered by the opioid crisis, most of the young people who overdose in Delray Beach are not from here. They are visitors, mostly from the Northeast and Midwest, and they come for opioid addiction treatment and recovery help to a town that has long been hailed as a lifeline for substance abusers. But what many of these addicts find here today is a crippled and dangerous system, fueled in the past three years by insurance fraud, abuse, minimal oversight and lax laws. The result in Palm Beach County has been the rapid proliferation of troubled treatment centers, labs and group homes where unknowing addicts, exploited for insurance money, fall deeper into addiction.”
Why this matters. The addiction myth that drug use per se causes addiction, and not the situations faced by users, has resulted in a major shift of government money to funding treatment, without demonstrated efficacy, and away from funding such social fabric matters as education, general health care, housing, et al. Meanwhile private treatment is an industry largely unshackled by the requirement of proving its efficacy.
V. The New Drug Policy Reform
Drug policy reform has increasingly advocated for the use of narcotic substitute drugs (suboxone, methadone, buprenorphine). And data do show that treatment graduates placed on these drugs are less likely to encounter problems, up to an including death.
Advocates for this approach, such as Maia Szalavitz, argue that MAT (medicine-assisted treatment) is a proven treatment method for addiction. But, while providing substitute narcotics for people makes it less likely that they will seek dangerous street drugs, it in no way weans them from their addictions. If anything, MAT convinces people that they suffer from a disease they can never remedy. And, if and when they should ever desist their reliance on a prescribed substitute narcotic medication, what happens then?
Many will return to unregulated street use. How else to explain this strange phenomenon: while MAT has increased dramatically, even in those places where it is most systematically administered (like New York), drug deaths have continued to rise, often dramatically.
Why this matters. Ironically, it may seem, drug policy reformers have now adopted policies and treatment approaches fully in line with the disease model provided by the National Institute on Drug Abuse, against whose policies reform organizations were once adamantly opposed. Now, as I describe in this podcast, such organizations are in danger of becoming policy adjuncts to the most reactionary and repressive drug regimes.
The United States, from reactionary anti-drug forces like Chris Christie and the Trumpadministration, to radical reform organizations that favor drug decriminalization, are all aboard for the same disease model of addiction and its treatment. And all remain smugly content with their wisdom in this transition.
With only one problem. We can’t seemingly stem the tide of drug-related deaths. The actual lesson yielded by the limited efficacy of providing narcotic substitutes is to reaffirm that providing drug users reliable, guaranteed supplies of narcotics (as they are by heroin maintenance or injection sites throughout Europe, and which are now being considered in the U.S. from Seattle to Philadelphia) is the safest support plan for drug users.
There is nothing magical about drugs and addiction. All of the same common-sense dictates that are at work in human behavior and that make sense in social policy apply to drug use and addiction. In contrast, the truisms of drug addiction that are widely propagated and universally accepted throughout our society, on all sides of the political spectrum, have coincided with our unprecedented descent into drug death hell.
Kurt Anderson commends rationality and science (except for alcohol, of course).
I have to tip my hat to New York magazine writer and public radio host, Kurt Anderson, for passionately detailing how America has descended into irrational and magical thinking(“How America Lost Its Mind”), since I wrote about this idea (“America, Land of the Irrational”) in PT in 2008.
Why, Andersen even pointed out that Oprah Winfrey, a potential American president, is one of our country’s greatest purveyors of magic and superstition: “Oprah Winfrey Helped Create Our American Fantasyland.” That guy’s got guts! (That’s Kurt Andersen. Gillian Anderson, star of the X-Files, is 100 percent behind Oprah.)
However, that same Kurt Andersen became as mad as a hatter when discussing alcohol (this is America, after all), claiming that George W. Bush quit drinking without going to AA and was thus in denial, which is why he invaded Iraq. See his argument here, to which I objected:
He (Bush) quit out of his love for his family? Could anything be more ridiculous than that?
See this clip from his interview where he explained quitting: “I didn’t like the person I was.” (Mr. Andersen, is that denial?)
Science be damned, you can’t quit drinking on your own without being crazy—no matter what the data show.
(By the way, I love Gillian Anderson, who overcame a rebellious youth that included drugsand alcohol without going to AA, to become a positive life force, in both her acting and charitable work, according to Wikipedia.)
In the meantime, the President’s doctor explains why Trump has good heart health—he doesn’t drink alcohol. However, as I explained here (bear with me, this is a complex concept), abstinence from alcohol is a risk factor for heart disease and premature death.
To quote the U.S. Dietary Guidelines:
According to the experts charged with creating the alcohol section, strong evidence indicates that “the lowest mortality risk for men and women [occurs] at the average level of one to two drinks per day, [and] is likely due to the protective effects of moderate alcohol consumption on CHD [coronary heart disease], diabetes and ischemic stroke as summarized in this chapter.”
As a result, I see Trump’s abstinence somewhat differently: as a sign of a personality disorder.
But, remember, if you object to this, I don’t want you to drink. After all, if you believe something contrary to the facts, you should be willing to die for it, as you would for God and country.
THE GROWTH OF ADDICTION TREATMENT in the United States, predicated on the idea that alcoholism and addictions of all kinds are diseases, is a public-relations triumph, and not a triumph of reason or science.
The idea that modern addiction treatment—like that provided at private alcoholism hospitals—is eminently successful is a myth. More people quit alcoholism and addiction on their own than do so through treatment, and evidence is that in many cases people trying to quit an addiction (such as smoking) are better off attempting it without the help of typical treatment programs. There are therapies that work better than disease-oriented alcoholism clinics or nicotine gum therapies for smokers, but you would be hard-pressed to find such treatment if you tried. That’s why we developed the Life Process Program.
We believe that many people want an open-minded, realistic way to understand and deal with addictions—their own, their spouses’, their children’s, their friends’ and employees’. This book is a response to that need. It begins by making clear what addiction is and what it is not. Addiction is an ingrained habit that undermines your health, your work, your relationships, your self-respect, but that you feel you cannot change. Addictions are difficult to change, because you have relied on them—in many cases for years or decades—as ways of getting through life, of gaining satisfaction, of spending time, and even of defining who you are. Whereas some addictions involve drugs (like smoking or problem drinking), some do not (like shopping, or eating, or sex). It is impossible, therefore, to relate addiction to one chemical or biological process or another.
Because of the distinctive approach we take, you will find guidance here that in most cases you cannot get elsewhere. That is, we do not regard addiction of any kind as a disease. Thus, we do not recommend that you see a doctor or join a twelve step group organized for one disease or another as a way of dealing with addiction. These approaches, we believe, have already been shown to be less effective than others that are available. The same is true if you are concerned that your children and their friends are using alcohol and drugs—the common practice of putting them in a hospital will usually do more harm than good. Our approach for changing destructive habits, called the Life Process Program, is instead rooted in common sense and people’s actual experience.
This approach is more empowering—and therefore more effective—than conventional treatment or self-help methods. Because our approach differs so drastically from the messages you get constantly in public-service announcements and advertisements for alcoholism centers, we review a great deal of evidence to show you that the conventional notion of addiction as an uncontrollable “disease” is baseless. It doesn’t get at what causes people to be addicted and it is ineffective for most people as a method of treatment or self-help. It is disturbing that an approach to addiction that is widely claimed to be scientific is actually false and is more often harmful than beneficial.
The good news is that many people are beginning to question how accurate or helpful it is to think of addiction as a “disease.” These may be people with substance-abuse problems whose needs are not met by twelve-step support groups. Or they may be people who don’t buy the claim of the alcoholism movement that announcing you are powerless helps you change. They may be researchers who find that the evidence doesn’t back up the personal testimony of addicts who tell us incessantly in the media that conventional treatment works.
They may be individuals who have been exposed to the treatment system—because their children used drugs or because they were arrested for drunk driving—and who were appalled by its coerciveness and irrationality. They may be especially mystified that anyone wants to weigh adolescents down with the message: “Because you have been drinking or using drugs, or because your father or mother did, you have a disease you can never overcome.”
Sometimes people with questions like these stumble upon the best-kept secret in the addiction treatment industry—that many more people give up addictions on their own than through treatment, without taking on the stigma that they suffer from a disease. TV talk-show host Oprah Winfrey, for example, discussed her struggle to lose (and keep off) weight on a show she did on the disease theory of alcoholism. She remarked that she could accept the disease theory “intellectually,” but that she just didn’t see how believing she was forever “powerless” could possibly help her with her weight problem. What Oprah and others like her should know is that calling addiction a “disease” is just as wrong “intellectually” as it is unhelpful.
Indeed, what about all the people who are so uncomfortable with twelve-step groups that they can’t bring themselves to attend one or don’t stick with it if they do attend? Are these people all, like Oprah, really in “denial”? As a result of such “failures,” many people mistakenly think they can never overcome their addictions. Wouldn’t they benefit from knowing that the great majority of people with addictive habits—particularly young people—can outgrow them without entering a hospital program or following a twelve-step regimen?
They may be able to do it on their own. Or they may benefit from the kind of treatment represented by the Life Process Program—treatment that builds on people’s own strengths, values, and confidence in themselves and on their existing ties with friends and family, while improving how they deal with their lives.
The disease model of addiction does more harm than good because it does not give people enough credit for their resilience and capacity to change. It underestimates people’s ability to figure out what is good for them and to adapt to challenging environments. At the same time, it disempowers people, because it fails to hold them accountable for acting irresponsibly while under the influence of alcohol or drugs, or for excessive behaviours ranging from shopping to gambling. The disease theory of addiction can even serve to perpetuate addiction and to excuse repeated relapses. Our approach, in contrast, respects every person’s capacity to make positive choices, even in the case of the most compulsive behaviors. Instead of undermining your integrity, we give you credit for being a responsible adult capable of self-management. The Life Process Program takes us far from the frightening assumption that a compulsive behavior is a disease that you will have to live with forever.
It brings us into the practical human realm of individual self-assessment, planning, and action. As you will see, the myths of addiction and the realities with which we contrast them offer radically different ways of freeing yourself from addictions ranging from overeating and smoking to alcohol and drugs. They also have different implications for how you deal with heavy drinking or drug use in a spouse or lover, a child, a friend, or an employee. The Life Process Program and the disease model also give you different messages about what it means if you come from a family with a history of some addictive problem, like alcoholism.
Finally, the two different approaches point in different directions concerning the social problems and public-policy issues that we confront, such as drunk driving, drug testing, and widespread drug abuse and drug-related violence in the ghetto. Popular attitudes about addiction, instead of locking people into their addictive dependencies, can instead encourage individual and community strength and autonomy. For although this book is mainly about overcoming addiction as individuals, the crux of the struggle against addiction lies in the social and cultural environments we create. The widespread failure to realize this holds more danger for our civilization than does crack or alcohol or any international drug cartel.
The key to giving up addiction is to mobilize the necessary motivation, values, skills, and environmental supports. In most cases, you already have these things. Our emphasis, therefore, is on kindling your desire to stop harming yourself and others and your belief that you can do so. We never tell you that you are powerless. When you feel strongly enough the urge to change your life in a healthful direction, you can often develop the means for stopping unhealthy addictions quite naturally.
Thus, instead of a single, prepackaged program for recovery, we provide the highlights of successful self-cures and successful therapy for you to use as signposts for change. You must then see how they fit into the rhythms of your own life. The Life Process Program, while it makes the experiences of others accessible to you, remains something you create for yourself out of your own experience and personal values.
Our approach has no gimmicks. It is grounded in the reality of the numerous studies we cite and the many personal accounts we relate. Whatever solution proves right for you, it is unlikely that you will succeed by working on the addiction in isolation from the rest of your life. Indeed, as the Life Process Program shows you, you cannot escape addiction without dealing with your entire world, including your family, your community, and society as a whole.
This program points out many actual stories of recovered addicts, virtually all of whom did it on their own. These cases come from all walks of life, and from all of my many activities. That is, some are based on interviews I have conducted with addicts or former addicts, some come from my therapy experiences, some come from e-mails from my website on addiction, some are cases described in the research by other investigators, and some are well-known ones drawn from history and literature.
But many others come from people I have known and observed. The point of this is to show ordinary people overcoming addictions without professional assistance, in the normal course of their lives. In cases I have observed or been involved in myself, of course, I disguise all names, locations, and identifying details.
The reason for this variety, and the inclusion of “ordinary” lives, is that this book is not about therapy. It is about people, many of whom have not sought and will not seek therapy. Even if they turn to therapy, their attacks on their addiction will occur mainly outside the therapy experience.
I am a psychologist and addiction therapist. I see my job as helping people build the foundation that must be in place before they successfully quit addictions. From the standpoint of would-be helpers, including therapists, friends, and parents, it is essential to get people attached to life in as many ways as possible.
People with strong values, and with the motivation to change, succeed better at quitting addictions.
People with friends, intimate relationships, and families; people with stable home and community lives; people with jobs and work skills; people with education; people who are healthy—all do better at getting over addictions, just as they do at avoiding addictions in the first place.
In addition, you are assisted in quitting addictions by things larger than yourself and beyond your own life. One of these things is the support of those around you and your community. Another is to have and to seek greater goals in life, to commit yourself to be good to other people and to make positive contributions to the world.
We frequently hear from people who say: “I drink too much sometimes, but I don’t think I’m an alcoholic. And I don’t want to stand up and talk about myself in front of a group. Is there any other way I can change the way I drink?”
“I’m overweight, but I understand that people are born to be fat and there’s not much you can do about it. I know I’ve tried to lose weight a million times and failed. Does this mean I’m doomed to be overweight?”
“I saw an ad saying the only way to beat your addiction to nicotine is by going to a doctor. Is that really true? Don’t people ever quit smoking on their own?”
“My father was an alcoholic. Does that mean I’m likely to become an alcoholic myself? Should I play it safe and quit drinking altogether? A friend of mine joined a ‘Children of Alcoholics’ group, even though she’s never even been drunk. Should I join such a group? And what about my kids?”
“My son was caught smoking marijuana. Now I’m told that, unless I place him in an expensive residential treatment program, he could escalate his drug use and die. I don’t have the money for this but, of course, if I have to save his life I’ll mortgage the house!”
People are much concerned about bad habits (which sometimes reach life-consuming proportions) that they’d like to do something about-drinking, smoking, overeating, taking drugs, gambling, overspending, or even compulsive romancing. We hear more and more that every one of these things is a disease, and that we must go to treatment centers or join twelve-step support groups like Alcoholics Anonymous or Gamblers Anonymous in order to change any of these behaviors. Is there really no other way to change a powerful habit than to enter treatment for a disease? Do personal initiative, willpower, or just maturing and developing a more rewarding life have anything to do with people’s ability to overcome addictive habits?
As children, as spouses, as parents, as employers, as consumers, and as citizens we must struggle to understand and master the destructive potential of drugs, alcohol, Gambling, and related addictions. The kinds of questions so many people face today include: What do we do if we discover our children are smoking marijuana, or worse? Should we put them in a treatment center that will teach them they are chemically dependent for life? How can we tell if co-workers, employees, and friends are secretly addicts or alcoholics? What is the most appropriate way to react to people who drink too much or do anything that harms themselves and others?
Furthermore, as a society, how should we deal with these problems? Are our incessant wars on drugs really going to have the positive impact the generals in these wars always claim? Or is there some more sensible or direct way to reduce the damage people do to themselves through their uncontrollable habits? Rather than arrest drug users, can we treat addicts so that they stop using drugs? And if we expand the treatment for all the addictions we have seen—like shopping and smoking and overeating and sexual behavior—who will pay for all this treatment? Finally, does addiction diminish people’s judgment so that they can’t be held accountable for their behavior, or for crimes and financial excesses they commit while addicted?
What you will read here is not the same as what you see and hear in newspapers and magazines, on television, in addiction treatment centers, in twelve-step groups, and in most physicians’ and therapists’ offices or what your children are learning in school. For in its desperate search for a way out of the convulsions caused by drug abuse and addiction, our society has seized upon a simple, seductive, but false answer that this program disputes. What we say is, indeed, so different from most things you hear that we have provided extensive documentation at the end of this information.
The simple but incorrect answer we constantly hear is expressed by the familiar statement, “Alcoholism is a disease.” In other words, we can treat away these problems in a medical setting. This viewpoint has proved so appealing that it has been adopted by professional organizations and government agencies as well as by groups like Alcoholics Anonymous and Gamblers Anonymous And now the “disease” label is applied not only to alcoholism, drug addiction, cigarette smoking, and overeating, but also to gambling, compulsive shopping, desperate romantic attachments, and even committing rape or killing one’s newborn child! A.A.’s image of “powerlessness over alcohol” is being extended to everything that people feel they are unable to resist or control.
But what lies behind the claim that alcoholism and other addictions are diseases? How accurate is it? What evidence supports it? Most important, what good does it do us to believe it? Will it really help you or someone you care about to overcome an addiction? This book will show that the answer is no—that, in fact, it may do more harm than good. What’s wrong with calling a tenacious and destructive habit a disease? Three things:
It isn’t true.
It doesn’t help most people (and even those it does help might succeed just as well in some less costly, less limiting way).
It prevents us from doing things that really would help.
Here we will summarize what the disease model says, why it is wrong, and why it is harmful. As you will see, there is no good reason to label yourself or people you know as forever marked by an addictive “disease.” Challenging this useless folklore is the first step toward understanding addiction and doing something about it.
Then we will present an alternative way of thinking about and dealing with addiction called the Life Process Program. The accompanying table previews the major differences between the Life Process Program and the disease model of addiction.
Myths Versus Realities
To highlight some of the surprising facts we will reveal, here are some common beliefs about various addictions:
A person needs medical treatment or a program like Smokenders to quit smoking.
Attending Alcoholics Anonymous meetings is the most effective way for alcoholics to stop drinking.
Once a compulsive gambler has this disease they are powerless over this illness and there is no cure.
Nearly all regular cocaine users become addicted.
Very few people who have a drinking problem can ever drink in a normal, controlled manner.
Drunk drivers who undergo treatment for alcoholism are less likely to repeat the offense than those who receive normal judicial penalties such as license suspension.
Most people with an alcoholic parent become alcoholics themselves.
Most people who are binge drinkers in their twenties go on to become alcoholics.
Most of the American soldiers who were addicted to heroin in Vietnam remained addicted or became addicted again after they returned home.
The fact that alcoholism runs in families means that it is an inherited disease.
Fat children, because they have inherited their obesity, are more likely to be fat in later life than are people who become fat as adults.
Actually, the best scientific evidence available today indicates that none of these statements is true. Such specific misconceptions grow out of a foundation of false assumptions about the nature of addiction generally.
Ten Assumptions that Distinguish the Life Process Program from the Disease Model
LIFE PROCESS PROGRAM
1. Addiction is inbred and biological.
1. Addiction is a way of coping with yourself and your world.
2. The solution is medical treatment and membership in spiritual groups such as A.A.
2. The solution requires self-awareness, new coping skills, and changing your environment.
3. Addiction is all-or-nothing; you are or you aren’t an addict.
3. Addiction is a continuum; your behavior is more or less addicted.
4. Addiction is permanent and you can relapse at any moment.
4. Addiction can be outgrown.
5. Addicts are “in denial” and must be forced to acknowledge they have a disease.
5. You should identify problems and solutions in ways that work for you.
6. The recovering addict/alcoholic is the expert on addiction.
6. Those without an addiction problem are the best models.
7. Addiction is a “primary” disease.
7. Addiction stems from other life problems you have.
8. Your main associates must be other recovering addicts.
8. You should associate with a normal range of people.
9. You must accept the disease philosophy to recover.
9. Getting better is not a matter of believing a dogma.
10. Surrendering to a higher power is the key to recovery.
10. You must develop your own power to get better.
What Is the Disease Model of Addiction?
At first, it seems hard to understand what is meant by saying that something a person does (such as drinking alcohol or, especially, gambling) is a disease. Habitual, voluntary behavior of this sort does not resemble what we normally think of as a disease, like cancer or diabetes. What is more, AA, hospital programs for alcoholism, GA don’t actually treat any biological causes of alcoholism. After all the claims we have heard in the past decade about biological discoveries concerning alcoholism and addiction, not one of these findings has been translated into a reliable treatment used with many people. Instead, the same group discussions and exhortations that have been used for the last fifty years are employed in hospitals and treatment programs. Nor is any medical test used to determine whether someone is an alcoholic or addict, other than by assessing how much that person drinks, gambles et al. and the consequences of that behavior. If you went to a hospital and they did a PET scan of you brain and declared, “You’re a gambling addict!”, you might sue them for malpractice.
There is, however, a standard way those who claim addiction is a disease describe addictive diseases. This description has been developed by groups such as Alcoholics Anonymous, by the medical profession, and by various popularizers of the idea that alcoholism is a disease. What they say is in every regard wrong. When they tell you that you have the “disease” of alcoholism, “chemical dependency,” obesity, compulsive gambling, or whatever, this is what they mean:
The basis of the disease is inbred and/or biological.
There is no need to look for the causes of the disease in your personal problems, the people you spend time with, the situations you find yourself in, or your ethnic or cultural background. Addiction is bred into you from birth or early childhood. Your current experience of life has nothing to do with it; nothing you can do makes you either more or less likely to become addicted.
It involves complete loss of control over your behavior.
Once involved in your addiction, you are utterly at its mercy. You cannot choose whether, or how much, to lose yourself in the involvement. No matter how costly it may be in a given situation, you will go all the way. You cannot make reasonable, responsible choices about something to which you are addicted.
Addictions are forever.
An addictive disease is like diabetes—it stays with you as long as you live. The mysterious bodily or psychic deficiency that lies at the root of addiction can never be remedied, and you can never safely expose yourself to the substance to which you were addicted. Once an addict, always an addict.
It inevitably expands until it takes over and destroys your life.
“Irreversible progression” is a hallmark of addictive diseases as they are conceived today. The addiction grows and grows until it devours you, like AIDS or cancer. No rewards, no punishments, not even the most momentous developments in your life can stay its course, unless you completely swear off the addictive substance or activity.
If you say you don’t have it, that’s when they really know you have it.
According to this “Catch-22” of the disease theory, anyone suspected of having an addictive disease who insists that he or she doesn’t have the disease is displaying the disease symptom of “denial.” In this way, the “disease” label is like a web that traps a person more firmly the harder the person fights to get out of it.
It requires medical and/or “spiritual” treatment.
Thinking you can cure your addiction through willpower, changes in your life circumstances, or personal growth is a delusion (like denial), according to disease-theory proponents. Addiction is a disease of the body that can be controlled only by never-ending medical treatments. It is also a disease of the soul requiring lifetime membership in a twelve-step support group like Alcoholics Anonymous. Why supposed medical treatment consists mainly of going to group meetings and why people can’t develop their own spiritual approaches to life if they choose are questions disease theory boosters ignore.
Your kids are going to get it, too.
Since addiction is an inherited disease, the children of addicts are considered at high risk for developing the same disease—no matter what you or they do or how careful you are. Logical deductions from this viewpoint are that you should have your kids tested for their genetic predisposition to alcoholism or addiction before they start school, or that you should simply teach them never to touch a drop of alcohol or expose themselves to whatever your addiction is. Obviously, this approach presents special difficulties in dealing with addictions to eating, shopping, and making love.
Where did these notions come from—notions that, when examined in the clear light of day, often seem quite bizarre and contrary to common experience? The disease theory takes a set of precepts that were made up by and about a small group of severe, long-term alcoholics in the 1930s and applies them inappropriately to people with a wide range of drinking and other life problems. The original members of Alcoholics Anonymous, realizing they would soon die if they did not give up alcohol, adopted wholesale the dogma of the nineteenth century temperance movement. The one major difference was that the A.A. members said drinking was a disease only for them, and not for everyone who drank—therefore not everyone needed to eschew “demon rum,” as temperance advocates had insisted.
Every major tenet of the “disease” view of addiction is refuted both by scientific research and by everyday observation. This is true even for alcoholism and drug addiction, let alone the many other behaviors that plainly have little to do with biology and medicine.
No biological or genetic mechanisms have been identified that account for addictive behavior.
Even for alcoholism, the evidence for genetic inheritance is minor. At one point we seemed to hear regular announcements that scientists have discovered a gene that causes alcoholism or addiction. But this idea is no longer proposed the way it was. Sure, people still feel that addiction may be inherited. But no one speaks about a gene for addiction—there’s a recognition that addiction is just too complicated to be contained within a simple inherited process. Even if a number of genes (which is now how such thinking runs today) are found to influence addiction, would the same genes cause alcoholism and drug addiction? What about smoking? Would the same genes also cause compulsive gambling and overeating? If so, this would mean that everyone with any of these addictions has this genetic inheritance. Indeed, given the large number of addictive problems we’ve uncovered, it would seem that half of the population has some form of these addiction genes.
How could an addiction like smoking be genetic? Why are some types of people more likely to smoke than others (about half of waitresses and car salesmen smoke, compared with about a tenth of lawyers and doctors)? And does believing that an addiction like smoking is genetic help the person quit (are all those smokers who quit not “genetically” addicted)? Returning to alcohol, are people really predestined biologically to become alcoholics and thus to become AA members? Think about the rock group Aerosmith: all five members of this group joined AA at once, just as they once all drank and took drugs together. How unlikely a coincidence it is that five unrelated people with the alcoholic/addictive inheritance should run into one another and form a band!
The idea that genes make you become alcoholic cannot possibly help us understand how people develop drinking problems over years, why they choose on so many occasions to go out drinking, how they become members of heavy-drinking groups, and how drinkers are so influenced by the circumstances of their lives. Genes may make a person unusually sensitive to the physiological effects of alcohol; a person can find drinking extremely relaxing or enjoyable; but this says nothing about how the person drinks over the course of a lifetime. After all, some people say, “I never have more than one or two drinks at a time, because alcohol goes straight to my head.” And how much more true is this for people taking drugs like crack, which only some groups go in for. And why do more younger people become obese all the time, if obesity is inherited?
You will see here and in the following modules that whether people become—and remain—addicted has a lot more to do with the groups they come from and associate with, and from their beliefs and expectations about alcohol or drugs (or other activities), than from their biological makeup. Often, people who become addicted set themselves up by investing a substance or an
experience with magical powers to transform their beings (“When I drink I’m really at ease”; “Drinking makes me attractive to people of the opposite sex”; “I only feel good about myself when I am buying clothing”; “Gambling rescues me from my hum-drum existence.”). It is simply not within the chemical properties of alcohol or a drug, or the experience of activities like shopping and gambling, to offer people what they want and seek from an addiction.
People find these feelings in an addiction when they believe they can’t achieve the feelings they need in ordinary ways. Clearly, attitudes, values, and the opportunities people have in their lives have the most to do with whether a person has a significant risk for one type of addiction or another.
Addiction is not a “hot spot” in the brain.
In the last twenty years, our attention has shifted from genetics to neuroscience, as represented by Nora Volkow, director of the National Institute on Drug Abuse, who has become a media star with the meme, “Addiction is all about the dopamine.” This refers to a neurochemical that may be entailed in the pleasure centers of the brain, and which various drugs and activities stimulate.
On the one hand, focusing on dopamine and neurochemistry offers a chance to put a wide variety of addictions in the same bag, since eating, sex, gambling, shopping may all stimulate dopamine. And, so, decades after I wrote Love and Addictionwith Archie Brodsky, where we said gambling and non-drug activities can be addictive, comes the American Psychiatric Association’s diagnostic manual to recognize gambling, and potentially many other things, as being addictive. Addiction is not due to drugs!
But this simply raises the same old specters. If everything and anything can be addictive, then what causes someone to become addicted, since we all do one or many of these things? In come deficiency models—perhaps some people don’t have enough dopamine production. But, then, why do people largely give up their addictions—like smoking and, as we shall see, alcoholism and drug addiction? The neurochemical model is no good for telling us about maturing out, the most common route out of addiction. It tells us primarily that we are (thank you Dr. Volkow) hopeless, unless and until we rely on an addiction doctor, like those in the newly-formed American Board of Addiction Medicine.
Volkow is fond of interviews (like one on 60 Minutes) where she points out the certain places in the brain light up on brain scans when people take cocaine. Right—and so what? Why do some people continue to return to this state ad infinitum, some do it occasionally, and some do it intensely for a time, and then quit, or even cut back? Now that we know that similar (or other) parts of our brains light up when we have sex, or eat, or go shopping, or gamble, what stops us all from being permanently addicted. Volkow is fond of showing that, as we have long known, the brains of adicts light up even when not taking the drug from seeing the drug, or even locations where they took it. Yes, and so why did my Uncle Oscar—and many, many people you know, or perhaps you yourself—quit his (in Oscar’s case) four-pack-a-day habit in his early forties, after 25 years of smoking, and never smoke again?
People, like you, quit addictions when they want to, need to, have to, live out more important parts of their lives, and then they cope with urges to return to smoking, or gambling, or drugs, or alcohol—or cut back on shopping, or eating and, yes, even gambling, sex, and drugs. I testified at a murder trial where the defense’s position was that the man had killed because he had an irresistible need for cocaine which he could only get through stealing his dealer’s cocaine stash, which in order to do he would first have to kill the man (and, while he was at it, his girlfriend). Would you kill someone to go shopping?
The reason I ask is because the defense attorney asked me, “Are you going to tell me that since my mother quit smoking a dozen years ago, she hasn’t woken each and every morning wanting to smoke a cigarette?” And I replied, “Has she smoked again? (She hadn’t.) And if she really wanted a cigarette, would she kills someone to get it?” Or, we might ask, “Would your mother keep smoking if she knew she was deforming a fetus in her womb?” Because the answer, for more mothers and other people than for any recipient of psychiatric meds, the answer is often “no.”
People do not necessarily lose control of themselves..
In spite of what the government and treatment programs tell us, we all know that many people escape addictions without treatment. How do we know? Because so many of us, our friends, and our loved ones have quit addictions, including the most common drug addiction, smoking. You have heard, and no doubt believe, that smoking is an addiction. But you may feel it’s not an addiction like heroin addiction or cocaine addiction or alcoholism. However, those in the best position to know—alcoholics and drug addicts who smoke—rate smoking at the top of the list of hardest addictions to quit.
Yet, around 90 percent of addicted smokers who quit do so without any kind of treatment. This percentage of smoking self-quitters has gone down slightly since the 1980s, since so many medical treatments for quitting (i.e., nicotine gums and patches) are promoted endlessly on television and other media. But self-quitters smokers are still the large majority of ex-smokers. You can prove this by asking a group of middle-aged people if any of them has quit smoking, and then asking how many did so through any form of treatment (like a nicotine patch).
I do such “experiments” all the time. For instance, I lecture groups of alcoholism/addiction counselors, people who swear that the only way addicts can recover is through going to treatment and joining AA or another twelve-step group like they did. I first ask them, “What is the toughest drug addiction to quit?” The audience, virtually in one voice, shouts out “nicotine” or “cigarettes.” “How many of you have quit?” I inquire. Often a majority raise their hands. Then I ask, “How many of you quit smoking because of treatment or joining a support group?”
In rooms of hundreds of people who work in the treatment field and have quit smoking, never more than a handful have ever said they quit with formal treatment. “Wait a minute,” I deadpan. “You people are too radical for me. You tell people all the time that they can’t quit addictions on their own. Yet you—a group of highly experienced counselors, many of whom have quit more than one addiction yourselves—tell me you quit the toughest addiction without treatment.”
In a further development, in 2012 leading smoking researchers checked to see whether people who quit cigarettes did better with nicotine replacements (like gum or patches). They did no better than those who quit without the drug replacement. And the worst smokers (the most addicted) were twice as likely to relapse when they relied on such medical interventions as those who quit cold turkey!
How Uncle Ozzie Quit Smoking
So how do so many people quit the toughest of all drugs? Let’s examine the remarkable story of my Uncle Ozzie. Ozzie was born in Russia in 1915 but came to the United States as a small child. As a teenager he developed an addiction to smoking. Outwardly calm, Ozzie did not have obvious reasons for smoking. Nonetheless, he continued to smoke into the early 1960s. But Ozzie quit smoking in 1963, the year before the surgeon general’s 1964 report making clear that cigarettes cause cancer.
I didn’t actually notice my uncle had quit until years after the fact, when I saw him at a family gathering when I was home from school, after I became interested in the question of addiction. I asked him, “Ozzie, didn’t you used to smoke?” Ozzie then told me his story.
He began smoking at the age of eighteen and continued smoking for thirty years. Ozzie described his smoking as “a horrible habit”—he smoked four packs a day of unfiltered Pall Malls. He kept a cigarette burning constantly at his workbench (Ozzie was a radio and TV repairman). He described how his fingers were stained a permanent yellow. But, he said, until the day he quit, he had never even considered giving it up. On that day the price of a pack of cigarettes rose from thirty to thirty-five cents. While eating lunch with a group of fellow employees, Ozzie went to the cigarette machine to purchase a pack. A woman co-worker said, “Look at Ozzie—if they raised the price of smokes to a dollar, he’d pay them. He’s a sucker for the tobacco companies!”
Ozzie replied, “You’re right—I’m going to quit.”
The woman, also a smoker, said, “Can I have that pack of cigarettes you just bought?” Ozzie answered, “What, and waste thirty-five cents?” He smoked that pack and never smoked again. A few years ago, Ozzie died. He was over ninety years old.
Why did my uncle Ozzie quit? To understand that, you’d have to understand what kind of person he was. Ozzie was a union activist and shop steward. Adamantly left-wing, he was a man who lived by his beliefs. It was Ozzie’s job to stand up for any worker sanctioned by the company. As a result, he believed, he was punished for his activism by being sent out to the worst parts of the city on television repair calls.
Why did Uncle Ozzie quit smoking that one day, after thirty years of constant, intense smoking? He had never previously considered quitting, but less than twenty-five words thrown out by a blue-collar colleague somehow caused him to drop the addiction. We will return to this question in a subsequent blog, but for now it is enough to recognize that he did it.
Without the aid of a support group or medicated patch, Ozzie overcame his smoking addiction. And fifty million other American ex-smokers have done the same thing.
Guest Column: A case for safe injection facilities in Chittenden County
By Zach Rhoads
By Observer November 30, 2017
During a press conference Wednesday, State’s Attorney Sarah George announced she will support legislation to legally permit state-run “supervised injection facilities” — where drug users are permitted to consume or inject drugs under medical supervision.
George spoke on behalf of a commission she launched in February, tasked with deciding whether these facilities could curtail harms associated with intravenous drug use in Chittenden County. The group of drug treatment, health care and law enforcement experts made a unanimous decision to support the proposed bills (S.107 and H.108).
“When people first asked me about (supervised injection facilities), I had no idea what they were, and I got a little uncomfortable with it,” she told me. “But after doing some research, I found that they were shown to save lives, which was enough for me to make this a very public conversation.”
Indeed, SIF, as they are called, are widely known to reduce harm and social costs related to injection drug use. One of the key features of these facilities is having medical staff on board to save lives, should anyone overdose. Among the 100 such facilities that already exist within 10 countries worldwide, every public health metric is headed in a positive direction.
But the concept is literally foreign to Americans — no SIFs exist in the U.S. — and many citizens of Chittenden County have serious concerns around the concept. That’s why Sarah George and the commission wrote a detailed, publically-available report.
“The report outlines all the pros and cons the best we can,” George explained, “People want to know, is there a risk of people driving under the influence? Is this going to cost taxpayers a lot of money? Will this increase crime around the facility? Does this enable drug use?’”
The weight of evidence overwhelmingly contradicts those fears. SIFs reduce public injecting, increase voluntary enrollment in treatment, reduce bloodborne diseases, minimize overdose-related deaths, and save money due to reduction in emergency services. George added something crucial regarding the fear that we will enable drug users: “Research has shown that it is not true,” she said. “If anything, the people who will use a safe consumption site are already using. So yes, we are enabling — we are enabling people to make safer choices than they were before.”
These facilities are effective because they are woven into the social fabric. People use drugs in dangerous ways because stigma and fear of legal sanctions deter them from seeking help. Their isolation prevents them from accessing available resources, leading to unsafe use that multiplies their chance of dying. SIFs remove users’ fear of stigma and legal consequences, making it easier for them to access treatment and to further integrate into a non-using lifestyle.
Public fears around SIFs are eerily similar to the fears around Burlington’s syringe exchange program (Safe Recovery) before it opened in 2001. It’s worth mentioning, Safe Recovery has been beneficial for public health since day one. It helped reduced much of the harm associated with intraveinous drug use, including HIV and Hepatitis C. The program still provides clean drug injection equipment, medical assistance, naloxone (an overdose antidote) and on-the-spot referrals to evidence-based treatment. It even provides support with housing, insurance and legal problems, understanding that people must become stable before they can make positive long-term changes.
Perhaps it will ease the minds of concerned citizens to think of a safe injection facility as a logical extension of Safe Recovery. It would likely include all of the tried-and-true health services currently available while also providing a safe and hygienic setting for injection with medical staff aboard should an overdose occur (there has never been a death at any of the 100 SIFs around the world).
Given our current public health crisis, it would be unwise to ignore any serious attempt to reduce harm. With SIFs, there is abundant evidence of effectiveness.
While there is currently no specific plan to open a facility in Chittenden County, the proposed legislation could lay the legal foundation for that process. The state’s attorney’s commission will present its report at a legislative session Jan. 5.
Zach Rhoads is a graduate of Williston Central School and Champlain Valley Union High School. He is an interventionist at South Burlington High School and member of the Chittenden County Opioid Alliance.
Conservative Republicans and Christians aren’t against sex — just adult sex
News item: Roy Moore, the Republican senatorial candidate from Alabama, stands accused of dating teenagers when he was a professional in his 30s (to which he has largely conceded) and — criminally — of sexual petting with a 14-year-old.
Roy Moore stands out even among modern Republicans for his religiosity — having been forced out of his judgeship, first for insisting on religious ornamentation in the courthouse, and again for refusing to obey Supreme Court rulings concerning gay marriage. In his judicial actions, Moore has declared that all power “comes from God,” rather than from the Constitution.
Which makes him unfit to hold public office in the United States. But it’s only his dating history that has seemingly endangered his ability to assume a Senate seat as a Republican.
Moore operates within a national Republican Party that holds as a fundamental principle the defunding of Planned Parenthood. PP, for its part, holds as one of its founding principles the right of women to have sex while protecting themselves from health and family-planning hazards.
The idea of mature independent women’s sexuality drives Republicans’ and conservative Christians’ opposition. This follows, as Kathryn Brightbill has made clear, since adult male sex and marriage with teen girls is a regular feature of Evangelical Christianity adopted into conservative politics:
“Duck Dynasty” star Phil Robertson advocated for adult men to marry 15- and 16-year-old girls and deemed age 20 too old because “you wait until they get to be 20 years old, the only picking that’s going to take place is your pocket.” Home-school leader Kevin Swanson, whose 2015 convention was attended by several Republican presidential candidates, defended Robertson on his radio show after the story broke. Advocating for child marriage hasn’t slowed down Robertson’s career. He just got a new show on the conservative digital network CRTV.
As witnessed by hyper-Christian Moore’s dating habits with (in his words) “young women” on his return from the service to a rural Alabama county, where he served as an assistant district attorney. And we can’t be surprised by Alabamans’ biblical defense of Moore.
Moore didn’t have sexual intercourse with any of the young women; he merely courted them, first (it seems) getting their parents’ permission.
Except with the 14-year-old, whom he is accused of seeing surreptitiously, then engaging in secondary petting (contact outside their underwear).
This is in the late 1970s when, shall we say, many people of Moore’s age were engaging in mature, adult sex.
Moore may have been guilty of a sexual crime for having any sort of sexual contact with a minor — a crime not to be made light of.
But what drove his allegedly illegal — and always inappropriate — sexual connection to virginal teenagers was a case of arrested sexual development that runs much deeper than his own psyche. This failure to accept adult sexuality is one embedded in his entire cultural context.
Fareed Zakaria, CNN commentator, Yale trustee, Harvard Ph.D., Washington Post columnist, and best-selling author has now weighed in on his plagiarism. I find three things notable about his explanation/excuse-making and the reactions it has generated—especially in light of my experience reporting plagiarism to the Harvard Medical School some years ago against the head of Harvard University’s Division on Addiction, Howard Shaffer.
1. He did nothing wrong. Although people, including journalists, refer to Zakaria’s initial apology as an acknowledgement that he plagiarized, it was nothing of the sort. As I pointed out, Zakaria never admitted to plagiarizing, but simply asserted on the pages of Time that observers were “right” to notice the “close similarities to paragraphs in Jill Lepore’s essay.” What the hell was he admitting to, I asked?
I also correctly predicted his defense, that of most plagiarizers, that “they inadvertently lift the passages and store them as notes, then just as inadvertently plunk them back down in their own article, dissertation, or book.” As reported in the Huffington Post: “Zakaria strongly denied that any assistant or intern wrote his work, and said that his mistake came from mixing up different notes from different sources.”
This has been, from time immemorial, plagiarizers’ defense. The Atlantic’s Wire noted this going back a decade and more:
As Slate’s David Plotz pointed out in 2002 (in reference to the Stephen Ambrose scandal):
No matter what they steal, they fall back on the same excuses, as Thomas Mallon shows in his wonderful plagiarism book Stolen Words. Before the computer age, they blamed their confusing “notebooks,” where they allegedly mixed up their own notes with passages recorded elsewhere. These days, plagiarists claim they mistake electronic files of notes with their own writing.
Zakaria can especially point out that he was using the source he stole from as a source for other materials, which somehow makes it less stealing. As one commenter to my Huffington Post blog put it: “The poor guy was merely recounting FACTS. YES they were lifted. YES he probably just read Lepore’s article and started paraphrasing. But it’s not like he completely stole her argument.” See, just because someone else has read and thought about a topic or idea, and you short-circuit that process by lifting their citations and the writer’s descriptions of them in making your argument, that’s not plagiarism!
In my case with Dr. Shaffer, the main liftings were of references and their interpretation in terms of a larger argument that Shaffer and I were both making. What’s the harm in that? Shaffer might have read them and had the same reactions and made the same arguments—he just borrowed mine without attributing me. Then Shaffer raised the “notes” argument—he just made them and accidentally credited them as his own writing. After noting the lifted passages (which even Shaffer acknowledged), the HMS ethics committee bought Shaffer’s argument hook, line, and sinker.
As I said to the committee evaluating the case, and as I noted about Zakaria, how does that work? You mean the person reread the notes he copied and thought that he wrote that, read those references, and had those thoughts about them himself? “My, I really wrote something pretty clever there, perhaps while I was sleeping.” I just don’t understand that process.
2. Attack the complainant. A typical comment at my HuffPo blog based on my post about Zakaria’s plagiarism: “Fareed Zakaria has a dedicated anti-fan club that constantly posts extremely negative comments about his views and attacks him as a person.” This was Zakaria’s own main point of attack: “Zakaria was also forced to address accusations of quote-lifting in a recent book, causing him to lash out at critics who he said were trying to use the fracas to wound him further.”
I’m not guilty! I’ve never criticized Zakaria before! I always thought he was insightful and well-informed!
Psheew. Let me calm down. I got a little defensive there. But you see how this works. In my case, when I complained to Dr. Shaffer, he told me that he had ceased referring to my work, since I was such a complainer! He did nothing wrong—it was my problem! This was what caused me to file my complaint with Harvard Medical School. While my complaint was pending, Shaffer’s attorney contacted and threatened me. Harvard noted Shaffer’s effort at intimidating me and that this was a violation of their procedures. Shaffer desisted—at least he never sued me—but not before I was forced to hire an attorney. The committee said that Shaffer might have been sanctioned for his actions in interfering with its process, but he wasn’t.
3. What’s the big deal? It now seems as though Zakaria will skate. At least his media platforms have begun excusing his actions and welcoming him back. Zakaria did resign from his trustee’s position at Yale, however. Yale might have faced larger problems in tolerating Zakaria’s malfeasance, since the University constantly confronts incidents exactly like it—down to the same excuses and rationalizations—perpetrated by students.
Anyhow, Shaffer is still director of Harvard’s Division on Addiction and never suffered any consequences of which I am aware. (You don’t think he’s going to sue me now, do you?*)
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* I wrote Howard:
Howard, What did you think of the Zakaria scandal?
It reminded me a lot of what you did, didn’t it you? Please let me know if I got any facts wrong so that I can correct them. (Do you still use the same attorney? Shall I expect to hear from him?)