Dislocation Theory of Addiction
Addiction: Hopeful Prophecy From a Time of Despair
Bruce K. Alexander
April 19, 2017
Revised September 9, 2017
Expanded version of a presentation to the “New Directions in the Study of Alcohol Group,” Fortieth annual meeting, Bradford, UK, April 24 2016. However, the ending of this written version was not completed until a year after the speech was given because, as I neared the end of delivering the speech, I realized I could not fully believe what I was planning to say! I had to end the speech on a minor point (Alexander, 2016a). The new ending is a more fully developed and considered version of what I wanted to say out loud in Bradford, but couldn’t.
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 the “New Directions” society was first formed. 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. As a prelude to envisioning addiction in the year 2056, I have found it necessary to explore a much longer stretch of history, 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 is drawn from 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 prophecies do not actually have a divine source. My only hope of adding gravity may be revealing that I take my prophetic undertakings so seriously that I have given the written version of this presentation to each of my children and grandchildren, with a request that they put it away for 39 years and then check out their ancestor’s vision of the future when 2056 finally rolls around. I would hate to embarrass them or myself then by what I am writing now.
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, as I foresee, addiction will not seem nearly so mysterious then as it does today.
Forty years ago. Year: 1976. My age: 36.
Forty years ago, addiction was very narrowly conceived. Most people 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 addicted to cocaine, amphetamines, or marijuana, because these drugs, unlike heroin and alcohol, did not produce dramatic physical withdrawal symptoms. Withdrawal symptoms were the sine qua non of addiction. Hardly anyone in the field even considered the possibility of serious addiction to anything that was not a drug.
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 heroin-using “junkies”, who seemed unworthy of normal human respect. Many people saw surging heroin use 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; Hari, 2015) and in many other places.
The War on Drugs involved more than police chasing users and traffickers 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 exaggerated or untrue. Some doctors’ offices were visited by police informers who dressed like street drug users and begged for prescriptions to 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 terribly 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). The only acceptable way to recover from the disease of addiction in 1976 was immediate and total abstinence. Abstinence had to be forced either by the addicted person’s fear of imminent death (“bottoming out”) or by coercion, because otherwise “once a junkie, always a junkie.”
None of these desperate, warlike, efforts to curtail drug addiction in 1976 could demonstrate real evidence of success. Nonetheless they were enthusiastically supported by the public, politicians, and drug treatment professionals.
Young professionals entering the field of addiction, including myself as a newly-minted psychologist, had been schooled to understand addiction as a virtually incurable habit caused by the use of opioids or alcohol drugs. I have come to call this way of seeing addiction the “Official View.” An expanded and modified form of it still prevails today (Alexander, 2016b).
In the 1976 version of the Official View, anyone using any of the opioids or alcohol more than a few times would experience unbearable withdrawal symptoms if they tried to stop. The withdrawal symptoms would cause the luckless experimenters to chase the addicting drug forever after, losing all decency in their fatal quest. Addictions to habits other than heroin or alcohol use were not even on the radar in the Official View.
Withdrawal symptoms were explained on a rigourously scientific level in the psychological learning theory and the neuroscience of the day, but, unlike today, the neurotransmitters that were usually invoked were not dopamine or serotonin, but the endorphins.
The small number of 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 – were generally ignored and sometimes cut off from further research grant funding, as we were (Alexander, 2007). They were also occasionally censored as was the WHO’s worldwide cocaine project in the 1990s, in which my colleagues and I participated (Goldacre, 2009).
Other lines of investigation about drug addiction were also being starved for funding, ignored, or repressed. These included 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. Many addicted drugs users do not report withdrawal symptoms, and many people have no serious difficulty abstaining from drug use, even when they experience withdrawal symptoms.
3. 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;
4. Natural recovery usually occurs from addictions of all sorts, including severe drug addictions, quite often without any formal treatment;
5. “Controlled use” is a workable goal for treatment and for natural recovery in many drug addicted people;
6. Many seriously addicted people are not “out of control,” but can explain the function that their addiction serves and why they continue it;
7. Nearly 90% of the thousands of heroin-using American soldiers returning from Vietnam gave up their heroin addictions without treatment;
8. The desperate measures of the War on Drugs did far more harm than good (for documentation of all these findings, see literature reviews in Alexander, 2008/2010, chap. 8 and Alexander, 2016b).
Although the Official View was predominant and evidence against it suppressed, there was also a vigorous theoretical periphery. Countless explanations of the causes of addiction had accumulated in a variety of religious and spiritual traditions in the 19th and 20th centuries and also within psychoanalysis, pharmacology, neurology, immunology, genetics, evolution, economics, demonology, the psychology of learning, humanistic psychology, libertarian psychiatry, nutrition, criminology, sociology, hypnosis, and family systems theory (Lettieri, Sears, & Pearson, 1980; 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 based on one or another of them. It was, thus, a time of both dogmatic certainty by authoritative advocates of the Official View and contradiction and confusion among everybody else. In short, addiction was an intellectual disaster area. We produced a massive addiction literature, but little relief for the afflicted.
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 on the fringes that can be retroactively recognized as harm reduction. These included large scale 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 by prescribing drugs that they believed, often rightly, were in their patient’s best interests. Likewise there were many fringe 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. At these times addiction to opioids slipped into the background of public concern, even though it continued as before. 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, addictions to many other habits and pursuits, such as wealth, social status, power, religious extremism, violence, extreme sports, celebrity worship, 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 only a few voices today calling for warlike enforcement measures in the style of 40 years ago. Despite the theoretical dominance of the modified and expanded 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 and cognitive behavioural therapies; supportive religious groups; drug courts; mindfulness meditation; and therapies based on psychedelic drugs. These compassionate interventions are not new, but they are far more acceptable than they were 40 years ago (Jones, 2016; Noffs, et al., 2016; Paungsawad et al., 2016). The move from warlike enforcement towards compassionate treatment occurred in large part because of the dedication of a relatively small number of amazing people: Social activists, clinicians, academics, and policemen who had the compassion and courage to speak out against the misbegotten War on Drugs. I had a small role in working towards this transformation with some of these amazing people in my own city, Vancouver.
To me the most impressive of today’s 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 and some of his associates have 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 Philippines 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 forward as a dangerous zombie idea.
Today’s really bad news is that, despite the compassionate new era 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 solid intellectual consensus concerning addiction’s 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 current epidemic of opioid overdoses are every bit as terrifying as accounts of the heroin epidemic forty years ago (e.g., Farrell, 2015; Associated Press, 2016; Carreiro, 2016; CBC News, 2016). The high prevalence of addictions to various drugs, alcohol, and a number of process addictions, particularly gambling and Internet addictions (e.g., Sussman, Lisha, & Griffeths, 2011; Schüll, 2015; Rosengren, 2016; Phillips, 2017) are causing public alarm in many parts of the world.
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).
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 closely 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 have given 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, 2012, chap. 9).
Not only is there no sign that the flood of addiction is abating, but also the field of addiction remains an intellectual disaster area today, as it was four decades ago. Although some of 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. Department 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 by its advocates. 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 unproven. Dozens of reputable researchers and social scientists have been chipping away at its overwrought scientific claims for decades (e.g., Peele & Brodsky, 1975; Alexander, 1990; 2016b; Kalant, 2009; Hart, 2013; Satel & Lilienfeld, 2013; Hickman, 2014; 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 (L. Slater, 2005, chap. 7; Macmillan, 2013; Hari, 2015). Our cocaine research, 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, the Official View remains predominant, because new theoretical defenses for it are erected as old ones are chipped away, because abundant American government money is available to propagate them, and because repression of conflicting views is apparently considered fair game.
Today’s field of addiction has a very large periphery in which there are as many formally and informally stated theories or models of addiction (West, 2006) as there were forty years ago. Moreover, there is a strong eastern spiritual influence today that includes 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, contested 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 or to generate a solid theoretical consensus? This is especially mysterious because we live in an age of dazzling progress in scientific medicine. We are surrounded with new intellectual breakthroughs and technologies – but not in the field of addiction.
I hope each of you in the audience today will take a moment to ponder this mystery before we proceed.
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 research and 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 believe that it is necessary to take a much longer look into history and philosophy in order to understand the disappointments of the past forty years and to 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 portrayed 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 apparently 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 345 BC/1970, text lines 649-650).
Addiction to wine 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 unmistakeably 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 consider this authoritative 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 harmless, to those that destroy body and soul. This is what the word “addiction” has meant in the English language, since the time of Shakespeare.
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 in general usage that has been influenced by it, “addiction” has been restricted to severe drug and alcohol addiction since the late 19th and 20th centuries. This restricted meaning did not appear in the OED until the 1933 supplement. It appears in today’s OED as definition 1b. Throughout this presentation the word “addiction” is used in its more general and traditional sense of definition 1a.
Neither Plato nor St. Augustine thought of addiction as a medical problem. Rather they recognized it as one of the forms of self-destructive behaviour that characterized their age.
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 Christian Bible says about addiction is scattered and ambiguous. 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 sins were less habitual, but no less 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 officially construed as either a moral failure or a medical problem since the 20th century.
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 the cause of severe addictions. 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 in moderation or ignore them? This is a painful 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 fundamental 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 all-encompassing faith in God. Both of these ancient prescriptions remain sensible counsel today, but neither 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 countless answers have been proposed, by thinkers of every variety, none has stuck even now, twenty-four centuries after the question was first recorded. There is still no consensus, despite the pompous claims 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 anything wrong with the individuals who become addicted (moral weakness, disease, inheritance, traumatic past or whatever) or of their immediate families. Nor does it lie in any special “addictive” property of particular drugs or habits.
Plato argued that the root cause of epidemic addiction lies in the structure of society itself. Plato argued essentially that in “just” societies, addiction is a rare problem. However, totally “unjust” or tyrannical societies are so distorted and imbalanced that almost everyone succumbs to one addiction or another (571a-573b). Standing between just and unjust societies, are societies where many people must struggle with addictive urges and some people succumb to them while others, slightly more fortunate or lucky, find a way to resist them, manage them, or recover from their addictions. Perhaps the most important question we can ask in the 21st century is not what kind of individual weakness, vulnerability, or addictive drug exposure, leads some individuals to severe addiction. Perhaps we should be asking why our current society makes it increasingly difficult for great masses of people to avoid the whole range of addiction to countless habits, only some of which involve drugs.
Plato’s astounding idea fits with many historical studies that suggest that addiction is much more prominent at particular periods of history and in certain kinds of society. Whereas conflicting theories of individual addiction have produced an intellectual disaster area for addiction professionals, historians generally agree that the breakdown of functioning societies has led to extensive dislocation, and to widespread addictions of many sorts in the ancient world (Dodds, 1965), in aboriginal people who are being colonized and civilized (Samson, 2003), and in the modern world (Hughes, 1987; see review in Alexander, 2008/2010, chap. 5).
Plato’s idea has proven fruitful for health issues other than addiction. 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 fragmentation 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).
A few decades 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 caused by society for his Christian followers. If God is perfect, St. Augustine maintained, the governments that He establishes are intrinsically righteous. Any individual problems that arise – including addictions – must result from corruptions of individual free will imbued by original sin, and any solutions must be based on individual faith and reform (St. Augustine, 426 AD/2000, Book 3, chap. 24; Alexander, 2008/2010, p. 308, endnote 8). This individual orientation to addiction has carried over into the medicalized thinking of the current era, where individual disease has takes the place of individual sin as the modern cause of addiction, and genetic predispositions take the place of original sin.
This individual orientation has remained central to Christianity for centuries although there is also a countervailing Christian “transformist faith” that recognizes the need for regular social change within the realm of God’s creation as part of the master plan for the improvement of human well-being (Baum, 2006, 159-167; chap. 9; Pope Francis, 2013, chap 2, 4; 2015).
Plato’s startling pre-Christian insight on a particular kind of malfunctioning society as the root cause of epidemic addiction and other psychological problems was almost completely forgotten until it started re-appearing in the writings of some great social thinkers of the 18th through the 21st centuries. But why would a brilliant social analysis of human problems, including addiction, be ignored for over 20 centuries during which no really convincing understanding was found on the individual level? And how could it still be largely ignored today, 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 force a society that is faced with epidemic addiction 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 for anyone to maintain balance between the powerful, conflicting human needs that reside in each individual’s psyche. Unable to balance their needs, individuals focus on 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.
Plato’s explicitly invites us to face the nightmare possibility that in a society that is deteriorating in this way, the most addicted people would become the leaders, because the ferocity of their master passions for power would make other citizens turn to them in the vain hope of finding safety. May I ask you to reflect for a moment on the otherwise inexplicable charisma of Donald Trump, the American president; of Rob Ford, the popular former mayor of Toronto; and of Rodrigo Duterte, the president of the Phillipines. These highly popular politicians appear to epitomize “master passions”, i.e., addictions, for power, money, and narcissistic gratification (Mayer, 2016; Towhey & Schneller, 2015; Hedges, 2016; Klein, 2017, pp. 59-60). 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. The deepest thinkers have always known that the greatest addictions need not involve drugs at all.
I fear that we are currently moving closer to a world 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 struggle successfully 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 elaborating on Plato’s political analysis of five types of ancient Greek city states, I have put my account into the language of some great historical and social thinkers of the 19th, 20th, and 21st century. Many thinkers have applied the essence of Plato’s astounding idea to the globalizing society of the modern era. In particular, my analysis has been influenced by Fyodor Dostoyevsky, Emile Durkheim, Max Weber, Franz Kafka, Karl Polanyi, Christopher Hill, R.H. Tawney, C. Wright Mills, Erich Fromm, 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, Harvey Cox, and Pope Francis.
The Dislocation Theory of Addiction
Figure 1 represents a flood of addiction as one component of a vicious cycle that is build into modern society. I have centered this representation on a portrait of Christopher Columbus, looking worried. I hope you will quickly see why Columbus should be the central image, and why he was right to be worried.
I call the idea that addiction is built into modernity the “dislocation theory of addiction.” The dislocation theory of addiction does not focus on drugs and alcohol, but rather on severe addictions of every sort. Of course, modernity has dire effects that extend far beyond addiction. Some of them, especially the spectres of nuclear war, environmental destruction, extreme inequality, and deep public resentment or apathy are more terrifying than the rising tide of addiction. However this presentation focuses on addiction, while showing, at least briefly, how it is interwoven with other problems of modernity.
“The modern age”, taken roughly as the past five centuries of western history, has long been a topic of intense study among social scientists. For a serviceable, compact description of how social scientists conceptualize modernity, see Berman (1988, pp. 15-21). For a more recent, but less compact, description, see Mishra (2017). In this presentation I focus on five rapidly globalizing aspects of modernity: free-market economics, ever-advancing technology, individualism, colonialism, and scientific epistemology.
Please note: To say that addiction is built into modernity is not to deny that addiction is affected by well-known risk factors such early-life traumas, dysfunctional families, overprescription of drugs, individual alienation, insidious advertising, predisposing genes, and deliberately addicting gambling machines. Rather, it is to say that the basic structure of modern society tilts the playing field in favour of addiction by ensuring that a huge number of people experience risk factors like these as the consequence of social and economic forces that are beyond their control. Modern society also tilts the playing field by making it difficult for people who have acquired unsustainable addictive lifestyles to find deeply satisfying alternatives. Under these conditions, quelling the flood of addictions in the modern world will require profound social change. Otherwise, the problem will continue to increase no matter what kinds of treatments or harm reduction strategies are offered and no matter how resolutely drug use and other potentially addictive practices are controlled.
Please note also: To say that modernity is a root cause of many dire problems is not to deny that modernity has been a brilliant success in many other ways or to advocate a return to the dark ages. Every age of human history has its characteristic achievements and successes as well as its unwanted side-effects. In the early years of an age or civilization, the side-effects are obscured by the accomplishments. In the later years, every age must face its unwanted side-effects.
From the time of Christopher Columbus onward, European powers have crushed pre-modern societies and aboriginal tribes by conquest, disease, enslavement, enticement, economic exploitation, forced religious conversion, and ecological devastation (Hobsbawm, 1989, chap. 3; Dussel, 1995; Wright, 2004; Mann, 2011). This social fragmentation was made possible by modern advances in science and technology, like the ship’s compass, heavy gunnery, mass production of cheap trade goods, and by powerful modern ideologies that ingeniously justified harnessing the entire planet to increase the wealth and power of the civilized nations of the world (e.g., Columbus, 1515/2004, 1-77, Kinzer, 2017).
As the colonizing 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 competed relentlessly 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.” In the late modern age, countless works of philosophy, fiction, poetry, and song lament the fragmented lives of the affluent and well educated as well as the poor and exploited (Mishra, 2017). Think, for example, of the poetry of T.S. Elliot and Allen Ginsberg in the mid-twentieth century.
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, ecological devastation, consumerism, gross inequality, third world “development,” financialization, corporate culture, “enterprise culture,” “metacolonialism,” high-tech surveillance, high speed technical change, 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; Hochschild, 2016; Mishra, 2017). Today’s global fragmentation is not only propagated by European nations, but also by American global dominance, and by major powers in Asia, as they modernize along the lines that originated in western Europe five centuries ago.
In my earlier writing, I focussed on free-market capitalism as the cause of modern fragmentation (Alexander, 2008/2010). I still see free-market capitalism as centrally important in the contemporary world, but broader historical thinkers have shown that the cause runs deeper, to the very roots of modernity. Christopher Columbus was not a capitalist, nor were Vladimir Lenin, Joseph Stalin, and Deng Xiaoping. But they were moderns. Christianity, international communism, and free-market capitalism have all provided justifications for the fragmenting advance of modernity in different times and places (see Columbus, 1515/2004, 1-77; Weber, 1920/1958; Lenin, 1918/1970, esp. pp. 36-40; Berman, 1988, pp. 87-110; Dussel, 1995, chap. 7; Alexander, 2008/2010, 141-144; MacLean, 2017).
Modernity obviously creates economic and environmental destruction, but my focus today is on the equally devastating social fragmentation. Beneath the steamroller of modernity, extended families and communities are scattered; nuclear families become dysfunctional; local societies are pulverized; legitimate authority is toppled, religious certainties disappear; and cultural arts salvage fragments of destroyed cultures as trinkets for tourist shops. People and social groups that do not contribute to the advance of modernity are marginalized or exterminated.
Societal fragmentation has come to seem an inescapable consequence of the modern miracles that have enabled the earth to support seven billion people. But this miraculously modern world society is in deep – possibly terminal – trouble, in large part because of diverse side-effects of fragmentation, most obviously environmental destruction, obscene inequalities of wealth and power, and the possibility of nucear war. 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 consequences that follow from societal fragmentation, as they manifest themselves in people’s everyday lives.
Dislocation has been described in many ways. For example, sociologists speak of the alienation and resentment of individuals in large bureaucratized societies that crush both self-confidence and a sense of community. Psychologists speak of impoverished experiences of attachment, belonging, identity, meaning, and purpose leading to disorders such as anxiety and depression in the people they study. Christians speak of the poor in spirit or of the loss of faith or of idolatry of the secular world. Existentialists describe feelings of anxiety, dread, absurdity, and nothingness in people who live in a pointless bourgeois society. 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 analysing dislocation in brain language (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 of compassion (MacLean, 2017, esp. pp. 142-143). After all, “business is business” and we expect our politicians to “grow the economy” and “create jobs” at all costs. 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 – and are paying the price in increased dislocation – and addiction (Mishra, 2017; Zhang & Chin, 2015).
Seen in a positive light, dislocation can provide a space for enjoyable individual initiative and creative freedom for people who have felt stifled by their local societies. However, prolonged, radical dislocation exacts a high price, because it ultimately generates misery in the form of anxiety, suicide, depression, disorientation, hopelessness, and resentful violence (Durkheim, 1897/1951; Kafka, 1937; Polanyi, 1944; Barrett, 1962; Dodds, 1965; Chandler, Lalonde, Sokol, & Hallet, 2003; Berardi, 2009; Mishra, 2017). In fact, prolonged dislocation is so unbearable that it has been imposed as an extreme punishment from ancient times to the present: e.g., exile, ostracism, banishment, shunning, excommunication, and solitary confinement. 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, I find it useful to describe dislocation in psychological terms, as the lack of attachment, belonging, identity, meaning, and purpose. But 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, theologians, poets, novelists and other observers of the modern era. Although it is easy to overlook the existence of dislocation in an academic milieu dominated by empirical epistemology and reductionist ontology, empiricism 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, surging addiction problems historically follow dislocation. Extensive historical, anthropological, and clinical evidence documents this predictable sequence in Europe, Asia, and North America. I have found it especially useful to study the devastating, long-lived surge in addictions in the indigenous people in my own part of the world, Western Canada, following the relatively recent fragmentation of their cultures and their resettlement on native “reserves” in the 19th and 20th centuries (evidence reviewed in Alexander, 2008/2010, chap. 6).
Abundant clinical and biographical evidence reveals the main reason 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 for them. (Alexander, 2008/2010, chaps. 6-8; Hart, 2013, pp. 74-95; Fetting, 2016). Addictions can be adaptive in a fragmented world because – in psychological terms –severely dislocated people can use them to obtain a modicum of attachment, belonging, identity, meaning, and purpose, at least in the short term. Without their addictions, many dislocated people would have terrifyingly little reason to live, and would risk succumbing to incapacitating anxiety, depression, or suicide.
For example, when impoverished drug addicts wake up, at least they 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 sometimes forming real friendships. At the same time, the fascinating addicted lives and deaths of William S. Burroughs, Curt Cobain, Phillip Seymour Hoffman, Amy Winehouse, Michael Jackson, Robin Williams, Prince, or Carrie Fisher can give meaning to their suffering by symbolically linking it with the suffering of 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 human 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 build their lives around one or more addictive pursuits. When severely dislocated people find that an addictive lifestyle provides their best hope for enduring the world, they seize it with the same iron grip they would grasp a piece of floating junk in a stormy sea.
Therefore, 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 psychological disorder, a genetic predisposition, a history of childhood trauma, or even an entrenched maladaptive habit. Adaptation is not a disease. All of 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 and other species that compete for survival as groups (Darwin, 1871/1981, pp. 70-95; Wilson, 2012; Alexander & Shelton, 2014, chap. 7), and addiction is one adaptive capacity we can use to respond 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 function to help people to endure bouts of dislocation and then move on to more socially integrated lives.
But some people do not get over their addictions or are seriously harmed or killed by them. This happens because adaptations that facilitate survival at first can become harmful or fatal if the dislocation is not relieved and the addictions 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 another well-studied example of this fact about adaptation (Selye, 1950).
Some adaptative capacities 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 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 adaptive functions for society itself. The insatiable economy of the modern world requires overwork and overconsumption to keep the industrial wheels turning and the share prices rising (A. 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 encouraged by modern culture and mainstream advertising. The individual and socially adaptive functions of addiction in the modern era go a long way towards explaining why addiction is as intrinsic to modernity as competitiveness, loneliness, and anxiety.
The adaptive functions of severe addiction in the modern world are often hard to accept. Many severely addicted people deny that they live in a state of dislocation, because they feel embarrassed to think that they do not “have a life”. They may not know that dislocation bedevils most people in the modern world. They may be unaware or ashamed of the adaptive functions of their own addiction. In moments of insight, however, severely addicted people 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 that severe dislocation 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 dislocation that their child had to confront were totally beyond parental control, acknowledging it could generate unbearable feelings of parental failure.
Mass media endlessly proclaim that addiction is a chronic brain disease caused by the effects of addictive drugs on the brains of people with a genetic predisposition to addiction, rather than an adaptation to dislocation in a fragmented world. This contemporary version of the Official View is bolstered by scientific authority and media dramatization (e.g., Nature editorial, 2014; Seelye, 2015; Pond & Palmer, 2016; Smith, 2017). It is lavishly funded and sponsored by the National Institute of Drug Abuse in the United States, despite its evident deficiencies.
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 dislocation. People may fit the dictionary definition of addiction when they undertake a binge of work to finish an important project before a deadline and thereafter return to normal work habits. They may also act addictively when they devote themselves to compassionate service and asceticism out of concern for suffering humanity, or when they fall in love. The dislocation theory of addiction explains the high prevalence of harmful, 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. For example, you don’t have to be dislocated to fall in love, but you do have to be dislocated to sacrifice your life to be addicted to 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 – if only partly successful – adaptations to dislocation in an increasingly fragmented modern world. And some some kinds of severe addiction are adaptive for society because they help to maintain high levels of production and consumption. But there is still another important reason why severe addiction is intrinsic to 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. (See Figure 1).
Consequences of addiction that exacerbate social fragmentation include: Environmental and social destruction mandated by wealth and power addicts pursuing profits in the executive suites of their multinational corporations (notoriously including many Canadian mining companies), investment banks, and hedge funds (P. 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 addictively involved with television, bingo, Sudoku, prescription drugs, or whatever.
Because of its long-term socially fragmenting 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 nightmare reality of our times is that 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 almost universal addiction in the midst of the collapse of the Athenian Empire and, eight centuries later, the Roman Empire.
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 providing psychosocial integration for all the millions of people who appear in each new generation of a globalizing world. Therefore severe addictions of all sorts will continue to be a problem. Our profession, which institutionalizes the compassionate human impulse to help people struggling to find a decent way to live in a fragmented society, will still be needed in 2056. However, I foresee 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 the ones that were known to Plato, St. Augustine, and Dante, as well as the new ones energized by the Internet and modern gambling machines and by newer technologies that cannot yet be imagined. The current fiction that psychoactive drug use is a uniquely addicting habit will be recognized as a relic of the twentieth century. This shift is already well under way.
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, partial drug legalization, 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 and because mass incarceration will no longer be affordable.
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 understanding and control of addiction as the coming paradigm shift away from unquestioned faith in 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 has a long history. It was immanent in the Roman Catholic beliefs of Columbus, the Christian Calvinism of the Reformation, and in the celebrations of private property and the emerging global market economy by John Locke, Adam Smith, and David Hume in the 18th century. Faith in modernism is explicit in the last century’s frenzied celebration of free-market economics, unending progress, and globalization as depicted by Friedrich von Hayek, Ayn Rand, James A. Buchanan, 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 “deified market” (Francis, 2013, paragraphs 54, 56). Americans know this faith in nationalistic terms as belief in “The American Century” or “American exceptionalism” and in the religious terms of some evangelical faiths (Hochschild, 2016, pp. 117-126). Perhaps the most exuberant form of this faith 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 on a platform of social media (Zuckerberg, 2017). But this faith is already losing ground.
The entrenched faith that sustained the modern age for five centuries 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 human spirit and 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; Klein, 2007; 2014; 2017; Pope Francis, 2013, especially chap. 4; 2015; Streeck, 2014; Cox, 2016; Dower, 2017; Mishra, 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 with enormous financial backing (Miller, 2016; Kassam & Mathieu-Léger, 2016; CBC News, 2017; MacLean, 2017), the defences have worn thin, though endless disappointments and broken promises.
Recognition that faith in modernity is waning can be obscured by the lament that the cycle of modern fragmentation, dislocation, and addiction has such huge momentum that is cannot be reversed, at least for the great majority of people (e.g., J.D. Vance, 2016, chap. 15, esp. p. 238). This defense is hard to ignore.
***This is the point in the original speech where I could not finish as planned. The remaining part of this written version was mostly written in the year after the speech was given.***
5. Forty years from now, in 2056, with modernity no longer sacrosanct, the function of severe addiction as a desperate way of adapting to a fragmented modern world will be far easier to comprehend. Consequently, addiction will no longer constitute a dark mystery for most people. 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 understood 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 video of 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 a grotesque extension of modernity in the United States, in an nightmarish mixture of neoliberalism, libertarianism, nationalism, racism, religious hatred, computerized voter manipulation, and bizarre political theatre – and perhaps a similar shift in Europe as well (Monbiot, 2016b; Thomas & Stevenson, 2016; Chomsky, 2016; Wolff, 2016; Lofgren, 2017; Klein, 2017).
I learned long ago, that I can only overcome writer’s block (or, in this case, speaker’s block), by being more honest than I have been previously. In this case, I must confess that I cannot rule out the possibility that modernity will still be the dominant paradigm for world society in 2056. (5.1) If modernity still is the dominant paradigm for world society, the addiction problem will worse in 2056 than it is now, no matter how much treatment, harm reduction, and recovery group methods have improved 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, as I re-wrote the unfinishable speech, I was inspired by Gregory Baum (2006). 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 found inspiration in Baum’s theology as well as his secular scholarship. I believe that his theological ideas can be well stated in secular language 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 after the speech by an insightful friend, David Seljak.
One of Baum’s important 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 unchanging human motivations and abilities will lead to the same outcomes in the future that they did in the past. However, Baum (2006) points out that prophecy involves a deeper realization: Human nature always includes the possibility for radical transformation at times when it is most needed. Besides, a prophet, like Isaiah in the Christian Bible, was as much a seer of the need for change in a dark era as a foreseer of the future (see also Cox, 2016, pp.143; 162-173).
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 may be most realistic precisely when times are darkest, because that is when people’s potential for radical innovation peaks.
Almost five decades of thinking about the addiction issue has led me to see addiction as a part of a larger problem, which I have summarized for this presentation in Figure 1. Gregory Baum’s writing, has inspired me to take the diverse indications that the vicious cycle of modernity is now rapidly losing its credibility even more seriously. (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 a once-entrenched faith in modernity and, soon afterwards, the emergence of a new era.
Paradoxically, the bizarre 2016 American presidential election helped me realize how much the tide is changing already. As I discussed the election with deeply concerned Canadian and American people, I found very few people who still believe in the promise of modernity, as their forefathers did. Almost everybody who is willing to look can see that the system must be changed profoundly if it is to avoid catastrophic collapse. Of course people on the political left and right differ in apparently fundamental ways 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. They embody the problem, not the solution. 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.
Baum and others are pointing out that the potential solutions to problems generated by the modernity trap lie in social change brought about by ordinary people finding common cause. 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 belongs to the people and to the planet that gives us life. 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, local communities, and natural environment combined – somehow – with an encompassing global humanism and an expanded, inclusive spirituality. I believe that the most powerful social an spiritual energy for a directional change of this magnitude will continue to come from the third world and from aboriginal people (e.g., Klein, 2014; 2017, chap. 10), from devoted young activists and intellectuals (e.g., Hawken, 2007; Leap Manifesto, 2015), from the Nordic countries (e.g., Young, 2017), from astounding advances in green science and technology that will make a radically new direction feasible (e.g., Boyd, 2015); and from fresh insights in ancient religious and spiritual traditions. Catholic and Protestant theologians are among those calling most pointedly for epochal change (Martín-Baró, 1994; Cox, 2016). Pope Francis himself has called for “a bold cultural revolution” (Francis, 2015, paragraph 114).
But how do the militant local movements that are emerging everywhere find common ground on an alternative to modernism that will eventually prevail on a more global level? I don’t think this final, essential step can be known in advance. This particular paradigm shift has never been made before and the end point cannot be foreseen, although many dilligent thinkers are trying to foresee it. Certainly a part of the common ground must be a shared respect for our battered and abused mother Earth (Klein, 2017). Another part must be the recognition that nuclear war is a path of no return. Perhaps another part of the common ground that is already visible is the emergence of global faiths that are as compassionate in their impulse as the great religious traditions of the past, but that explicitly venerate and serve planet earth and welcome all people into a new community without defining themselves in opposition to a heretical enemy (Berry, 2009; Pope Francis, 2013; 2015). Perhaps religion itself is being reborn when it most needs to be.
The sad part of this hopeful prophecy, for me personally, is that the epochal transformation in thinking and social organization that many of my generation have anticipated for much of our lives is not going to be well under way 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 exterminating inconvenient individuals, fragmenting human societies, misinforming the populace on a mass scale, 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 toxic governments and multinational corporations; “think tanks” funded by billionaires to overwhelm attempts at critical thinking with endless cyber-babble; and the “investor-state conflict resolution panels” ordained by international trade agreements. These entrenched institutions will have to be replaced by new institutions. This transformation will only be beginning in 2056 and the struggle will be extended and ferocious.
The existing institutions that sustain modernity as we know it are controlled by powerful vested interests that couldn’t care less whether the underlying faith that created them is moribund or not. Zombie thinking remains dangerous even after it is intellectually dead, because of the sheer momentum of its dead weight and its utter ruthlessness. Completing the shift to non-fragmenting institutions will take generations after 2056.
The struggle will be particularly fierce in the United States where modern values like individualism and consumerism are deeply engraved in the popular mind and the dogmas of modernity are backed by vast corporate wealth (Hochschild, 2016; MacLean, 2017). However, even in the United States, many people who run the operations of the powerful institutions of modernity can see the problem clearly and are ready to join in the coming shift. Harvey Cox points out that “they often feel trapped in a labyrinth with no visible exit…They need help from outside their golden cage” (Cox, 2016, p. 278).
Current responses to the tragic current surge in overdose deaths attributed to opioid 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 marketing practices used by some pharmaceutical companies to stimulate over-prescribing (Robertson & Howlett, 2016). However, the danger of over-reaction 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 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 published 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 addicted people towards illegal markets purveying far more dangerous opioids, they can also divert attention from the aspects of the late modern era that are causing the addiction problem – and hence the overdose death problem – to increase. Opioid deaths are not an new, isolated problem, but a currently visible aspect of a problem that is intrinsice to the modern era.
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 dislocation, including exclusion from mainstream society, public disdain, economic exploitation, and police brutality. Many 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., Hart, 2013; Hari, 2016). 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 farms. However, their descendants are less and less needed in the automated, off-shored, 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; Hochschild, 2016, chaps 9, 14).
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; J.D. Vance, 2016). Increasing rates of overdose deaths and addiction in this white underclass are certainly a major cause of the 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 (J. Slater, 2016; Bader, 2016; Amnesia, 2016; Hochschild, 2016, esp. pp. 136-140). The excessive opioid consumption of the American white underclass comprise another chapter in the long saga of fragmentation, dislocation, and addiction of the late modern era. However it is often portrayed as a relatively simple drug problem that can be solved with new prescription regulations or by closing the American-Mexican border.
Many of the reasonable interventions now are being hastily organized now 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 is intrinsic to modernity can be overcome by reducing the legal prescription of opioids, providing ample supplies of Narcan, providing more treatment centers for drug addiction, providing more self-injection sites, punishing illegal dealers more severely, or even limited legalization of opioids expresses a reluctance to turn the spotlight where it truly belongs, on the modern age itself.
(6.1) History will repeat itself, but only briefly, in the panicky attempt to control the surge in opioid overdoes that began in 2016. Although most of the harm reduction and treatment measures that are being introduced now are sensible and necessary, under-prescribing 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 modern thinking 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 innovative, compassionate support and treatment that we currently provide to addicted people, and must continue to provide. 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 addiction gene that can be deleted, new restrictions on prescribing, a newly rediscovered eastern spiritual practice, vast increases in the budget for existing treatments, etc. (Obama, 2016; Pond & Parker, 2016; Alexander, 2016b). 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. Of course our treatments do help some people and provide comfort to many others, but they can never be the basis for a full solution to the addiction problem or other human problems built into modernity. Some professionals are speaking this way already (Pipher, 2013).
Addiction is a different sort of a problem, and we addiction professionals 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 breadth and importance 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.