With an estimated 20 million people addicted to drugs or alcohol, North America is in the grip of an unrivaled epidemic. Overcoming Addiction reveals how seemingly contradictory treatment theories must come together to understand and end dangerous substance abuse.
Addiction treatment has become a billion-dollar industry based on innumerable clinical and psychological perspectives. Zealous clinicians and researchers have gathered around the theories, proclaiming each as the sole truth and excluding alternate views. In this book, leading bioethicist Gregory Pence demystifies seven foundational theories of addiction and addiction treatment. From Alcoholics and Narcotics Anonymous to methadone clinics and brain chemistry studies, each method holds foundation beliefs about human nature, free will, and biology. Understanding the diversity of these theories allows us to build a framework for more effective treatment for all addiction types.
For individuals suffering from addiction, their families, and those who devote their lives to ending addiction's grasp on our society, this book offers a fresh perspective and a framework for long-term solutions.
Autorentext
Gregory E. Pence is known as the founder of bioethics, having studied applied ethics with famous ethicist Peter Singer at NYU and written the leading textbook in the field, now in its 27 th year and 8 th edition. In 2000 he testified against bills to criminalize cloning before Congress and before the California Senate. He then defended cloning on national television on the CBS Morning Show, Talk Back with Gretta Van Susteren , and CNN News with Wolf Blitzer . He has published over seventy op-ed essays including ones in Newsweek , New York Times , Los Angeles Times , Chronicle of Higher Education , and Wall Street Journal . He lives in Birmingham, Alabama.
Inhalt
Preface Acknowledgments 1 America's Unsolved Epidemic 2 What Are We Getting Wrong? 3 Follow the Money 4 A Medical Disease 5 Chemicals and Electrical Impulses 6 Poor Choices 7 Avoiding the Worst Outcomes 8 Written in the DNA 9 Bad Ways of Coping 10 Beyond the Individual 11 The Seven Approaches and Super Pot 12 Ten Insights for Fighting our Epidemics Notes Index Preface Almost every day, newspapers or television describe deaths from overdoses. Educated people understand that addiction and alcoholism raise some of the most pressing questions of our times: what causes them, how should they best be treated, how much is the alcoholic or addicted person responsible for his or her condition, and can victims actually overcome these diseases? What people don't realize is that these questions not only raise factual issues but also deeply philosophical ones. In 2016, Surgeon General, Vivek Murthy, MD, in an essay in the New England Journal of Medicine decried "American's escalating opioid epidemic."[i] He wrote that, "more than 2 million people in the United States are addicted to prescription opioids," and that "we estimate that more than 1 million people who need treatment lack access to it." Some would call our situation in America a pandemic of addiction and of abuse of alcohol. Some scholars estimate that 1 American family in 3 suffers personal experience with addition or severe alcoholism. At the same time as the number of deaths grows each year from overdoses, various clinics and therapists claim to know the true cause of addiction and the way to cure it. They write books, start residential treatment centers, and charge substantial fees. Starting with Alcoholics Anonymous in 1935 and ending with insights from brain imaging in the last decade, families and addicts hear conflicting claims about addiction and how to treat it. In all this noise, it may surprise people that real understanding addiction may be as much a philosophical problem as a scientific one, that we really need to understand the foundational commitments of researchers and counselors. Just hearing one scientist pitch her views, without comment from other views, dooms listeners to an incomplete understanding. Getting to the bottom of addiction, and its twin, alcoholism, requires both philosophical acumen and hard-nosed facts. Getting to the bottom also requires exposing the many hidden ethical issues in competing claims about treating addiction, such as how Google can make $187 every time someone clicks on one of its ads for a a rehab center. Take one recent theoretical battle over treating addiction. A bitter, sustained debate occurred in 2018 in the normally boring New England Journal of Medicine. One famous physician- researcher claimed that addiction was an "acquired disease of the brain" and should be treated as such. An opposing researcher awhile later opposed that claim, arguing that addiction was learned behavior that could not be treated solely as a disease-of-the-brain. In turn, both thought the approach of Alcoholics Anonymous/Narcotics Anonymous, was simplistic and outdated. And in turn again, all these theories thought Kant's view of addiction and alcoholism, as a series of free choices for which people are responsible, was wrong and primitive (although many ordinary people and parents agreed with Kant.) Not understanding the philosophical conflict behind conflicting theories dooms each researcher, each family, to falsely believing that their approach is true view, while seeing other approaches as besot with ignorance or bigotry, just as many Christians, Muslims, Hindus or Jews believe that they grew up in the true religion and, sorry!, but all other religions are false. Each addiction specialist believes that he or she has discovered the true theory for treating alcoholism and addictions, but unlike theories of human nature defended by long-dead philosophers-these living specialists push their theories with take-no-prisoners zeal. The ferociousness of this debate will surprise readers, but sadly, it is an ongoing fact. Indeed, as a physician or PhD writing a book about alcoholism or addiction, it seems a prerequisite that one be recovering from one of these conditions (Paul Thomas, Leslie Jamison, Ann Johnston, Annie Grace, Judy Griesel, Marc Lewis, Maia Szalawitz, et al.) Yet the same passion that these writers bring to their subject narrows their focus to the theory that worked for them instead of the broader focus on what might work for other, different people. And that's important. If addiction and alcoholism are not all-or-nothing conditions, but spectrums, and if different people arrive at the same place on these spectrums for different reasons, then a one-sized approach won't fit all. Tolerance of other views and impartiality are rare virtues. In the author's reading about alcoholism and addiction over decades, he has never come across a writer who admits, "Every one of the other theories contains some truth." Instead, each writer vilifies the other approaches, accusing them of ignorance, greed, and lack of evidence. This book discusses the seven leading theories of addiction: Alcoholics/Narcotics Anonymous, Neuroscience, Kant, Genetics, Learning Theory, Harm Reduction, and Structuralism. An introductory chapter sketches the history and nature of our epidemic of substance abuse, while another gives an overview of theorizing about alcoholism and addiction. The latter discusses how theories might be usefully compared and evaluated. Seven core chapters, each covering one theory, follow the two introductory chapters. As the book progresses, each theory is subjected to criticisms by other theories. A concluding chapter offers some conclusions and suggests avenues of further inquiry. This book also emp…