August 20, 2014

Sleazy Tactics Used To Full Dramatic Effect in Kevin McCauley’s ‘Pleasure Unwoven’: The Choice Argument

Pleasure Unwoven is a slickly scripted and produced educational DVD presumably marketed to rehabs.  I can picture a room full of rehab patients being forced to watch it right now – but hey, it’s probably better than watching videos of that priest with a chalkboard from Hazelden.  I’ve digressed though – the website for Pleasure Unwoven promises:

In this DVD, Dr. Kevin McCauley explores the most important question about addiction: is it a choice? Or a disease?

…Come along as Dr. McCauley lays out the arguments both for and against the conceptualization of addiction as a disease or as a choice, and then reviews the latest research to arrive at the correct answer.

(Spoiler Alert: it’s a disease … of choice!)

Much of it (or perhaps all, I’m not sure) is available for viewing on Youtube.  One chapter of it, The Choice Argument, is especially manipulative.  Have a look, then we’ll discuss:

Now, my complaint is not that McCauley lies, or is particularly wrong in the above video.  He is quite correct – his scenario is supportive of a choice model of addiction – but it’s also simultaneously derogatory towards and misrepresentative of the choice model of addiction.

The problem lies in the example he quite deliberately chose to use: pulling out a gun and holding it to an addict’s head.  After his little demonstration he says:

that’s the choice argument’s point. With a strong enough threat I can get the addict to stop their behavior in the way that I can’t for real patients with real diseases

And as if that wasn’t enough, he goes on to say “They can quit if they choose to. You just have to ‘motivate them’ to make the right choice” as he waves a gun around!  The point is quite clear – he’s trading quite explicitly on a false dichotomy/strawman built up  for decades by the recovery culture.  The idea is that on one side you have the compassionate people who recognize addiction as a disease and want to help addicts – and on the other side you have those of us who see addiction as a choice: barbaric judgmental meanies who want to threaten, punish and coerce addicts.

The reason I call this a straw man argument is simple.  McCauley chose a gun and sarcastically delivers lines like “You just have to help them make ‘the right choice’” for the intentional purpose of associating the choice view with an intent to punish rather than help.  Tugging at the heart strings of addicts and their loved ones with this negative imagery then makes the choice view that much easier to knock down in his victims’ minds.  It wouldn’t be kind or ethically proper to chase addicts around with various threats in order to keep them from using.  So it all works out exactly as he wants – McCauley remains at least technically honest in his presentation of the choice argument, and his viewers leave with the impression that a choice argument can only lead to punishment and is therefore irrelevant.

Contingency Management

McCauley’s presentation isn’t even half the story.  He could’ve chosen completely different imagery while still staying true to his western theme.  Imagine this – he’s riding on the back of a burro through the grand canyon while explaining the choice argument, the camera zooms out to reveal that he’s holding a stick out in front of the burro with a carrot dangling from it – the burro keeps moving forward in an effort to get that carrot.

If McCauley was a proponent of Contingency Management (CM), that’s exactly the imagery he would’ve chosen.  And unlike the method of holding a gun to an addict’s head (for which there is no peer reviewed research!), there is actually a longstanding and growing body of research on CM – which is a method of treatment in which addicts are offered incentives (as opposed to the de-centive of a bullet to the head) to stay sober.  For example, addicts have been offered everything from housing and other social services to cash, movie tickets, and sporting equipment in exchange for clean drug/breathalyzer test results.  The research supports the approach as effective – doubling the rate of success of conventional treatment.[1]

A gun might work as a negative motivator (or de-centive), and more modest incentives such as movie tickets may work as positive motivators, and the hope is that in the interim while the addict is persuaded by such external motivators, she just might be conditioned to live a sober lifestyle long-term.  And this certainly may work in some cases.

Please Note: I Do Not Condone or Recommend Contingency Management

I’m adding this note on Dec 12, 2012: My discussion of CM data above is only meant to use the data to make a point. This should not be taken in any way as an endorsement by me of such methods. I bring this up because a few readers have made comments and email communications which showed that they think I endorse CM. I DO NOT. Contingency Management is a controlling model of help. It attempts to force judgments into the mind of the substance user. The human mind cannot be forced to think in any particular way or arrive at any particular conclusion (the desired conclusion in CM being that “I have better options than substance use”). As I already said in the paragraph below, I “wouldn’t advocate the use of the carrot or the stick as a solution for addiction.” While in a CM program, some people will voluntarily choose to believe that their other options are better than substance use, but this can’t be forced or guaranteed as a result. My preferred method of attempting to reach such conclusions is to engage in discussions and assign exercises that give people a platform in which to enlarge their range of options and accurately assess their options, and ask them to give such new evaluations a fair try. From their, it is entirely a voluntary process which must be freely chosen by the individual in order for any change to take place. I do not advocate holding a real or metaphorical gun to anyone’s head in order to force a mental conclusion out of them.

Still Not The Whole Story

Just as McCauley asserts, I do indeed look to such experiments as definite evidence that substance use is a freely chosen behavior – but alas, as a choice model advocate I still wouldn’t advocate the use of the carrot or the stick as a solution for addiction.  I simply recognize the nature of addiction as a behavior people choose because they think it’s a worthwhile option, and that when it ceases to be worthwhile, or better options are recognized, the addict will choose differently.  But chasing someone around with threats or rewards is impractical, and probably not the best way to get long-term results.  Contingency Management is the equivalent of giving a man a fish – you end up in a situation where you need to keep giving him fish, and you haven’t helped him to find a meaningful solution to his problem – you keep him dependent on circumstances.  If one chooses to expand their range of options and dares to believe that they can have a better quality of happiness with other behaviors, thought patterns, and life pursuits – then they will effectively have learned how to fish.  They will create change which is internal, and nowhere near dependent on circumstances.  Incidentally, this is exactly what the method I use to help people, Cognitive Behavioral Education (CBE) achieves.

NOTE: Mr McCauley, if you’re reading this, I hope you haven’t forgotten that treatment programs for pilots and doctors have made continued licensure in such professions contingent upon continued sobriety – and done so with great results.  Wink wink.

[1] Contingency Management Incentives for Sobriety.  Stephen T. Higgins, Ph.D., and Nancy M. Petry, Ph.D.  Alcohol Research And Health, Vol.23, No.2, 1999

BEFORE YOU COMMENT (added 9/12/13)

This article IS NOT, nor is it meant to be, a full critique of Pleasure Unwoven. This article is a criticism of McCauley’s usage of the “treat em or jail em” dichotomy. This should be self-explanatory, but judging from the comment thread, it is not. So now you know. I will eventually put up a full critique of Pleasure Unwoven, and I will link to it here when I do. But for now, please know that this article is not a full critique – it focuses on one main point: that McCauley’s video is a good example of the disease theorists’ longstanding tradition of portraying their opponents as wanting to punish substance users. Keep that in mind as you comment. In the meantime, if you’re looking for an alternative perspective on the brain disease model of addiction please see this post: http://www.thecleanslate.org/myths/addiction-is-not-a-brain-disease-it-is-a-choice/

Comments

  1. This may be a duplicate email. If so, sorry. How dare you attack Dr McCauley’s research and presentation of Pleasure Unwoven. The only sleezy thing here is your website blog slandering someone who has personally experienced addiction, is a medical doctor, personally conducted over 10 years of research and has no other goal but to help addicts and their loved ones understand addicitons as best he can.

    • How dare I? The mission of my site is to break down that harmful self-destructive myth that he’s spreading.

      I’m open to debate on why you think I’m wrong about addiction being a choice, but I can’t afford to get into any more arguments about righteous indignation with people who don’t present a counterpoint. It just ends up being a waste of time.

      • I am not coming from a place of righteous indignation only from a place of grief from losing my best friend, my sister to addiction on 09 and listening to Kevin. Kevin’s research and explanation of what happens to an addict’s brain and why the condition should be treated as a disease and addicts as patients makes so much sense to me. I watched my sister fight this and I believe after all she suffered and with all that she tried to do and could not, that she did not have a choice.

        I did not say you were wrong. I respect you and your point of view that addiction is a choice.

        Kevin is dedicated to this field as you are and has personal life experience with addiction as you do. His 10 years of research and all he has given of himself to this area deserves respect. I am sure he would be very willing to debate you with the evidence- based reasons he belevies addiction is a disease and I doubt he would ever refer to you or your beliefs as sleezy regardless of how different your opinion was from his. I suggest you call him or email him to discuss this professionally instead of attacking him in an inappropriate manner on a website. I think you will find him and him and the points he makes far from sleezy.

        • Sharon, I’m so very sorry that you lost your sister. I think you should give yourself credit for recognizing
          her problem and being willing to put yourself “out there” and try to help her. I’m the oldest of 5 and have
          3 wonderful kids(17,21 & 24) and an even more awesome husband yet no one can see that I’m dying. I’ve
          tried AA but havent gotten sober. My question to you is who is Kevin and what recovery plan does he
          advocate? I may have one shot at an inpatient situation and am trying to figure out which philosophy has
          the best success rate. Thanks for your time. Leslie

          • Leslie,

            Thanks so much for your kind words. My sister lit up a room with her smile and warmth and I miss her every day. You would have thought she had the world by the tail. I watched her fight and fight her addicitons and she finally gave up and took her own life in Jan 09..

            Kevin Mc Cauley is an addiction doctor who speaks internationally about why addiction is a disease and helps addicts and their loved ones understand addiction. That was the purpose of creating the DVD. Trust me, his tactis are not sleezy, by any means. I am not sure where you live but he speaks quite frequently in CO, CA, UT, and surrounding areas.
            If you want to view what his research and beleifs are you can google “Kevin T McCauley Meth Keynote speaker”. which will lead you to a video presentation he made in 07 at a Meth Convention and its excellent. Or, you can go to you tube and he has exerpts from his Videro Pleasure Unwoven, which is where I assume the things on this website came from. He also is co founder of a treatment and recovery center in Utah called Lemont Michel. Although its for men, you may want to google it and hear him and the other cofounder speak about their treatment philosophies. I am sure if you call him he would be able to recommend a similar facility for women. Please feel free to email me personally on sfitzptrk@aol.com with questions or any other information you need. My heart goes out to you. Dont give up. There is help out there.

      • YES! How dare you!

      • The implication he makes with the gun example it that this is absolutely the incorrect way to motivate someone to give up on their addictions. Your review has skewed and twisted the tone and notion of this short informative video on addiction. Of course there are always people who will hate and try to make something out of nothing. Now with that being said you can critique any piece of work as you wish because we are all entitled to our opinions but don’t completely diminish the meaning of this mans theory and understanding without providing us an alternate one which you seem to feel is better. You have not done so and being a snake and undermining others beliefs you will not bring any positive light on whatever theory or strategy you seem to feel is better or endorse.

        • Mia,

          Try looking through the rest of this website before you accuse me of not offering an alternative theory. Heck, just try looking at the tagline of the site – “addiction is not a disease, it is a choice” – there’s an alternative for ya right there.

          “The implication he makes with the gun example it that this is absolutely the incorrect way to motivate someone to give up on their addictions.”

          Exactly – we’re in agreement about that. But if you would actually understand what I’m saying, it is this: he’s attributing that view to choice model advocates. He is implying that our backwards big ol’ meany uncompassionate solution to addiction is to threaten and punish people. It is not.

          My solution, is to first liberate people from the backwards self-defeating beliefs spread by the likes of Mr Mccauley, and then to help them become more aware of other options for happiness (other than heavy substance use) so that they can make new choices.

          Please listen carefully to the following, and think about it: people who don’t believe they have the power to choose, will not make new choices. They won’t even begin the choice-making process.

          Now ask yourself who is “undermining” people.

          -Steven

          • I think “implying” is the key word here. The argument appears to be over what his intent is in the video. I agree that this is a drastic example of choice theory, which is precisely what he intended to do. The issue is how each of us decipher the information given in the video. I believe you are taking his “gun” scene example far out of context to what he is trying to accomplish concerning the choice theory. It seems to me you are taking a blanket approach to how he views choice theory based off one point made in his video. He is very apt to point out as well this is what he believes and never states such as fact. Mr. McCauley does give evidence to support his theory which is to be expected of anyone trying to get their point across. My belief is you’ve formulated an opinion based on extremely limited information and in turn have attempted to make a point using a drastic example, the same as which you are criticizing. I will hold judgment, though, as I am not aware of any further research or evidence you may hold which may have led to your thought process on this issue. See, now I’m guilty of the same thing, making a decision on lack of information. I enjoyed the video and information it provided, but will always remain open to other points of view as an attempt to further educate myself. Oh mercy, now I’m getting strangled in this spider web of the mind. Anyhow, I appreciate your thoughts and confidence by expressing your point of view and providing this forum for comments.

          • Dale Hogue says:

            “more aware of other options for happiness (other than heavy substance use) so that they can make new choices”. this quote is why you should pack it up shut it down and go do something that really can help mankind, I don’t mean that in a bad way, Im sure you are a smart guy, a lot smarter than I am, I don’t know how to start a website, just like you don’t know that heavy substance abuse DOES NOT make you happy! in fact it robs you of everything that makes you happy. we started off like anybody else that used making small choices like others that didn’t wind up addicts. like kevin said, small mistakes, you don’t even know your making until you cross that line, then its hopeless despair then death. Its believing the lie, the lie that I could quit on my own, i’ll quit tomorrow, the great lie took my wife kids family friends career money time health. it left me alone in a room full of vomit piss trash stinch maggots flies rats I called home that I felt normal in, yeah I was so happy I could die. it took everything but my faith, I quit when I realized there was nothing I could do to quit, I was consumed and powerless, then God stepped in and said that I would not bow to anyone or anything but him, he is the absolute truth light and way. went through a lot of rehabs jail all that stuff to come to that moment of truth, that it is a lie

      • Hi Steve, just read your site and wanted to comment. Saying addicts lose the choice to use or not, doesn’t mean they then have no hope of staying off drugs/alcohol (abstinence) or being happy to stay off (recovery). It means they need to recognize what happens to them physiologically to know that without help (whichever works for the individual) their chances of recovery are slim. The same way a person with cancer can not and will not seek help until they are convinced they have cancer. No one wants cancer and no one chooses to lead a life of degradation that addiction generally requires. I certainly didn’t spend 21 years in my own private hell because it was so much fun and trying to not use for the last decade of that. I managed to stop and be content , productive and happy (14 years so far) once i was convinced I can’t change my own physiology.
        Gus

      • Steven Slate is clearly not an alcoholic/addict.

  2. Steve, Kev beat you to an every day understanding of addiction which is remarkable, sour grapes you didn’t think of it first, now your slam has got you the attention you need/desire and appear just as knowledgable. Just be positive and help those who need it, really need it! Not your pockets!
    Wipe the Slate clean and do good!

  3. Nonsense says:

    You seem to misinterpret things. One of the big arguments for disease as a choice has always been “if the addict is faced with a life or death choice (gun to the head) most will choose not to use and this can’t be done with other diseases.” And actually that is not even always true if you compare this to some other psychiatric disorders (brain). He uses this line in attempt to explain his theory, which more and more research (MRI’s studies, etc.) have started showing. Even our own government who wages the drug war has decided addiction is a disease and have enacted new prescribing legislation in 2002. Even the major doctors and nurses associations have begun to adopt addiction as a disease. It’s been a big push over the past decade and this is where science has lead them. Not opinion of pro or anti disease/choice groups, but science. Neuroscience, an area we’re not very good at it yet and why many are resistant (in addition to a long ingrained cultrual stigma about drugs) to the emerging science. Remember, what we did to people with depression and psychiatric disorders about 100 years ago? Literally and sadistically tortured them to “get the demons out.” We didn’t understand anything about the brain.
    I never once thought that his illustration of an argument the choice group uses is in any way meant to paint them as mean etc. That seems like your own point of view. One of the best ways to logically refute something is to first bring up the other sides argument and tear it down piece by piece. That’s all he’s trying to do. The theatrics are designed to entice a broader audience who would otherwise be bored out of their minds.

    • Wait a minute – there’s a thing called neuroscience? I had no idea. Thanks for telling me about the MRI studies, now I’m really convinced! I didn’t realize the government and various professional organizations agreed with the disease view, I guess I haven’t kept up with these new developments. Thanks for enlightening me. The email address you commented under – nunya@business.com – is hilarious, and I’ve never heard that one before. They should put you on Leno. Good job.

      • Steve your comment here feels snarky? Seems belittling. So, you are aware of the research etc. Perhaps your reasoning would be more easily received by others if presented with less attack on the emotions of others? You arguments above this thread did not address the argument based from the neuroscience Kevin made so bring that up for discussion seems reasonable at this point in the thread.

        • At the risk of sounding either snarky or belittling once again, the comment of mine that you’re responding to provides several links, follow them, and find out if I address the neuroscience or not. If those aren’t good enough for you, then try clicking on the “Myths” tab and then the first link that appears on the dropdown menu labeled “Addiction as a brain disease” – this tab appears on 99% of pages on this website, and I link to within several other posts and comment threads throughout the site. And if that’s not good enough for you, go to my homepage, and scroll down to the bottom of the page where I permanently have a headline and link for that same article, under the category “In Depth” where the headline reads “Addiction Is NOT A Brain Disease, It is A Choice”. In case you didn’t know, neuroscience studies the brain, so where I promise to address the brain disease, I promise to discuss some neuroscience.

          Also, in this post I chose to attack a particular type of rhetoric that is well represented in the video clip. I’m sorry if every post I make doesn’t contain a full analysis of every point about addiction, but then every post would be totally boring. I’m already enough of a windbag as it is, and nobody would want to read any of this if I was expected to do that every time. This is why I provide links to articles where I have already addressed such things, and especially feature some of the most important discussion in menu tabs available at the top of every page.

        • BTW, before you get all high and mighty about the tone of my reply, please notice what I pointed out in my reply – the commenter left a comment with the fake email address of “nunya@business.com” – meaning “none of your business”.

          I don’t expect every commenter to know my full views, but it gets a little exasperating having people come on here and tell me, with much attitude, that I should know about this or that thing that I already address all over the site. They portray me as uninformed, and they do so very rudely, without even taking 30 seconds to inform themselves about what I might know by simply perusing through the site just a little bit, or maybe even looking at the “about” page, which again is accessible by clicking on a tab that appears in the menu bar on 99% of the pages on this site. I simply respond in kind.

      • Good God, I think I’m going to just duck out of this discussion for now. Sarcasm wasn’t really called for. You just blew all credibility about your good intentions here, Steve.

      • Linking to your own skewed and unsupported opinions doesn’t count as giving evidence. You’re fishing for hits and pretending to be knowledgeable about things you clearly oppose for the sake of argument. You’ve made no valuable comments under your hilariously inane blog post (because that’s all this site is, a blog) and the basic premise of your entire “model”seems to be that you oppose the Disease Model because you simply have no idea what you’re talking about. Both the disease and choice models are partial answers to the greater question of addiction, and it is both irresponsible and intellectually cowardly to pretend knowledge (and to pretend that your links lead to evidence supporting your empty conjectures) about something your own limited experience fails to explain.

    • Richard Conley says:

      Um, the AMA may be playing along by recognizing addiction as a disease, but trust me: behind closed doors, us MD’s and DO’s largely laugh at the disease model of addiction. The AMA does say addiction is a disease, but not because of any scientific reasons…the AMA says it’s a disease so doctors can get paid for treating it!

  4. If I may …

    Thank you, Steven, for creating the site – and for being such a passionate inquisitor of the “disease” controversy. This is something we share, even though we may differ in our conclusions.

    Being a bit of a contrarian gadfly myself, I admire the spirit which led you to create the site. It’s a great site, and I hope you’ll continue to “sound out the idols” that go unchallenged by many who work in addiction treatment. It was that same spirit that inspired the DVD in the first place.

    First off, by way of disclaimer, I should say that the previous commenter, Sharon, is my cousin, so she can be forgiven her defense of me (thanks, Shar!). Still, it’s interesting how emotional the “disease” debate can get and how heated the commentary can become, isn’t it? That’s part of the fun!

    Second, in all of my lectures and certainly in the DVD I’ve always tried to be respectful of the “choice argument.” It raises important points that cannot be dismissed, although some in the traditional addiction treatment industry might try to do so. The fact is: most people with drug and alcohol problems QUIT ON THEIR OWN – without treatment, without AA. They just stop. It seems reasonable to assume that some calculus takes place in their minds that weighs the costs of continuing against the benefits of stopping … and stopping won.

    But with that fact must go the recognition that there are people who undertake the same decision-making process and fail. Despite the fact that they have endured catastrophic consequences because of their addiction, they cannot bring those consequences to bear on their choices. In these people, punishment will not RELIABLY PREDICT the outcome of their decision to stop. In other words: punishment works MOST of the time in such people, but not EVERY time. The capacity we take for granted – choice – is breaking down.

    That must mean that something is going wrong with their ability to prioritize options. The neuroscience tells us is that areas of the brain that confer value and priority on rewarding objects/actions are active during craving states (or by their activity, disrupted). There is, thus, evidence that the process of normal decision-making (valuation) resulting in behavior (volition) can reach a pathologic state. Gene Heymann, whose book you mention elsewhere in your site, is exactly right: addiction is a disorder of choice. Choice, being a capacity of the brain, can break.

    To say that choice is somehow a metaphysical property untouched by the laws of nature strikes me as libertarian mysterianism. I think that’s wrong, and I think the ultimate failure of the “choice argument’ is that is turns choice into a fetish. This is where the neuroscience can shed light, and defeat the “folk psychology” that handicaps our notions of the mind.

    Most people who become addicted do, in fact, recover on their own. That doesn’t rule out addiction’s status as a disease any more than the fact that most people who get the ‘flu recover on their own, rules out viral respiratory illness as a disease. Some get better. Some don’t. The important question is: what are the people who get better doing that gives them an edge, and how do we give that to everyone.

    Lastly, your enthusiasm for contingency management is well-placed. The research supporting it is good. We use it at our center. To the extent that positive and negative consequences can support good choices, they should be used. But more is needed for those times that consequences fail to direct proper choices. Whether that’s social, or vocational, or structural, or “spiritual” (and being a contrarian biological naturalist, I dislike that word), remains a matter for further study.

    If, from your site, I read you, Steve, correctly, I’m sure you’ll agree that removing the “mystery” from the debate is the only honest path.

    • Hi Kevin,

      I think that much of the reason why we differ in our conclusions has to do with the fact that we differ in our basic premises. Let me show you what I mean. You said:

      But with that fact [that people quit without treatment] must go the recognition that there are people who undertake the same decision-making process and fail. Despite the fact that they have endured catastrophic consequences because of their addiction, they cannot bring those consequences to bear on their choices.

      In essence, you assume that the continuance of a given behavior in the face of extreme consequences is evidence that the behavior isn’t freely chosen, that it is pathological. In other words, if you don’t agree with someone’s judgment, then you assume they are sick, because nobody in their right mind would make that choice. I don’t assume that choices I disagree with are pathological. I realize that most people make choices I would never make, or never even consider, and that is their prerogative, and it doesn’t make them sick. The simple evidence of this view on your part is the usage of the term ‘fail’ in the above quote.

      Maybe, just maybe, it’s not a failure that they’ve returned to substance use. Maybe they’ve succeeded in carrying out the choice that they want, even though it has costs. Riding in a car is riskier than flying a plane – yet millions of people take driving vacations every year. Are they all diseased? My point is, the fact that one chooses a risky or costly behavior doesn’t make them sick, these are conditions we accept and deal with every day. Think of those who courageously work with highly contagious people, soldiers who trade their life for defense of an ideal, or professional athletes and stuntmen who face certain injury – all of these carry great costs, are we to believe all of these people have “failed” at making choices?

      It’s not enough to put forth your own cost/benefit analysis of a behavior, conclude that the behavior isn’t worth the costs, and to determine that this is such a self-evident fact that anyone who still chooses the behavior has “failed” (or that they’re clearly sick; “out of control”; powerless; or has had their free will “highjacked”). We’re not dealing with numbers or chemical equations here, we’re dealing with a subjective matter – individuals’ judgments about what can and will bring them personal happiness. If you take your implicit assumption that ‘no-one in their right mind would choose this’ out of the equation, then we’re simply left with behavior that we disagree with.

      You really should look at the assumptions you’re making in your analyses. For example, do you see the assumption here:

      The neuroscience tells us is that areas of the brain that confer value and priority on rewarding objects/actions are active during craving states (or by their activity, disrupted). There is, thus, evidence that the process of normal decision-making (valuation) resulting in behavior (volition) can reach a pathologic state.

      Which comes first – the thoughts about using, or the associated brain activity? Do we know this? Do we know that the brain activity isn’t changed volitionally? You seem to assume that because there is correlation between thoughts about using (“craving”) and specific brain activity, then there must be unchosen causation coming from the direction of the brain activity.

      The amazing thing is that the vast majority of those who are “treated”, are simply talked to. We have such a strong belief in this powerful disease, this handicap, this biological process that sneakily causes the choice to use – yet most everyone undergoes no surgery, and takes no medications for it – and yet their brains end up looking different after they choose to stop using for a while. You realize that, right? Even the people who are sentenced to inpatient treatment are choosing to stay there instead of running off to keep getting high. They’re choosing to be involved with 12-step activities rather than using – they’re choosing to stop using drugs. And after some time of choosing to do that, the brain follows – not the other way around. That’s a really odd and troublesome fact for those of you with the brain disease argument, isn’t it? The brain activity doesn’t change first – the behavior does! Just look at Volkow’s much touted studies of meth users for the evidence of that.

      For the record, I have no enthusiasm for Contingency Management methods. I’m simply interested in them as evidence of a choice making process. As I said in my piece “as a choice model advocate I still wouldn’t advocate the use of the carrot or the stick as a solution for addiction”. I don’t want to coerce people in either a negative or positive way. I want to show them that they can own their choices, not be ashamed, and openly pursue their own happiness. The judgmental treatment industry shames people for using by prejudging their happiness based choices as bad; then makes the error of assuming that because the choice is bad from their point of view, then it must be bad from the user’s point of view, and thus must not be freely chosen; consequently they’ve given the user a motive to make an excuse for their use (the shame they’ve heaped upon them) and have simultaneously given them the excuse on a golden platter (you can’t stop without help – you have a disease causing your behavior). The user, still naturally pursuing personal happiness, keeps using, and grasps onto the disease illogic to excuse their choices (which should realistically need no excuse in the first place). This is the point at which users generally begin to actually experience a real feeling of powerlessness – when they’ve been pressured into believing it!

      If we can clear this nonsense out, and just focus on methods for making choices that optimize happiness, then we can really help people.

      I look forward to hear what you think about all this.

      -Steven Slate

  5. I saw Pleasure Unwoven at couple years ago, at Kaiser Permanente in California. Kaiser’s chemical dependency program, which I briefly attended, requires 3 short sessions before you can take the other classes, and in those sessions we viewed the video. This is what I remember (forgive me if this is inaccurate). He said addiction is not a choice, but a brain disease, because in addiction the prefontal cortex is not working as it should, and the limbic system takes over. A man who wants a shot of whiskey will drink it even if a gun is held to his head, because he will hope he can down the whiskey before the gun goes off; thus, the man has proven he has lost choice. It’s a shame Kaiser made us watch that, instead of teaching us what is taught here.

    Kevin, I recommend you also read the addiction self-help e-book, The Forgotten Five Steps, by Timothy J. Welch. Welch makes it clear that a person will use drugs as long as that is his best option. He uses drugs because he thinks life would be worse without them, or life will be better with them. He uses as long as he thinks he needs them.

    For me, I had to come to believe that I could live without drugs, and that 2. that my life would be better without drugs. It is all about BELIEFS, what we think we need, what we think we can do without. Brain chemistry always follows our actions.

    It’s important to recognize that addiction to drugs is nothing more than a bad habit. All bad habits are difficult to break. I look at people who are obese, and I can’t understand why they don’t get off the couch and exercise! I’m sure parts of their brain dealing with exercise are pretty weak. Human behavior, our motivations, where we get our love, passion, comfort, are hard to figure out.

    I would love to see a doctor such as yourself, study these ideas and continue this dialogue.

    • You know, Kelly, I think there’s a bit of confusion here. McCauley has said that people can indeed use choice and willpower to just quit. Many people can. Addiction is a continuum. If you can tip it in the direction of just quitting, then you’re not a severe addict. It doesn’t mean that you have no problems, no needs for support, or no difficult path ahead of you. It just means that he’s talking about a far more severe form of addiction than you are. Anyone who CAN exercise that kind of choice, should definitely exercise it, and there are various programs for getting in touch with that, which McCauley doesn’t seem to have a problem with at all — for THAT level of addiction.

  6. I am an addiction counselor as well as an addict in recovery. Kevin’s work gives my clients clarity about why willpower has’nt been working. My clients have had serious, repetative consequences from their addiction. They come with shame, low self esteem from a faulty belief imposed on them that they have choice and should “man up”. (And they chuckle at the gun bit..that’s how they see their mandated treatmment. )

    Using this information has helped a number of people I see come to terms working a relapse prevention plan, in a positive, hopeful way. Come and tell them it’s just a slick presentation.

    Thanks though for any conversation about addiction, keeps the brain going!!

    • Thanks for the input Michelle. My recommendation is not to buck up and use willpower to quit, and the reason for that is that willpower is a useless concept here. But that’s a deeper discussion which I’ll give full treatment to on the blog at some point. Briefly though, and I think you may agree if you’re a stepper – these troubled people are successfully exercising a great deal of willpower – but it happens that their will is to use great amounts of drugs and alcohol.

      Could you please describe to me your understanding of “why willpower hasn’t been working”?

    • Michelle, I saw that movie my first day in outpatient treatment, and I resented it. The movie made me think there was something wrong with me. It turns out there is nothing wrong with me and Kevin is wrong: the disease theory is a myth. For me, that was a huge relief. (I know for others, the disease theory provides comfort,but is it worth lying to people just to make them feel good, maybe?)

      And hell yeah, we need to ‘man up’. And once you ‘man up’, your self esteem will go up automatically! Why don’t you teach them that?

  7. Henry Rivera says:

    I really don’t see the suggested incompatibility of motivational incentives (CM) and addiction being a disease of choice. Choice, related to willpower as you note, is susceptible to environmental influences as well as internal influences like fatigue, hunger, and dampened pleasure from a miscalibrated reward system. Adapting to such dynamic influences using self care, motivational incentives, and CBT interventions such as positive self talk can mitigate some of the negative manifestations of the dysfunctional choice system and lead to healthy outcomes. The same logic/interventions apply to the disease of diabetes.

  8. While I would really like to believe that incentives would work, through years of struggle with my son I can tell you they don’t- at least with him. I have been a HUGE proponent of the Choice argument. However, when offered things like 1) Getting your Car Back 2) Helping you pay your rent 3) Getting cherished and valuable musical instruments back (that I took in lieu of money and items stolen)…he continued to use. I finally told him I have never met anyone in my life that had a higher pain threshold than he does. So, then I SOLD his nice late model car and kept the money. I SOLD his vintage Fender and Gibson guitars and kept the money. Still nothing. Finally, I had to think, there has to be something else wrong with him. We knew he suffered depression for years and years. So we sent him to a DDE treatment center where they have worked as much on the mental health aspect and diagnosing that as they have the addiction. I don’t disagree with you necessarily- I absolutely believe there are people out there who respond to the CM style of treatment. Others, like our son, don’t. There is plenty of alcohol and substance abuse that runs in our family. I, fortunately did not get it. And i have done my fair share of drugs and still drink alcohol. And I am in no way an addict or an alcoholic. I can use and walk away and not touch it for months. Or only on purely social settings. No big deal for me. Not so for my son. I like my stuff- I don’t want to lose my house, cars, instruments and other toys. I worked hard for those. That’s why I don’t get why he has lost everything he owns and still continued to use. There’s something wrong inside there. So, I think you need to give Dr. McCauley’ s movie another listen my friend and be open to multiple treatment methods- no two addicts are exactly alike and you are trying the “ONE SIZE FITS ALL” analogy.

  9. In addition to my above comment, the ‘GUN’ I held to my son’s head was I have thrown him in jail twice! Still doesn’t get it. He’s a very brilliant and smart individual- when he’s not using. So again, taking everything away and SELLING IT (not being a pansy here), throwing his ass in jail twice for two felony possession convictions (I pressed the charges!), having a young son he should care for (still doesn’t get it)…I have to believe there is something terribly miswired in this guy’s head! I am not trying to make any kind of excuse for him at all. I simply took a step backward, tried to remove my emotions (anger, resentment, disappointment) aside and really examine why would someone continue to do this. A lot of criminals do “get it” when they do their time and come out and lead straight lives. Why can’t he?? So there you have it. Again, you can’t make blanket statements like this. I’ve been living this for a decade!!!

    • I feel for your pain. I was one such troubled son, and put my parents through a living hell with similar results and frustration. It’s sad, but many people are willing to pay very high prices for very cheap thrills – as I once did. They do this because they believe that the cheap thrill is the best they can do in the way of acquiring happiness. From your son’s point of view, being high has been a more attractive option than having a car and two guitars – and being high has been worth the price of doing time in jail – and being high has seemed like it would be more rewarding than raising his own child. He has value judgments that appear entirely irrational to you, but they are his value judgments. I guarantee you that if he does make long term change, it will be because he started to believe that being high is no longer worth it’s associated direct costs nor the opportunity costs. Is this a matter of disease, or a matter of thought and belief?

      I recently watched a wonderful movie on ESPN about several extreme skiers who died skiing. They knew the risks, they knew friends who died doing it, but they all said it was worth it. One even said that if he died doing it, at least he’d die doing what made him happy. Is skiing a disease? Or do these people value extreme skiing to a degree that neither you nor I ever would?

      • Recently my family intervened with my brother, asked him to accept our gift, he accepted and we attended family week. Dr. McCauley spoke while we were there and I found his assertions to be enlightening. I then returned home and googled his name and found your website Steven. While reading this site it dawned on me that no one person has put their finger on what is going on in an addicts mind and then received wholesale acknowledgement of their feat. If I’m not mistaken the same could be said about a non-addicts mind as well. So what is all of this about? Dr. McCauley seems to be trying his best to better this planet. How is this wrong? With that said I believe you would be served well if you were able to allow John Ryan’s words to sink into your conscious mind. If your practical knowledge helps someone get sober then let us all rejoice and thank you. My brother believes in Dr. McCauley’s assertions and if that helps my brother stay sober then let us all rejoice and thank him. Moral I’m attempting to convey is please stop trying to see who is smarter or more right and just do your work. Can we not agree you both are working for the same goal from different directions, and they are both good? One last thing, I understand you completely disagree with Dr. McCauley, but what if he’s right?

        • My grandmother was an alcoholic, my mother was an alcoholic and a drug addict. I was staunch in my belief that it was no disease, and she gave up her family (in theory) to enjoy her drugs and alcohol. I struggle with drinking at times, though I lead a very productive life. But, the irrational urge is there. My son has been a chronic marijuana user. I have been flabbergasted at the opportunities he has tossed away to keep his use going. He is now in inpatient rehab, and I totally agree with Kyle. If the disease theory works for him, then hallelujah. If the choice theory works for me, wonderful. Not to bring religion into the argument, but I have the same perspective there. As long as a person lives in such a way that they make this a better world, I don’t really care who they believe in, even though my religion ways we have to accept certain things to get into heaven. For me, it’s the outcome and I don’t feel qualified to judge how people get there.

      • The arguments could be joined actually, and easily so. Does the use of drugs create a disease state in the brain? The neuroscience research compellingly shows that it is so. However, if we use the neuro-plasticity argument for the becoming of a disease state, then the same science must compel us to see the ability to reverse such in time. When a person abstains from substances for an undetermined amount of time (different for different people), along with exercise and nutrition and some healing interventions–including prayer and faith (God is in it whether we see Him or not), the brain can be restored to its original pre-substance abuse/addict state and even made more healthy than ever.
        We can create a state of existence for ourselves physically and spiritually that debilitates the natural agency (ability to choice) according to our desired values. It happens to many of us to some extreme regularly. We can change that and get our agency restored.
        Thus, the brain disease model can fit into the choice model, and visa versa.
        The argument that the brain disease model is not like other diseases does not fit, by the way. If I realize the I have the diseased state of Type II Diabetes, I can change my lifestyle and cure that state and live a healthy life, non dependent on external insulin. I have the ability to change the state of my being. I have, however, created a state of being that makes me dependent, outside of my choice, on insulin (or death) and will be dependent on it until I have changed significantly enough to not needed it, weening off of it as my body progresses and heals. So, similarly to drug cravings during detox or healing in the early months or years of sobriety. It may be that my brain still triggers a neurological response to certain stimuli and says “I want drugs, alcohol, sex, sugar…” I may not be able to control that natural thought or craving, but I can change my behavior so that it won’t happen anymore at some point. And, at some point I will not even think of alcohol or whatever else; my brain will create a different response. I will be “insulin free,” craving free. I’ll still have to work on the rest of my life, and live a healthy life according to healthy principles. If I don’t, like the Type II Diabetic, I have a chance of more easily going back to the state I was in. If my friend who has CURED his Diabetes starts drinking lots of soda and eating lots of candy again (and other unhealthy foods) then he will likely have Diabetes again.
        SO, join the two; its easy to do. An addict? A diseased state? Yes. Incurable? Absolutely Not! The research shows both of these claims to be true.
        Just a note…from the 12 step perspective. The original 12 Steps is different than the “culture” of the modern day 12 Step community. Those men believed in being healed, recovered, released from their obsession with alcohol. They believed that God provided that healing, regardless of their years of abuse. And then, and only then, was it possible to work on the rest of their destroyed lives. So, even the early creators of “healing” from this so-called inucurable disease did not believe that a man could not live absolutely free from it. They also believed, as I presented above, that they could not go back to that life style without serious danger.
        Thanks.
        From a Clinical Director at Chateau Recovery Center; 22+ years of healing/sobriety–I’m not an alcoholic or drug or nicotine or caffeine addict anymore; and God based faith believer; who does NOT teach that “once and addict always an addict;” and I don’t call too many things a disease (not even cancer), only state of being that has been created and is most times healable.
        Healing and freedom are possible if the person is willing.

        ~Anoah

  10. John Ryan says:

    Other things you don’t mention that can be a huge factor with SOME addicts is mental illness. By that I mean Depression and other types of self-destructive behavior (cutting, promiscuity, whatever) that the addict does in order to feel something other than the hopeless feelings they are experiencing. In my son’s case, he has been diagnosed with depression for some years. He would see psychiatrists and doctors separately from his addiciton programs. The one he most recently completely, focused on BOTH issues simulataneously. They scrapped all his old meds, also introduced a thyroid hormone to help him have more energy, and focused on other issues in his life that have impacted him (his mother abandoning him at a young age for one). Again, not making excuses for his addiction with these, but the point of Pleasure Unwoven is that many brain functions are TIED together that result in addictive behavior. Is using drugs a choice? Absolutely! But what drives the wheels in the brain that come to make that choice? I think that is where your thought process becomes oversimplified. I would love to believe this as it would make things much easier, but you know what? If we had continued down this path, we wouldn’t be where we are at at this point in time with him. Do I think he can sustain his sobriety now? I don’t know. I HOPE so, but nothing is a guarantee in life, and especially in the addiction process. I think your stance does more harm than good, even though yes, there are MANY addicts that do just choose to use, and really have no other pscyh issues. What the basis of your view is that “one size fits all” and it doesn’t unfortunately. Believe me, until I saw McCauley’s film, I thought the Addiciton is a Disease was a lot of BS too! I truly felt that my son had to have some kind of control over his behavior and the Addiction is a Disease was an easy way out for him and his mother to deal with it. It’s like with a car- if an owner neglects to maintain their vehicle, it will break down. We all think ” what a dumbass- they didn’t change their oil, check the tires, etc. etc.”. Usually what I have found are people that treat cars like that have a host of OTHER issues in their life that also suffer from neglect, so there is something else going on here if you look deeper and just not on the surface. I think I make some good points for you to ponder.

    • Toni Greene says:

      John Ryan, will you please list the name/location of the dual diagnosis program that focused on both your son’s psychiatric illness and additction simultaneously?

      Steve, I don’t know if you are right or wrong but I appreciate that at least you stimulate some people to ask the question and explore the answer.

      Thanks

  11. Steve:
    Simply stated you are an unfortunate naive person

  12. I’ve seen the entire video and read all the posts. I’ve also struggled with addiction for 30 years. I dont favor one side of this debate over the other. I do think that Steve, who seems to want to keep the debate at an intellectual level, should remove the word “sleazy” from the page headline. Leave the name-calling to the children–this is an adult topic.

    • Thanks, Joe. I too have struggled and am trying to find answers. I need facts not opinions and I agree that the term sleazy and other jabs are not helpful for me and detracts from credibility. I would really like answers as to what is going on in my brain. Skiing because you love it and willing to take the risk is not the same as drinking in spite of negative consequences, as for many of us, drinking or using really isn’t all that fun anymore. I tell my husband all the time – if you haven’t ever truly been addicted, it’s very difficult to understand what it’s truly like. I appreciate Dr. McCauley’s information because he has known the struggle first-hand and is, like me, seeking answers. It goes well beyond the rebellious young adult looking for a cheap thrill. For those with addiction, the “cheap thrill” days are long gone, and the decision to drink or use is quite baffling.

      The analogy Dr. McCauley uses about choice theory is quite barbaric, and I don’t agree that those in that camp are uncaring. However, it seems that those with that viewpoint that I have had exposure to have either never been there and truly don’t understand that the way their minds work is different from ours, or they are addicts themselves and attempting to continue the very faulty logic and justification that gets us addicts into this mess in the first place.

      • “they are addicts themselves and attempting to continue the very faulty logic and justification that gets us addicts into this mess in the first place.”

        What’s responsible – logic and justification (a volitionally reasoned out thought process) – or a disease?

        If addiction was a true disease – then either faulty or sound logic about its nature would have absolutely ZERO effect on whether an “addict” continues to use or not. Do you see the contradiction that is inherent to your point?

        Also – if you didn’t enjoy drinking at all, then you wouldn’t do it. I think people who say things like “it’s not even fun anymore” are conflating disliking the consequences with disliking the buzz.

  13. It doesn’t really matter who is right in “choice or no choice” argument. What matters is that there are different methods of recovery out there for addicts. For most of them the consequences of their addiction, losing a job, a health scare, prison, will “force” them into making the “choice” to stop. There are however some addicts for whom this will not happen, for whom the consequences will never get bad enough. If the disease concept helps these people to stop and go on to have productive, happy lives where is the problem in that?

    • Jason – This is a thing that I still struggle with.

      I’m’ mostly a choicer and mostly not a fan of AA/Twelve Step, but I sometimes have this sentiment that I am in control of my own life but that I should be OK if others use AA as a tool to get well.

      The part that makes it more complicated to me is that the whole disease concept seems really important. What if Mr. Slate is correct that it is NOT a disease. I would still probably be OK with some adult doing whatever the Hell they choose if that is getting into AA. But there’s a problem there. AA pretty much demands that members try to 12 step other people as a means of recovery, does it not? And so the disease model will be spread by AA even if it is nonsense and folks who do not have a disease will be coerced into believing that they do or have that seed planted in their mind at vulnerable moments. I still have a problem with that.

      I’m still trying to sort this all out.

    • Are any of you alcoholics or addicts?

  14. Very interesting comments and discussion. My common sense tells me that abusing alcohol is a choice. But it’s not easy to simply say ‘I’m going to choose to quit today’ and make it stick.

  15. Manny Peters says:

    “I say “experience” of addiction, because there is no objective state of “addiction” in which people actually can’t control whether or not they use substances.” That statement is incorrect factual, based on biological studies as well as nueropsychological research that has been done on the subject of addiction. Saying addiction is a choice or that Tx does not work would go against findings based research done as well. The longer the Tx the better the results (28 days = 50% +- 4%) or 180 days = 79.4% +- 3%) now these of course are numbers provided by real Tx facilities such as Hazelden, Sierra Tuson, Guest House and many others who allow for follow up numbers to be collected and research to be done. Not places like Promises Malabu who disagree with the medical community about the disease concept, but will not allow their numbers to be published or their success rate studied.
    Magic doesn’t work.

    • Please show me the studies that prove that people cannot control their use of substances – I’ve been looking for years, and I can’t find any such evidence. What I have found however, are many studies which show that people can and do control their use of substances, and that when and where they use large amounts of substances it cannot be attributed to anything other than a desire for the effect of the substance. A wonderful source of information about this is the book Controlled Drinking by Nick Heather and Ian Robertson. One notable section reviews multiple “priming dose” studies in which “alcoholics” are given alcohol (at various times known and unbeknownst to them) and then checked for cravings, offered to have more of the drink, etc – and yet they don’t display any biologically triggered loss of control. Quite the opposite seems true in fact – when they’re told that they’re drinking alcohol, even if the drink contains no alcohol at all, that is when they drink more. It’s all related to expectation – they willfully choose alcohol for the effect.

      Again, I would love to see the evidence that shows that addicts and alcoholics cannot control themselves. If you honestly look for it, I think you’ll find that this idea is only ever assumed and asserted, but never actually studied and proven.

      • Steve,

        You don’t have to look. I am sitting right here.

        Matt

        • Richard says:

          The plural of “anecdote” isn’t “data.”

          • Yes, but it is my reality.

          • Richard says:

            “Your reality” isn’t necessarily synonymous with “reality.”

          • It is your perception of reality Matt, and yes, the belief that you are unable to control yourself will lead you to feel and behave in ways that appear to be “uncontrolled”, but if you’re not choosing these “uncontrolled” behaviors (excessive substance use) when you carry them out, who is?

            No matter how much you invest in the idea that you can’t control your substance use, it is not a “reality”, it is only your uninformed “belief about reality.” There are not multiple realities, there is literally only only one physical reality – and many interpretations of, beliefs about, or perceptions of that reality. Reality is not dependent upon our consciousness, it will continue to exist long after we’re all dead and unable to perceive it.

            I could think that I’m made of ice cream, and believe it, and tell you that it’s “my reality” all that I want – but it wouldn’t be “reality”, it would only be my “belief about, or perception of reality”, and it would of course be a factually incorrect perception of reality. I am not made of ice cream. Asserting that I am made of ice cream wouldn’t help me, or a doctor, or anyone at all to come up with a solution to any one of my problems. If someone did happen to accept my assertion as representing “reality”, they could then treat me with a new cone, give me sprinkles, or make me sit in a damn freezer – and none of those things would solve any of my problems, because they aren’t based on any FACT OF REALITY.

            Here are some readings that may give you insight into the philosophical errors you’re indulging in. I offer this assuming of course that you are searching for objective truth about this phenomenon known as addiction. However, my better judgment tells me you’re not on such a quest, because you seem to repeatedly assert that you are simply religiously committed to a belief in the disease of addiction and loss-of-control in the face of all evidence to the contrary.

            http://aynrandlexicon.com/lexicon/subjectivism.html

            http://aynrandlexicon.com/lexicon/primacy_of_existence_vs_primacy_of_consciousness.html

  16. Steve,

    You are very well spoken for someone made of ice cream.

    Matt

  17. Steve,

    Hopefully you are Vanilla! I want Oreo crumbles on top!

    Matt

  18. New research validating the false dichotomy you perpetuate with this site:

    “Policy debates have often centered on whether addictive behaviour is a choice or a brain disease. This research allows us to view addiction as a pathology of choice. Dysfunction in brain regions that assign value to possible options may lead to choosing harmful behaviours.”

    Read more at: http://medicalxpress.com/news/2013-05-addiction-disorder-decision-making.html#jCp

    • As Jonas said below, “validating the false dichotomy” is strange phrasing that I don’t think communicates the point you are trying to make. Nevertheless, I think I understand your point.

      If you are saying that disease vs choice is a false dichotomy, then I have one thing to say to you: when making a charge of false dichotomy, the onus is on YOU to present a third option. By presenting the idea that addiction is a disease of choice, you are effectively still presenting the disease model. Just because it includes the word choice, this doesn’t make it a new concept that somehow falls outside of the choice vs disease dichotomy.

      To choose, is to freely decide between two or more potential courses of action, by the power of your mind (by thinking, and then acting). If you contend that the brain is “dysfunctional”, and that this dysfunction is causing the choice, then you are saying the same thing that the recovery culture has been saying for close to a century – that substance use is caused by a disease (which BTW, is defined as “malfunction in some part of the body” – dysfunction is essentially the same meaning as malfunction for these purposes), and not chosen behavior.

      You might think about where the press release you linked to ever establishes causation. There are plenty of ways to find correlation between brain states and thoughts or activities, and this correlation isn’t denied here. However, I don’t see where causation is ever established – yet the recovery culture simply assumes the direction of causation.

  19. “Validating a false dichotomy” is a funny line. I think I get what you’re trying to say, Henry, but it’s still a strange line. Are you simply saying that Mr. Slate is perpetuating the idea that this dichotomy is flawed and therefor false? Because a false dichotomy is not a good description of what your link is suggesting. Your link is suggesting some kind of explanation about how addiction is both a disease and a choice and how that is not, in fact, a false dichotomy. As to the content of the link, I’ll have to give it some more time. I saw it reported somewhere else today as well.

  20. Henry Rivera says:

    “Is light a wave or a particle? You must choose one at the exclusion of the other. Those are your only options since only one can be correct.” That’s another example of a false dichotomy. Those debates are over, and it turns out reality is more complicated than we assumed. The research suggests the same is true with addiction, and when we have the full picture, we will find questions such as “Is addiction a choice or a disease?” similarly futile or at least ill-conceived.

  21. I find it interesting that you use the you tube clips which are only a small part of the entire video which when purchased for educational reasons coms with other information and tools. Have you actually seen the whole package. It feels like you are just trying to piggyback off someone elses notoriety in hopes of making a name for yourself by bashin their work.
    It is actually a bit sad.
    :(

    • It seems like you’re here to attack me without even addressing the point that I’m making in the post. Did you even read the post?

      As to the question of whether I’ve seen the entire video – I do not own it, and I do not know what comes in the full package, although I have seen the 9 or 10 chapters of it available on youtube. You might’ve surmised that from this sentence in the post, had you read it:

      Much of it (or perhaps all, I’m not sure) is available for viewing on Youtube. One chapter of it, The Choice Argument, is especially manipulative.

      I think I’m being pretty specific about what I’m criticizing here in this post, and all I’m getting back as retorts are very general claims about how I’m evil and uninformed. It’s a little tiring. Do you have anything to actually add to the conversation? Do you have anything to say about the point I have raised? To jog your memory, my complaint is that he’s trading on the decades old (or perhaps, century-old?) false dichotomy in which it is said that there are two, and only two (hence my usage of “false dichotomy”), approaches to addiction:

      1. Declare it to be a disease - and thus you can be “compassionate” towards addicts/alcoholics, care for them, help them, reduce stigma, etc.

      2. See it as a choiceand thus “moral failing” – which will lead you to judge, shame, hate, and of course attempt to punish addicts and alcoholics until they sober up.

      If you actually want to engage in a constructive debate, please show me how he isn’t trading on that false dichotomy – please show me how he isn’t making a mostly emotional argument in which the viewer becomes a good person for believing the disease concept or a bad person for believing such behavior to be freely chosen. If there are other materials in the package that somehow add more nuance to this emotional argument that he makes, and show that you can be a believer in free choice unhampered by disease, and still care about people and not want to punish them and force them to live a certain way, then please show it to me. If you want to sidestep that issue altogether, that’s ok too – then let’s discuss the merits of the brain disease argument, and whether or not it establishes causation. Please, do anything to forward the conversation without furthering the emotional argument yourself. I’m dying to discuss this without having to defend my personal virtue, but crap like this won’t allow that to happen.

      I don’t deny that Mccauley’s presentation is emotionally powerful, but that’s exactly the problem. Do you think I’m not touched, and that I can’t relate at the end of the whole series of videos when he talks about the suffering feeling of craving to get high? Unfortunately, I can relate to that feeling very well, because I used to go through it myself. It’s a horrible feeling. You know you’re really causing a lot of problems, but all you want to do is run and do anything possible, including committing crimes and hurting those closest to you if need be to get more drugs and get high – and you feel as if you have no other choice. I have great sympathy for anyone going through it. It’s painful. Emotionally painful. But that doesn’t make it a disease.

      That feeling of craving is based on thoughts. It comes from an emotional attachment to the high. It comes from the meaning you attach to that experience. It’s not unlike what a young person goes through when they get dumped by their significant other, or what someone feels when a loved one dies. It’s a matter of thoughts and beliefs, and when people change those thoughts and beliefs, they eventually put an end to that horrible feeling. I don’t need to believe that addiction is a disease in order to be sympathetic toward people going through this, just as I don’t need to believe that the pain someone experiences after the death of a spouse is a disease – in order to feel sympathy and want to help someone going through that. Nor do I need to experience it myself. All I need to know is that in that person’s mind, the thing they want holds great importance to them. Pain is no less important, painful, or legitimate, just because it’s a product of the mind – your body doesn’t really know the difference. But what is important is how to address that pain. If it’s a product of the mind, address it with mental means. If it’s a “disease”, address it with medical means.

      The fact that there are neural correlates to “addiction” doesn’t make it a disease – there are neural correlates to everything you think or do.

      • ATTENTION PLEASE!

        Commenting on this Blog by Steve Slate is a waste of time and energy in my opinion. All you need to do is read “The About” section of this website. After reading the About The Clean Slate Addiction Site, About Steven Slate, Policies and the Official Positions sections several times, I encountered numerous hypocritical statements, personal experiences portrayed as undeniable truths when in actuality, they are merely his opinions. Steve’s opinions have been molded with unnecessary jargon to appear professional (and I believe) all in order to convince his readers that HIS TRUTH IS THE ONLY TRUTH. I can not help but notice that this particular critique of “Pleasure Unwoven” contains nothing helpful to me. This Blog is full of negativity and an outlet for Steve to share his personal resentments. Throughout his About section, Steve makes judgements going in one direction, then a paragraph later he contradicts himself over and over. It is nerve-wracking to read how much Steve proclaims to only want to help people by spreading “HIS TRUTH” to the rest of the world. Readers take note:

        We take the position that addiction, meaning a destructive pattern of substance use, is not a disease, but instead a freely chosen behavior, therefore we can not offer medical treatment or a “cure”. <—— Steve Slate's personal opinion on addiction.

        . compulsive need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly : persistent compulsive use of a substance known by the user to be harmful <———– Merriam-Webster Definition of Addiction.

        : a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms : <———- Merriam-Webster Definition of Disease.

        One other thing I noticed in this Blog, Steve does not address the issue of the staggering percentage of addicts/alcoholics who have (unknown to them) one or more family members who suffer from addiction. I'm not talking about family they have or had contact with, so you can't use the reason of learned behavior. What do you say to that Steve?
        There's nothing wrong about expressing one's personal opinion, but to dress it up and make it seem like it is factual for everyone else is, in my own opinion, a Crock. Steve can delete this comment at any time and forge his website into a forum that praises himself, and that's that.

        Sincerely,

        • Hi Kara,

          I like that you’re trying to debate by starting with definitions. It’s important that we start there, so that we know what we mean by the claim that “addiction is not a disease.” Unfortunately, we’re at a stage of history where the concept (definition) of disease has been purposely undefined or redefined by many. The definition you gave for disease is both good and bad – it communicates the idea, but it’s not specific enough. It allows for any problem of any kind to be labeled as a disease, when interpreted liberally, as it is by the mental health system. The term “condition” is too broad. Real disease includes cellular malfunction – it needs to be a condition of cellular malfunction.

          The birth of modern scientific medicine is usually dated to the publication, in 1858, of Cellular Pathology as Based upon Physiological and Pathological Histology, by the German pathologist Rudolf Virchow (1821– 1902). Emanuel Rubin and John L. Farber, authors of the textbook Pathology, state: “Rudolf Virchow, often referred to as the father of modern pathology … propos[ ed] that the basis of all disease is injury to the smallest living unit of the body, namely, the cell. More than a century later, both clinical and experimental pathology remain rooted in Virchow’s Cellular Pathology.” 19

          The standard American pathology text, Robbins Basic Pathology, defines disease in terms of what pathologists do: “Pathologists use a variety of molecular, microbiologic, and immunologic techniques to understand the biochemical, structural, and functional changes that occur in cells, tissues, and organs. To render diagnoses and guide therapy, pathologists identify changes in the gross and microscopic appearance (morphology) of cells and tissues, and biochemical alterations in body fluids (such as blood and urine).” 20 The pathologist uses the term “disease” as a predicate of physical objects— cells, tissues, organs, and bodies. Textbooks of pathology describe disorders of the body, living or dead, not disorders of the person, mind, or behavior.

          Szasz, Thomas S. (2011-07-12). The Myth of Mental Illness: Foundations of a Theory of Personal Conduct . HarperCollins. Kindle Edition.

          You may want to read the article which contains this quote:

          Disease is a physical concept and verifiable phenomenon, the name scientists give to an organism’s biological condition accounting for abnormalities in cell, tissue, and organ structure and function. Accordingly, gastroenterologists study the abnormal states of the digestive system — not gluttony. Urologists study the abnormal states of the genito-urinary system — not prostitution. Neurologists study the abnormal states of the brain and nervous system — not murder or suicide. LINK

          If definitions are too broad, then they become meaningless. If we are to use any objective definition of disease, then from there we will find that addiction doesn’t fit it.

          • Again, we’re at a strange point in history where we’re defining disease and viewing human behavior in strange ways. We look for neural processes that occur at the same time as various thoughts and behaviors, and then assuming them to be the causes of those thoughts and behaviors. Then we’re declaring those thoughts and behaviors to be involuntary. Then if we don’t like the thoughts and behaviors, we call them a “disease.” But every thought and behavior has neural correlates, so then, isn’t every behavior involuntary? Isn’t every behavior then a “disease.” And then, doesn’t the term disease, when used this way, become completely meaningless? Disease then becomes merely a distinction between thoughts and behaviors that we like and dislike.

          • I agree that the terms “Addiction,” and “Disease” are relative. Since every human being is different, we can expect an endless variety of psychological, and physical indications and behaviors. I have a huge problem with “experts” and their tendency to throw everyone into an all inclusive group. Let’s be real here, no addict will ever be identical to the next. My personal experiences with an Alcoholic are my own and do not represent everyone else. The behaviors I have witnessed, the struggles I’ve encountered all fall into the realm similar to what “Pleasure Unwoven” describes. I have been there when my Alcoholic is intoxicated, in agony, sobbing, praying, pleading, apologizing, and crying out that he wants to stop, he hands over all his bottles and begs me to get rid of them. I’ve sat with him hour after hour after hour enduring his tormented state, then guess what happens the following night…….. he buys more alcohol to drink and the cycle repeats itself. He knows it will make him miserable and suffer numerous forms of pain, To me, it is a form of insanity. He somehow expects a different result or consequences. It is clear to me he wants to stop, but something in his brain is malfunctioning. It infuriates me to hear someone say all addicts need to do is choose not to use. It is far more complicated than that, at least it is in my experience. I would not wish addiction upon my worst enemy, “if I had one that is.”

        • Hi Kara,

          In regard to your point about heritability, I’ve been working on an article about that for a while. I’m currently doing further research on the topic by reading Genetic Explanations: Sense and Nonsense

          Here’s a good excerpt:

          The authors of a 2010 article on cognitive ability and genetics noted, “It is difficult to name even one genetic locus that is reliably associated with normal-range intelligence in young, healthy adults.” 8 By 2012 the situation remained the same. 9 Risch and colleagues concluded that “few if any of the genes identified in candidate gene association studies of psychiatric disorders have withstood the test of replication.” They further concluded:

          Despite progress in risk gene identification for several complex diseases, few disorders have proven as resistant to robust gene finding as psychiatric illnesses. The slow rate of progress in psychiatry and behavioral sciences partly reflects a still-evolving classification system, absence of valid pathognomonic diagnostic markers, and lack of well-defined etiologic pathways. Although these disorders have long been assumed to result from some combination of genetic vulnerability and environmental exposure, direct evidence from a specific example has not been forthcoming. 10

          Thus the fields of behavioral genetics and psychiatric genetics are rapidly approaching a period of crisis and reexamination. In the words of a leading group of psychiatric genetics investigators, writing in 2012 about the decades-long failure to uncover any genes that cause schizophrenia (the most studied psychiatric disorder), these negative results “suggest … that many traditional ideas about the genetic basis of SCZ [schizophrenia] may be incorrect.” 11 There are two broad explanations for the ongoing failure to discover genes in psychiatry and psychology. The first, which is favored by genetics researchers and their backers, is that genes for “complex disorders” exist (although each gene may be of small effect size) and will be discovered once researchers improve their methods and increase their sample sizes. The second explanation, rarely considered in mainstream works, is that genes for psychiatric disorders and for normal variation in psychological traits do not exist. The latter explanation is consistent with Latham and Wilson’s position that apart from a few exceptions, “genetic predispositions as significant factors in the prevalence of [most] common diseases are refuted,” and that the “dearth of disease-causing genes is without question a scientific discovery of tremendous significance.” 12

          Krimsky, Sheldon; Gruber, Jeremy (2013-02-26). Genetic Explanations: Sense and Nonsense (Kindle Locations 1969-1989). Harvard University Press. Kindle Edition.

          To my knowledge, an alcoholism or addiction gene hasn’t been verified by research, and much of the twin studies are flawed and made up of surprisingly small sample sizes. Stanton Peele has addressed the genetic issue often in his research and columns, and concluded the same.

          • Kara – You should check out another of Steven Slate’s posts on how Gene Heyman has resolved a contradiction with addiction.

            He wrote this book which explains how addiction remains a choice even though it can look so much like it is not in a situation like the one you describe. And that is not to say that those of us who agree with this mean that people dealing with addiction do not deserve sympathy or help.

  22. Henry Rivera says:

    This implication of the disease vs not-a-disease distinction promoted on this site is one of attribution. Do we attribute the aberrant behavior to the individual fully or can we absolve the addict of all responsibility? As you know, my suggestion is that one not fall into that either/or trap. The dysfunction at the brain level contributing to addition is one of learning. It’s really irrelevant whether you call this a disease or not except with respect to the attributtion of responsibility implied by callng something a disease or not. Even if popular opinion decides addiction isn’t a disease, I am not willing to lay all responsibility on the individual. Similarly, if popular opinion decides addiction is a disease, I am not willing to lay all responsibility on the disease. Overriding learned behavior is the challenge, and it appears we are not equal with respect to our ability to successfully override behavior which has been rewarded via our evolved survival circuits. My extensive review of the self-control literature shows that we can teach people to improve self-control and predict ways to decrease self-control. Learning ways to help people who are poor at overiding behavior that brings significant negative consequences is one aspect to treating addiction. Here is some new research that contributes to this area of study. http://medicalxpress.com/news/2013-06-habits.html

    • That’s interesting. My question is, What is Kevin McCauley proposing? Is it something similar? Now that he says it’s a disease, what does he recommend we do about it?

  23. Peter Dumas says:

    I watched the video and am unimpressed. Also, I viewed some of the making the video pieces and am now convinced money matters first for Kevin. Kevin states that he created the “periodic table of the intoxicants” and that he is “unsure if it even works.” Yet, this is on his web site:

    Poster Size 22″x36″: Periodic Table of the Intoxicants
    Poster Size: Periodic Table of the Intoxicants
    Introductory Price: $24.95
    Regular Price: $29.95
    Periodic Table of the Intoxicants: 8.5″x11″
    Periodic Table of the Intoxicants
    Introductory Price: $14.95
    Regular Price: $19.95
    …and is only one of the many products on his site for extreme profit. $30 for a poster?

    Hmmm, did I miss the store on Steve Slate’s web site where he is charging money for…anything?

    • Lol, the periodic table of the intoxicants is funny. However, I wouldn’t jump to thinking Kevin McCauley is only in it for the money. He seems to really care and really believe in what he’s saying, and there’s nothing wrong (from my perspective) in trying to sell what you believe to be useful info/help. My personal opinion on what he’s selling though, is that at best, it’s clearly comforting to those families who want a no-fault explanation for their loved-one’s troubles; and it’s clearly immediately comforting to people with problems; but I don’t know that it actually helps anyone to create long-term change. I know there are probably people who would credit him with saving their lives, but I don’t know that that percentage who is successful reflects anything more than regression to the mean.

      FYI- although I’m not personally selling anything on this site, I do link to my employer’s website, where you can pay to take classes with me.

      • Sure, but then again, there’s the old Upton Sinclair line that is something along the lines of “It is impossible to convince a man of something when it’s his job not to be convinced of it.” I think this applies to plenty of people in the “recovery culture.” It’s quite convenient that their spiritual program is also a source of income, and they benefit from both.

  24. I was blown away by Dr. McCauley’s hourlong speech on YouTube, and as usual with me, I did a Google search to consider critical viewpoints. I’m open to them. But this is not a valid critical viewpoint, as presented here. In short, it presents a strawman argument of its own. In fact, McCauley never presented that gun-to-the-head “choice” scenario as the methods of the other side — just that side’s most convincing argument, in his estimation. He didn’t base his entire positive argument toward the disease model on debunking a fictional, strawman choice but rather on debunking any kind of real choice at all. He KNOWS that guns to the head are not a real therapeutic method being pushed out there. He separately made a great case, based on recognized research, for the center of addiction being in the survival-oriented midbrain rather than the choice-oriented frontal cortex. No choice. Just no choice. Craving. And when he describes that craving, as someone who knows it, he nearly moved me to tears. I don’t know that kind of craving, but someone I love does. In fact, he sent me the link to that YouTube speech. I’m guessing he made, is making, yes, a choice with that beautiful frontal cortex of his, all the while praying for relief from that tyrannical midbrain. Have some respect for that, please. I do. Thank you.

    • I understand that McCauley isn’t literally saying that the other side wants to literally hold guns to the heads of “addicts.”

      However, he is using a little thing called symbolism. The gun to the head is symbolic of harsh laws and punitive sentences to be used against people with substance use problems. I think this was sufficiently clear in my criticism. If you missed it, here’s an excerpt of what I wrote in the post:

      The point is quite clear – he’s trading quite explicitly on a false dichotomy/strawman built up for decades by the recovery culture. The idea is that on one side you have the compassionate people who recognize addiction as a disease and want to help addicts – and on the other side you have those of us who see addiction as a choice: barbaric judgmental meanies who want to threaten, punish and coerce addicts.

      The reason I call this a straw man argument is simple. McCauley chose a gun and sarcastically delivers lines like “You just have to help them make ‘the right choice’” for the intentional purpose of associating the choice view with an intent to punish rather than help. Tugging at the heart strings of addicts and their loved ones with this negative imagery then makes the choice view that much easier to knock down in his victims’ minds. It wouldn’t be kind or ethically proper to chase addicts around with various threats in order to keep them from using. So it all works out exactly as he wants – McCauley remains at least technically honest in his presentation of the choice argument, and his viewers leave with the impression that a choice argument can only lead to punishment and is therefore irrelevant.

      I do have respect for the inner turmoil that people with substance use problems experience. I experienced it. I empathize. And because I respect the people who go through it, I want to help them to get the most effective help. Coming to believe that you will be forever stuck with uncontrollable cravings is not helpful. It is counterproductive.

      • You know what else is counterproductive?…Creating a website that you say is intended to help people recover from drugs and alcohol, and then all you do is point out flaws and put down other means of recovery. You also, argue and put down everyone else’s comments that doesn’t agree with you. You belittle and try to point out every flaw in people’s comments. You try to make people feel minuscule, and you ALWAYS think you are right. Your “About” section on the site is loaded with lies. Tell me…How is this, at all, productive to someone who is trying to stop using? If your only means of helping people is to keep them out of any 12 step facilitation, then you are doing a fabulous job!

        • Hi Matt,

          I want to thank you for making many comments on my site. Each time you do so, you increase my search engine relevancy, which means that more people will find my site, and I will get closer to my goal of keeping people from entering into Twelve Step Facilitation and other 12-step based methods of help for substance use problems. I’m very grateful to you for that.

          But again, I must ask you not to lecture me on tone. Let me remind you of one of your first comments on this site: http://www.thecleanslate.org/alcoholics-anonymous-increases-binge-drinking-brandsma-study/#comment-9034

          You asked: “How is this, at all, productive to someone who is trying to stop using?”

          I know I’ve explained this to you before, but I’ll explain it again, and please don’t ask again. I believe that people would be better off if they didn’t believe that they were incapable of change. 12-step programs teach them they are incapable of change. If the information and ideas presented on my site dissuade them from being brainwashed into those beliefs, then they’ll be better able to exercise their power to change- in my educated opinion.

          You certainly have every right in the world to disagree, but please cease to pretend you don’t know why I think cutting down the disease/powerlessness/loss-of-control paradigm is a productive activity.

          You say: “Your “About” section on the site is loaded with lies.”

          Please back up that statement, or withdraw it.

          Have a nice day,

          -Steven

          • Steve,

            No problem! I love helping out my friends! No explanation needed. It was more of a rhetorical question, so I didn’t really need you to answer it. I can see the productivity spewed all over this site.

            It is just hilarious to me! It’s like, you have this humongous grudge against 12 step. Who gives a shit? You don’t like it! I get it, but move on with your life. I don’t like cauliflower. Should I create a website to try and get people to stop eating it?

            Good luck with that goal, Steve, I hear you are really really close.

            Matt

  25. Just a couple of things: Steve you say you had your own experience of addiction, did you try the 12 Step program of recovery?
    I agree that the “recovery industry” creates a myth that you will always be recovering, you will always need support and aftercare. Treatment centres can help an addict get some stability in a safe environment, but there main priority as a business is to make money, the longer you need them the more money they make.
    I used/abused/was addicted for many years. The consequences of this were horrendous, self-harm, suicide attempts, prison, committment to institutions, not to mention the destruction I wrought on my family, friends and complete strangers.
    For 15 years I tried various strategies, therapies, and medications. Cognitive Behavioural Therapy was just one of the many things I tried. None of them worked for me although over the years I have seen these methods work for hundreds of people.
    I always thought I hated drugs and if I could just find a way to stay clean my life would improve.
    The truth is I loved the feeling that using heroin and crack gave me. I loved it more than anything and at the expense of anything and anyone. All my problems were related to this, all my problems were of my own making. I had to find a sufficient substitute for heroin and crack. Tough ask!
    This didn’t just pop into my head, I wasn’t told this by a doctor, judge, psychiatrist, drug counsellor. I discovered this as a result of attending a 12 Step fellowship meeting and being told by a guy that my childhood, upbringing and environment had nothing to do with it. He told how my crisis was self-imposed and if I was willing to honestly look at myself and the reasons I do it he could show me a sufficient substitute. He told me he could show me how to recover from “a seemingly hopeless state of mind and body”
    He was true to his word. All he asked in return was a promise that if I succeeded in changing my life I would help other people to change theirs.
    I no longer take drugs. The ideas, emotions and attitudes which were once the guiding force of my life have been replaced with a new set of conceptions and motives.
    Most people can quit or moderate on their own. Others can quit or moderate with the help of medication or psychiatric/psychological help. Some can quit or moderate with CBE, SMART, Intuitive Thinking or any of the various programs out there. Some can quit or moderate through attending treatment centres or any of the various 12 Step fellowships. Some people can quit or moderate by getting religion and going to church.
    There are however some people for whom none of the above methods are successful, people like myself. In my experience most people in 12 Step fellowships do not actually engage in the 12 Step recovery program and if I’m honest probably most of them don’t need to.
    In my experience addicts who actively engage with the 12 Step recovery program can and do recover, they never need use drugs again, and can and do go on to live happy, productive lives.

  26. Steven, in your reply to Matt, you stated:

    “I believe that people would be better off if they didn’t believe that they were incapable of change. 12-step programs teach them they are incapable of change.”

    You seem to have totally misunderstood the 12 Step program. It is about change.

    I had to change three things:
    The way I thought.
    The way I felt.
    The way I reacted towards others.

    I was a selfish, irresponsible, thief and drug addict. I am know an honest, responsible, productive member of society.

    This change does not come from attending, treatment centres, meetings or churches. This change comes through actively engaging in the 12 Step program of recovery.

    • Hey Jason. Thank you for your posts. I also do not think that my 12 step program tells me that I am incapable of change. It also doesn’t tell me that I can’t drink. On more than one occasion I have heard “if you believe you can, go and try some controlled drinking.” I at this point know where that gets me, and I’ve seen enough ER’s. My program tells me that I can change. Why in fact it says, “All you have to change is everything.” We call our disease a “thinking” disease, and learn that if we don’t keep our thinking focused, we’ll be back out on another “road trip.” I LOVE to drink. I love the way it tastes, I love how it feels. I love how it makes me feel cool, and clever, and pretty and confident. But it also ruins my life. Destroys my liver, kidneys, pancreas, GI tract, esophagus, skin, hair, etc. I would have died a young death, with a lot of people I love mourning my death feeling mixed up feelings of pity and anger. But I changed all that. Because it is a disease that effects your choice. It argues with you, it rationalizes, it pleads. And yes, you eventually cave in and choose to use again. But it’s like your “chooser” is broken (a little Dr. Seuss-y, I know). It’s a disease that affects your ability to choose rationally. Choice isn’t some magical thing we do, it’s a chemical process controlled by synapses and hormone balances and all kinds of other complicated processes I’m not well versed in, in a tangible part of your brain. And just like a disease can affect other parts of your brain/body, this disease affects your choice center. The program gives us tools when willpower won’t hack it. Outpatient taught me how to identify my triggers. And both together taught me that I don’t have to do it alone, that in fact my chances of staying sober were better if I didn’t. I chuckle when people call it brainwashing. I’ve been brainwashed to accept that I’m not the center of the universe, to accept responsibility for my resentments, face my fears, and to make real, meaningful human connections. I’ve been brainwashed to work on my character defects and highlight my positive attributes and natural gifts. If that’s brainwashing, then I’m ok with it. I now possess a little of the cool, clever, confident person I was when I was using, by working on bettering myself, and I don’t feel like I need to use so much anymore. But every once in a while, my “chooser” gets a little crazy and I think that maybe it’d be different this time, and that’s when I pull out my toolbox and start fixing all the leaks in my “thinking problem.” So in closing, I really liked the “Pleasure Unwoven.” I tried to get sober on the values of the choice argument and it didn’t do a damn thing. And it made me feel worse and worse about myself because I couldn’t live out the choices I wanted to make with all my heart and soul. Eventually my thinking would direct me back to the liquor store. Many times I couldn’t even recall how I got there. I felt possessed. When I realized that my “chooser” had a disease and that I needed to treat that, the answers made sense. And for those of you who think that we use the disease argument as some sort of cop-out, I’m sorry you think that. I have and continue to take responsibility for my behaviors and the people I hurt. I practice my amends every day by living sober and keeping my promises. By staying close to the program so that I don’t “think” myself back to justifying picking up a drink. I’ve realized the only choice is the first one, and that one I now know how to prevent. To the guy who runs this page, I came across it trying to find out more about the doctor who made the Pleasure Unwoven videos and started browsing the comments. As far as I’ve read, whether or not your argument is valid, I don’t care. I know what works for me, and the hundreds of people I help, and the thousands of people around me who maintain sobriety with the program. They are my friends and my family and they are the proof I need. You, as a person, have an outrageous ego, and I hope for your sake you deal with that someday. Being right isn’t the most important thing. Helping people help themselves is. But I won’t go on and on, there are lots and lots of people who need to be right. And that’s your right to believe that you are. You can also believe that you are God, a superhero, a celestial being, whatever you want! Believe away.

  27. Richard Buell says:

    Are those lab mice banging away at levers all the livelong day really exercising choice?

  28. Evan Middaugh says:

    My only question about this whole argument is that “why can’t it be both”? There is some element that relates to the brain of an addict, and there is clearly an element of choice. Why not both? As much as I feel the mental health and drug addiction field needs to continue its trend of looking at people going through these issues as patients with a disease (more so to assist with the strong stigma that often accompanies rehabbing addicts) , that doesn’t mean there isn’t some element of choice and personal motivation that needs to be present to get clean. Using hypothetical disease X, let’s say that this disease can be cured with a simple process of an injection to the arm. This hypothetical is probably one of the few cases where choice could actually be removed from the equation (this brings up all sorts of ethical concerns, hence being a hypothetical), and addiction is not nearly as clean of a process as that example. So why is it such a big deal which side you take? Shouldn’t it just be a combination of evidence-based practice, education, and any other helpful methods to help give addicts their best chance at recovery?

  29. Dick Hammer says:

    Wow,,,,,ok then. All this talk and for what? Personally, I am an advocate for whatever works and a advocate for those who are out there studying addiction, counseling, making 12 step calls and what have you. This is coming from someone who battled alcoholism for over two decades. In my experience death is the only thing that woks on everybody. For the rest of us who have survived addiction and lived to tell about it, our stories of how we recovered vary greatly. Another thing I can say with absolute confidence is that knowledge is not the answer. This is where so many therapists (and Steve Slate) go wrong, they try to help by explaining to the addict why they do what they do. I imagine they do this because they are also well aware that they do not have a solution to the real problem, the one Dr. McCauley tries to address in his video.
    So here is how I see it: We all know how arrogant the medical community is. It was probably killing them that they could not figure out what addiction is. So much so that they had to label it. So, viola, they labeled it addiction. As an addict (alcoholic), I am not sure about this label. It just doesn’t settle with me. What I am sure about is that whatever addiction is, it is very real, and the solution is way beyond simply choosing not to use. Anybody who has thought about their drug use and decided that it did not serve their best interests any longer and quit were never addicts to begin with. The ONLY reason I did not drink myself to death is because I did not have the resources to achieve it. It takes a lot of money to make this happen. I know because I came close on two different occasions. So you tell me how choice comes into play when I was doing something to myself that instinctually I was terrified of, suicide. I wanted so much to die and I wanted so much to live at the same time. So for anybody who is actively reading this and in active addiction, just keep trying until you find something that works for you. Don’t give up!! And don’t discount anything just cause some bonehead who thinks they are an authority on the subject doesn’t agree with it. It may be just what you need!! You’ll never know if you don’t try it for yourself.

    And by the way, I saw McCauley’s video in a rehab, and I’ll tell you what I was thinking about the gun to the head, and actually, what any person who is truly and addict would think, “no damn gun is going to stop me, if that guy doesn’t get bored and leave soon, I’m going to take that gun from him and stuff it up his ass.” That’s right, I’d have gotten that drink or died trying.

  30. Elizabeth Ely says:

    I just received a fresh bunch of comments from this blog, which I started commenting on last summer, and I would like to thank these commenters for their overwhelmingly positive, open-minded and hopeful tone. Sadly, that has not been the general tenor of the replies that I received over the summer and later, particularly the ones from the originator of this blog. I made a very well-considered choice not to respond, not to get drawn in, and I’m proud of myself for facing my own addiction — argument. It leads nowhere, guys. I’m unsubscribing at this point, but I wish you all well in your exploration of this topic. It’s worth the trip, and it’s worth it to keep all options on the table, including the “slick” and what-have-you ones that certain people feel all smarty-pants about critiquing — there are bigger pleasures in life, I assure you. If I could leave you with one thought, it’s this: If an interaction feels toxic to you, it most likely is; conversely, if it feels generous and kind, it probably is. This Dr. McCauley shared his own courageous journey and has dedicated his life to leading others there. and that’s good enough for me. I can literally feel his sincerity and dedication, right in my bones. It feels wonderful, and I wish I could personally thank him for his insights, which provided a light in the darkness at a time when I was striving to be authentic with an alcoholic boyfriend. Good things come in simple packages, and you can feel their goodness and integrity.

  31. Steve, as a sister, wife and a mother of addicts I can fully say that 12 step programs work, addiction is a disease, McCauley’s video is informative and your an ass.

  32. Steven, it is always interesting to note how critical people can be of things they claim to understand but have not the credentials commensurate to whom they are criticizing or critiquing. I have not noticed your credentials nor how you can intellectually and medically argue one way or another with any level of competence. You will notice the comments of others and the initials after their names and their opinions are based on experience, years of erudition not suppositions.
    Dr. McCualey’s postulates and conclusions are in line with what we now know of the brain and how it works. His behavior model is upi and running with enormous success. We can now recognize the magnitude of what an addict is facing but moreover an explanation how how in the world they would make the decisions they do and the behavior they exhibit. We can also help map out a plan of recovery based on the best knowledge we have at the time. Intrinsically, this makes total sense when looked at from an objective point of view in the experience of addiction. A ship my friends and members of my family and I were on for several years.
    Start with a Clean Slate and argue from a sound medical/behavioral standpoint and avoid looking foolish and incompetent to the rest of us.

    Dr. M Alan

    • Bravo Doc! Encore please!

      Love ya Steve,
      Matt

    • Dr M Alan,

      I am embarrassed for you, because even I, who painfully lacks initials after my name (and before my name), know that an appeal to authority as you have just made, is not an argument. Have you studied logic 101? In case you don’t realize how you did nothing more than appeal to authority, let me quote you:

      …they claim to understand but have not the credentials commensurate to whom they are criticizing or critiquing. I have not noticed your credentials nor how you can intellectually and medically argue one way or another with any level of competence. You will notice the comments of others and the initials after their names and their opinions are based on experience, years of erudition not suppositions.

      That’s what you attempt to persuade me to shut up with? That there are people with “initials after their name” who claim addiction is a brain disease? I can cite plenty of people with “initials after their name” who do not think the brain disease models of addiction hold water. Here is a list:

      Stanton Peele PhD
      Sally Satel MD
      Gene Heyman PhD
      Jeffrey Schaler PhD
      Marc Lewis PhD
      Alva Noe PhD

      And there are more, but please investigate the work of these individuals before you walk around pretending that every ‘credentialed’ person with “initials after their name” is on board with Mccauley’s point of view. You don’t want to look “foolish and incompetent” now, do you?

      Do you want to get into an appeal to authority pissing match? To me, it seems a little silly, because of course fact isn’t discerned or established by a vote, popularity, or prestige. We couldn’t determine whether addiction is a brain disease by counting how many elite individuals believe it or not. We can only determine it by logically analyzing the pertinent information. So, it strikes me as hollow for you to come here and assert that I have no idea what I’m talking about while backing up this assertion with nothing more than an appeal to authority and a questioning of my authority.

      I have presented some detailed arguments on what I believe to be the holes in the brain disease model of addiction. Incidentally, my most popular article in which I tackle this issue has recently been published in the same textbook on addiction of which an earlier edition featured an article by Mccauley. Popularity and being published doesn’t make me correct, but maybe you could take it to mean that my argument on the brain disease model of addiction is at least worth considering. Maybe you’d like to read it, and punch some holes in it You can do so here: http://www.thecleanslate.org/myths/addiction-is-not-a-brain-disease-it-is-a-choice/ – I invite you to tear it apart on its content, in a sound way rather than just dismissing me out of hand because I don’t have ‘initials after my name’ – i.e. attacking the messenger. You’d look less foolish if you did so.

      And if you enjoy tearing that one apart and find yourself able to argue “with any level of competence”, I’d also invite you to take a stab at my article regarding the sort of neuro-reductionism that these brain disease claims rest upon: http://www.thecleanslate.org/philosophical-brain-disease-addiction-epiphenomenalism/ Again, you’d look less foolish if you addressed the issues rather than trying to humiliate/stifle/socially intimidate me by highlighting the fact that I don’t have “credentials” or ‘initials after my name.’

      For the record, I think my experience and number years “in recovery”, working professionally to help people with this problem, and studying the issue of addiction is comparable to Mr Mccauley’s experience. I’ve simply gone about it in a different way. I am co-author of the latest edition of The Saint Jude Program, which has an independently verified 62% long-term abstinence rate. And I’m sure I care as much about the problem and helping people with it as Mr Mccauley does. I do not question his motives – he obviously genuinely cares and wants to help. However, I think his vision of addiction and how to help people with it is wrong, and I think the way that he argued against a choice view of addiction was fallacious, because it was an emotional appeal meant to set up a false dichotomy between the disease view as compassionate and the choice view as punitive and heartless. I find this insulting; and though he’s not the only one to use this false dichotomy to win converts, he has provided a striking example of it which I chose to highlight here.

      -Steven

  33. Mark Dutcher says:

    “…the nature of addiction as a behavior people choose because they think it’s a worthwhile option, and that when it ceases to be worthwhile, or better options are recognized, the addict will choose differently.”

    Wow. I’m sure you have some data or reasoning to back up this statement. It took thirty years for me to progress from trying my first beer at 15 to seeking help for the first time at 45, and while I understand that anecdotal evidence is of little value, I can assure you that for many years I tried and failed to “choose differently”. It was not possible for me to choose in a meaningful way, as I was unable to act on my choice.

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