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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. 

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Dr. No: Stanton Peele Takes on the "Addiction Establishment"

By Stanton Peele

05/19/11

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Ever since Bill Wilson published A.A.'s Big Book in 1938, Alcoholics Anonymous and its numerous 12-step spin-offs have dominated the national discourse about addiction. Afflicted with a condition that most physicians considered untreatable, many addicts and alcoholics ended up in sanitariums and prisons. A.A. offered them a glimmer of hope. In the past few decades, the fellowship has provided a sanctuary for three generations of addicts, who have sought, and often found, sobriety in its rooms. At the same time, Wilson's pioneering program of spirituality and abstinence, and the disease model of addiction he endorsed, have spawned a lucrative industry of medical professionals, rehab centers, and treatment programs. America alone is home to 20,000 rehabs that earn over $20 billion a year. Every day, an estimated 750,000 people check in to treatment programs across the country—most of which strictly adhere to A.A.'s 12-step traditions.

Founded in an Akron hospital room, A.A. has gone on to become a world-wide phenomenon. Today there are thousands of 12-step meetings in nations from North Korea to Nepal. (There are twelve A.A. meetings every day in Teheran alone.) But despite A.A.'s growing influence, not everyone approves of its approach. In recent years a growing group of scientists, activists and social workers have criticized the group's all-or-nothing approach to abstinence and it's religious view of recovery. But few critics have been more vocal than Stanton Peele. In hundreds of books and articles, and on his website, the 65-year-old psychologist-cum-lawyer has argued that addiction is not a progressive, lifelong medical condition, as many experts contend,  but a negative pattern of behavior—a “problem of life” that often resolves itself organically, or can be mastered through psychological treatments like cognitive-behavioral therapy.

Noting the relatively low success rate of most 12-step programs, Peele claims that abstinence-only programs may even be harmful to many addicts, who internalize their inability to maintain continuous abstinence as a personal or moral failure. When pressed, Peele admits that A.A. does work for some people. But at the same time, he has famously decried the program as “a religiously rooted folk movement…[whose] success is not one of clinical outcomes but of public relations and cultural appeal.”

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.

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