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Denial.

31 October 2014

I received an interesting email from a friend today who writes about the recovery and substance abuse industry. She asked me why I thought that places like Huffington Post, and Salon, and Substance.com are so reliably anti-treatment, anti-12 step, and even anti-addiction as a concept. Obviously, I wish I knew, and I wish I knew how to fix it. All I can do is speculate.

One of the things we talk about in AA is that it’s ok that people outside the program don’t get it. We don’t need you to get it. And most of the people writing about substance abuse, and studying addictions, and developing treatments are not addicts or alcoholics. Most of them don’t understand how if feels and what it means to be an addict. That does not mean they have nothing to contribute.

Enormous strides in treating alcoholism and addiction have been made by people who have no personal history with the disease. We know now how to prevent lethal seizures in alcohol detox, for example. We have ways to block uptake of opiates. All kinds of medicines which assist in treatment and recovery. And that’s a good thing. But medicine alone cannot treat addiction, because real recovery requires the engagement of the addict to progress and prevent relapse. Unless the individual is engaged, they will accept no medicine. And if they are engaged, once through the initial detox, they need none.

But the denial that addiction even exists? That’s a peculiar state of denial. I can understand the denial of one’s own addiction. I did that for years. But to deny that addiction exists, as some on the alternative-medicine left do, is fundamentally foreign to me. There’s a great difficulty in getting good evidence about effective treatment for addiction. But there is no difficulty at all demonstrating that addiction exists in humans and other animals.

At the core, I don’t think this is about addiction. I think there’s a strange complementary nature between the anti-science right and the anti-medicine left. And I think both are probably about hope, and about searching for control in a world that defies us. When we are confronted by terrifying things that either science insists are happening or that medicine cannot cure, it is seductive to decide that science and medicine must be wrong, rather than our world is huge and horrifying and uncontrollable.

Autism seems like a devastating diagnosis. So if I believe my child will not develop it if I don’t vaccinate, if I believe I can assert control, then that seems like a rational thing to do. And if my fear is substantial enough, and my need for control powerful enough, then I will be recalcitrant to the truth that vaccines and autism are entirely unrelated. Similarly, if climate change threatens my way of life, my economy, my cultural identity, and my fear and my need for control are enough, I will search for anything I can cling to that says I don’t need to change.

Hope and fear are useful tools. There are reasons we can experience them and they serve us in myriad ways. But they can become toxic when they become paralyzing. They can lead us to making terrible decisions that fly in the face of the truth. That then can combine with defensiveness, or arrogance, or greed, to produce phenomena like “Rolling Coal”, or the vaccination rate in some southern California enclaves dropping to levels normally associated with war-torn failed states, or bans on research into gun violence, or homeopathy for cancer.

In recovery we work to examine how our fears and our assumptions and expectations drive us. Now, I’ll make no claims about how recovery impacts a person’s politics, but in Alcoholics Anonymous we do have, right in our literature, that we are not doctors, and that listening to physicians is appropriate in recovery. Though, many will claim that the spiritual aspects of 12-step programs are no different from homeopathy. And that’s fine. They don’t need to get it. As I’ve written here many times, I think there is absolutely nothing magical about the spiritual aspect of AA, and I am not a spiritual person. But these concepts are useful tools for recovering from specific aspects of addiction. At least, my manifestation of addiction.

I am not an “evidence-based” stickler when it comes to medicine, because I have seen what passes for “evidence” in many cases (read everything by Dr. Trish Greenhalgh, right now.) and it’s disturbing what scientists and physicians will declare constitutes evidence, and then how they’ll apply it in deeply unscientific ways. And I believe that in many cases, the plural of anecdote in fact is evidence, because we lack the capacity to study outcomes in a metrizable way.

But we should not deny or ignore evidence where it exists, and is good. And there is no better evidence in any field of medicine than there is for the fact that vaccines are safe, and have saved millions, maybe billions, of lives. Just as there is ironclad evidence that the climate is warming. Nor should we ignore obvious truths simply because we don’t know how to perform a randomized controlled trial on them.

But mostly, I think so much of this denial stems from feeling frail and hopeless in the face of enormous, implacable nature. Nature that does not care what we want, and is not aware we exist. But upon which we have profound impacts regardless of our intentions or beliefs. We are thirsty and dowsing. Any drops of water we find feel like confirmation we looked in the right spot. But often, there is a river just beyond the knoll where we could simply kneel, and drink.

2 Comments leave one →
  1. 1 November 2014 10:09

    Denial is not a review in Egypt

  2. 19 November 2014 22:24

    speaking of popular portrayals of 12 step, what did you think of the leap episode of this american life where Tina concludes she never was an alcoholic?

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