The Controversial Heretic Who's Taking On AA
For three decades, psychologist Stanton Peele has riled the recovery movement with his relentless attacks on abstinence and A.A. Critics have dismissed him as a self-promoting quack. Now he's firing back.
Last week, in recognition of his long-time labors, we included Peele in our list of the 10 top addiction experts in America. Not surprisingly, his appearance sparked a fire-storm of condemnation from many readers, who denounced the doctor as a hater, an opportunist and a quack. True to form, Peele didn't take the criticism lying down. In response, he sent us a treatise that he hoped "would accurately articulate my view of an addiction model for the 21st century." We agreed to run it. Some of Peele's positions will no doubt be troubling to people in the recovery community. But while we suspect that most A.A. stalwarts are unlikely to be swayed by his arguments, there's no denying that to a surprising degree, many of his once-heretical beliefs have increasingly been adopted by mainstream medicine. Whether or not you agree with him, it's a safe bet that his alternative approach will be at the center of the most critical debates in the coming decades. So let the fireworks begin.
The Gospel According to Stanton Peele
1. Addiction is not caused by substances.
When I started working in the addiction field in the early 1970s, heroin was the only substance viewed as addictive.
When I started working in the addiction field in the early 1970s, heroin was the only substance viewed as addictive. In the ensuing four decades, the range of addictive substances has expanded exponentially—and in directions that were entirely predictable. Cocaine was widely considered to be a non-addictive drug, until I called smoking addictive in 1975—some 13 years before the Surgeon General finally recognized nicotine as an addictive chemical.
Now, for the first time, the new diagnostic manual for the American Psychiatric Association, DSM-5, due out in 2013, labels compulsive gambling as an addictioon. The doctors who are putting together the manual are still debating if sex, eating, shopping, video games and other activities completely unrelated to drugs or alcohol should also be classified as addictions. Ultimately, I believe, they will be. Why? Because addiction is about the intensity of the harm people experience from their (often uncontrollable) involvement in a certain activity—not the activity itself, whether it’s consuming narcotics or liquor or online pornography.
This reclassification of addiction by the DSM is nothing short of revolutionary. Don’t let the technical terminology fool you. The DSM is a cultural document of awesome power: it defines the many disorders for which people are diagnosed, treated, insured, and medicated. Even more importantly, it provides a scientific template for how we think about ourselves, our health and even our values. (For more about the current DSM controversies, see my 2010 article in Psychology Today.)
To some extent, the new DSM guidelines are merely reflecting the popular view that recognizes that addiction can appear almost anywhere in our high-tech consumer society. So it’s not too surprising that the head of the DSM-5 Substance-Related Disorders Work Group, Dr. Charles O’Brien, a respected University of Pennsylvania psychiatrist and researcher, has added gambling to the list of medically recognized addictions. He said he made his ruling because “substantive research” indicates that “pathological gambling and substance-use disorders are very similar in the way they affect the brain and neurological reward system."
O'Brien's assertion that intense activities like gambling and powerful drugs like cocaine are addictive because they stimulate similar neurochemicals and brain pathways challenges the establishment view of addiction. Arguing that high-order brain processes are the most important factor in determining addiction contradicts the long-held view that addiction is largely a biological problem. This profound shift in our understanding of addiction promises to permanently transform the addiction landscape in the 21st century. But to get there we’ll have to ignore decades—and perhaps centuries—of suspect science, that blames addiction entirely on genetics.