21 Things Obama and Macklemore got wrong about addiction

I almost died of a misinformation overdose watching President Obama and rapper Macklemore talk about addiction yesterday. Luckily though, I had some Narcan-for-myths handy: the knowledge I gained from studying drugs and addiction for over a decade now.

President Obama’s Weekly Address was filled with misinformation. I counted 21 false statements in all. In fact the myths only stopped in the last 30 seconds when they uttered a few niceties and plugged their MTV Special.

Watch it for yourself, and then we’ll walk through everything they got wrong together:

“Hey, everybody. I’m here with President Obama because I take this personally.” —@Macklemore on addiction: https://t.co/35Zfbeu3gR

— The White House (@WhiteHouse) May 14, 2016

Now here’s your Narcan for each myth:

1 – Right out of the gate Obama called addiction “a disease that we too often whisper about.” First, addiction is not a disease. The movement that popularized the disease model of addiction has never produced any reliable evidence to back it up – none. As Gene Heyman Phd wrote for the journal Frontiers in Psychology in 2013:

Although the brain disease model of addiction is perceived by many as received knowledge it is not supported by research or logic. In contrast, well established, quantitative choice principles predict both the possibility and the details of addiction.

Further, in a section headed “But Drugs Change The Brain” Heyman acknowledges that neural adaptations are indeed found, but that:

There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug.

The evidence doesn’t add up to the conclusion that addiction is a disease. Read Heyman’s paper here, or check out my article on the brain disease model of addiction for more on this point. There have been plenty of authoritative sources over the years who’ve made the case that addiction is not a disease, check them out here: Addiction Is Not A Disease – Quotes From Experts.

2 – Furthermore when Obama says it’s “a disease that we too often whisper about“, he’s also getting that whispering part wrong. Nobody is whispering about this. They’re screaming about it. For example, the National Council on Alcoholism (NCA) was formed 70 years ago to spread the idea that alcoholism was a disease. They quickly triumphed with a massive public relations campaign by lobbying politicians, getting cultural leaders onboard, and commissioning one Elvin Jellinek, a scientist who falsified his qualifications, to put his and Yale’s stamp of approval on the idea. They knew that calling it a disease was shaky, but they pushed ahead anyways. As Gary Greenberg reported in the New Yorker, a disease label:

brings social resources—not just money for research and treatment but also sympathy, understanding, and acceptance, not to mention accommodations by our legal and educational bureaucracies. More than anything biochemical, this is what a disease is: a ticket to our collective wealth, for doctors and patients alike.

Jellinek knew this. In 1942, his journal published “Alcohol and Public Opinion,” in which Dwight Anderson, a recovering alcoholic and chairman of the National Association of Publicity Directors, spelled out the importance of gaining alcoholism’s entry into the halls of medicine. “Only by this means can the required approvals be gained for changing existing situations, for the creation of new institutions, for the formation of groups to do things.” Say what you will about the disease model of addiction, since 1942 it has done things.

The disease label was a means to an end – some kind of social change that would be expected to help people with drinking problems. But it was not something objectively caused by a biochemical abnormality – what any right headed person considers a disease. Nevertheless, by the 50’s the American Medical Association declared alcoholism a disease in response to the NCAs PR campaign. The NCA was loud. They lobbied. They got intellectual leaders on board. They got entertainers to do public service announcements. They got playwrights to incorporate their disease idea into their works. They even brag about getting Alfred Hitchcock to do an alcoholism storyline on his popular show.

They didn’t whisper, and they embraced the battle of getting drug addiction to be seen as a disease as well. That’s just one group. Plenty of other groups have been screaming this disease stuff over the years. The funny thing is, they keep acting like it’s a brand new idea that no one’s ever heard of before. Whispering? Come on.

3 – Macklemore says he “battled addiction”

“Addiction” is nonsense. A bogeyman. We’ve already established it’s not a disease, but furthermore, the key feature of addiction – loss of control – does not exist. Drug and alcohol users of all levels are choosing each and every hit or drink they take. They are not compelled, they have not lost control. This has been born out by many experiments. The research spans from the 1960’s to today. See some of the research here: Do Addicts and Alcoholics Lose Control?

Furthermore, Gene Heyman demonstrates that although addiction looks so irrational as to be compelled behavior, it’s not – and it follows principles of choice. He concludes that:

it is time to abandon the medical model of addiction. It does not fit the facts. The matching law, melioration, and hyperbolic discounting predict that drugs and similar commodities will become the focus of destructive, suboptimal patterns of behavior. These same choice models also predict that individuals caught in a destructive pattern of behavior retain the capacity to improve their lot and that they will do so as a function of changes in their options and/or how they frame their choices.

The behavior we call addiction can’t be proven to be a disease, and can’t be proven to be involuntary. So that just makes it free behavior. There’s nothing to battle. The battle is contrived and unnecessary, like Don Quixote tilting at windmills. I’m sure Macklemore and many others feel like they’re battling some entity that’s forcing them to use drugs, but it’s all in their mind. I know, I’ve been there.

4 – Macklemore says “If I hadn’t gotten the help I needed when I needed it, I might not be here today.”

If he hadn’t gotten help to battle the imaginary disease then it could’ve killed him. Right.

This idea that people will die without treatment is the worst. It’s not as if he’s got cancer and needs chemo. He’s got an idea that he needs drugs. Ideas can’t be medically treated out of anyone. People can only change their minds themselves about whether further heavy substance use is worth it to them to continue.

We constantly hear that 9 out of 10 people who need addiction treatment don’t get it. But the fact is, that the vast majority of people who have substance use problems resolve them, more often without treatment. Where data is available, it demonstrates that people do as well or better at resolving their problems without treatment than they would with treatment. For example, see my article on the NESARC results about alcohol dependence.

5 – Obama says addiction “often starts in a medicine cabinet.”

What he means by this is that the drug itself hooks people into using it. So you might hurt yourself and be prescribed an opiate for pain relief, but then the drug turns you into an addict and you must have more and more – you’re hooked.

The fact is that drugs don’t hook anyone. We hook ourselves to them, and we are fully capable of unhooking ourselves because it’s only a mindset that keeps us there. Addiction is learned, and it can be unlearned (rather than battled – it’s not a thing, it’s an idea).

Opiates have been around for thousands of years, and used mostly without “addiction” until the past century or two – and the defining difference has been ideas/cultures. As Richard Degrandpre reported in The Cult of Pharmacology:

traditional opium-eaters showed an overall pattern of regular, nondependent opium use. Many compelling examples come from the opium-eaters of the Punjab, a region now split between India and Pakistan, but that was under British control late in the nineteenth century.

And recounting testimony given to a Royal Commision on Opium:

A British professor of medicine working in Bombay, Sir George Birdwood, gave a similar report to the commission, distinguishing between Indian use of opium and the use of morphine in the United States. Although he acknowledged that the latter might be harmful, Birdwood asserted that the use of opium in India was not: “The healthiest people I knew, the best people, the wholesomest people, and those you trusted most in their work, were always the opium-eaters; invariably.”  The royal commission also heard testimony from a retired surgeon general, Sir William Moore, who described the Indian use of opium in a manner one might use to describe the casual use of alcohol in America today, noting its role as a much-needed distraction from everyday boredom, exhaustion, and stress. In terms of addiction and dependence, Henry Waterfield, a high-ranking British military officer who served in India, reported to the commission that 80 percent of the Sikh soldiers were regular but casual users of opium, 15 percent were habitual users, and only 1 percent were excessive users. 35 William Biscoe, another high-ranking military official, testified that among the opium-eaters in his Sikh regiment, 60 percent “took it and left it off as occasion required.”

In 1947, sociologist Alfred Lindesmith published a deep investigation into opiate use in the United States and came up with one of the most important findings people still fail to realize today: you have to believe you’re addicted to feel addicted. He realized this by looking at exactly the scenario of addiction “starting in the medicine cabinet” and found in fact that it doesn’t. When people are prescribed opiates by a doctor, perhaps large amounts of morphine after a surgery, they take them to the point of having what we’d call “physical dependence”, and then, often all at once, they stop taking them and go through withdrawal quite uneventfully. They don’t seek out more drugs. They don’t tear out their hair and go crazy. They get the physical symptoms that “junkies” get, but they don’t perceive them as signifying a need for more drugs, so they don’t feel compelled to get more drugs.

Nailing the point, Lindesmith recounted several cases of recreational opiate users who stopped and started at will until a well-meaning friend or doctor witnessed their withdrawal symptoms and informed them that they were “hooked.” After gaining that wonderful knowledge they then began to act like stereotypical heroin addicts.

The point of all this is that heroin, morphine, percocets, oxycontin, opium, or whatever other of these drugs don’t make people addicted – even though consistent use will lead to withdrawal symptoms upon cessation. Addiction doesn’t start in the medicine cabinet. Journalist Johann Hari did a great job of explaining this in a TED Talk. Here is that video (I recommend the first part of his thesis, but not the second part about disconnection and such):

6 – Macklemore says “Addiction is like any other disease – it doesn’t discriminate.  It doesn’t care what color you are, whether you’re a guy or a girl, rich or poor, whether you live in the inner-city, a suburb, or rural America. 

Well, yes and no. Yes, anyone can display the behavior pattern we call addiction. But no there isn’t a disease of addiction that will infect anyone like a virus. “Addicts” are essentially people who presently have an extremely high preference for substance use, and anyone can develop that preference. This does vary by race, religion, age, culture, socioeconomic status, gender, education level, etc. One extremely common finding is that women have lower rates of addiction than men. Another is that Asian-americans have lower rates of addiction than all other races in America. People of lower socioeconomic status are more likely to recover via abstinence, while higher socioeconomic status is predictive of recovery via moderation. The list of differences goes on and on.

No one is immune, because there is nothing to be immune to – but some life situations are more conducive to heavy substance use than others. Some cultures bestow ideas about drugs and alcohol that can be the basis for problematic or non-problematic use. For example, there are great differences among religious groups depending upon their views of alcohol.

7 – Macklemore continues his last point to say that “This doesn’t just happen to other people’s kids or in some other neighborhood.  It can happen to any of us.”

Addiction is freely chosen behavior. It doesn’t “just happen to” anyone. This is important to note because people who believe that something is out of their control to change lose the motivation to change. See Carol Dweck’s work on Mindsets/Self Theories for evidence of this.

Obama’s remarks about addiction starting in the medicine cabinet display the same sort of thinking – that addiction just happens to people, because a doctor prescribed a drug, or they found access through someone else and were curious and got addicted. People use for their own individual reasons of whether they think it will bring what they want out of life.

8 – Obama says “we need to get treatment to more people who need it”

This goes back to myth #4 – treatment does no better than going without treatment. Rates of self-change are high. No one “needs” it, and in fact people may be better off without it. In the case of alcohol, exposure to the loss of control ideas of standard 12-step based treatment raises binge rates; and belief in the tenets of the disease model is one of the only strong predictors of relapse. These ideas in treatment hurt people – they need treatment like they need a hole in the head.

For opiates, let’s look back at Lee Robins’ famous study of Vietnam War Soldiers heroin addictions. First, the vast majority of them got over their problems without treatment. But second and almost more important is the fact that they did far better than heroin addicts who received treatment. As Robins wrote in 1993:

In the first year after return, only 5% of those who had been addicted in Vietnam were addicted in the US (Fig. 4; Robins, Davis & Nurco, 1974b). This finding was totally unlike the outcomes of young men treated in Lexington, the Federal Narcotics Hospital at the time. When those young men were followed 6 months later, two-thirds were found to already be readdicted (Stephens & Cottrell, 1972). Even veterans still on narcotics at departure from Vietnam were doing very well 8-12 months after return. The curve showing the likelihood of any use, heavy use, and addiction for veterans was the mirror image of that for treated civilians. Nor was this good result transient. When we followed veterans at 3 years, only 12% of those addicted in Vietnam had been addicted at any time in the 3 years since return, and for those re-addicted, the addiction had usually been very brief.

It was not treatment that explained this remarkable rate of recovery. Only a third of the men addicted in Vietnam received even simple detoxification while in service, and only a tiny percentage of Vietnam enlisted men went into drug abuse treatment after return—less than 2% of those who used narcotics in Vietnam, 6% of those who were positive at departure, and 14% of those positive at departure who continued to use after return (Robins, 1975). Yet, those who did enter treatment had relapse rates as high as the young civilian men in Lexington—two-thirds had relapsed by the time we interviewed them. Relapse often occurred the very day they left the hospital

Nor did recovery require abstention. Although nearly half the men addicted in Vietnam tried narcotics again after return, only 6% overall got re-addicted (Fig. 6). Some were spared by using only narcotics other than heroin; some by not injecting, some by using only occasionally. But even regular heroin users became re-addicted in only half the cases (Robins et al., 1980).

This surprising rate of recovery even when re-exposed to narcotic drugs ran counter to the conventional wisdom that heroin is a drug which causes addicts to suffer intolerable craving that rapidly leads to re-addiction if re-exposed to the drug.

So, given this type of information, I think it’s quite hard to honestly say that heroin users “need treatment” or that treatment is even helpful. You know this instinctually already though, don’t you? How many people die right after they get treatment? Plenty. You hear it all the time. Then the next thing you hear is that this tragedy shows that people need treatment. Does it?

9 – Obama says “We’re working with law enforcement to help people get into treatment instead of jail.”

I don’t question the statement itself here, I’m sure it’s true. What isn’t true is what people hear from this sort of talk. People generally think it means that drug users will stop being treated like criminals. That implication couldn’t be further from the truth.

Obama is following the lead of Governors all across the country who claim they’re treating addiction as a health problem rather than a crime, and ceasing to treat addicts like criminals. There is little difference. For example my home state Governor Deval Patrick says, like so many other politicians, that “We have to treat substance abuse as a health problem instead of a criminal one.”

And here’s what they all mean by that – involuntary commitment to a treatment program. From Massachusetts’s FAQ’s on their law that aims to treat rather than jail:

“What happens once a petition is filed with the court?

Here are the next steps in order:

The court reviews the facts and decides whether or not to issue an order of commitment

If yes, then the person who is the subject of the petition must come to court that day. The court issues them either a summons or a warrant of apprehension.

Summons – a written notice delivered to the person

Warrant – allows police to pick the person up. A warrant can be issued only during court hours. Police will pick a person up only if the court is open.
If a warrant is issued and the person is picked up, they will be handcuffed, taken to court, and put in a holding cell to wait for a hearing.

– The person has the right to a lawyer and to present their own experts.

– The court will arrange for a (forensic) psychiatrist or psychologist to examine them”

It sounds exactly like treating people like criminals.

10 – Macklemore says “recovery isn’t easy or quick”

There is no recovering from a non-existent disease. But if he means that ending a pattern of problematic substance use has to be a long drawn out process, then he is wrong. It doesn’t have to be. It can be done at whatever rate the individual is willing to re-assess the value of substance use in their life. Unfortunately, it often takes people a long time to stumble backwards into this realization because they’re fighting a fake disease and trying to arrange their life so that they don’t get “triggered” by the sight of drug dealer, drugs in a movie, talk of drugs, or a goddamned spoon.

Macklemore thinks it’s a struggle because that’s what he was taught by the dysfunctional recovery culture.

11 –  Macklemore say “along with the 12-step program, treatment has saved my life.”

See points #4 and #8. Treatment works no better than receiving no treatment. In the Vietnam case, receiving no treatment was BETTER than receiving treatment.

12 – Macklemore says “we need our leaders in Washington to fund it [treatment] and people know how to find it.”

So I’ve established that treatment doesn’t work, and is toxic in its own ways, right? Good. We don’t need to fund it, and maybe we should even try to hide it from people.

13 – Obama says “This week, the House passed several bills about opioids – but unless they also make actual investments in more treatment, it won’t get Americans the help they need.”

See #12

14 – Obama says “doctors also need more training about the power of the pain medication they prescribe, and the risks they carry.”

Now this is just silly. Go back to #5. These drugs don’t have the power to addict people, and they don’t have the power to cause people to take more than they are prescribed. Doctors are a great scapegoat, but in fact it’s probably the government’s overhyped messages about the “addictiveness” of drugs that causes people to feel addicted. After all, that was Lindesmith’s main point – that you have to perceive yourself as addicted for the withdrawal effects of narcotics to become a cue to further use. More doctors need to know that these drugs are not addictive. Thankfully I recently had a surgeon who knew this and tried to explain it tom, even though I already knew. It was a good sign that there’s still some sanity in the world.

15 – Obama says “Another way our country can help those suffering in private is to make this conversation public.”

First, it is public. Remember point #2 – there is no whispering going on. Now look at point #5 & #14 again if you don’t get it. If we teach people that these drugs have power over them, they’ll be more likely to behave like addicts.

16 – Macklemore says “shame and the stigma associated with the disease keeps too many people from seeking the help they need.”

He’s correct in a way he doesn’t understand. The disease model is a source of shame, as I wrote in another article:

for shame to set in, the individual must first judge their behavior as bad, and then they must internalize that badness – thinking of it as a stable unchanging part of their very basic nature or identity.

Contrary to the unending claims that believing addiction to be caused by an incurable disease would absolve people of shame, it actually PROMOTES this sort of thinking. In the disease model of addiction you are taught to think of yourself as having an incurable disease; a fatal flaw; a trait that will forever be with you.

Of course what Macklemore means is that we have to spread the disease idea far and wide so people won’t feel shame and stigma will disappear. He’s dead wrong. Every time it’s been reliably measured, these disease models of normal life problems actually increase stigma.

17 – Macklemore says “Addiction isn’t a personal choice”

Yes it is. Again, see Gene Heyman’s very readable journal article, and you’ll understand that in every way, it fits the mold of choice rather than compelled behavior.

18 – Macklemore says “And sometimes it takes more than a strong will to get better – it takes a strong community and accessible resources.”

Choices about personal behavior are made inside the mind of each individual – not in the mind of a community. Thinking is an individual sport.

Also, I bristle at the talk of strong and weak wills and willpower. You know what takes a strong will? Walking 13 miles in the snow to get a meager amount of heroin. I’ve done it. The stories of substance users going to great lengths to get what they want are endless. So let’s not talk about levels of strength – it’s a distraction from showing people that they can modify their wants and pursue them with the same vigor.

19 – Obama says “When we talk about opioid abuse as the public health problem it is, more people will seek the help they need.”

The help seeking part may be true, but needing it is not. The last 15 years have been a juggernaut of promotion of the brain disease model of addiction. After about 20 years of stability, alcohol use disorders have risen by 50% in that time; and heroin overdoses have tripled. The idea that any of this publicity of literal misinformation will lead to progress is complete and total horseshit. It’s actually quite enraging to me every time I hear it. It’s a travesty. People are in control of their own drug use and drinking. We need to let them know that – rather than trying to strip them of any self-efficacy and confidence they may have.

20 – Obama says “More people will find the strength to recover, just like Macklemore and millions of Americans have.  We’ll see fewer preventable deaths and fewer broken families.”

Nope. See #19

21 – Macklemore says “We have to tell people who need help that it’s OK to ask for it.  We’ve got to make sure they know where to get it.”

Another repetition of #12. Isn’t also infuriating that almost every time they speak they’re saying the exact same thing? They’re like little parrots that can only say “addiction is a disease” and “we need to get people treatment.”

Infuriating, and dangerous.

About the only good helpful thing President Obama had to say is that he’s trying to make sure first responders have Narcan, a drug to reverse overdoses. Other than that, the entire proposal sounds like more of the same crap that has never amounted to anything other than greater problems.

It’s nice to want to get people help. I think all of us want that. But the treatment in our country today is not necessarily helpful – probably because it’s based on flawed premises. The best a president could do to change things is to swing us towards decriminalization and eventual legalization of drugs, and stop spreading myths about the dangers of drugs. Yes you can overdose and suffer various injuries and health problems from choosing to do drugs – but drugs can’t make you choose to do drugs, and this is important.

See the original video and full transcript of the President’s address at whitehouse.gov

Correction: under #19, it previously read “After about 30 years of stability, alcohol use disorders have risen by 50% in that time” – this was an error, and the figure was changed from 30 to 20 years to reflect the best available evidence.