Before you comment on the site, please give this a read – you might find that your questions and comments are already addressed here. This is by no means an exhaustive list of frequently asked questions; it will be expanded over time.
Who writes this stuff? Whoever they are, they must not be an addict.
All content on the site is written by me, Steven Slate. I don’t consider myself an addict, because I don’t subscribe to that label. However, my former behavior would probably classify me as an addict in most anyone’s book. I was an avid substance user between 1993 and 2002. For the last 5 of those years, I used drugs in a very troubling on a daily basis, with a few short periods of abstinence. I felt as if I needed the drugs during that time. I lied, cheated and stole in order to fund my habit. Made several trips through the addiction treatment system and several 12-step groups. I felt powerless at certain points, as if I needed drugs, and was unable to stop. I ended up homeless for a while, was arrested many times, and did a short stint in jail. Luckily, I found an answer, and changed my substance use habits in 2002.
What makes you qualified to talk about addiction?
I’ve studied it for 16 years. Before that, I lived it. I have 12 years experience working for Baldwin Research Institute/Saint Jude Retreats (a non-12-step educational program for people with substance use problems) as an instructor, lead instructor, instructor trainer, director, and author/researcher. I have chapters on addiction in college textbooks. I count Mark Scheeren and Stanton Peele (both giant thinkers in the field in my eyes) as personal mentors in helping me to understand this fascinating phenomenon and make my own contributions to understanding it.
I ask no one to believe my views based on my personal and professional experience with substance use problems alone. I hope you’ll look at the information on the site, check out some of the citations for yourself, analyze the ideas critically, and form your own opinions.
What do you think about Harm Reduction?
I’m all for it. The ultimate harm reduction measure, as I see it, would be full legalization of all drugs for adults. This would remove the harms of the black market, including especially the harms coming from unknown quality of drugs, and exorbitant drug prices artificially inflated by prohibition and the drug war. And of course, if people didn’t have to worry about arrest and deal with being caught in the legal system, their lives would be harmed far less by their victimless choices. Liberty for drug users would go furthest in reducing harms.
Needle exchange is obviously good, full legalization of needles would be good too. We could go on and on with great things that are being done and can be done to reduce harms. I’m all for it.
I have one major issue with Harm Reduction though, and that’s the rhetoric surrounding it. Many seem to base it around the idea that people with drug use problems are incapable of solving their problems. Fuck that. They can, and we do them a disservice by conveying the message that they can’t. And by “solving their problems” I do not exclusively mean abstinence. I mean, they can stop feeling the need to use drugs in a destructive way. But while we’re at it, abstinence can also be the ultimate harm reduction – yet many (not all) in the harm reduction movement seem to pit harm reduction against abstinence. And again, they suggest that it’s impossible for some. Now I don’t believe anyone should be required to abstain, or led to believe they must abstain – but they also shouldn’t be told that abstinence is bad or impossible. I was abstinent of all drugs for almost 5 years, and I believe it was the absolute best choice for me at that time of my life. I think that to help people, we have to help them to explore their choices, which means openly exploring abstinence and forms of moderation – as well as continued heavy use with harm reduction measures. Let’s put it all on the table. The anti-abstinence camp is overreacting to the history of enforced abstinence, in my opinion.
On a personal level, I think the easiest thing any individual can do to help reduce harms is stop badgering people to quit. They’re already stressed the fuck out, and more pressure isn’t gonna make their journey any easier. Also, stop portraying them as powerless. If they like getting high, accept that – it is their life, not yours. Don’t put them in the position of having to justify their preferences to you. This only confuses them and deepens the problem. I know this from being on the receiving end of the pressure to quit and to justify myself. I only dug my hole deeper in response to that crap.
What do you think of buprenorphine / methadone / MAT / OAT / OST?
I am critical of the hype around these addiction treatments, but I am not against them in any way. I think that the claims of their effectiveness have been very deceptive. Activists have focused on evidence of reduction in fatal overdoses associated with use of these medications, which is important. But this evidence has been conflated with the claim that these medications are effective at treating addiction. Addiction is a slippery concept to be sure, but one thing it means to most people is continued excessive use of a substance despite high negative costs and consequences. So, an effective addiction treatment, in most people’s minds, would be something that helps people to reduce their substance use. Evidence of overdose reduction is not evidence of success in treating addiction. It is evidence of preventing one negative consequence of addiction. I’m not trying to downplay that. Preventing overdoses is a great thing. It’s just not the same thing as successfully treating addiction.
To be clear, my issue with the hype around these medications is that they are claimed to be the “gold standard of opioid addiction treatment” and said to have a lot of evidence to prove that, but this claim is almost always followed by a reference to evidence of overdose reduction. It would be more accurate if activists just made a claim about overdose reduction instead of conflating overdose reduction with treating addiction.
I have not been able to find evidence that these treatments help people to significantly reduce their substance use beyond a period of a few months. When I criticize, I am not trying to deter anyone from taking these medications. I am simply arguing for realistic presentation of the reality of these treatments. While there are certainly anecdotes of success with these medications (and anecdotes of failure), there does not seem to be a good body of evidence of long-term effectiveness at reducing excessive drug use with them. My opinion, based on the evidence I’ve seen, is that successes seen in methadone/buprenorphine patients are usually a matter of regression to the mean. That is to say, these successes represent changes the individual would’ve gone through even if they hadn’t taken the treatment.
Some important context needed in assessing the effectiveness of any addiction treatment: most people get over these problems without treatment. For example, 88% of the American soldiers in Vietnam with heroin addictions quit upon returning home and did not relapse. Only 2% received treatment when coming home. In 24 year follow up, 96% had recovered. Date from NESARC 2002 epidemiological survey showed that the probability of recovery from prescription opioid addiction is 96%. Furthermore, 88% of people who’d had heroin addictions at some point were currently recovered for a year or more, and those who received treatment did not have a higher rate of recovery than those who received treatment. When we hear a story of someone recovering with a particular treatment, we tend to think the treatment was the cause of the recovery, when in fact the person is just as likely to recover without it – which makes it very hard, when you think critically, to credit the treatment for their success. For this reason, I am skeptical of all claims of treatment effectiveness, not just MAT.
With that said, I am happy for anyone who finds methadone or buprenorphine personally helpful and lifesaving. There is nothing for you to be ashamed of, and nothing wrong with taking a medication for the rest of your life when you find that the benefits personally outweigh the costs.
For anyone who thinks they may need buprenorphine, you can find prescribing doctors through the SAMHSA Buprenorphine Practitioner Locator.
Many (not all) MAT activists have made the issue very black & white, and seem to be intolerant of any opinion that doesn’t glorify these medications. For this reason, many are quick to portray me as being against these medications, or as a denier of any success associated with their use.
To be clear I am not anti or pro these medications. I am neutral. While I do not think that they work like many think they do, this is not the same as being against them or against people taking them. I also support full legalization of all drugs, for any adult to walk into a pharmacy and buy without a prescription – that includes methadone and buprenorphine. This does not mean that I recommend them or against them.
Stop bashing AA. Why don’t you create a program instead of knocking other programs?
I don’t think I’m really “bashing” AA (based on my concept of bashing), but yes I’m very critical, and I won’t stop. I’m here to explore and spread the truth about addiction, and I will continue to feel free to criticize anyone who I believe stands in the way of that mission and/or actively spreads misinformation. If you don’t like it, close the window. If you’re about to send me hate-mail telling me that I’m killing people with my words, save it – I’ve gotten that email about a million times.
I work developing solutions for people with substance use problems. I created my own educational program that I used with clients as part of coaching for a few years; then I worked with Stanton Peele translating some of his work into a distance learning program; and then I went back to work with the Saint Jude Retreats, where I co-authored the 13th edition of the Saint Jude Program (published May 2014), and have been intimately involved in the development of our Cognitive Behavioral Education method of helping people with substance use problems.
I knock other programs because it is actually addiction mythology spread by those programs that keeps people feeling trapped in addiction. They cause more problems than they solve.
You say “addiction is not a disease” – don’t you know the authorities say it is definitely a disease?
I do know that NIDA, ASAM, the AMA, Nora Volkow MD, Dr Phil, Dr Drew, and many others say that addiction is a disease. Just as I hope you don’t uncritically take my word on the issue, I hope you don’t uncritically take their word on it as well. Please think critically, and judge the evidence for yourself. I have looked at the evidence and arguments presented for the disease model of addiction, and I can’t find anything that holds up to scrutiny.
If authority is all you care about, then let me say this – I can list plenty of authoritative sources who have also concluded that addiction is not a disease: Gene Heyman PhD of Harvard; Sally Satel MD of Yale; Stanton Peele PhD of NYU and The New School for Social Research; Peter Cohen PhD of the Centre For Drug Research in Amsterdam; Thomas Szasz; Professer David Hanson PhD; Professor Jeffrey Schaler; Dr Tom Horvath and the many other PhDs behind SMART Recovery. There are more to be listed, in fact there have been several polls over the years asking doctors if they believe addiction or alcoholism is a disease, and majorities have said they don’t believe it is a disease.
So we could come up with two groups of professionals that hold opposite opinions about whether addiction is a disease or not. What would we do then – count them up and see which side has more people? Is that how you decide a scientific truth – by a vote? Obviously it is not. A fact is a fact regardless of how many people believe it or not. So please, analyze the available information, and judge for yourself.
For you people who can only comprehend appeals to authority, here is a page full of quotes from credentialed experts. LINK to Quotes from Experts About Addiction. I hope and pray that you gain the courage one day to think for yourself and trust your own judgment.
Why does it matter whether addiction is a disease or not? Let’s just help people.
There is such a thing as a stupid question, and this is one. If you want to solve a problem, you need to understand the nature of the problem. If your car won’t run because it’s out of gas, changing the battery won’t do a damn thing to fix that problem. Likewise, if people are experiencing problems with drug and alcohol use, we need to understand why they are using drugs and alcohol. Is the use caused by a disease or something else? This is important to know because it will direct your approach to solving the problem.
If heavy drug and alcohol use isn’t caused by a disease, then why do people do it?
People freely choose to use drugs and alcohol because, at the time they’re doing it, they believe it will make them happy. At the time they do it, they believe it is their best available option for attaining happiness.
But there are horrible consequences to heavy drug and alcohol use. How can that make people happy?
Those negative consequences (or costs) may not make people happy. The consequences are often extreme and disastrous, even fatal. Obviously, the consequences put people through a lot of turmoil, so they’re not happy about the consequences when they set in. Nor are they necessarily happy in times where they simply feel regret about continuing their destructive habit. However, this doesn’t change the fact that at first, when the high kicks in, they experience a certain kind of happiness/pleasure.
So people use drugs and alcohol because they’re depressed?
No. I see how people arrive at that conclusion, and I see how a state of depression can be used as a reason to use drugs and alcohol, but it’s important to know that depression (or other troubling mood states such as anxiety or stress) doesn’t directly “cause” drug and alcohol use. A vast majority of people experience depression without reacting by using drugs and alcohol. Why is that? Probably because they don’t believe that drug and alcohol use is their best viable option for attaining personal happiness. Again, people use drugs and alcohol because they believe it will bring them happiness.
But I have stress/anxiety/trauma/depression, and these problems make me use drugs and alcohol. Are you saying I shouldn’t get help for those things?
No. You should get whatever help you feel is necessary for those things. However, as long as you believe that drugs and alcohol are your best viable option for happiness, you will continue to use drugs and alcohol – no matter what help you’re getting for your other problems. On the issue of “addiction”, you will change it when you cease to believe that heavy drug and alcohol use is your best option for finding happiness. Work on changing that belief if you want to change your habit.
Believing in the “underlying causes of addiction” (and/or “self-medication”) model creates a more complicated problem. If you invest in this idea, then every time life sends a problem your way, or when you feel the very normal emotions of sadness, depression, stress, or anxiety – then you will feel as if you must use drugs and alcohol. If you cease to believe that heavy drug or alcohol use is your best option for happiness then you will cease the heavy use of drugs and alcohol – regardless of whether you continue to face depression, stress, anxiety, etc.
But what about physical addiction – tolerance and withdrawal – doesn’t that cause people to use drugs and alcohol?
No it doesn’t. These are medical problems which are separate from the behavioral pattern known as addiction. Withdrawal syndrome is a set of physical symptoms people experience when they stop using alcohol and certain drugs. It doesn’t cause you to do anything other than experience the consequences of detoxification. If you believe you’ll be happier detoxifying with medical help or not, then you will do that. If you believe you’d be happier taking more drugs and alcohol, you will do that. But in neither case are you forced to do anything behaviorally. If you’re experiencing withdrawal symptoms, the best choice is usually to seek medical help from your local emergency room, as withdrawal from alcohol and some drugs can have fatal consequences.
Consider the fact that a large proportion of people who receive medical help with detoxification go back to heavy drug or alcohol use after withdrawal symptoms are gone. What caused them to do that? You guessed it – they thought they’d be happier drunk or high. Substance use is a choice like any other choice that people make every day of their lives: people do what they think is their best option within their power to be happy.
You say addiction is a choice, so what do you suggest people do, use willpower to quit?
No. Willpower is a confused concept. I suggest people stay as far away from that idea as possible. “Addicts” have no less or no more “willpower” than anyone else. Every behavior that every person makes at any given time is, in a sense, an expression of willpower. To do something is to exercise the power to carry out your will. If you’re choosing to use drugs, then that is your will. If you’re choosing to ride your bike, go to work, clean your house, or drink a smoothie – then those are also your will. I don’t suggest that anyone go on a hunt for some special level or source of “willpower.”
What you can do, is change your will. When you start looking for new options in life, re-evaluating your usual options, and examine and change the beliefs that underlie the “will” for heavy drug and alcohol use – then your “will” will probably change. Essentially, if you choose to think differently about drugs and alcohol, and about how they fit into your life and competing goals, then your desire for them will change.
When we think about using willpower to change a substance use habit, we’re probably accepting the desire/will for substance use as an inevitability – a thing we’re stuck with, that we must battle with this special force called willpower. And in a certain sense, we’re thinking of it as not being our own will. But it is. If you’re doing a thing, you are willing it – and you can’t will it’s opposite at the same exact time.
See how confusing all of that is? But it is the trap we get into when we conceive of willpower as a force we need to build in order to battle our own will – a sort of circular thinking necessitated by modern willpower theorists.
However, if you think of the context in which willpower is usually mentioned, it often represents the act of subjugating your immediate gratification desires to your longer-term goals. If you care more about those longer term goals, believe you can achieve them, and think it’s worth delaying your gratification – then you will end up without the will to use substances heavily – no special power needed, just a different set of thoughts and perspective. But then, the concept of willpower needn’t be involved at all – because it only mucks up the situation, and makes you feel like you’re weak and need to summon some extra strength. You don’t. You just need to believe in a different path to happiness, and thus have a different “will” to carry out. Some people who are successful in 12-step programs invest in the idea of carrying out god’s will. It becomes so attractive to them, that they no longer have the will to use substances. That’s wonderful for them, but that idea doesn’t appeal equally to all people.
So what should I do to change my substance use habit?
If you think you may need help for physical withdrawal symptoms, get it (from a hospital, emergency room, or private doctor). Then…
The simple answer is: make different choices. The slightly more complex answer is: develop a vision of a lifestyle and choices that will make you happier than how you’re living now – this will lead to the motivation to live differently and make new choices. It’s not an easy answer, because it means that you have the responsibility for change in a very personal way: you need to think about what you want for yourself in a big way, and go about pursuing it. This answer doesn’t allow you to blame any “causes of addiction”, or attempt to shift the responsibility for change onto a therapist, god, support group, or medication. It requires new thoughts from you, if you want change.
There are infinite paths that will get you to a place where you no longer believe that heavy substance use is your best option for happiness. I mentioned one in the FAQ above – some people come to believe that they’d be happier with the 12-step lifestyle than with a heavy substance use lifestyle. Unfortunately, I can’t recommend that one, because it comes along with a set of beliefs that undermine most people’s efforts at change (and with AA’s 95% dropout rate, it clearly isn’t attractive to most). Nevertheless, some still find it to be a better option than heavy substance use – they find it so attractive that they can actually become somewhat impervious to the negative teachings and dynamics of the 12-step world. The good news is that most people figure out that they’d be happier with a new course of behavior on their own, without formal help. You can be one of those people. There is no set of easy steps that will help everyone to find their happier lifestyle, and there is no way to force someone to believe that they’ll be happier with a different lifestyle. Each individual must think for themselves about the value of their habit, and to think of their happiest options, and whether to pursue change or not.
I maintain strongly that everyone already has what it takes inside of them to change their substance use habits. If you have your heart set on getting formal help with a substance use problem, the only program I can wholeheartedly recommend is the Saint Jude Program. It’s the solution I used for my own life back in 2002, and it is offered by the company I now work for – and as of today (3-25-14) they are advertising on this website. You’ll see their number listed above and in some banner ads on the site. As with everything I say here on the site, please don’t just take it on my authority – see what else is out there, and see what they have to say, and use your best judgment to compare.
My recommendation comes mostly from my hardline stance that addiction is not a disease, and that substance users of all stripes are always in full control of the choice to use substances. The Saint Jude Program is the only one I’ve found that truly operates with these facts as its foundation. Furthermore, it doesn’t prescribe a specific lifestyle or demand abstinence as 12-step programs do. It puts the responsibility on the troubled person to develop their own vision of a happier lifestyle, and gives them a forum which encourages doing so, and the knowledge to efficiently make personal changes that last – rather than being distracted by battling an imaginary disease or weakness.
“Why are you so obsessed with Cognitive Behavioral Therapy (CBT)? I did it at rehab and it didn’t work.”
I AM NOT.
People keep falsely attributing a recommendation of Cognitive Behavioral Therapy to me. I have studied CBT, and found it to contain much wisdom. Much of that wisdom – but not all of it – is identical to what I think is most meaningful for understanding personal problems such as heavy substance use, and how to change such problems. I have respect for CBT.
Also, my employer, Baldwin Research Institute, have pioneered an alternative method of help for people with substance use which they called Cognitive Behavioral Education – CBE. The E is key. E stands for education. They also called it CBL (Cognitive Behavioral Learning) at some point. While both of these names have been abandoned, and our approach is now named The Freedom Model, It never was a form of therapy, and I do not personally recommend or discourage therapy. BRI’s and my approach is educational. We provide educational experiences.
The confusion over the name of our approach, and the fact that we do cite research and principles identified in the CBT world may be the reason some people think I am recommending generic CBT. But again, the only things I recommend are education about the facts of “addiction,” and medical help with detoxification when needed.
“I agree with you Steven, people choose to get addicted. It’s their fault because they chose to do drugs in the first place, and then got addicted.”
I realize this isn’t a question, but it’s a frequent comment that I need to address. Now, please take note of my response to this sentiment, and let me be totally clear:
WE ARE NOT IN AGREEMENT BECAUSE THAT IS NOT HOW I SEE THIS.
The way I see it, all substance use is freely chosen. All of it. No one ever “gets addicted” by the power of a drug and enters a state where they can’t stop using drugs. There has never been a solid demonstration of the notion that those who are called addicts (or those who feel addicted; or those who feel/believe/say that they cannot stop) are involuntarily using drugs (or alcohol). The best evidence shows the opposite – that the same factors that influence other voluntary behaviors also affect the behavior of substance use in those considered “addicted.”
So I don’t think it’s people’s fault that they got addicted, because I don’t believe anyone gets addicted. “Addicted” in the common usage of the term, means unable to choose to stop; compelled to continue to use substances; using substances involuntarily.
I am also not looking to “blame” or “shame” people. I’m not looking to judge them as morally bad. I am looking to identify the fact of where control of substance use resides, and to use that knowledge to help people solve their problems. The control resides squarely in the mind of the individual.
Don’t get addiction confused with withdrawal syndrome and tolerance either when making this silly statement. These are very different things. Even NIDA understands that these are separate things. This is NOT a controversial point at this time in history of knowledge about substance use. Here’s a quote from NIDA about the distinction:
Is there a difference between physical dependence and addiction?
Yes. Addiction—or compulsive drug use despite harmful consequences—is characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal. The latter reflect physical dependence in which the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal). Physical dependence can happen with the chronic use of many drugs—including many prescription drugs, even if taken as instructed. Thus, physical dependence in and of itself does not constitute addiction, but it often accompanies addiction. This distinction can be dificult to discern, particularly with prescribed pain medications, for which the need for increasing dosages can represent tolerance or a worsening underlying problem, as opposed to the beginning of abuse or addiction.
From: Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) 2012 by NIDA (National Institute on Drug Abuse) (accessed 2/15/16)
Please keep in mind I don’t endorse that entire quote, but it makes the basic distinction clear. And now that we have that to think about, maybe you’ll want to change your position? IDK. But if you’re just thinking of physical dependence, then you may want to modify your statement to reflect that? Still, it wouldn’t apply to everyone. There are many people who have unwittingly gained a physical dependence to drugs prescribed by a doctor. That’s not their “fault” if you’re concerned with fault. However, they also aren’t “addicted.” They have a physical condition, which with many drugs and with many people, will simply cause discomfort when they cease to use, and will go away in a matter of days uneventfully as long as they don’t make it out to be more meaningful than it is. With some other drugs (primarily alcohol and benzodiazepines), in some people, depending on levels and frequency of use, medical help may be needed to safely go through withdrawal (take care, the effects can be fatal – the only way to find out for sure is to seek proper medical care). Nevertheless, this is not addiction, and these people are not compelled to continue using at high levels. This is medically handled in a matter of days. If it was what we call “addiction” then everyone could be cured of addiction in 3-14 days in hospital detox unit. Those detoxes are revolving door centers though – because people still CHOOSE to use at high rates even after their withdrawal symptoms and tolerance are gone, and dig the hole of negative consequences all over again. This behavior is what is referred to as addiction. In light of this common pattern of behavior known to all who work at detoxes, the withdrawal syndrome is actually completely INCONSEQUENTIAL to what is called addiction.
NEXT
If you try to make some comparison to cancer or diabetes, then you look like a total idiotic fool, and I hate to be associated with you. I hate it. Your argument is so silly on it’s face. People say nonsense such as:
“You don’t choose to get cancer but you choose to get addicted. You didn’t have to take drugs but you did, and now you got yourself addicted, and it’s your fault – so addiction isn’t a disease, it’s a choice.”
God, I really can’t get across how much I HATE being associated with such views. I completely disagree.
Here’s a simple hole in that statement: you absolutely can make choices that bring cancer upon yourself. Lung cancer from smoking is the perfect example. And now your whole argument has fallen apart. So if your contention is that any condition acquired by choices is not a disease, then you are wrong. PLENTY of disease are acquired by our freely chosen behavior. The fact is that you can make the choices that develop cancer, but then the cancer has a life of it’s own, and you can’t choose to not have it in an instant. It requires medicine or a fluke of a miracle to reverse/stop the progression.
Also, in such an argument, YOU ARE AGREEING WITH THE MAIN FEATURE OF THE DISEASE MODEL OF ADDICTION. You are saying that they’ve gotten into an addicted state in which they can’t stop. You may say you don’t believe addiction is a disease, but YOU BELIEVE IN EXACTLY THE SAME THING.
The debate here, for people who are seriously interested in addiction is whether or not people who use substances are compelled or currently in control. It’s not about their past choices – it’s about their present ability/or inability. I believe they have the ability to choose now, and I believe my conclusion is a solid scientific conclusion based on all the evidence I have been able to gather and analyze.
I can’t say this enough times: people choose every single instance of substance use. They aren’t “addicted” they are freely acting at all times. IF YOU THINK PEOPLE “GET ADDICTED” THEN YOU AND I DISAGREE.
How are you a .org?
This question was recently asked of me, and I can only assume it was asked to troll me and suggest some kind of wrongdoing, since I’m always being accused of doing something nefarious here – but I’ll answer it anyways. I wanted the name cleanslatedotcom, but that wasn’t available. I started looking up other variations, like thecleanslatedotcom. Had that been available, I would’ve registered it. I saw that .org was, and so I jumped on it, end of story.
According to Wikipedia:
The domain org was one of the original top-level domains, with com, us, edu, gov, mil and net, established in January 1985. It was originally intended for non-profit organizations or organizations of a non-commercial character that did not meet the requirements for other gTLDs.
Registrations of subdomains are processed via accredited registrars worldwide. Anyone can register a second-level domain within org, without restrictions.[4][5] In some instances subdomains are being used also by commercial sites, such as craigslist.org. According to the ICANN Dashboard (Domain Name) report, the composition of the TLD is diverse, including cultural institutions, associations, sports teams, religious, and civic organizations, open-source software projects, schools, environmental initiatives, social, and fraternal organizations, health organizations, legal services, as well as clubs, and community-volunteer groups.
Why is your site named The Clean Slate?
It’s a play on my own name (Steven Slate), the word “clean” which is recovery lingo, and the goal of the site – which is to “wipe the slate clean” of everything you thought you knew about addiction. I really do believe that if our world was rid of the harmful recovery & addiction rhetoric, less people would develop substance use problems, and those that did would get over them quickly – lacking the self-defeating disease model of addiction.
Steven, I am so glad I found this site. I have always had questions about the “disease model” of alcoholism. My question: Can you recommend any programs on DVD that mainly focus on the behavior model of addiction or at least give an honest comparison of the disease vs. behavior models of addiction? I just want evidence to present to my SA groups for them to at least consider another way of thinking. I very much look forward to hearing from you and thank you in advance for your time…Tom
I agree whole hearted that addiction is not a disease. I believe it is also like obesity whereas people make choices that become a lifestyle and the effects physical and mental are justified by the individual persons perception that they can’t control their behavior or choices.
I have found the answer. Make better choices and create a vision for my life. You saved my life. Thanks. When can I start drinking again?
Is it possible to return to normal social drinking after being clean for 20 years? I have been clean since I was 17, I now have a desire to drink socially with other adults. I feel like I am missing out on social events . I have an amazing life, am a mother of three, and have a great husband. Life is good. I think I have “matured out.” , however after attending meetings for 10 plus years I have been programmed to feel guilty and that I may be worse off than when I stopped using. Do you know people with similar stories that have started social drinking?
I was a child when I started drinking/using drugs. Now I believe I was trying to escape the dysfunction of my upbringing. I stopped using at 17 when I met an older man who was in recovery . People in AA/NA parented me. Something that I lacked at home. I went on to build a normal life, going to college, starting a career , having children. Once I had my second child 12 years ago I stopped regular participation in AA/NA. “Addictive ” behavior has not been a factor in my life for many, many years.
Hi Kim,
I have a very similar story as you and have been feeling the same desire to drink again. i too feel like there are certain social events i would like to take part in without being the sober dude that I’ve been for ten years. i used from the ages 14-20. anyways did you end up going through with it? i feel for me when i refuse a drink in moments where (oddly) i feel it would be the right thing for me to do i am instead succumbing to a sort of fear…its so strange, that i would feel the need to drink so that i may move forward in a way. dunno…would love to hear whats happened if you’ve chosen to drink.
Hi Tom- Yes, I did decide to drink. I believe I made a descion that was not a relapse. I had thought about it for years, discussed it with my family and feel I made the right choice for me. It hasn’t become unmanageable at all. It has been 9 months since I started. I honestly feel freeer now. In recovery I felt like I was able to do anything except drink. Now I know I can and dont have issue with it. At first and sometimes now I question it as recovery was such a huge part of my life. But I really believe that I was never an alcoholic. I was a neglected / depressed kid who chose alcohol as a way out. The people In recovery parented me when my parents didn’t. I will be forever grateful for them and the tools I have because of my time In the program. Good luck in your choice , it took me years to finally make mine.
I too have recently made the decision to drink socially and moderately after being sober for nearly seven years. I was a heavy opiate user for about five years in my teens and very early twenties and went through a Christian program that helped shed light on the reasons I was using substances.
The decision was made with my family and loved ones in the loop. I wanted the choice to be out in the open, however I still feared the reaction I would get from friends and colleagues who are also in the recovery community. It was a massive leap for me because I had grown so safe in my sobriety bubble. Even my wife was grateful to be able to enjoy a drink or two with me.
It’s been a couple of months since I made the decision and I have no regrets. The motives for my drinking these days is a world apart from my my younger years ten fold. I have learned and practiced disciplines to handle life on life’s terms without having to turn to substances to medicate pain or run out of fear. It was a mixture of God’s guidance, other people and personal responsibility that took me down a road that has truly lead me to more freedom that I thought I’d ever have. It was NOT overnight and I completely understand the aversion to explain to ANYONE how to do it. There are a thousand ways up the mountain.
In short, I can essentially look at my drug abuse as a response to the crippling low-self esteem I had mixed with a very insecure upbringing as well. I had no father figure who could teach me how to channel my emotions the way they needed to be channeled. I had very little teaching on delayed-gratification. I lost vision and purpose for my life and deemed myself as “less-than” others.
I remember when I would get very defensive of the twelve-steps or my sobriety based view points because for me, it was doctrine. A huge portion of my life (and security) was tied to the ladder and if anyone challenged it, I would become afraid and uncomfortable (lashing out and becoming Uber-Defensive in response). I really do understand why this is such a hot-topic. It’s a heavy discussion and it involves A LOT of emotion. I’m what you would have called an “addict” and I have now shifted into leaning towards the choice-model.
I urge everyone here to respectfully disagree with one another. It does nothing except polarize us even more when we become disrespectful towards others. I fully agree that twelve-steppers are just as “on-board” to help people struggle with drug abuse as the people who share this website’s perspective. Free speech is probably one of the most important tools we have as a society. Let’s respect the right we all have to use it.
As someone who thought they would never make it to live past 25 from a heroin “addiction”, I fully empathize with the gravity of the fear and pain that comes with it. I can see now that I bought into a lot of doctrine I don’t see as true anymore.
I loved the metaphor that Steven uses in his Ted Talk with the child falling off a monkey-bar. It’s hard to combat what everyone else says about you if you hear it enough times.
Wow! Very novel idea! Woo! I choose to not be an addict at this very moment, my struggles are over and I’m cured. Why is the United states not funding this stance on addiction? It kinda sounds familiar tho hmm like from passages Malibu? Idk if you ever heard of them?
Hi Jay,
I don’t pretend to be the first person who has challenged the disease model of addiction. Nevertheless, the organization I work for (Baldwin Research Institute and Saint Jude Retreats) has been challenging the disease model since 1989, long before the existence of Passages Malibu. Stanton Peele has been challenging the disease model since 1975, and certainly there are many others. The folks at Passages are not the originators of a non-disease approach to substance use problems; furthermore, I would argue that their approach is basically equivalent to a disease model approach anyways, as I explained in this article back in 2010: http://www.thecleanslate.org/fake-alternative-addiction-treatments-part-1/
Regarding your sarcastic response to the idea that addiction is freely chosen behavior, you might want to read an article I wrote called Choices Come In All Shapes and Sizes. The thrust of it is that heavy substance use is a complex choice. It’s not like choosing a topping on your pizza.
As an analogy, suppose you’ve been single for a long time, and I tell you to go choose a bride and marry her tonight. That’d be an absurd demand for me to make right? And it’d be absurd to give yourself that task as well. I mean, it’s possible, but it’s not really the most efficient way to go about getting married – and I’d venture to guess that it’d lead to a divorce (or in addiction……to a relapse – get it?). Yet you’d agree that people choose their marriages, right?
Substance users classified as addicts or alcoholics have usually spent a long time developing their relationships with substances, and have demonstrated quite clearly that they are convinced that heavy/frequent substance use is their best available choice. To choose to change that relationship means that you choose to change your view of substance use and your other options in life.
Incidentally, like I said, it’s possible to do that successfully in one day, but not probable for most. Changing your thoughts on a variety of factors that have fueled your massive desire for drugs/alcohol is a process. If you treat it as simplistically as picking toppings for a pizza, then you probably aren’t making a serious enduring choice.
I hope some of this helps you to understand the issue better.
-Steven Slate
Hi Steven,
I happened upon your website after trying to find some answers. obviously i can’t ask my old sponsors or AA buddies cause i know what they’ll say. i am coming up on ten years sober. i used heroin and weed and drank (more towards the end) from the ages 14-20. i went to AA and it did help me and i don’t regret it, i didn’t know where else to go. well now I’m torn, over the past 8 months I’ve had 3-5 occasions where I’ve been in a situation where i wanted to drink and out of fear i said no. it was so strange, afterward i felt like it was the wrong choice, to say no. it was as though i said it out of an unhealthy fear. rightly so considering what i experienced with drugs and alcohol however i truly feel so far from the child i was. AA instilled this idea that i could never drink again but i feel like i can. i have such a bigger life than back then. maybe i just need to experiment? i know you don’t have THE answer but if you could point me in some direction or have other stories i’d love to read them. I feel so silly taking this sobriety stance still. Ive been totally ok with not partaking in social activities most 20 something year olds are apart of. I’ve spent nearly all my 20’s sober. i feel now i want to be able to drink and not feel this impending doom. today i told my gf and she really supportive and said she’d drink w me if/when i was ready and wouldn’t judge me. it such a hard line to cross. not drinking was the medal on my coat in so many peoples eyes especially my family. and what will happen when I’m drunk? will i turn into a crazy person? will i want drugs? i truly feel i have a good head on my shoulders. kicking at a young age really paved the way for a wise mans journey. now, i feel like there’s another step. just looking to talk to some folks who may get it cause i have no one i know who has used and went back out. thanks.
-Tom
Hi Tom,
About 50% (or more) of people formerly diagnosable as Alcohol Dependent are currently drinking without fitting the diagnosis of Alcohol Dependent – in other words, more than half of former alcoholics become moderate drinkers. You’re right, I cannot answer whether you should drink or not. But I can say I have found no evidence that anyone is incapable of moderate drinking. The case against moderate drinking rests on the myth that alcoholics literally lose control of their drinking. This theory has never been confirmed by research. In fact, the available research shows that addicts/alcoholics are in control of their substance intake. I covered that topic here: http://www.thecleanslate.org/addicts-alcoholics-lose-control/
So the question isn’t whether you have the ability to drink moderately – it’s more a question of “do you really want to drink moderately?” I have discussed the issues surrounding that here: http://www.thecleanslate.org/successful-moderate-drinking-substance-use-who-can-moderate-when-and-how/
You might also want to Tina Dupuy’s story on This American Life: http://www.thisamericanlife.org/radio-archives/episode/539/the-leap
Tina was featured in the “Young People and AA” pamphlet, and was a popular speaker for years, having quit at a young age. Eventually, she questioned whether she really couldn’t control her drinking, and became a moderate drinker. I take issue with her views – she thinks she’s “not a real alcoholic” and that other people are. I don’t think anyone is a real alcoholic, based on what I know about “loss of control” and other premises of alcoholism. Nevertheless, that’s a story of someone who questioned whether she ever really lost control or not, and proceeded to drink at socially acceptable levels. So you might relate to it.
I became a moderate drinker after 4.5 years abstinent of everything. It’s been about 10 years now, and to date I’ve never felt an impulse to use heroin, which was my favorite drug back in the day when I used problematically. My drinking back in those days was a rush to guzzle the strongest liquor I could find to get totally drunk as fast as possible. Now, it is obviously markedly different. I drink at what I feel is a normal pace, on no regular schedule or frequency, and without problems of any kind. I should mention that in the year prior to having that first drink, I spent countless days in the NYU library printing out medical journal articles about addiction and alcoholism, educating myself about the facts of this mythological disease. I knew without a shadow of a doubt that loss of control and the disease were nonsense. I had a huge knowledge base. I don’t know if this is necessary for others, but I believe it was what mentally insulated me from the self-fulfilling prophecies I had been taught for years in 12 step programs/treatments. When I drank again, I had no fear, and I saw substances as offering nothing more than a cheap thrill.
Best,
Steven
Thanks for the response Steven. I ended up drinking the night after I posted that. It’s funny, it wasn’t even a big deal. And honestly I didn’t even like it as much as I thought. I thought I was gonna react different. I’m glad I chose to drink. I feel it brings a choice back into my life that will lead to me having the power and the understanding of other areas of choice in my life. The other night I had a glad of wine and red a book. It was nice. Wine allows for a nice relaxing mood. Now that I’m not drinking to become drunk I can actually enjoy it. Thanks again.
-Tom
I want to follow up on my own comment as this site helped me make the decision to drink again after almost ten years sober. So far it’s been a few months and I have not had obsessive cravings. When I drink I am aware of myself and I make a conscious choice to not overdo it. It is possible which to me was something I did not think nor was led to believe would be. Also once I feel the effects of alcohol I won’t go much father past that. Being too drunk is not something I want to feel. I’ve gotten that tipsy feeling and thought “how or why would I ever have wanted to push it beyond this?” Of course, for me it has been somewhat of a research and observation approach as this was a big step for me. To move beyond my sober years and all that I learned in AA the first 6 years was not easy. But I do know now that it was imperative to my growth. I do have a choice. Having a few glasses of wine in me and being able to say ‘that’s all for me.’ Is something I am happy to have not only expierenced but meant. I will write again as the months go on. Also I want to note that i smoke grass one night. Just a few puffs all alone out in nature and it was a beautiful time spent. That was weeks ago and I have had no obsession to do it again. last note, I started using oxytocin when I was a kid. A friend got into my grandpas medicine cabinet and then it was all down hill from 15-20 years of age. I’ve been in town for a few weeks and stopped by my grandparents the other day. No one was home and there were 10 OxyContin pills scattered on the table. I didnt gobble them down or snort them. I’m not that person anymore. I have the ability to make choices. It’s very powerful if you experience this step yet it looks very simple. Again I’ll check back in, in a few months.
-Tom
Tom. Thanks for your comment. I have had almost the exact same experience. Hope you’re well.
What scholarly journals and specific articles are you using to back up your argument? The one obvious one that you do use is Gene M. Heyman. Is there any other scientific evidence to support your claims? The DSM -V labels substance use as a disorder. The mental obesession and cravings are not choices and it is different from the healthy population. I just hope that you are aware of the consequences that this can have on people who actually need help.
Ummmm – this is a broad FAQ’s page with brief summaries of my views. I don’t know which point for which you are seeking citations. Maybe if you tell me, I can point you to a full article on this site where I give somecitations to support that point. Or maybe the point you’re curious about is simply a matter of logic. I don’t know until you ask a much more specific question.
This may sound crazy, but, is that a threat or something? It seems like you are trying to intimidate me. I am providing my analysis of these theories and the available evidence, and I ask my readers to judge that for what it is. If they are truly under the grip of “the disease of addiction” then it MUST be impossible for my words to have any effect on anyone’s substance use – the disease is in charge – it’s been doing pushups.
Interesting, you and THE COMPANY YOU WORK FOR $$$$, have been challenging the disease model since 1989. mmm, how is that working out for you? Sure you get your centers filled and make money I suppose, but overall, hmmmm. Science, the medical community, the federal government, oh, and THE INSURANCE COMPANIES who pay for treatment, all seem to be on the same page, AND NOT THE ONE YOU ARE ON. But YOU ARE RIGHT, AND EVERYONE ONE ELSE IS WRONG. FUNNY.
Hi Chris,
You can use the contact page to send hatemail to me directly. This page is for good-faith questions, not for smearing, slandering, or spewing hatred towards me.
Since you seem to be completely shocked that someone could have the opinion that addiction is not a disease, then I’ll assume that a question you might have is “are there other people in the world who also hold this opinion?” Yes. Yes there are.
Here is a whole page of quotes from all sorts of credentialed experts who share the opinion that addiction is not a disease: http://www.thecleanslate.org/addiction-is-not-a-disease-quotes-from-experts/
And here is an article by a neuroscientist that has been making the rounds. He has a past with addiction and went the standard recovery route to dealing with his problems, yet reviewing the evidence, he concludes that addiction is not a disease: http://www.vice.com/read/this-neuroscientist-argues-that-addiction-is-not-a-disease-and-the-rehab-industry-is-bullshit
There’s more too. If you follow some of the links and citations around the site, you can get more of the picture. I hope you find it enlightening.
-Steven
I’ve been an “addict” for many years. First work(80hr/wk), then uppers, alcohol, meth, coke. I’d do a run then quit, sometimes for years (with no outside help). I just recently got out of treatment and have been trying to develop my own beliefs. The “Doctors Opinion” from the Big Book just made no sense to me. How do you call something like an addiction to work, sex, overeating or alcohol an allergy? The definition of an allergy is so contrary to how “addicts” react to their activities or drugs of choice that it sound ridiculous. I wish I had an allergy to meth – once the rash or other very uncomfortable symptoms you actually get when you have an allergy to something, went away, I certainly wouldn’t want to puff-up again.(sorry long sentence). I’m not sure how people just believe without stopping to think. People are allergic to sex? Food? Well sex maybe, now my wife can understand my wanting it more than her. It’s not my fault, it’s my allergy acting up!
But, to the point. I think Chris, and a lot of other people are saying “you’re being contrary to what everyone knows is common sense”. My immediate reaction to that is “we can see the sun goes around the earth and the earth is flat”. The creator of the Toyota Production System used to say, “Common Sense is always wrong”. Einstein said “common sense is the collection of prejudices acquired by the age of 18”.
FROM PSYCHOLOGY TODAY:
The word common, by definition, suggests that common sense is held by a large number of people. But the idea that if most people think something makes sense then it must be sound judgment has been disproved time and time again. Further, it is often people who might be accused of not having common sense who prove that what is common sense is not only not sense, but also completely wrong. https://www.psychologytoday.com/blog/the-power-prime/201107/common-sense-is-neither-common-nor-sense
So – I’m not sure of all my beliefs on this, I started a search for “allergy to alcohol” to see if there was evidence and I found Steven’s site. I shouldn’t have been surprised that I wasn’t the first one to question this. AA has helped some people, but I’m really not sure it’s been that many. Of the ones that I’ve seen that seem to be successful in not drinking/drugging, a lot of them have just switched obsessions. Some throw themselves into AA or exercising, or tattoos – just go to any AA/NA meeting for evidence of this. I don’t think any of these are nearly as harmful as drugs, but it also seems to support the idea that these people weren’t addicted due to an allergy. I mean – who can just decide to trade their allergy from shellfish to goldenrod?
Sorry for the long response; once I get going you know…. Steven – thank you; you’re taking a somewhat unpopular stance and I admire the guts it takes. I’ll be doing a lot more reading on your site as well as your references. I will determine my own beliefs, based on effort, time and thought. I won’t be a slave to your, Bill’s or anyone else beliefs just cause it’s easier than actually battling it out in my own mind.
You are an idiot. Are you actually calling the insurance companies some sort of authority on substance abuse? Insurance companies pay for about 4 days of detox and send people out to money grubbing outpatient treatment centers where if you fail at an time they kick you out. Thats because insurance companies really don’t care if you get better or not. If you fail it gives them an excuse to not allow you back in treatment although it is a well known fact that most people relapse unless they have been in an extended treatment facility for 90 days so that they can learn new thought processes. Anyone who detoxes for 4 days will turn back to drugs or alcohol as soon as they can’t sleep at night or become sad or happy or mad or angry…..Unfortunately, treating people for 90 days or more costs a lot of money. If you have insurance through your workplace the insurance company knows that as soon as you relapse you will lose your job if you haven’t already and they won’t have to deal with you any longer. I could go on and on and on but maybe this basic idea is beyond your understanding!
Well Barb instead you can SELF-PAY out of pocket between $12,900–$30,000 for six weeks (42 days) to attend St. Jude’s Retreat “educational” treatment program that Mr Slate recommends. (BTW- they can kick you out too with a 0%refund… an insurance based treatment program can only bill for services actually provided).
Here’s what a St. Jude’s employee responded to a negative review on Google after a family member complained his wife spent all their money shopping while she was skipping seminars, began an affair with another guest, and never stopped drinking.
“Our retreats offer a safe and supportive environment, but are not and will never be a lock-down or guarded facility, nor do we would impose or enforce moral codes on our guests. Each guest is taken through a process of intensive self-analysis and makes their own choices and moves on with their life the way they perceive will bring them happiness. Our abstinence based success rate is not 100%, nor do we claim that it is; it is 62% which means that approximately 4 in 10 people choose to continue substance use at some level.”
So here’s my point: You can complain to your insurance company if the place they pay for your treatment isn’t using the insurance companies money appropriately. You can report the facility if they bill your insurance for a “class, group, counseling appt., seminar” that wasn’t attended by the client because they took the shopping excursion instead. You can report misconduct to the state board that licenses the facility, or their employees directly, for gross failings in ethics, behavior, HIPPA violations etc.
The treatment program I went to had some repeat client’s they welcomed back. When I couldn’t pay my co-pays they gave me a “scholarship” so I could keep attending, When I relapsed they adjusted my level of treatment and increased it appropriately to best help me. I was able to stay in outpatient treatment there for a YEAR! I was taught that priorities including financial, relationships, employer, social, physical and mental health responsibilities being kept in order would help me stay clean and keep some of those “excuses” people use to choose substances at bay. I had to NOT be under the influence to go there. And I’m pretty sure if I started a relationship with another client it would not have been tolerated. I know not everyone will have my experience, or the opportunity to have my experience, but they wanted me to be a success and called me out when I complained like a “victim”.
You are 100%right, insurance companies don’t know a damn thing about addiction treatment, and they may refuse to pay for certain types of treatment, but facilities have to meet standards, prove their credentials, and usually employee licensed staff.
Or you can shell out $25,000, and be told “make good choices that make you happy.”
Naltrexone implants, & cbd is what saved my life-
Clean for over a year now from ice & smack
I had spent 5 years in & out of na/cbd tributed rehabs – with no long term success.
I got clean when i found a career i liked – so what steven is saying is 100% correct-
“When the rewards of success become more appealing than sticking a loaded pick in my arm on a daily basis then the addict will change his behaviour”
This is 100% my experience.
I like the point about “people who attend aa/na become clean with a brain that is apparently altered – all you aa clowns can’t argue the point on that one! Gabor mate & steven slate have the 2 most practical & common sence approaches regarding addiction i have experienced.
This website is just pure hate and bitterness. The only reason I came to this website is to get an opposing viewpoint, hence the reason I was asking for citations and references. I just don’t think this is a joke either people die from addiction everyday. 12 step programs have worked for many people since the 1930’s that is what works for them. It has been accepted by professionals that substance abuse is a disorder. Why does this particular population experience a craving that others don’t? This need to use a substance to feel normal? What do you recommend people do then? I just hear arguments but no solution. Addiction field needs all the help it can get. Have you seen the relapse rates and overdose rates?
If you want to go against the grain then contribute.
Oh I want to apologize if I made you feel threaten in anyway that was not my intention at all. I just wanted to know the premises of what you were basing your argument on that is all. I may come off too strong because I am so passionate about this subject.
Thanks for the advice Adeline. Perhaps, if you had stopped to read this page before commenting on it, you would understand that I have contributed, and continue to contribute. I am co-author of the 13th edition of The Saint Jude Program, which is an educational program for people with substance use problems. I’ve contributed to textbooks on addiction. I’v taught for the Saint Jude Retreats for 6 years. I’m currently in development on another book that will bring our method to the masses outside of our retreats.
So thanks again, but I’m already contributing. Talk about negativity? You didn’t even read this before you started cutting me down. You should be ashamed of yourself. Please take your trolling elsewhere.
-Steven Slate
How many times do you plug ST. WHOEVER and this work you PIONEERED in the above attack on Adeline above? The good news people, Steven here and whoever else will fade away and not soon enough. My question Mr. Slate is, “ARE YOU TRYING TO HELP PEOPLE, OR PROMOTE FOR PROFIT YOURSELF AND THIS GREAT COMPANY YOU WORK FOR?” WHAT IS YOUR ANGLE IN ALL THIS, AS PEOPLE DIE EVERYDAY?
Wow. What a psycho..
Obviously Slate is offering his own, very sensible if you ask me, take on an issue where AA has had little success. And if he is building his own thing, more power to him.
See, I am interested in recovering from addiction. Developing some kind of spiritual connection is all well and good. But that is a separate topic from retraining your brain and body to develop new mental and physical habits as alternatives to self-medicating to get high/feel good/escape reality/etc.
The responses he is getting on this forum typify the kind of mentality AA fosters, one based on small-minded ignorance, magical-thinking, and defensiveness. Sorry, but AA people have enough resources out there. If you’re not on board with it and trying to stay clean it’s tough to find others to not feel so alone in fighting this fight. So back the hell off AA people and give others the chance to develop some alternatives. God knows we need ’em.
Keep it up Slate. This is valuable stuff.
Addiction is such a horrible place to be…I don’t care what works to help someone and their family to deal with and overcome it. If 12-Steps works for someone…that’s great. I know many in many programs that find great peace and joy in those programs. If that doesn’t work…find something else like what Steve peddles. Be tolerant and supportive of anyone and any process that works for some people. There is no one solution, one point of view, one way. Grow up and help those in need…regardless of the path that works for them.
If people have to believe addiction is a “disease” to be able to recover from it and use 12-step programs as their “medicine”, then OK. (You don’t know how many meetings I heard this stated). Whatever works for you, as long as you aren’t killing yourself, robbing, and pillaging to get high, then OK. But, how dare anyone judge any viewpoint on any solution offered to end this way of life. That’s what it is, regardless of if it’s a disorder, a disease, or plain and simply a choice, which makes sense to me after being on both sides of the spectrum. It is a way of living. So, if you want to use FEAR as a way to stay clean, OK. But, if someone offers an alternative idea that has worked and is working for others, then what are people so threated by? You do what works for you, and those of us who have found our identities as something other than ADDICTS or ALCOHOLICS who must fear the substance and anyone who partakes of it, even in the least amount….. can proceed living our lives as well. But, when you make a mistake, have a “slip”, or a “relapse”, get it out of your head that you are going to die, or that you are going to have to use more now, or you are going to end up living to use and using to live, and maybe, just maybe, you will NOT. Maybe you will wake up, see it for what it was ( a choice), and don’t take on all that shame the 12-step program will try to heap on you. You are human. You CAN choose differently today….and tomorrow. You can even do it without anyone guiding you or directing you to. I promise. I did.
You sir are 110% correct in your stance and beliefs on this subject. Life in the long run and many mistakes along the way have taught me this as well. I applaude your boldness and willingness to speak the truth about this and take the criticism and bashing that surely you must face from those who find it easier to say im sick instead of having to own the choices they make and taking responsibility for them. Unfortunately although it is truth i feel it will never be accepted purely because of the money, the medical field and “addiction” industry, and the country’s screwed up legal system. And too people (including the government) never like to say “we were wrong” even if it meant helping countless people with their problems, educating the public, and making the world a better place in general. I must also give you credit for the job you do defending your stance and beliefs. Although “addiction” is a commonly accepted “fact” these days the truth is there is no real solid science that ive seen to prove their view either. It must be true because the government says so though….right??? How many millions of lives has history shown us that blindly following a government can cost? Again in closing sir…great job! You are correct and keep up the good work!
I still don’t get the difference between CBT and CBE except the difference of the words “therapy” and “education”. Both maintain conscious thoughts can influence a person’s behavior all on its own. I was a huge help to me in treatment in dealing with things that I thought were impossibly overwhelming. If those thoughts and feelings had no influence in my choice to use then why does CBE help me chose not to use or allow me to chose use non-destructively?
Awesome! Bravo! Love your work…keep going. You are so very needed. We desperately need truth and light on a sick and outdated recovery program that is ignoring new scientific data on the subject. The lack of self care and acknowledgement in some recovery programs is criminal and lack of professional psychiatric oversight even more so. Class action lawsuit, for wrongful death from uneducated relapse, sexual harassment, rape and murder should have already taken place. Very convoluted mission and very outdated views written by a slob to be carried out by other slobs…egad. I apologize for offending all of the chairs who read that and got angry with me, but go take a look in the mirror, you probably need some serious care, I haven’t seen one in 30 years who didn’t.
I accidentally stumbled into your site here the other night while trying to find alternatives to AA, the only real group recovery in my area. I am recovering with self care and rational thought. I really don’t want alcohol anymore. The less I am using the less I like it. After a couple of months now, the results are great and I don’t feel like I’m denied. And I haven’t treated myself like an out of control child in a candy store. I’ve tried the self denial and total abstinence route before and it really did some damage. I am not applying any method but I’ve absorbed a lot of the recent findings with addiction and what I’m doing on my own seems to be helping. Still though, I was hoping to find a group alternative to AA.
Also I was dating a man who started attending his AA more and more often the further along we got into our relationship, until I literally cried that he planned his AA life with sponsor and sponsees (2) without even considering me and what I may want to do on a Saturday night. I told him it was over when he said he had to commit to 5 nights a week of this program indefinitely and would not compromise or find an alternative program we could go to together. I am hurt for being passed over, but I’m better than I was bargaining for attention from a man who said how in love he was with me, but more evidently in love with AA. I say AA not sobriety, because he’d been sober for almost two years and now his reasoning was that had to pay back his debts to others in AA for crimes he’d committed to his family and friends when I didn’t know him. So ultimately I had to sacrifice my needs in a relationship so that he could pay his AA conceived debt, back to others in AA..um..wtf. The Robin hood way to repentance. Count me out there.
Anyway, moving right along.
I am a child who was brought to AA back in the 80s with my father entering one smoke filled room after another, shoved in the back somewhere with my coloring and forced to listen to strangers stories of failure, peril, resurrection and salvation via Bill W. Being just a kid it was all surreal. I hated their smell, hair, lingering attitude of self pity and ultimate defeat with each one at different stages of new hope, settled acceptance or old timer ego. They didn’t really grow, they abstained and not even for a God they all shared in common, nope! One to each his own, in a room of the spiritually lost and divided with no real goal, but admitting powerlessness, and holding hands praying the serenity to their uncommon God’s and that ever repeating sentence of relief for my suffering at the end “keep coming back, it works if you work it” finally this meeting adjourned until tomorrow, when I’ll be dragged to another.
After 10 years my father relapsed and eventually lost everything he’d worked for in his life. Now 20 years after that he is learning through a tough fight with cancer how much kindness, forgiveness, self care, love and patience really helps happiness, peace and true recovery, something AA never gave him and never tried to.
This man I was with, like my father, is so wrapped up in the rooms that he literally freaked out after I read one of your articles, the SMART review, I really wish there was one in my area. I am in south Florida and we are being infiltrated with sober houses and fly by night recovery centers. They are poorly run and even more poorly monitored by mental health and government, their success rates are seriously low. The worst part is that the people trying to recover have no option besides AA for help here after release. They try to make it, but I’ve seen many fail and either go home (whichever state they came here from) to the same issues with the same people or stay here and end up in another center or worse our jails. It’s becoming a big problem here and with AA having such a poor success rate, I figured maybe my guy would be interested in helping start a movement in this area, an alternative to 12 step and one that may even work better with a longer positive outcome. He wasn’t interested and vehemently expressed that fact, so much so that we broke up an hour later.
I alone cannot make a change here, but I want to start contacting people who can. We need solutions, besides a group that dictates how broken someone is, how diseased they are and how they can never learn anything else..because it’s all lies and the science on addiction is now proving that. People can change for good and they can live sober lives without the ball and chain dogma, control and negativity of a 12 step.
I could go on and on about the flaws with AA. It’s nothing more than an addiction under a spiritual guise to replace an addiction for people who would benefit more from true healing, especially in regards to past trauma and mental illness diagnosis and proper management.
The rooms are dark and they shut out the light of love, respect, true thought, self reliance, positive expression and last but not least an honest relationship with God or any other human being for that matter. I have a deep seeded disdain for 12 step, I’ve been watching for 30 plus years from child to middle aged adult and all I’ve seen it do is offer false hope, hurt, drama and failure. It’s not broken addicts failing the system, it’s a broken system failing addicts.
So who will reform the 12 step madness..it’s time. You seem to be getting a good start here. Shout it from the rooftops. Thank you for your work and writing.
Great job Steven,
I stumbled upon your site just looking for more information on the non-disease of addiction. I already was near certain it was true and felt that way for years. I quit myself after 20+ years of alcohol abuse. I would take breaks but never intended to quit. AA only fuels addiction for most. Being told your powerless and can’t do it yourself is rubbish. Turn your life over to God as you see him? What?
Nobody is going to tell me I have a non-existent disease that has to be “managed” for life by a unseen power that doesn’t answer questions. I won’t air my dirty laundry to a surrogate family of “fellow” drunks who tell me I’m branded with the scarlet A of alcoholism for life and they are the only way.
I made bad decisions and used my perceived ideas of worthlessness to excuse my bad behavior. No disease process compelled me to act stupidly or drink uncontrollably. I know right from wrong.
When abusing we don’t think straight. Irrational behavior sometimes the rule rather than the exception. The disease concept fuels addiction and abuse by allowing excuse for poor behavior. It is not acceptable.. But it can be forgivable when one chooses abstinence. Withdrawal sucks but it does end and a new life can begin.
Make a plan to quit and stick with it. Going to meetings and dwelling on regret is counter productive. Detox and get some abstinence behind you and move on with your life. Don’t look back.
Realize that you don’t have a disease and your not condemned to a lifetime in the clutches of the recovery movement. Understand, that most (60 to 70% maybe higher) of true substance abusers/addicts quit on their own. They do it quietly and move on with their lives. We were in a shitty way of thinking and being, but we don’t have a disease. There is not one speck of scientific truth to the concept. I become angry and ashamed that this country allows misinformation to be given as fact and peoples lives condemned to the big money business of lies that is the recovery catastrophe. It makes our healthcare system look like a joke.
Make a decision; a choice. Life in addiction or the recovery mess. Or your own free choice to be abstinent and free. It’s only hard at first and then over time the path gets smoother and smoother. If it doesn’t, you have the choice to use again or try recovery. At least if you try you can make the choice rationally with a clear head. We’re not powerless. Give yourself credit. Give yourself a chance.
Frankly, I’d rather be a drunk again than step foot in a 12-step program or 12-step oriented rehab.
sorry for the rant.
Hi Steven,
I stumbled upon your site doing research about addiction & Dr. Peele. I couldn’t agree more that addiction is not a disease. I feel that is an easy way out for people. It’s a way for them to not have to take responsibility for their actions bc the fact that they can’t stop using couldn’t possibly mean that it’s bc they don’t want to. There must be something else to blame. At 16 years old, when my mother gave me a piece of her OxyContin pill to chew up because of my painful menstrual cramps, I had NO clue what that type of drug was & what it would do to me. If I had know that 13 years later, it would be something I struggle with on a daily basis, I would have never taken it. I didn’t ask to be exposed to that lifestyle. But once I became an adult & still continued to seek out those pills, I took responsibility for it. I have been on a Suboxone regiment for a year & a half and know that when I choose to stray & take pain killers that I have no one but myself to blame. That it’s my lack of will power & wanting to completely change that are the root of my problem. Not some “disease” that I have no control over. It’s the reason I went to one NA meeting & decided it wasn’t for me. How can I possible fix something if I’m being told “it’s not my fault” and “I have no control, I’m powerless to my addiction.” It’s the issue I take with my mother when she tells me that I have no right to hold any grudge against her because “she wasn’t thinking right, because she has a disease.” It’s just the lack of accountability that I don’t like. To me, children with cancer have a disease. Not an adult who continues to pop that pill, or take that drink.
Responsible people do not use the SCIENTIFIC PROVEN FACT that addiction is a disease as an excuse and and nothing is our fault. It is a way for us to understand our actions and why we struggle to control our choices. Understanding the FACT that once we are in our addiction and our decisions are now being made by our mid brain (survival function) and not our pre-frontal cortex (logical decision making function) helps us realize the work we have to do to “rewire” our neurochemistry. Ashley, I encourage you to do some more research and don’t take my word or anyone else’s, simply look at the scientific evidence. Your very words that you are not powerless, but you’ve “struggled” for quite some time, and you have been on Suboxone for over a year does not help your argument that it is a will power or choice. If it is, why are you on suboxone? Why don’t you just free yourself of all of this mess now and quit. Go through the withdrawals, get it over with and use your will power to not “struggle” any longer. There will always be people that try to use the disease model as an excuse or cop out, but that is not what the FACTUAL SCIENTIFIC EVIDENCE is there to support, that’s people using it for their means. Remember people once believed the earth was flat, until a FACTUAL trip on three ships proved it wrong. So try to have an open mind and look at what the medical community has been working for decades to understand about addiction and the amazing advances that are being made. Use science, not NA, not religion, and no offense, not what you “think” you know. Remember, Kings and queens and all of the little people thought the world was flat and if you went sailing out to the horizon you would fall of the earth. I guess what I am saying is you don’t have to be an extremist on either side of these arguments, NA is not for everyone and is certainly not the “cure all” for opiate addiction, it is simply a tool for some people’s battle. If you are not powerless, fine, use your power and self control to look at factual research and not someone’s opinion to make your decision. But please do not believe that Utah has the 4th highest opiate overdose rate in the nation because people in this state simply do not “want” to change. And again, if it’s choice and will power, prove it to yourself and quit suboxone. If you want to see FACTS on this disease, I encourage you to visit https://www.drugabuse.gov . Ashley, I am not adding this comment to be combative or argumentative with you so I hope you do not read it this way. I just hope you can allow yourself to look at evidence.
I am co-founder of a program in Vermont called Natural Transformations. There is not time here to delve deep into this issue or how I treat folks but let me say a few simple things. Addicts have two options – 1) a clinical awakening or 2) spiritual one. The rest of what treatment addicts receive are window dressing. Once someone finally accepts that their addiction is more about self-hatred then ‘liking’ their drug of choice, they may be on a new discovery road of healing. My motto: ‘addiction is not a disease. Dis-ease is the presence of some ‘thing.’ Addiction is the ABSENCE of everything!’ Addicts are empty vessels seeking pleasure at all costs because coping skills to them = fun and euphoria always vs. learning how to adore the ‘sacred mundane.’ I have been very successful with my program NT because ALL of what I teach or facilitate is nature based, ceremonial and forces addicts or anyone in a crisis to confront truths. America is so sick now that unless we all return to tribal adoration and reverence of this planet above our self-indulgences, humans are doomed anyway, which is a good thing.
Worst thing one can tell an addict is that they are important. They’re not that special. No human is, some more benevolent than others but nobody is more special than another especially a pleasure seeking and absent drug addict searching for attention. The disease mantra has ruined self-reliance to many addicts because they are told that in order to get well they must INGEST something – meds, therapy, 12-step philosophies. But the answer to healing is PURGE, forcing out and letting go NOT taking in and that is what I teach. You want NOT to be an addict, learn humility in nature in a program as I offer and others out there but not many – and STOP believing that somehow you were cursed by your parent’s DNA. You weren’t, you CURSED yourself into believing that coping meant, dropping out for the soft landing at the end of the day as a reward. Only in America, one of the sickest countries on Earth could create ailments such as bulimia, anorexia, restless leg syndrome, depression etc etc so that big pharma can make meds that remove your true persona that may have helped you get well. This nation earns billions off addicts. And the prescribed meds have such dire side effects why would anyone take them?
Beds and meds don’t work long term. Detox perhaps, After that then what? If you want more information about Natural Transformations please contact Mr. Chris Laro at chris_laro@yahoo.com. I will reply no matter what you believe. I truly wish ALL speedy healing in any way healing comes to you through the spirit realm.
cl
Hi Steven,
Any chance that your logic for alcoholics and drug users would translate to someone who is a gambler?
I hope the answer is yes.
Kate
I don’t see why not.
So why can’t individuals just choose what method they want to try instead of someone that does not know anything trying to persuade them on what to think and believe? One thing we do know is there are millions of people who are in Self help groups. Just walk in one on any given day. We also know there are several approaches that actually work. One thing that has never worked is closed mindedness. (think about it)
Should I take this question seriously?
Who said they can’t make their own choices? Also, who says I have stepped into someone’s life unsolicited and told them not to go to a support group? Do you have evidence of this? Or is it just the fact that I’m saying what I want to say on my own damn website that people come to and read of their own volition?
Steven,
Please do not listen to these fools. Yours is the rare sane voice within this emotionally charged, well-intentioned (yet woefully misguided) chorus of self-appointed experts.
As a long time substance abuser, I have dramatically reframed my relationship with alcohol and other drugs in a way that is life-enhancing, sustainable and without the specter and dogma of “addiction” hanging over me. What a relief! This is after having tried the AA route, spending large amounts on treatment centers, etc. All to no avail. What did work about the treatment experience was the act of stepping away from my life and having a chance to honestly reflect on where I was and where I wanted to be and commit to the notion of incremental improvement that becomes substantial in aggregate. Here I am two years later a productive, happy individual who is still able, if I choose, to use alcohol and other drugs responsibly. This is something the AA crowd told me would be utterly impossible. What a load of bollocks!
Thank you for exposing the truth about the myth of addiction that has swept this country by storm and overruled any voices of sanity. What’s worse, they perpetuate a victim mentality that becomes contagious, actually fuels and justifies substance abuse, and drags families into a web of self-serving profiteers that seek to capitalize on their misery in the form of “addiction treatment”. As if there was anything to treat! Like you say, substance abuse is an idea and an attitude towards oneself as means to satisfy certain ends. It is an existential condition, and what is needed are new ideas; new mental frameworks and ways of retraining ones mind in order to form and maintain new habits, which ultimately translate into a new way of life (meditation/mindfulness have been especially helpful to me in this regard).
Anyway, keep up the good fight; don’t let the bastards get you down. They mean well, even if they are full of shit.
Best,
Will
Thank you for having the courage to post your opinions. I also beleive that addiction is not a disease and we are not “doomed” for the rest of life. I have been addicted to heroin 2 separate times in my life and both times I quit on my own. “Treatment” centers I think help, with the various group talks and cbt sessions, but I think the 12 step approach is ludicrous. Everything about the 12 step approach defies all logic to me. I feel my mind is too inquisitive and logical for a pseudo/religious/defeatism approach. I am a survivor, I am not defeated, and I am certainly not “powerless”. Powerless….. ughh If I was truly powerless, I would still be shooting dope. Disease Model… more like $$ model. Thanks again for saying what everyone else is afraid to say. We do have the “power” to stop abusing drugs.
I have bought into the disease theory of addiction, because that is what I was taught. It fits the AMA’s definition of a disease: “1) an impairment of the normal functioning of some aspect of the body; 2) characteristic signs or symptoms; and 3)harm or morbidity. It certainly has genes that if present, make one susceptible. How is this any different from heart “disease?” Genetic predisposition to atherosclerosis, coupled with dietary choices that lead to illness over time. Response?
My second point/question is: at the end of the day whether it’s a disease or not largely involves semantics. What are the OUTCOMES of improving someone’s life as it applies to abstinence from mind altering substances as compared to traditional AA/rehab treatment?
I Have worked in psychiatry and substance abuse treatment as a licensed clinical social worker for close to 40 years. I’ve worked in hospital detox units, hospital emergency rooms, opd methadone treatment programs (in fact, I was the director of two METHADONE programs for 6 years) in and out patient psych programs, community clinics, school and campus based settings, iop outpatient substance abuse programs and in private practice —- most in some of the most renowned organizations in new York City. I have seen it all, and you, sir, have not. Your theories and conclusions are simply wrong. Anyone whose done any level of college or grad. School work knows that statistics and “studies” can be manipulated to show whatever outcome the author wants. Your conclusions appeal to folks who haven’t yet found the right path to their own recovery and pointing fingers to the people and approaches that haven’t yet helped them falsely validates their belief that elusive success is everyone else’s fault. You may be surprised to hear that though these are my feelings, if your work does actually help some people, I hope you continue to help them….whatever works for an individual is their right way— but please stop misleading others that existing services and approaches are without merit. True, the recovery rate is nowhere near where it needs to be — but what is your 5 and 10 year sobriety rate ? I don’t think you, or your co
Leagues have been at it long enough to even be able to answer that question — or maybe you don’t want to. I just wonder how many addicts your views have discouraged from continuing to try — and will never have the means or the opportunity to give your approach a shot. Instead they will continue to delude themselves, suffer, bring suffering to their loved ones –then die. Maybe if you collaborated with the substance abuse treatment community instead of smearing it, you really can be a part of the solution. Please consider this. Phil Tamburino, lcsw-r
In 17 years of follow up surveys, my company’s long term abstinence rate averages out to 62%: Saint Jude Retreat Success/Abstinence Rate
For most of the time that research was done, we conducted 2 surveys per year, with nearly everyone who had attended the program. In 2004, when we had the funds we outsourced the research and started doing a random sample.
Keep in mind it’s an abstinence rate though, and this isn’t the only way to measure success. We used this measure because we were stuck in the recovery culture’s paradigm of fetishizing abstinence. There are plenty of moderate outcomes as well that we didn’t measure. I went through the program, was abstinent for 4.5 years, then I decided to drink moderately, and I haven’t had a problem with that in 10 years now. If I were contacted today with the same sort of follow up, by abstinence measures only, I’d be considered a failure. But of course, I am not a failure. I went from feeling compelled to be intoxicated all day every day, committing crimes, et cetera, to casually drinking when I like, holding down a job, and supporting myself with no substance related problems.
Most existing services are essentially useless. They do not beat rates of natural recovery – yet it is claimed that people NEED treatment or they’ll die of addiction. It’s such an absurd claim. When people come to see me for a consultation, I educate them on natural recovery rates, and show them they are already capable of changing their substance use with or without me. I never claim anyone NEEDS my program – only that the information I offer in the classes will be helpful towards doing what they’re already capable of doing.
I do not communicate to people that they shouldn’t try to change – I communicate to them that they are capable – that they have the power to change. I communicate that when they do, even if it is with my program or a 12 step program, it will be they who change themselves. While withdrawal syndrome can be successfully treated, addiction cannot be treated because it is just a preference – not an involuntary behavior that results from a disease. A preference can’t be treated. It can only be changed by the individual who holds it.
I really hope you’ll look into natural recovery rates – it would be eye opening: http://geneheyman.com/wordpress/wp-content/uploads/2013/11/heymanannrevclinpsych13quitdrugs.pdf
I am a parent of a child who uses Heroin. I am not disputing what you say because I do not have your experience and I do agree with you about the measures of rehabilitation that are have been and continue to be taught today, they are ineffective. My only experience is as a parent, and as one I am trying to understand and educate myself to better understand how to get through this episode in my life. You say addiction is a choice. I think this is incorrect. To use is a choice, to become addicted is a result of that choice. At first you may enjoy the choice, for whatever reason. The drug you have chosen to use has an addictive component. So when you continue to use it you will become addicted. At first you may think becoming addicted will not happen to you, but eventually it does. So now you are suffering the withdrawal symptoms which you explain as flu symptoms. I have witnessed someone kick cold turkey first hand it is not a pretty sight. It began with flu symptoms, then escalated to excruciating pain in their bones, down their spine, diahrea, sweats, anxiety, they could not stay still, they buckled in pain, they cried, screamed, they can’t sleep to get relief or even to function. You were a Heroin addict yet you explain it as if it was only the flu? Did you not experience these withdrawal symptoms? These are the symptoms of withdrawal, but there are also character changes that take place. One is the compulsiveness to do whatever is necessary to get money to get the drug, lie, steal, manipulate. The ability to reason seems to diminish because they can’t see the predicament they find themselves in and the need to do something about it. When they are exhausted of the life they have created to maintain their usage and the vicious cycle they’ve created seems without end they become desperate to be freed from it’s apparent control and they beg to be helped. They get detoxed and easily forget and return to the same vicious cycle. And how about when they overdose and spend days in ICU hooked up to a respirator because they can’t breathe on their own and need rehabilitation to restore the damage afterwards, or worse get arrested and are facing felony charges and jail time and still continue to use, is this choice? Because the normal functioning person fears incarceration and death and would not return to such destructive behavior. So when you say it is not a disease I agree because disease’s are not self inflicted, but it is an addiction and addiction has very real affects on the brain, but they are not irreversible or preventable or treatable and the means in place to treat it I am in total agreement are ineffective and I believe they are designed to be just that. Because it doesn’t take a rocket scientist to figure out that they are not working because the issue has grown to epidemic proportions. Someones pockets are being lined to keep that system alive and at the cost of many many lives, but that is my opinion, however my opinion is being supported by the impact it is having on the nation, yet they keep coming up with solutions that are equivalent in nature to the problem. God help us. There have been non narcotic alternatives available for over 12 years that are only recently beginning to be made available but only through the structure of the failed rehab system presently in place. The most effective method is not even covered by insurance. Your primary physician can not treat you for the symptoms of withdrawals, nor can emergency rooms. Yet you can be given Narcan to reverse the effects of an overdose that could turn you into a vegetable or worse kill you. I believe that doctors that can offer you the alternative treatments are being allowed to do so only if they promote rehabilitation within the same failed structure, when what they need to promote is detox, then continued treatment of the opiate inhibitor which is non-narcotic, but gives the person the time they need to allow the effects caused to the brain by the drug, to heal itself. The brain has the ability to rebuild and restore itself, and while under this treatment that should be covered fully by insurance, participate in the type of educational program you are promoting where they can begin to believe again in themselves and their abilities to make better choices once they are no longer functioning with an impaired brain. The brain is an amazing thing in what it can accomplish on its own if given time and why not use the aid of something that is a non-narcotic to help you regain back the ability to choose life the way it was intended to be lived. I look forward to hearing your feed back.
Gloria. Well written comment. I hope that Steven Slate makes an attempt to reply to your comment, especially in regards to your passage, “You say addiction is a choice. I think this is incorrect. To use is a choice, to become addicted is a result of that choice … At first you may think becoming addicted will not happen to you, but eventually it does … there are also character changes that take place. One is the compulsiveness to do whatever is necessary to get money to get the drug … When they are exhausted they become desperate to be freed from it’s apparent control and they beg to be helped. They get detoxed and easily forget and return to the same vicious cycle.”
You mentioned that, “the normal functioning person fears incarceration and death and would not return to such destructive behavior,” and yet we see that people do go back to these destructive behaviors time and time again. Is it because they choose happiness which can only be brought about by drugs, as Steven mentioned in her FAQ, or is it because the individuals brain is neurologically rewired to make these choices seem like the best options?
Until you can defend yourself, Steven, I am going to believe that what what you are promoting is in fact not a safe way to council someone to kill there substance use disorder, nor one I would hope anyone would recommend.
I have been in AA and sober from opiates for three years after a near fatal overdose. It has been working for me and has allowed me to live a far more fulfilling life. I don’t have issue with any of your insight on this site. I think if you find a solution that works for you that is great.
However, I do feel that a lot of the writing on this site is filled with negativity and defensiveness from both Steven AND from AA’s responding to his posts. This isn’t productive for anyone.
Steven I appreciate you voicing your experience and opinions, and I do think it is important for there to be open and honest conversation so people can understand their options.
I encourage you to continue the great work you are doing, but I hope you can be more thoughtful about doing so in a way that is less combative.
In the end, I hope everyone struggling with addiction can find a way for them to live a happy and prosperous life. How you get there doesn’t really matter.
I wish you all the best.
Alright, so I’m a trauma therapist and I’ve also done a lot research. I get that the disease model is questionable. I also get that many treatment centers who treat the “underlying causes” do so in such a way that can be considered to create more weakness rather than strength. My disclaimer for my comment is that I am much more interested in complex trauma and attachment injuries (which I see as injuries, not mental illness by the way) than addiction on it’s own. That being said there is a LOT of co-occurrence between the two presentations so I do have to address addiction in my practice. it is interesting to me that you are going against the self-medication concept. What about the idea that drugs, alcohol, self-harm, disordered eating, high risk sex and the like can be seen as pretty incredible attempts by people who are trying to regulate themselves and manage painful affect. There is A LOT of research to support the theories that a) major childhood trauma disrupts the normal development of affect management; meaning people can’t make themselves feel better or self-soothe, b) that when this happens these people need external regulation in the forms I mentioned earlier in order for them to behave or appear “normal” otherwise they would be totally dysregualted and nonfunctional until they learn how to self-sooth and repair attachment injuries, c) that drug/alcohol use is one of the most effective ways for these people to feel better (I know people who got high to keep from dissociating in grade school and no one knew because they looked normal) and d) that in treatment programs that offer comprehensive trauma and attachment repair programs that they leave knowing how to regulate and manage their own affect and don’t need drugs anymore. My concern is that if you are telling people not to get treatment for addiction they may never learn that it MIGHT be due to childhood trauma and that they can be empowered and learn how to manage themselves. Most people see the addiction as the most imminent problem and that leads them to get help. What about the ACE study?
WOW Lana…YOU MAKE TOTAL SENSE to me…drugs and drink and all other negative choice behaviors are due to self-hate through difference circumstances when children…mostly from parents, teachers, preachers, and many others who have no time or patients to educated them with love so they scare kids with threats of spankings, gods gonna get you, wait till your father comes home etc etc …and many more…I feel so sorry for the children of today..
I stumbled upon this website while looking into “evidence based medicine” and 12 step programs.
I am a physician and have a child who has struggled with addiction.
It is interesting to read the comments about whether addiction is a disease.
While I do not claim to be a historian on 12 step programs, AA seems to have started by 2 individuals who were desperate and did not have any readily available options. I commend them for at least trying to do something, rather than remain victims.
I will be researching St. Jude’s program and I commend Steven for bringing another option to the table.
In no way do I see anything he has written here as self-promoting.
My personal experience with treatment centers is that at least they give the addict the opportunity to detox, and if they are able to stay long enough, to get a clear enough mentality to think straight. The affects of hard core drug or alcohol abuse certainly affect a person’s mood and perception of reality.
Some comments mentioned jail as a horrible consequence. Not so in my opinion. You get detox and it is more difficult to get drugs in jail than on the street. So the addict does get a chance to clear their thoughts.
Steven points out that people have to choose something other than drugs to find happiness and that is innately available to us as humans. We should be allowed the dignity to choose happiness or serenity.
If the 12 step program works for you, great.
It does not work for everyone.
And correct me if I’m wrong, but I don’t think Steven is suggesting anyone “use” or experiment. If you are satisfied spending the rest of your life without using any form of drug or overindulging in general, then more power too you.
My initial reason for looking at 12 step programs stems from my own involvement in Al-Anon. I consider it a “self help” program for those who are affected by alcohol/drug abuse in family or friends.
Al-Anon is based on the 12 step program of AA.
Hearing the jargon of “evidence based decision making” in our recent district meeting intreagued me and so I’m on my search for personal knowledge.
When one program is touted as the only solution to a multitude of problems, be cautious.
It makes me think of the saying “when your only tool is a hammer, you treat every problem as a nail”.
Keep an open mind and keep the conversation going.
Thanks, Steven, for your input on a very serious and widespread problem
Steven,
As I have been reading your research and your writings, I began to wonder how the addiction model stuck in the first place and why we have it today. I would have to imagine that people recognized there was an issue with drugs and alcohol and some form of action had to be taken. Calling it a choice would have lead to no allocation of resources for research and study. Based on my experience, I would guess the only way to get any attention to the issue in the early stages would have been to label it a disease and not a choice. I understand the necessity, that was most likely behind this. Perhaps without those first steps, this site and all others on the matter, might not exist. It is unfortunate that once something like the disease model is accepted as conventional wisdom, we as a society have a hard time reexamining previous beliefs to see if they still hold up. We also rarely remember the context from which addiction was probably labeled a disease. It was probably a means to get a very serious and misunderstood problem much needed attention.
I appreciate the the website. I am sure it can be difficult to write thinking outside of the box that is “conventional wisdom”, especially when you are demonized for it. This site can be a great aide in understanding substance use. Even if you do not agree with the premise of this site, if you are a free thinker, it can definitely give you some food for thought.
I find your stance very interesting. I agree to a certain degree that using alcohol and drugs is a choice, at least initially; often I got stuck in a paradoxical cycle. As you aptly put it, the idea of choice is not black and white. I do subscribe to the AA method, or rather I participate and my life has improved dramatically. I am naturally of scientific disposition, so I struggle. However, it has been the only method that has worked for me; SMART, CBT, DBT, life improvement and a change in circumstance never worked. I am not naïve enough to believe other methods do not work. I imagine you would agree that AA works for certain people (apparently less than 5% or so?). The long and short of it is that if somebody is naïve enough to hold the belief that AA is the only way, they should be shot down. However, like any method that produces statistically significant results, it is worth a try? That is part of the human experience, trial and error. Though, I am of the view that, despite my AA convictions, if people present AA as a scientific entity it should be treated as so, criticised healthily.
The treatment centre sector is very divisive and profit driven. However, it is not fair to say that within the recovery sector and specifically the 12-steps that treatment and the 12-steps are necessary to combat addiction. I guess the big-book has a bit of a get out clause in regards to classifying alcoholics. Seldom have I heard somebody say that the programme is necessary to overcome addiction. In fact, it explicitly says in AA literature that some people can overcome addiction through over means, whether that is through moderation, change in life circumstance or a sudden profound moment of clarity.
I agree with a lot of what you are saying and I am not sure whether neuroplasticity supports it or not. Would you concede that certain genes predispose people to engage In some addictive behaviours? i.e. the DRD2 transporter gene? Predisposition still requires a choice though 🙂
Further, I do agree that labelling can either be positive or negative. For me, it provided a schema in which I could interpret my previous life experiences and how to proceed to better improve my life. Admittedly, for a while, I did get stuck in a trap of “powerlessness” where it would become both my excuse and my justification for using.
My personal interpretation of powerlessness is that if I decide to use Heroin tomorrow, after a while, it is likely that I will get in a self-defeating cycle of physical addiction, psychological dependence and will struggle to get out.
I’m an atheist too since I was 8 years old…drinking and drugging are CHOICES…period…UNLESS ONE WANTS TO HANG ON TO their VICTIM STATUS they’ve created for themselves…
I’m an atheist and have discussed this gene thing with Geneticist…there is no SUCH THING AS A GENE for negative behavior or any other kind of behavior… Some people think they’re druggies because of a drug gene…which begs the question… then there must be a gene for eating bananas and many other things.
Author: Alex
Comment:
Gloria. Well written comment. I hope that Steven Slate makes an attempt to reply to your comment, especially in regards to your passage, “You say addiction is a choice. I think this is incorrect. To use is a choice, to become addicted is a result of that choice … At first you may think becoming addicted will not happen to you, but eventually it does … there are also character changes that take place. One is the compulsiveness to do whatever is necessary to get money to get the drug … When they are exhausted they become desperate to be freed from it’s apparent control and they beg to be helped. They get detoxed and easily forget and return to the same vicious cycle.”
You mentioned that, “the normal functioning person fears incarceration and death and would not return to such destructive behavior,” and yet we see that people do go back to these destructive behaviors time and time again. Is it because they choose happiness which can only be brought about by drugs, as Steven mentioned in her FAQ, or is it because the individuals brain is neurologically rewired to make these choices seem like the best options?
Until you can defend yourself, Steven, I am going to believe that what what you are promoting is in fact not a safe way to council someone to kill there substance use disorder, nor one I would hope anyone would recommend.
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Destructive behavior is to lie, steal, cheat, or do to harm another. There are people that do this, with, or without, drugs. Therefore, drugs are not the cause. You are demonizing an atom of the universe. People are responsible for their own actions. If you, or they, want to say that they could not help themselves because of x, then you seem to support that they are utterly incapable of making a good choice.
This post reminds me of one I read recently. A social worker followed a book on how to be a social worker. She came up with umpteen medically defined theories of why some people were incompetent parents, and was responsible for breaking up many families.
When she, herself, was called incompetent, as a mother, and lost her own children, she renounced her own profession.
Darwin did the same, with his theory. He renounced his theory, and admitted he had not connected the dots, and led people to believe, that they were descended from apes.
So does everyone, when faced with what they teach, as a theory.
What about you is confused that people actually want to be happy? rlife for everyone, is so normally, inspired to be happy.
Are you putting forward, an opinion that people are not allowed to be happy? That those that lie and steal and cheat and harm others, have greater entitlement to life, than those that do not?
If you cannot see that the root cause of all that can be said to be wrong with anyone’s life, is because someone lied, stole, cheated, or harmed them, then your thought that drugs are the problem, is so whacky!
Get real. We are all equal. Only those that dip into breaking the laws of decency, evoke hell for themselves.
No one has to prove it you.
It is despicable that there are those, in the medical industry, that promote a pill, as a solution.
Hi Steven Im so happy for you finding a way to be and stay clean. Congrats! If you don’t mind me asking, what was your substance of abuse when you considered yourself an addict? How much and for how long. Also, i have been approached by clean slate addiction centers, are you affiliated with them?
I would just like to say to each his own opinion. My husband was a full blown alcoholic still is always will be but hasn’t drank in going on 6 yrs now thanks to AA & his higher power who is & always will be God. You can say what you want but this works for a lot of people & to put this kind of doubt in peoples minds is BULLSHIT! Unless you have been thru an addiction yourself & struggle to beat it no matter how you choose to do it don’t go around knocking what works for a lot of people! I think this all boils down to another ploy to attack God & finish taking him out of things you have no control over. So what you are atheists! That’s on you! You are only responsible for your own soul we are responsible for ours. But in the end this program took a drunken man who no longer wanted or cared to live & changed him to a different person he is today. My husband has a story of how AA saved his life & how God saved his life. He was on his deathbed at one point & laughed when it come to God or getting sober. Now he helps others & is healthier than he ever was. So before you go putting something down do some more research. You might just be surprised. God bless!
very well said!
PS…I’ve been sober over 31 years…but then I do research histories… funny how gods do so much for AA drunks and nothing for cancer and all the REAL DISEASES…..THEY’RE FORCED to go to modern medicine…thank the universe…I have lots of friends that live a long time with HIV because medicine helps them…GODS NOT AT ALL…THEY WOULD BE DEAD LEFT IN GODS GRIP..
You’re lucky….AA fails 95% of the people 95% of the time since it began…the people that were involved writing the so called Big Book were drinking in a year….you don’t hear about that in AA meetings…the secrets AA has hiding in it’s closet would boggle any rational persons mind.
Amen. Put together 32 years only through AA. My own personal rule making never was adqequate. Its not perfect but it works for me. As for the the other 95%, that still out there and/ or miserable on there DRY drunks. Im an addict of every kind but I don’t take substances which allow me to have a quality of life second to none.
With the relevancy of opioid addiction and the political will to finance its reverberations in society there is a huge money grabbing opportunity. I see all the failed and irrelevant motivational speakers getting involved for a $$ piece of the action. Unless your an addict you got no reason for making any rules regarding substance abuse addiction. Mr Slate’s rules work for him and he is entitled cause he’s an addict. He’s got more paper than me but my rules are just as important.
Degree holders with regard to substance abuse have nothing to offer other than theoretical opinion. Only addicts can prove to addicts there is an alternative. This is by demonstration and there is no fee. The alternative methods are profit tools. There is currently an exponential greed opportunity in the treatment of addiction. This will dissipate as society realized there is no quick fix. There will stillbe AA and NA long after all the opinions are debunked and the $$$$ are spent.
The first drink or drug a person takes is a choice always…. without fail. The reason most point at drugs as the problem is because that is what they use…TO ESCAPE THEMSELVES….It never occurs to them that the ESCAPING THEMSELVES IS THE ADDICTION… NOT WHAT THEY USE TO ESCAPE WITH…BE IT FOOD,DRINK, DRUGS, SEX, and countless other BAD CHOICES. Until the medical professionals step in and understand this there be be no change…PS..15,000 so called Treatment Centers in this country are nothing but CASH COWS for the lawyers and doctors that invest in them…in 2016 they sucked out 45 billion dollars from families and insurance companies, knowing they have a 95% patient fail rate but also a 85% patient return rate…that’s ads up to $$$$$$$$$$$$$$$$$$$$…
You have opened my eyes to this way of thinking i want to learn more. My question is what is your opinion on Terrace Gorski’s ideas ? Is it all wrong way of thinking? My dream would have your ,The Freedom Model together with a place like your retreat but 100% free for anybody who wants to chose to stop using and can get in that same day ,no .waiting list . This morning i called st jude after reading about this model. i got to talk to Mark Scheeren and impressed me because he talked with me for a long time and i really want to do the retreat . My only barrier is the money. I destroyed my finances making the choice to get loaded and burnt every bridge. I cant afford to go. Grrr. My credit is so bad its two digits. I hope and pray that someday i can go to your retreat. Im tired of using and i will do whatever it takes to go to your retreat. Thank you for this information i am going to make a change.
Hi Keith,
I want you to know that the vast majority of people who reduce/quit substance use do so without treatment or any other formal help. Even those who do get help essentially “do it on their own” because they are the ones who make their own choices every day of their lives. You can resolve your substance use problem without Saint Jude Retreat. If you want to learn and implement our approach, you can get our book, which will be available in November.
Best,
Steven