Articles & Speeches
Addiction: A Hopeful Prophecy From a Time of Despair
Bruce K. Alexander
April 17, 2017
Expanded version of a presentation to the “New Directions in the Study of Alcohol Group,” Fortieth annual meeting, Bradford, UK, April 24 2016. A video version of that presentation is available (Alexander, 2016a.) However, this written version was only completed a year after the speech was given, because I found I could not end the speech properly in Bradford and had to finish on a minor point. Most of the original speech appears within this expanded, written version, up to the point near the end where my words stuck in my throat and I could not finish as planned. The ending of this version is new.
As requested by the conference organizers, this presentation has three parts. I will start by describing the field of addiction as I found it 40 years ago, when I was a young psychologist. I will then compare that scene to today’s field of addiction. Finally, I will attempt to prophesy the field of addiction forty years in the future. In order to envision the field of addiction in the year 2056 in a credible way, I have found it necessary to also discuss a much longer stretch of history than these forty year segments, including a look at addiction in the ancient world.
The attempt at prophecy at the end of my talk is totally unproven, of course, but it comes from serious reflection on a lifetime of experience and study. It is customary to lend gravity to prophecies by attributing them to a heavenly voice that only the prophet can hear, but I suspect that my visions do not actually have a divine source. My only hope of adding gravity to my prophecy may be revealing that I take it so seriously that I am giving the written version of this presentation to each of my children and grandchildren, with a request that they check out their ancestor’s vision of the future when the year 2056 finally rolls around. I would hate to embarrass them or myself then by what I am writing now.
Of course, the field of addiction may not be a special interest of my children or grandchildren forty years from now. However, addiction does not exist in a social vacuum. Envisioning the future of addiction requires envisioning the social and political structure of the future world, so I am hoping the prophecy may be interesting in 2056, even if addiction, as I foresee, will not be such a dark and threatening mystery then as it appears today.
Forty years ago. Year: 1976. My age: 36.
Forty years ago, addiction was very narrowly conceived. Most addiction professionals thought that people only became seriously addicted to opioids like heroin and to alcohol. Many mainstream professionals proclaimed authoritatively that people could not get really, physically addicted to cocaine, amphetamines, or marijuana, because these drugs, unlike heroin and alcohol, did not produce dramatic withdrawal symptoms. Withdrawal symptoms were the sine qua non of addiction. Serious addictions that did not involve drugs or alcohol were off the radar.
Although the scope of the mainstream field of addiction forty years ago was tightly constricted, its vehemence was unbounded. Many otherwise kindly people turned a blind eye to brutality and door-busting home invasions by narcotics police as long as they only targeted “junkies”, who were deemed unworthy of normal human respect. Many people saw the extent of heroin addiction as imminently catastrophic. Many people were panicky about the “addiction epidemic”, the “addiction crisis”, and the “curse of addiction.” The panic was used by American politicians like Richard Nixon and Nelson Rockefeller, and later by Canadian prime minister Brian Mulroney, to justify a cruel and futile War on Drugs which was accepted without serious question throughout the US and Canada (Alexander, 1990, chap. 1) and in many other places.
The War on Drugs involved more than police chasing users and dealers and soldiers raiding poppy fields in the third world. It found its way into schools, doctor’s offices, and hospitals. Schools were bombarded with sensational anti-drug propaganda, much of it untrue. Some doctors’ offices were visited by police informers who looked like street drug users and who begged for prescriptions that would relieve their suffering. Some well-meaning doctors lost their licences and/or went to jail when they wrote prescriptions in good faith (Beyerstein & Alexander, 1985). Many hospitals in the US and Canada allowed seriously ill patients to suffer prolonged agony because giving them enough morphine to control their pain would, presumably, turn them into addicts (Alexander, 1990, p. 47-49; 2008/2010, p. 179, including endnote 45).
Young professionals entering the field of addiction, including myself as a newly-minted psychologist, had been schooled to understand addiction in terms of a scientifically-worded theory. I have come to call this way of seeing addiction the “Official View.” A modified form of it still prevails today (Alexander, 2016b).
In the Official View of 1976, heroin, a few other opioids, and alcohol were the prototypical addictive drugs. Using any of these drugs a few times would cause unbearable withdrawal symptoms in anyone if they tried to stop. The unbearable withdrawal symptoms would cause the luckless experimenters to chase the addicting drug forever after, losing all behavioural control and damaging their brains in their fatal quest.
Withdrawal symptoms were usually explained in terms of the psychological learning theory and the neuroscience of the day, but, unlike today, the neurotransmitter that was usually invoked was not dopamine but the endorphins. Addictions to habits other than heroin or alcohol use were not even on the radar for most people.
The only way to recover from the disease of addiction was short-term total abstinence (called withdrawal or detox), followed by long-term total abstinence. Abstinence had to be forced either by the addicted person’s fear of imminent death (“bottoming out”) or by coercion, because “once a junkie, always a junkie.”
Researchers and therapists who seriously challenged the Official View – as did my colleagues and I with our “Rat Park” experiments beginning in the late 1970s and with our contribution to the World Health Organization’s global cocaine research project in the 1990s – were generally ignored and sometimes cut off from further research grant funding, as we were (Alexander, 2007). They were also occasionally censored (Goldacre, 2009).
Far more important than my own research, other lines of investigation about drug addiction were also being starved for funding, ignored, or repressed. These included full documentation that:
1. Widespread, extended recreational and medical use of the irresistibly “addictive” drugs, including heroin, does not cause addiction in the great majority of users;
2. Experimental administration of opioids to people who are neither addicted nor in pain almost never produces an ecstatic “high” and usually no pleasure at all;
3. Natural recovery usually occurs from addictions of all sorts, quite often without any formal treatment;
4. “Controlled use” is a workable goal for treatment and for natural recovery in many drug addicted people;
5. Many seriously addicted people are not “out of control,” but can explain the function that their addiction serves and why they continue it; and
6. Nearly 90% of the thousands of heroin-using American soldiers returning from Vietnam gave up their heroin addictions without treatment (for documentation of all these findings, see literature review in Alexander, 2008/2010, chap. 8).
Although the Official View occupied the well-funded, professionalized center of the addiction field, there was also a vigorous periphery. Countless explanations of why drugs and alcohol seemed to cause addiction had accumulated in a variety of religious traditions in the 19th and 20th centuries and also in psychoanalysis, behavioural psychology, pharmacology, neurology, immunology, genetics, evolution, economics, demonology, developmental psychology, humanistic psychology, libertarian philosophy, nutrition, criminology, sociology, hypnosis, and family systems theory (White, 1998).
There were scholarly advocates for each of these diverse theories of addiction as well as people who could honestly testify that they had been saved by a treatment regime that had been derived from one or another of them. It was, thus, a time of both dogmatic certainty in official circles and collective contradiction and confusion among everybody else. In short, addiction was an intellectual disaster area. Violent enforcement, ineffective treatment, and endless talk filled our time, but produced no real progress.
Twelve Step groups derived from Alcoholics Anonymous were still intellectually peripheral forty years ago, but they shared some beliefs with the Official View, and their ideas were very rapidly being absorbed into mainstream treatments.
“Harm reduction” was not part of the language of the addiction field yet. Nonetheless, despite heavy opposition from some quarters, some very sensible practices were in use that can be retroactively recognized as harm reduction. These included legal heroin maintenance by private physicians in the UK, and the earliest methadone maintenance programs in the US and Canada. There was also a lot of illegal medically-based harm reduction provided by compassionate doctors who risked their careers to provide drugs that they believed were in their patient’s best interests. Likewise there were many community organizations providing compassionate support that can retroactively be understood as predecessors of today’s recovery movement.
Today. Year: 2016. My age: 76.
Most discussion of addiction today still focuses on drug and alcohol addiction, today, although the field of addiction is less blinkered than it was 40 years ago. Over the past 40 years public attention has been focussed at various times on addiction to benzodiazepines, powder cocaine, crack cocaine, methamphetamine, and marijuana as well as addiction to opioids and alcohol. Serious attention is now being paid to “process” addictions to gambling, social media, Internet games, overeating, pornography, love, sex, exercise, work, eating and shopping. However, process addictions to many other habits and pursuits, such as wealth, social status, power, religion, violence, extreme sports, etc. are still mostly off the radar (see review by Sussman, Lisha, & Griffiths, 2011).
The good news of today is that even in the midst of the current panic over overdose deaths from various opioids, there are very few voices anywhere today calling for brutal enforcement measures in the style of 40 years ago. Despite the continuing theoretical dominance of the Official View, today’s tide is flowing towards non-punitive kinds of intervention, including many types of harm reduction; the recovery movement; community policing; voluntary, non-punitive medical therapies; supportive religious groups; drug courts; mindfulness meditation; and therapies based on psychedelic drugs. None of these compassionate interventions are new, but they are more acceptable than they were 40 years ago (Jones, 2016; Noffs, 2016). The move from ham-handed enforcement towards compassionate treatment is occurring in large part because of the tireless activity of a few clinicians, academics, and policemen who have had the courage to speak out against the misbegotten War on Drugs and to take the consequences. I think that the policemen’s voices were the most influential and that they have paid the heaviest price for speaking out (see LEAP, 2017).
To me the most impressive of these non-punitive kinds of intervention can be broadly referred to as the recovery movement. I am honoured to participate in this session with Keith Humphreys, who I see as one of the early, exemplary leaders in the recovery movement in the US (see White, 2011) and Wulf Livingston who has played a leadership role in the UK. I am also inspired by the presentations on the recovery movement at this conference by David Best and Jamie Irving.
Today’s really good news is that no informed person can defend the War on Drugs with a straight face anymore, although Donald Trump has come disturbingly close (McHugh, 2016). This is a huge improvement on the rhetorical level, even though absurdly violent, arbitrary drug war actions are still being carried out in some places, most notoriously the Philipines and some American states (e.g., Berehulak, 2016; New York Times Editorial Board, 2016; Goldstein, 2016; Sack, 2017). Although the War on Drugs is intellectually dead, it still lurches onward as a dangerous zombie idea.
Today’s really bad news is that, despite the compassionate new climate of non-punitive therapeutic techniques, harm reduction, and the recovery movement, and despite the intellectual death of the War on Drugs, there has been neither a discernible decrease in the prevalence of addiction nor any real intellectual consensus on its nature or cause.
In fact, a train of catastrophic drug addiction “epidemics” has been reported in the last few decades: to powder cocaine, crack cocaine, methamphetamine, and, currently, to opioids. The North American mass media accounts of the latest epidemic are every bit as terrifying as accounts of the heroin epidemic forty years ago, and accounts of epidemics to various non-opioid drugs in the interim (e.g., Farrell, 2015; Associated Press, 2016; Carreiro, 2016; CBC News, 2016). The high prevalence of addictions to drugs, alcohol, and a number of process addictions, particularly gambling and Internet addictions, are causing public alarm (Sussman, Lisha, & Griffeths, 2011; Schüll, 2015; Rosengren, 2016).
The War on Drugs still consumes somewhere around $100 billion a year worldwide (Dorward, 2016). Drug treatment is a high-tech growth industry in the US, estimated to be worth $35 billion a year and growing rapidly (Munroe, 2015; Research and Markets, 2016).
Perhaps most surprisingly, middle-aged white men and women in the United States, particularly in what has been called the “new white underclass,” have been experiencing an unprecedented increase in mortality rates after 1998 largely due to the causes of death that are most associated with drug and alcohol addiction, namely drug poisoning, suicide, and liver disease (Case and Deaton, 2015; 2017). Hospitalizations for problems caused by illicit drugs and alcohol have been steadily rising in British Columbia since 2002 at least (AOD Monitoring Project, 2016). Many people in the treatment business seem to be giving up the attempt to overcome addiction, by reframing addiction as a “chronic” disease that can be managed by lifelong monitoring and treatment, but not cured (Hoffman & Froemke, 2007; Schüll, 2015, chap. 9).
Not only is there no sign that the flood of addiction is abating, but also the field of addiction is as much an intellectual disaster area today as it was 40 years ago. Although its details have changed, the Official View still holds the center of today’s field of addiction. The Official View (e.g., Hoffman & Froemke, 2007; Volkow, Koob, & McLellan, 2016; U.S. Office of Health and Human Services, Office of the Surgeon General, 2016) is heavily funded and supported by governments and professional associations and is sometimes called the “brain disease model of addiction,” the “medical model,” or the “NIDA model.” (NIDA is the American government’s National Institute of Drug Abuse.) The Official View is represented as the scientific view of addiction. It contains remnants of the withdrawal symptom-centered analysis of 40 years ago but centers on a different set of motivational and cognitive explanations for drug addiction explained in terms of the neurochemical and epigenetic effects of drugs on the brains of people who are said to be genetically predisposed to addiction. These changes are metaphorically said to “flip a switch” in the brain that transforms genetically susceptible people into addicts who can be managed but never fully cured.
Despite the relentless publicity and official support in the US and elsewhere, the Official View is shaky because dozens of reputable researchers and social scientists have been chipping away at its scientific claims and therapeutic efficacy from various directions for decades (e.g., Peele & Brodsky, 1975; Alexander, 1990; 2016b; Kalant, 2009; Hart, 2013; Satel & Lilienfeld, 2013; Lewis, 2015; Szalawitz, 2016; see also the manifesto published by Heim and 94 co-authors published in Nature, 2014). My colleagues at SFU and I have had an unexpected role in today’s chipping process because our Rat Park experiments, which were published about 40 years ago and largely ignored for decades, have re-emerged as a matter of public discussion today (Slater, 2005, chap. 7; Macmillan, 2013; Hari, 2016). Our cocaine research which was part of the global WHO project in the 1990s might be part of the chipping process too, except that the final WHO report was politically repressed and has still not been published, two decades after it was completed (See Goldacre, 2009). Despite all this chipping, it is hard to discredit the Official View, because new theoretical defenses for it are erected as old ones are chipped away, because abundant government money is available to propagate them, and because repression of conflicting views has been seen as fair game.
Today’s field of addiction has a very large periphery in which there are as many formally stated theories or models of addiction (West, 2006) and as many alternate forms of treatment as there were forty years ago. Moreover, there is a strong eastern spiritual influence today that has expanded the periphery to include meditative therapeutic practices that were less known outside of Asia forty years ago (e.g., Peltz, 2013). So much is being written on addiction from every conceivable viewpoint that nobody can possibly read it all.
My wife, an avid knitter, suggested that I seriously consider some articles about the “Knit to Quit” movement for this presentation. This movement is said to work wonders in overcoming addiction to cigarettes (Brody, 2016). I read the articles and concluded that mindful knitting is every bit as theoretically defensible, well-intentioned, and evidence-based as a cure for smoking and related problems as thousands of other interventions that can legitimately claim to have helped some addicted people and therefore to be theoretically relevant, if not totally explainable. Despite the excellent work on the periphery, however, the mainstream media and professions endlessly proclaim the unassailable scientific status of the Official View.
In summary, the field of addiction was in serious trouble 40 years ago and it is in even more serious trouble today, because the addiction problem appears to be getting worse, and because of truly bewildering, conflicting views about what causes addiction and how it should be treated.
This state of affairs is not only bad news: It is also a mystery. How is it possible that more compassionate and scientific thinking as well as monumental expenditures have not been able to stem the rising tide of addiction?
I hope each of you in the audience today will take a moment to reflect on this mystery before we proceed, although there will be no time to discuss your individual reflections in this large group. I will propose my solution to the mystery to you in a few minutes
Forty Years in the Future. Year: 2056. My age: Deceased.
A simple extrapolation from 1976 and 2016 would suggest the disturbing possibility that in 2056 we will have a still more compassionate view of addiction, more sophisticated medical and psychological methods of treatment, and, at the same time, even worse results, along with continued intellectual chaos. But why would we expect the future to proceed in the same perverse direction as the last 40 years, rather than changing course? I found that it necessary to take a much longer look into history and philosophy, before I could either understand the mystery of the past forty years or seriously try to envision the future.
Interlude on the way to Prophecy: Addiction in the History of Western Civilization
People who would be classified as severely addicted today are unmistakeably described in Plato’s Republic, published four centuries before the birth of Christ (e.g., Plato, circa 380BC/1987, text lines 573a-575a), and in St. Augustine’s Confessions, published during the final decline of the Roman Empire (e.g. St. Augustine, 397AD/1963, book 6, chaps. 6-8).
In these two ancient eras, eight centuries apart, addictions were evidently matters of deep concern. Plato described addictions to wealth in citizens of oligarchical city states and addictions to riotous living, ruinous extravagance, and power in tyrannical city states. (Plato’s Republic lines 544a-575a; see also Plato’s Laws, circa 350BC/1970, text lines 649-650).
Alochol addiction was a serious problem in the Roman Empire. St. Augustine described his own mother’s addiction to wine in her youth, but wrote most about the addictions that he directly observed in himself and his friends. These included addictions to sex, love, worldly success, attending gladiatorial blood-sports, overeating, and – most surprisingly – intoxicating speculation in the new science of astronomy (St. Augustine’s Confessions, book 10, chap. 35; Alexander & Shelton, 2014, chap. 2).
Of course neither Plato nor St. Augustine used the English word “addiction.” But they described certain individuals whose habitual behaviours fit the centuries-old English language meaning of “addiction.” Definition 1a in the current, on-line Oxford English Dictionary (or OED) defines addiction as a state of “…being dedicated or devoted to a thing, esp. an activity or occupation; adherence or attachment, esp. of an immoderate or compulsive kind…”
Please read this authoritative, traditional dictionary definition carefully! It encompasses addiction to countless addictive possibilities beyond alcohol and drugs. Note also that this authoritative definition of addiction can encompass a broad range of addictions from those that are short-lived and minimally harmful, to those that destroy body and soul. This is what the word “addiction” has meant in English, since the time of Shakespeare.
The OED definition 1a describes the way the word “addiction” was traditionally used by literate English-speaking people and to a considerable extent still is. However, within the professional field of addiction, and to some degree in general usage, “addiction” was restricted in the late 19th and 20th centuries to severe drug and alcohol addiction. This new restricted meaning did not appear in the OED until the 1933 supplement. It appears in today’s OED as definition 1b. In this presentation the word “addiction” is used in its more general and traditional sense of definition 1a.
An aspiring prophet like myself can easily snip sentences from ancient texts and academic dictionaries and use them to support almost any conclusion. But please trust that I am not cherry picking to make the addiction problem seem older, more widespread in ancient times, or broader in scope than it actually has been. The problem of severe addiction, as we would now call it, is not vague or peripheral in either Plato’s Republic or St. Augustine’s Confessions, but explicit and interwoven with the main thrust of both works and of other ancient writings. (By contrast, what the Bible says about addiction depends much more on how a relatively small number of words are translated and interpreted, and I must leave that difficult exegesis aside in this brief presentation.)
Plato wrote the Republic about eight centuries before St. Augustine wrote the Confessions. What happens if we jump another eight centuries beyond Augustine into the 1200s and 1300s? We find clearly recognizable descriptions of addicted people in the medieval writings of Aquinas, Chaucer, and Dante. For example, Dante populated circles 2, 3, and 4 of his Inferno with the tormented souls of those who could now be described as addicted to sex, food, and greed during their lifetimes by the traditional OED definition of addiction (Dante Alighieri, 1317/2009, cantos 5-7). People with other forms of addiction can be identified elsewhere in Dante’s hell, mixed in with the other sinners whose evil behaviours were less habitual – but equally damnable.
And what if we jump another eight centuries from there? We would have jumped back into our own era, where the emphasis has been primarily on drug and alcohol addictions since the early 20th century, but where a few other kinds of addictions are now being recognized as equally important again.
If we look between these eight-century leaps, we would also see not only that the object of addiction varies, but also that the prevalence of addiction waxes and wanes enormously. Whereas addiction has, in some times and places, been a matter of great concern, it has at others been so unimportant that it was apparently not even an interesting topic of conversation to the great thinkers of the day (Austin, 1985, pp. xiii-xv; Alexander, 2008/2010, chap. 6; Alexander & Shelton, 2014).
Both Plato and St. Augustine, and some other ancient thinkers, worked hard to explain why severe addictions occurred in their own day. Why, each of these great thinkers asked, are some people dominated by narrow, intemperate needs to the extent that they damage themselves, their families, and their societies, while others can satisfy these same needs casually or ignore them? This is a question when you are contemplating an addicted person whom you care about. As St. Augustine showed, the question is even more agonizing when you feel forced to ask it about yourself.
Plato and St. Augustine came up with fundamentally different answers to this essential question. Their different answers led them to very different prescriptions for ameliorating the problem. Plato’s main remedy was teaching people from childhood that balanced living was the key to happiness as well as virtue. St. Augustine’s main remedy was deep faith in the Christian God. Both of these ancient prescriptions remain sensible counsel today. However, neither prescription has been sufficient to quell the flood of addiction in our times.
The mystery addressed by Plato and Augustine has still found no definitive solution. Ask yourself the ancient question: Why do some people habitually act in addicted ways that injure themselves, their families, and their society, while others do not? Although this question has been answered in countless ways, by thinkers of every variety, none of the answers that have been proposed has stuck even now, twenty-four centuries after the question was first recorded. There is still no consensus, despite the pompous pronouncements that “evidence-based science” makes the current Official View unassailable.
The history of science shows that when people spend centuries trying to find the answer to a question, but still get nowhere, it is time to shift the paradigm and ask a different question (Kuhn, 1970). I believe we have reached that tipping point in the field of addiction.
I have gradually come to believe that Plato himself expressed the essential paradigm-shifting idea. In Book Eight of the Republic (544a-575a) Plato raised the astounding possibility that the root cause of widespread, severe, addiction does not lie in any defect or unusual feature of individuals who become addicted or of their immediate families.
Plato argued that the root cause of epidemic addiction lies in the structure of society itself. Plato argued that in “just” societies, addiction is rarely a problem. Totally “unjust” or tyrranical societies are so distorted and imbalanced that everyone succumbs to addiction (571a-573b). In between are societies where many people must struggle with addictive urges and some people succumb to them while others find a way to resist them, manage them, or recover from their addiction. Perhaps the most important question we can ask in the 21st century is not what kind of individual weakness, vulnerability, or drug exposure, leads some individuals to severe addiction. Perhaps we should be asking why our current society makes it difficult for great masses of people to avoid the whole range of addiction from relatively minor and emphemeral to severe, intractable, and potentially fatal.
Plato’s astounding idea fits with many historical studies that suggest that addiction is much more prominent at some periods of history than others and in certain kinds of society. Whereas conflicting theories of addiction have produced an intellectual disaster area for addiction specialists, historians generally agree that the breakdown of functioning social ties and institutions leads to extensive dislocation, and to many forms of addiction (e.g., Dodds, 1965; Hughes, 1987; review in Alexander, 2008/2010, chap. 5).
Plato’s idea has proven fruitful for health issues other than addiction as well. A current movement within the health professions and the World Health Organization contends that a great many health problems are more fully explained by the distortion of social relationships caused by the structure of modern society than by individual differences in genetic susceptibility or other risk factors (Jetten, Haslam, & Haslam, 2011; Allen, 2016; Monbiot, 2016a) For a broader analysis of the “social determinants of health perspective” within today’s health professions, see Davis & Gonzáles (2016, esp. pp. 11-12).
Shortly after Plato, Aristotle briefly discussed the power of some societies to implant addictions to power in his Politics (Book 7: chap. 14). However, eight centuries later, St. Augustine authoritatively ruled out the possibility that addiction could be a product of certain kinds of society for his Christian followers. If God is perfect, St. Augustine maintained, the governments and nations that He establishes are intrinsically righteous. Any individual problems that arise must result from sinful failures of individual free will, and any solutions must be based on individual, not social, reform. This kind of individual orientation has remained central to Christianity for centuries although there is a countervailing Christian movement towards a “transformist faith” that recognizes the urgent need for social change within the realm of God’s creation (Baum, 2006, 159-167; chap. 9; Pope Francis, 2013, chap 2, 4).
Plato’s startling pre-Augustinian insight on distorted societies as the root cause of epidemic addiction was almost completely forgotten until it started re-emerging in the writings of some great social thinkers of the 19th, 20th, and 21st centuries. But why would a brilliant social analysis of an important issue like addiction be ignored for over 20 centuries during which no really convincing understanding was found on the individual level? And how could it be ignored, when it sits in plain sight in a book that has been read by the most educated people, in every language, for most of that period?
Perhaps the reason is that Plato’s insight could require a society in which addiction is common to face terrifying realities about itself. Plato argued in the Republic (544a-575a) that addiction is rare in “just,” well-balanced societies. But when a deteriorating society reaches its final decline and is careening towards tyranny, it become impossible to maintain balance between the powerful, conflicting human needs that reside in each individual’s psyche. When balancing the full range of human needs is impossible, individuals cleave to a smaller number of intense needs or to a single one, to attain any satisfaction at all. These overworked needs become “master passions”, i.e., addictions.
The most addicted people are recognized as leaders in a society that is deteriorating in this way, because the ferocity of their master passions for power and status makes other citizens turn to them in the vain hope of finding a protector. Perhaps in such a society, extreme passion comes to seem like a virtue. May I ask you to reflect for a moment on the otherwise inexplicable charisma of American president-elect Donald Trump, of the popular former mayor of Toronto, Rob Ford, and of the current president of the Phillipines, Rodrigo Duterte. These highly popular politicians appear to suffer from powerful “master passions”, i.e., addictions, for public recognition, money, and power (Mayer, 2016; Towhey & Schneller, 2015; Hedges, 2016). Prior to his death, Rob Ford was also infamous for his alcoholism and drug addiction, although I know no evidence of alcohol or drug addictions in Donald Trump’s or Rodrigo Duterte’s lives. As the deepest thinkers have always known, the greatest master passions need not involve drugs at all.
I fear that we now moving closer to a society that inexorably creates a flood of master passions, i.e., addictions, and that almost everybody is affected to a greater or lesser degree although many people manage to keep addiction at bay, or to recover from it in a relatively short time. I have applied Plato’s insight to our modern era in the next part of this presentation. However, instead of summarizing Plato’s political analysis of five types of ancient Greek city states, I have put my account, which I call the “Dislocation Theory of Addiction”, into the language of some great historical and social thinkers of the 18th, 19th, 20th, and 21st century. These thinkers have, in a variety of ways, adapted the essence of Plato’s astounding idea to the globalizing society of the modern era. You will be correct if you think you detect the influence of Fyodor Dostoyevsky, Emile Durkheim, Max Weber, Franz Kafka, Karl Polanyi, Christopher Hill, R.H. Tawney, C. Wright Mills, Eric Hobsbawm, Ivan Illich, Eric Erikson, Marshall Berman, Thomas Homer-Dixon, Charles Taylor, Mary Pipher, Thomas Berry, Sheldon Wolin, Gregory Baum, Naomi Klein, Pankaj Mishra, or Pope Francis in the following analysis.
I will call the idea that addiction is built into the modernity trap the “dislocation theory of addiction.” The dislocation theory of addiction does not focus on drugs and alcohol, but rather on severe addictions of all sorts. Of course, modernity has diverse effects that extend far beyond addiction. Some of them, like environmental destruction, extreme inequality, and the potential for nuclear war are more terrifying in the immediate future than the rising tide of addiction. However this presentation focuses on addiction.
“Modernity”, taken roughly as the past five centuries of western history, has long been a topic of intense study among contemporary social scientists. For a serviceable, compact description of how social scientists conceptualize modernity, see Berman (1988, pp. 15-21).
Please note: Recognizing that addiction is built into modernity does not mean denying that the occurrence of addiction is affected by well-studied risk factors such early-life traumas, exposure to drugs, social alienation, insidious advertising, predisposing genes, and deliberately addicting algorithms in gambling machines. It means that the basic structure of modern society tilts the playing field in favour of addiction by ensuring that a huge number of people experience those risk factors as the consequence of economic and social forces that are beyond their control. Modern society also tilts the playing field by making it ever more difficult for people to find satisfying, accessible lifestyles as alternatives when their particular risk factors make them vulnerable to severe addictions. Under these conditions, quelling the flood of addictions in the modern world will require deep social change. Otherwise, the problem will continue to increase no matter what kinds of treatments or preventive strategies are offered and no matter how resolutely drug use and other potentially addictive practices are controlled.
From the time of Christopher Columbus onward, large scale colonization of the globe by European powers crushed local societies and aboriginal tribes by conquest, disease, enslavement, enticement, economic exploitation, religious domination, and ecological devastation (Dussel, 1995; Hobsbawm, 1989, chap. 3; Wright, 2004; Mann, 2011). This social fragmentation was made possible by modern advances in science and technology, like the ship’s compass, heavy gunnery, industrial production of highly desirable trade goods, and by a powerful modern faith that it was right and somehow virtuous to harness the entire planet to increase the wealth and power of the civilized nations of Europe.
As the colonizing European nations fragmented distant societies, they also crushed and impoverished the rural subcultures of their own homelands, although with somewhat more restraint, to magnify their national wealth and power. Agricultural and industrial revolutions devastated stable peasant farms and commons throughout Europe. (Polanyi, 1944; El Saffar, 1994, pp. 62-68; Bollier, 2014). Refugees from this domestic social fragmentation were cruelly stigmatized and economically exploited in European slums or shipped abroad to populate the colonies (Isenberg, 2016).
Although it is sometimes overlooked now, European nations also fragmented their own upper crust of the rich and powerful. Rich manufacturers entered into relentless competition with each other to maximize their individual wealth and glory. As Karl Polanyi (1944, p. 128) described early modern England, “... the most obvious effect of the new institutional system was the destruction of the traditional character of settled populations and their transmutation into a new type of people, migratory, nomadic, lacking in self-respect and discipline—crude, callous beings of whom both labourer and capitalist were an example.”
The fragmentation of society that began in the early modern era still escalates in both rich and poor nations in the 21st century. This fragmentation has been shaped by different economic and political regimes in different times and places over the centuries of the modern era, but it is currently shaped primarily by the dominance of free-market capitalism, neoliberalism, economic growth, consumerism, gross inequality, financialization, corporate culture, “enterprise culture,” “metacolonialism,” high-tech surveillance, high speed technical change, ecological devastation, real estate bubbles and crashes, relentless increases in efficiency in manufacturing and agribusiness, robotization, “ludocapitalism,” financial market crises, and continuing plunder of the remaining aboriginal territories (Chossudovsky, 2003; Dufour, 2003; Harvey, 2011, pp. 66, 176; Schüll, 2012, pp. 53; 73; Hickinbottom-Brawn, 2013; Polanyi-Levitt, 2013, chaps. 1, 5, 10, 11; Snowden, 2014; Klein, 2014; McWilliams, 2015, Nikiforuk, 2015; Levitin, 2015; Bulhan, 2015; Rodrik, 2016; Daley, 2016). Today’s global fragmentation is not only propagated by European nations, but also by major powers on every continent, as they modernize along the lines that originated in western Europe five centuries ago.
In my earlier writing, I depicted modern fragmentation as a consequence of unbridled capitalism (Alexander, 2008/2010). I still see capitalism is a major part of the cause, but I now believe the cause runs deeper, to the roots of modernity. Christopher Columbus was not a capitalist. Vladimir Lenin, Joseph Stalin, and Deng Xiaoping were not capitalists either. Christian universalism, international communism, and free-market capitalism have provided alternative doctrines underlying the fragmenting advance of modernity (see Berman, 1988, pp. 87-110).
Beneath the steamroller of modernity, extended families and communities are scattered; nuclear families become dysfunctional; local economies are pulverized; legitimate authority is toppled, religions certainties are shattered; and cultural arts are reduced to trinket production for tourist shops. People and social groups that do not contribute to the advance of modernity are expendable.
Societal fragmentation has come to seem an inescapable consequence of the modern age. Increasing industrial productivity, economic integration, and technological innovation have enabled the earth to support seven billion people. But this brave new world society is in deep – possibly terminal – trouble, in large part because of diverse side-effects of fragmentation, most obviously environmental destruction and intolerable inequalities of wealth and power between people and between nations. The most important of these threatening side-effects for this presentation, however, are dislocation and addiction.
Mass Dislocation of Individuals
I use the word “dislocation” to designate the individual psychological devastation that follows from societal fragmentation, as it manifests itself in people’s everyday lives.
Dislocation has been described in many ways. For example, sociologists speak of the alienation of individuals in large bureaucratized societies that lack real community. Existentialists describe feelings of nothingness or non-being in the modern age. Psychologists speak of diminished feelings of attachment, belonging, identity, meaning, and purpose leading to disorders such as anxiety and depression. Christians speak of the poor in spirit or of the loss of faith in a secular world. Evolutionary biologists speak of failure to satisfy the innate social needs of the human species in modern times. Dislocation has not yet been adequately described in the language of neuroscience – but it needs to be (see Hellig, Epstein, Nader, & Shaham, 2016). Recent research on the neuropeptide oxytocin suggests one promising starting point for describing dislocation in the language of neuroscience (e.g., Merolla et al., 2013; Buisman-Pijlman, et al., 2014; Alvez et al., 2015)
Mass dislocation has come to seem unavoidable. The modern market system requires that individuals must perform competitively and efficiently, unimpeded by sentimental ties to families, friends, traditional values, or religious norms. After all, “business is business” and politicians who promise to “grow the economy” and “create jobs” at all costs win elections. Stringent economic rationality is said to make the law of supply and demand function efficiently, and thus to “clear the markets” each day. China, India, and other nations that have embraced the modern market system in recent decades have joined the economic superpowers.
Seen in a positive light, dislocation can provide a space for enjoyable individual initiative, creative freedom, and adventure for people who have felt stifled by their local societies. However, prolonged, radical dislocation has a high price, because it ultimately generates anguish, suicide, depression, disorientation, and domestic violence (Durkheim, 1897/1951; Polanyi, 1944; Barrett, 1962; Dodds, 1965; Chandler, Lalonde, Sokol, & Hallet, 2003, Berardi, 2009). In fact, prolonged, radical dislocation has been imposed as an extreme punishment (e.g., solitary confinement, exile, ostracism, banishment, shunning, and excommunication) from ancient times to the present (White, 2014). Radical social isolation is an indispensable part of today’s terrifyingly scientific technology of torture (Klein, 2007, chap. 1).
As a human experience, “dislocation” defies quantitative measurement. For example, dislocation is described, in psychological terms, as the absence of attachment, belonging, identity, meaning, and purpose. But to what degree can a strong identity make up for a weak sense of purpose? Can a strong sense of attachment and belonging make up for other lacks? How are dislocation, attachment, belonging, identity, meaning, and purpose measured? It is impossible to answer such questions precisely. Nonetheless, dislocation – under various names – has been recognized as a major problem by leading social scientists and other students of the modern era. Although it is easy to overlook the existence of dislocation in an age dominated by positivist epistemology and reductionist ontology, positivism and reductionism cannot legislate it out of existence. They can only obscure it.
Flood of Addictions: Severe Addiction as an Adaptation to Dislocation
Just as dislocation historically follows fragmentation of a society, addiction historically follows dislocation. Extensive historical, anthropological, and clinical evidence documents this predictable sequence in Europe, Asia, and North America (evidence reviewed in Alexander, 2008/2010, chap. 6).
Abundant clinical and biographical evidence show one of the reasons why severe addictions track dislocation so closely. Addictions can provide dislocated people with some relief and compensation for bleak, empty lives, when nothing else works. (Alexander, 2008/2010, chaps. 6-8; Hart, 2013, pp. 74-95; Fetting, 2016). Addictions can be truly adaptive in a fragmented world because – in psychological terms – they can provide severely dislocated people with a modicum of attachment, belonging, identity, meaning, and purpose, at least in the short term. Without their addictions, many people would have terrifyingly little reason to live, and would risk succumbing to incapacitating anxiety, depression, or suicide.
For example, when impoverished heroin addicts wake up, they at least know who they are and what they must accomplish that day. Rather than being overwhelmed by unbearable emptiness, they keep frantically busy chasing drugs, and interacting with other drug chasers. At the same time, the fascinating addicted lives and deaths of William S. Burroughs, Curt Cobain, Phillip Seymour Hoffman, Amy Winehouse, Robin Williams, Prince, or Carrie Fisher can give meaning to junkie suffering by linking it with the suffering of the tragically hip celebrities or “the coolest” (Burroughs, 1967; Pryor, 2003).
Another example: Many people use horserace gambling addictively to colourize their otherwise bleak existences. They exchange information and hunches at the track with a colourful subculture of track habitués, and share a mythology of famous gamblers and legendary horses (Ryan, 2014a, b). Some people who gamble addictively on slot machines or the Internet do not seek social interaction, but rather a “zone” of intense engagement with gambling machines that have been ingeniously designed to be engaging and interactive, without having the threatening or annoying qualities of actual human beings (Schüll, 2012; 2015).
People who are not addicted to drugs or gambling are able to use drugs or to gamble without getting into serious difficulties. However, there are millions of people whose dislocation is so desperate that they seize onto one or more addictive pursuits, and build their lives around them. When severely dislocated people find that an addictive lifestyle provides their best hope for enduring the world, they hold onto it with the same iron grip that they would apply to a piece of floating junk in a stormy sea.
To speak of a person’s addiction as an adaptation does not imply that the person necessarily has a wicked soul, a pathological brain, a dysfunctional genome, a psychological disorder, a history of childhood trauma, or even a maladaptive habit. Adaptation is not a disease. We exist because our ancestors successfully adapted to their environment behaviourally, as well as structurally and physiologically. We all survive by using the adaptive capacities that we inherited from them. Chronic dislocation creates a desperate need in human beings (Darwin, 1871/1981; Wilson, 2012; Alexander & Shelton, 2014, chap. 7), and addiction is one way that people adapt to that need (Alexander, 2008/2010, chaps. 6-8). When addictions are short-lived and not too damaging, as they most often are (Heyman, 2009, chap. 4), they can help people to endure and survive bouts of dislocation. People who recover from their addictions learn from them.
But some people do not recover from their addictions or are seriously harmed or killed by them. This happens because adaptations that facilitate survival at first can become harmful or fatal as they continue too long or are worked to exhaustion. Adrenal stress responses collectively known as the General Adaptation Syndrome and the stress diseases that can result from these responses if they are worked to exhaustion provide one well-studied example of this fact about adaptation (Selye, 1950). Addictions provide another.
Some adaptations are obviously harmful from the outset but are essential for survival, because they protect a person from a greater evil. The famous case of an American hiker who hacked off his own arm with a pocket knife to avoid death after an 800 lb. boulder had been pinned his arm for five days in a remote mountain region provides an example (Kennedy & Simon, 2010). Harmful and dangerous addictive practices provide another. Severe dislocation can cause invisible suffering and sometimes the only accessible relief comes from habits that are visibly harmful and/or dangerous from the outset.
The individual utility of addiction in adapting to dislocation partially explains its dangerously high prevalence in a fragmented, dislocated world. But addiction also has an adaptive function for society itself. The market economy of the modern world requires overwork and overconsumption to keep the industrial wheels turning and the share prices rising (Slater, 1980; Vance, 2015; Kantor & Streitfeld, 2016). Therefore the addictions that favour economic growth and corporate profit, e.g, addictions to wealth, consuming, shopping, casino gambling, and overworking are subtly encouraged by mainstream advertising. The individual and socially adaptive functions of addiction in the modern era explain why addiction is as intrinsic to modernity as competitiveness, loneliness, apathy, obesity, anxiety, and depression.
The adaptive functions of severe addiction in the modern world are often hard to admit. Many severely addicted people deny that they live in a state of dislocation, because they feel embarrassed that they do not “have a life” or that they have been taken in by insidious advertising. They may not know that dislocation bedevils most people in the modern world. They may be unaware of the adaptive functions of their own addiction. In moments of insight, however, even they can explain the functions of their addiction with surprising candour (Alexander, 2008/2010, pp. 158-160; Schüll, 2012; 2015; Pond & Palmer, 2016, pp. 21-22).
Parents often insist that their offspring’s addictions were caused by addictive drugs, genetic predispositions, or chronic brain dysfunctions. Such parents may torture themselves poring over the years back to birth searching for the hidden causes that they may have missed. Acknowledging severe dislocation that arose from inadequacies of the home, school, and neighbourhood environment they were able to provide their children may be impossible. Even when the kinds of fragmentation that their child had to confront were totally beyond parental control, this acknowledgement could generate unbearable feelings of parental failure.
Mass media endlessly and authoritatively proclaim that addiction is a chronic brain disease caused by the effects of drugs on the brains of people with a genetic predisposition to addiction, rather than an adaptation to dislocation in a fragmented world. This cotemporary version of the Official View is endlessly bolstered by scientific authority and media dramatization (e.g., Nature editorial, 2014; Seelye, 2015; Pond & Palmer, 2016). It is lavishly funded and sponsored by the National Institute of Drug Abuse in the United States, despite its glaring deficiencies (Alexander, 2016b).
Another complication that obscures the adaptive functions of severe addiction is that people may be addicted, especially for a short time and in a relatively mild way, for reasons that have nothing to do with adapting to dislocation. People may fit the dictionary definition of addiction when they undertake a binge of work to finish an important project, devote themselves to compassionate service and asceticism out of concern for suffering humanity, or fall head-over-heels in love. The dislocation theory of addiction explains the high prevalence of severe, long-lasting kinds of addiction, but less extreme forms of addiction can serve quite different adaptive functions and often occur in situations where dislocation is minimal. You don’t have to be dislocated to fall in love, but you do have to be dislocated to sacrifice your life to futilely trying to maintain a dysfunctional or violent love relationship (Peele & Brodsky, 1975).
Consequences of Severe Addiction: The Cycle Continues.
Many people cling to severe addictions because they are indispensable, but only partly successful, adaptations to dislocation in an increasingly fragmented modern world. Some kinds of addiction are socially encouraged because they help to maintain high levels of production and consumption. But there is still another important reason why severe addiction is so prevalent in the modern world. Many long-term harmful consequences of severe addictions exacerbate the fragmentation of modern society, thereby increasing the dislocation that flows from it. Increased dislocation leads to more addiction. The vicious cycle takes another turn.
Fragmenting consequences of addiction include: Environmental and social destruction mandated by wealth and power addicts pursuing profits in the executive suites of their multinational corporations (notoriously including Canadian mining companies), investment banks, and hedge funds (Slater, 1980; Cramer, 2002; Schüll, 2012; Polk, 2014; Daley, 2016; Poplak, 2016); environmental and social destruction caused by wasteful addictive consumption of millions of more-and-less severely addicted customers; the fragmentation produced by all the talented people who are lost from healthy family functioning and productive work because of severe addiction, protracted recoveries, or overdose deaths; social insecurity produced in local communities by the overtly criminal street addicts supporting their drug habits; and elders who cannot contribute stabilizing wisdom to succeeding generations because they are consumed by addictive involvements with television, bingo, Sudoku, prescription drugs, or whatever.
Because of its long-term harmful consequences, severe addiction is not only a downstream adaptation to societal fragmentation but also an upstream cause of it. Addiction is built into modern, global society structurally.
The vicious cycle that is built into modernity cannot continue indefinitely. Eventually the strain on the earth’s ecosystems and on human culture would become unsustainable, and modern civilization, like every civilization that has preceded it, would collapse. (Toynbee, 1948). It worth contemplating that both Plato and St. Augustine wrote their descriptions of societies plagued by severe addictions in the midst of the collapse of the Athenian and Roman Empires.
Prophecies: Forty Years from Now, In The Year 2056…
(My attempts at prophecy are written in bold text, and my explanations in unbolded text).
1. Forty years from now, in 2056, there will still be large numbers of addicted people and there will still be addiction professionals striving to help them find a better life.
No conceivable twenty-first century scenario, no matter how enlightened the world becomes, can completely eliminate dislocation by fully integrating all the millions of people who appear in each new generation. Therefore severe addictions of all sorts will continue to be a problem. Our profession institutionalizes the compassionate human impulse to help people struggling to find a decent place in society. We will still be needed in 2056, although I think that fewer of us will suffice.
2. Forty years from now, in 2056, a majority of the problems that addiction professionals will be called upon to treat will be “process addictions,” including all the ones that were know to Plato St. Augustine, and Dante, as well as the new ones facilitated by the Internet and modern gambling machines and by newer technologies that cannot yet be imagined. The current fiction that being addicted to drugs is essentially different, more harmful, and more responsive to treatment than being addicted to anything else will already be known as a relic of the twentieth century.
3. Forty Years from now, in the year 2056, it will be clear to most people that the new, more compassionate interventions in the field of addiction, some of which are already being used in 2016, are little more successful in bringing the problem of addiction under control than was the War on Drugs that they are replacing, although they are less harmful. These compassionate interventions include advanced pharmaceutical and behavioural treatments for addiction, expanded harm reduction practices, an expanded recovery movement, destigmatization, improved controls on marketing and prescribing opioid drugs, community policing, drug courts, entheogenic drug therapy for addiction, and eastern meditation practices. Some people will urge going back to the War on Drugs to cut costs, but they will not prevail because that great harm that was done by the War on Drugs will not have been forgotten.
4. Forty Years from now, in the year 2056, today’s deeply entrenched faith in modernity will be largely dissipated. A major paradigm shift away from dogmatic loyalty to the values of the modern age will be widespread and deeply felt. Nothing that occurs in the field of addiction between now and 2056 will have as large an effect on the prevalence and understanding of addiction as the coming paradigm shift in the understanding of modernity.
Until recently, the great majority of people have been able to accept the faith that exploitation of the earth and human beings built on the globalization of western culture, industry, economics, science, and technology, is somehow deeply right and will ultimately make things better for all people (Baum, 2006, 117-124). This faith was immanent in the early modern Christian beliefs at the time of Columbus, the Christian Calvinism of the Reformation, and in the celebrations of private property and the market economy by John Locke, Adam Smith, and David Hume in the 18th century. Faith in modernism is explicit in the last century’s enthusiastic celebration of free-market economics and globalization of Friedrich von Hayek, Ayn Rand, Milton Friedman, Ronald Reagan, Margaret Thatcher, Deng Xiaoping, Augusto Pinochet, and Tony Blair. This faith in modernism is today glitteringly personified and glamourized by celebrities like Sir Richard Branson and Elon Musk. This faith has been called the “spirit of capitalism” by sociologist Max Weber (1920/1958). Theologian Harvey Cox has written of “The Market as God” (Cox, 2016) and Pope Francis has written of “the sacralised workings of the prevailing market system” and of the “deified market” (Francis, 2013, paragraphs 54, 56). Americans know this faith in nationalistic terms as “The American Century” or “American exceptionalsim”. Its most exuberant form today is the belief that dazzling new computer technology will make our individual human minds transcendently intelligent and essentially immortal (Kurzweil, 2006; O’Connell, 2017) while building a truly supportive, safe, informed, civically-engaged, and inclusive global community with social media (Zuckerberg, 2017).
The entrenched faith that sustained 5 centuries of the modern age will not be abandoned in the blink of an eye, but it will be waning fast in 2056 because it will no longer be possible to ignore the destruction that modernity has imposed on the social and cultural foundations of human well-being as well as on the planetary ecosystems that sustain life itself. Mass reaction against the faith in modernity has already begun, as witnessed in the English speaking world by spurning of conventional political promises by both the political left and right in 2016, the year of Donald Trump, Brexit, Bernie Sanders, Naomi Klein, and Standing Rock (e.g., Corasaniti, Burns, & Appelbaum, 2016). The decline of faith in modernity is not only apparent in the growing unruliness of voters and protestors, but also in the accumulating, weighty critiques of the modernity trap by celebrated scholars, public intellectuals, and spiritual leaders (e.g, Dufour, 2003; Harvey, 2011; Wolin, 2008; Baum, 2006; Pope Francis, 2013, especially chap. 4; Klein, 2007; 2014; Cox, 2016; Dower, 2017). Definitive popular media are beginning to carry devastating critiques of modernity now (e.g., Porter, 2016; Jacques, 2016; Monbiot, 2016a, b) Although faith in modernity still has many eloquent defenders (e.g., Miller, 2016; Kassam & Mathieu-Léger, 2016; CBC News, 2017), the defences have worn thin, though endless disappointments.
***This is the point in the original speech where disaster struck. The remaining part of this written version was written months afterwards.***
5. Forty years from now, in 2056, with modernity no longer sacrosanct, addiction will no longer constitute a dark mystery, because the function of severe addiction as a desperate adaptation to a fragmented world will be more obvious. The necessity for epochal social change in order to control addiction, as well as to control other potentially catastrophic side effects of modernity, such as environmental destruction and gross inequalities of wealth, will have become widely accepted by 2056. The corner will finally have been turned – at least conceptually.
I wrote my original speech with the idea of ending it with a convincing prediction that defragmentation of society and substantial control of the flood of addiction on a global scale would be well under way forty years from now. But when I actually delivered the speech in April 2016, the words stuck in my throat. I could not believe my own prediction! I had to end the presentation on a detour (see recorded speech, Alexander, 2016a). My inability to believe my own prediction increased as the American election came and went later in the year, and I saw an grotesque extension of modernity in the United States, in an ugly amalgamation of neoliberalism, nationalism, and religious prejudice – and perhaps a similar shift in Europe as well (Monbiot, 2016b; Thomas & Stevenson, 2016; Chomsky, 2016; Wolff, 2016; Lofgren, 2017). Moreover, the new American president appeared to be sympathetic with the War on Drugs in many ways (McHugh, 2016).
I learned long ago, that writer’s block (or, in this case, speaker’s block), can only be overcome by being more honest than I have been previously. In this case, I must confess that (5.1) I cannot rule out the possibility that modernity will still be the dominant paradigm for world society in 2056. If that is the case, the addiction problem will worse in 2056 than it is now no matter how much treatment and harm reduction methods have been developed and how much money is spent implementing them.
After the speech in Bradford, with my hope of predicting serious progress towards defragmentation forty years in the future stuck and mired, I searched for inspiration among the thinkers I most admire, including some classic writers and some wise friends. Most significantly today, as I re-wrote the speech that I could not end properly when I gave it, I was inspired by Gregory Baum. He is an odd choice of inspiration for me, because he is a contemporary Catholic theologian (as well as a sociologist and political economist). I am not a religious person and am not about to become one. Nonetheless, I find inspiration in Baum’s theology as well as his secular scholarship. I believe that his theological ideas can be well stated in the language of secular history and I have presented them that way here. He is also an odd choice for me, because I had not yet read him when I originally gave the speech and I have still not met him personally. I was introduced to him just a few months ago by an insightful friend, David Seljak.
One of Baum’s most relevant ideas is that prophecy differs from prediction. One might be forced to predict a grim future by thinking like a gambler who predicts football games, or like an underwriter who predicts accidents. Gamblers and underwriters make their livings by anticipating that the same human motivations and abilities will lead to the same outcomes in the future that they did in the past. However, Baum points out that prophecy involves a deeper realization: Human nature always includes the possibility for radical change at times when it is most needed. A prophet, like Isaiah in the Christian Bible, is as much a seer of the need for change in a dark era as a foreseer of the future.
To prophesy a movement away from continuing fragmentation is to see that people’s motivations in the future could be radically different from their motivations in the past and the present. Hopeful prophecy is most realistic precisely when times are darkest, because then people’s potential for radical innovation is at a maximum.
A professional lifetime of thinking about the addiction issue has led me to see addiction as a part of a larger problem, which I have called the modernity trap in this presentation. Gregory Baum’s writing has inspired me to recognize that the modernity trap is now rapidly losing its credibility. (5.2) The dominant form of contemporary modernity is not the “end of history” (cf. Fukuyama, 1992). On the contrary, history will soon record the end of modernity and the emergence of a new era.
Paradoxically, the bizarre 2016 American presidential election made me realize how much the tide is changing already. As I discussed the election with deeply worried Canadian and American people, I formed the impression that almost nobody on either the political left or the political right still believes in the promise of modernity, as their forefathers did. Almost everybody who looks can see that the system is broken and must be changed profoundly if it is to avoid catastrophic collapse. Of course people on the left and right differ on what should replace the broken system, but major change of some sort is imminent.
I think people are also beginning to accept that no useful formula for change will be forthcoming from our business or government “leaders” or mainstream media. For the most part, they embody the problem, not the solution (Lofgren, 2014). People, in their own families, communities, and countries must take on the problem of recreating a world in which their children and grandchildren can hope to thrive, and this must be done without leadership from officialdom, without an authoritative formula to follow, and without any promise of success.
Perhaps intellectual paradigm shifts, like physical earthquakes, can be detected as anticipatory tremors by detectors that are in the right places at the right time. I believe that I am detecting anticipatory tremors in the desperate thinking of people now.
Baum points out that the potential solutions to problems generated by the modernity trap lie in social change brought about by ordinary people gradually finding common cause as well as future leaders who will arise to coordinate their activities. It is not a worry if the various groups of aroused people do not seem to be moving in the same direction at first. Quite unlike a utopian blueprint, large scale coordination can only emerge organically. It cannot be planned or engineered.
The new direction that I feel will be predominant in 2056 is an amalgam of resolute commitment to our families and local communities (see Hawken, 2007; Klein, 2014) combined – somehow – with an encompassing global humanism and an expanded form of spirituality (Berry, 2009; Pipher, 2013; Pope Francis, 2013; 2015). I believe that the most powerful energy for a directional change of this magnitude is likely to come from the third world and from aboriginal people everywhere (e.g., Klein, 2014), from the Nordic countries (e.g., Young, 2017), and from new directions in traditional religious and spiritual traditions.
But how do the militant local movements that are emerging everywhere find common ground on a paradigmatic alternative to modernism that will eventually prevail on a more global level? I don’t think this final step can be known in advance. This shift has never been made before and the end point cannot be foreseen. Perhaps the part of this move to common ground that is already visible is the emergence of global faiths that are as compassionate in their impulse as the great religions of today, but that explicitly venerate and serve planet earth and welcome all people (Berry, 2009; Pope Francis, 2013; 2015).
The sad part of this hopeful prophecy, for me personally, is that the epochal transformation in thinking and social organization that many people of my generation have anticipated for much of our lives is not going to occur until after we are dead. When world society unmistakeably turns the corner and begins the paradigm shift, by 2056, we will not be around for the celebration!
But many of you who are hearing or reading this will be around in 2056. I hope you will take a moment at that time to remember those of us who dreamed of this paradigm shift in our lifetimes, but had to miss the party when it finally came. Especially if you happen to be one of my children or grandchildren.
6. Forty Years from now, in the year 2056, even though faith in modernity will be moribund, the powerful, entrenched institutions that have been spawned by that outmoded faith will still be pursuing their interests by their usual methods which include repressing or killing inconvenient individuals, fragmenting human societies, and devastating the biosphere. These institutions include, for example, the governments of most developed and developing nations; enormous military bureaucracies; the interlocking network of multinational corporations and financial institutions; the mainstream media, political parties, and professional associations that shamelessly serve misguided governments and multinational corporations; “think tanks” funded by billionaires to overwhelm attempts at critical thinking; and the “investor-state conflict resolution panels” ordained by international trade agreements. These entrenched institutions will have to be curtailed and eventually replaced by new institutions. This transformation will only be beginning in 2056 and the struggle will continue to be ferocious.
These institutions are controlled by powerful vested interests that couldn’t care less whether the underlying faith that created them is justified or not. Zombie thinking remains dangerous even after it is intellectually dead, because of the sheer momentum of its dead weight and its ruthlessness. Completing the shift to non-fragmenting institutions will take generations after 2056.
The current rush to greatly curtail the prescribing of opioids drugs because of a spike in overdose deaths and addiction provides one illustration of the persistence of obsolete thinking by today’s governments, institutionalized professions, and mass media. Elements of the moribund faith in modernity and the War are Drugs are visible within it. Similar obsolete thinking will still have to be contested in 2056.
Of course the spike in overdose fatalities linked to opioid drugs in the US and Canada over the past decade calls for sustained caution in the way that opioid drugs are prescribed and curtailment of the shameless efforts by some pharmaceutical companies to stimulate over-prescribing (Robertson & Howlett, 2016).
The danger of over-reaction based on obsolete thinking, however, is very great. In the drug panic over heroin forty years ago, the dangers of over-prescribing morphine and other opioids were grossly exaggerated by modern governments, professions, and the public seeking a quick, technical fix to a complex societal problem. Serious under-prescribing and onerous policing of medical practice followed, causing great suffering to those who needed morphine and other opioids drugs to control their very real pain and to doctors who wanted to help them (Alexander, 1990, pp. 47-49; 2008/2010, p. 179, including endnote 45; Beyerstein & Alexander, 1985). Today’s increasingly sensationalized reporting on the surge in overdose deaths associated with opioid drugs (e.g., Associated Press, 2016; Jones, 2016; Allen, 2016; Woo, 2016; CBC News, 2016; Crawford, 2016) is becoming reminiscent of the sensationalized reporting that has instigated damaging under-prescribing in the drug panics of the past 40 years and earlier (Silver & Aldrich, 1979). Draconian measures are already being proposed, including curtailments of manufacture of opioid drugs that are essential in medical practice (DEA Public Affairs, 2016) and rigid control of medical prescribing by individual physicians (Woo & Howlett, 2017). The first reports of unbearable suffering caused by under-prescribing are appearing as well (Bramham, 2017). There will be more.
Not only can excessive restrictions on opioid prescriptions cause misery for millions of medical patients who need pain relief, and drive law-abiding addicted people towards illegal markets of more dangerous drugs, they can also divert attention from the aspects of the late modern era that are causing the addiction problem to accelerate, including the current surge in opioid overdose deaths itself. For example, there has long been an American black underclass spread across the rural south and packed into the slums of the northern cities. The black underclass has suffered from generations of extreme poverty, ill health, under-education, public disdain, economic exploitation, and police brutality. Many have adapted to their dislocation by becoming addicted to drugs and other habits (Sidhu, 2012). Drug addictions of the massively dislocated black underclass were the primary justification for previous drug panics, particularly those that were directed at heroin and crack cocaine (e.g., Hari, 2016; Hart, 2013).
The American underclass is now being augmented by the rapid expansion of the white underclass. Although there has been an American white underclass from the beginning of the United States (Isenberg, 2016), the ancestors of the currently expanding white underclass had an important social role in the twentieth century. They had an established social position because they did the heavy lifting in American factories and on the farms. However, their descendants are less and less needed in the automated, low wage, non-union economy of the twenty-first century. They have been reduced from the proletariat to the “precariat” or the “unnecessariat”. (Reding, 2009; Longworth, 2016; Amnesia, 2016).
Like the black underclass, this rapidly expanding, grossly dislocated white underclass shows very high rates of addiction to all kinds of drugs (particularly alcohol, methamphetamine, and prescription opioids), drug overdoses, liver disease caused excessive drinking, suicide, diabetes due to unhealthy eating, and many forms of mental disorder and stress diseases (Reding, 2009; Szalavitz, 2011; Case & Deaton 2015; 2017; Amnesia, 2016). Increasing rates of overdose deaths and addiction in this white underclass are certainly a major cause of the apparent current “epidemic” of opioid overdose fatalities.
Many members of the white underclass are also subject to corrosive disrespect in American culture because their lack of education and sophistication marginalizes them in the new information economy. In addition to the economic stress all members of the underclass must endure, members of the white underclass in the US can no longer bolster their identity with a sense of racial superiority, as many did in the past. In 2016, with a black American president and celebrity neuroscientists, actors, and public intellectuals of every ethnicity and race, whiteness no longer offers the symbolic status it once did. In an age when “black lives matter”, some members of the expanding white underclass may sense that their own lives matter less. Moreover, much of the public financial support they might hope to receive appears to go to poor immigrants. They are inclined to support Donald Trump as a presidential candidate as well as to poison themselves with drugs and alcohol (Slater, 2016; Bader, 2016; Amnesia, 2016). The woes of the American white underclass comprise another chapter in the long saga of fragmentation and dislocation of the late modern era that is often portrayed as a relatively simple drug problem.
Many of the interventions now are coming on line are likely to decrease the spike in overdose deaths, and that is a matter of great importance. However, embracing the illusion that the addiction problem that arises from the modernity trap can be overcome by reducing the legal production of opioids, punishing dealers more severely, policing doctors to prescribe less opioids, providing ample supplies of Narcan, providing more treatment centers for drug addiction, and providing more self-injection sites obscures an underlying problem that is greater than the current drug panic.
(6.1) History will repeat itself, but only briefly, in the panicky attempt to control opioid addiction that began in 2016. Although most of the harm reduction and treatment measures that are being introduced now are sensible and necessary, underprescribing of opioids will also occur and it will exacerbate the suffering of countless men, women, and children who need pain relief in the next few years. This torture will not decrease the prevalence of addiction or overdose fatalities in the expanding underclass or in an increasingly dislocated mainstream society. Instead it will drive some of the people who suffer from treatable pain into overusing alcohol or seeking out illegal drugs that are more dangerous than the current generation of opioids.
By 2056, society will be forced to face the real problems that underlie the current surge in opioid overdosing and the other drug panics that will have arisen in the forty years since 2016. However, other obsolete impulses from entrenched but moribund institutions of modernity will have to be confronted and overcome.
Postscript for Addiction Professionals
I think that addiction professionals have a uniquely important role to play in the defragmentation of world society that will be necessary to bring addiction and other crucial problems under control. This role goes beyond the compassionate care and treatment that we currently provide to addicted people. Politicians and the popular media today are pinning the public’s hope on a treatment breakthrough – a new vaccine, a new form of cognitive behavioural therapy, a new drug that somehow reduces cravings, a new gene that can be deleted, new restrictions on prescribing, a newly rediscovered eastern religion, vast increases in the budget for existing treatments, etc. (Obama, 2016; Pond & Parker, 2016; Alexander, 2016). Often these are touted as if there was not a long history of innovative medical treatments, spiritual discoveries and re-discoveries, and new regimes of drug control extending back well into the 19th century (White, 1998). This simplistic rhetoric needs to be interrupted. I think we addiction professionals can best interrupt it by using some brave policemen as our role models.
Just like the police of the past who had been burned out by the war on drugs spoke out to inform the world that we cannot punish our way out of the addiction problem no matter how much money is poured into enforcement (LEAP, 2017), treatment professionals need to say that we cannot treat our way out of the addiction problem no matter how many of us there are or how much money you give us. We also need to say that no matter how many research grants you give us, we are not going to discover a single, controllable gene for addiction or a widely effective medication or form of psychotherapy that will bring it under control.
Addiction is a different sort of a problem, and we, of all people, need to say so, loud and clear. To not speak out is to foster the illusion that there is a quick fix to the problem of addiction and that we can eventually provide it. I think many more addiction professionals will be publicly rejecting this illusion in 2056 and that they will be justifiably proud of responding to the full depth of the addiction problem more than their predecessors did.
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1 These “Stephanus Numbers” refer to the original Greek text and should refer to the same sections of text in all translations of the Republic. The same is true of the text numbers that are referred to in Plato’s Laws.