Articles & Speeches

A Final Conversation with Addiction Professionals

A Final Conversation with Addiction Professionals
 
Bruce K. Alexander
Simon Fraser University
 
This is a written version of a webinar presentation organized by the Addiction Theory Network on April 19, 2022
  
            By compiling the best evidence pro and con, the new edited book Evaluating the Brain Disease Model of Addiction(Heather, Field, Moss & Satel, 2022) shows that the Brain Disease Model of Addiction is a weakly supported, largely fruitless theory. This despite its authoritative endorsement by governmental agencies and professional societies, and despite its extensive data base in advanced neuroscience.
            In the context of this game-changing new book, I want to make some very strong statements about addiction myself. My justification for this outburst today is that I have been working in this field for more than half a century and am now 82 years old. I will not be doing a lot more public speaking. I want to state what I have learned in my long career as emphatically as possible before I quit. I do not claim to have the final answers, but I do credit myself with having examined the most difficult issues from many directions. Here are seven conclusions that I have reached:

1.   We Have Ignored the Greatest Threats that Addiction Poses to Modern Society.
            Today I see addiction as much more dangerous than I did half a century ago. This is only secondarily because of the visible flood of addiction to drugs of all sorts as well as to gambling, social media, computer games, and consumer goods. (Courtwright, 2019). Primarily, it is because I have become more aware of particular mass addictions that can not only destroy individual lives and families, but also pose an existential threat to society itself.
            I am aware of the long history of hysterical fear mongering about illicit drug and alcohol. Nonetheless, I am hoping that you will be willing to discuss my own current state of fear in the group discussion that will follow my presentation. In the hope of kick-starting that discussion I would like to pose a question to each of you: “What is the most dangerous addiction to society as a whole that we currently face?” I ask that you mull that question over as we proceed. I will come back to it after introducing some other conclusions I have reached in my half century of professional involvement.
 
2.   We are Stuck Theoretically
            I believe that theoretical development in the field of addiction is seriously “stuck.” Despite our enormous, highly sophisticated professional literature and despite helping to discredit the cruel and futile War on Drugs, we have achieved nothing like a working consensus that would enable us to make steady theoretical and therapeutic progress, as other sciences have. Most of the problems we are trying to solve appear to be getting worse.
            We are the only field in which scholars frequently find it necessary to start professional presentations by offering their own definition of “addiction,” the central term in the field. Moreover, none of the countless, often conflicting, definitions and theoretical orientations within the field can be either proven or disproven conclusively. As time passes, we generate more data, more theoretical writing, more definitions, and even new journals, but we have used these mainly to hassle over the same irresolvable issues for more than a century (see White, 1998; Fisher, 2022).
            By contrast, genetics and evolutionary biology have solved amazing technical and theoretical problems in my lifetime, such as mapping the human genome and resolving the theoretical problem of how “altruistic” behaviour can evolve in some species. Medical geneticists have developed therapies that are amazingly effective for some formerly untreatable types of cancer. Why have they made such substantial progress, while we have not?
            I have had the opportunity to ask several contemporary geneticists if they are excited about the recent progress in their own field. “Yes!” they say. Then I ask them if they have made progress on the genetics of addiction. “No!” they say, “because we cannot specify the phenotype.” In their genetic terminology they are saying that they don’t know precisely how to tell if a person is addicted or not. Why haven’t we been able to tell them?
            In saying all this, I mean no affront to my fellow toilers in the field of addiction. Even though we are collectively stuck, we work hard; we try to keep up with our ever-expanding, deeply conflicted literature; we are as collegial as possible under the circumstances; we care deeply about the suffering of our addicted clients; and we do help some addicted individuals and puzzled policy makers. It is a shared misfortune that we have made so little conceptual progress, and nobody’s fault in particular.       
 
3.   WhyWe are Stuck: The Myth That Cannot be Dispelled
            When I entered the field in 1970, it was dominated by an idea that I call the “Myth of the Demon Drug.”The Myth stated that there was a certain drug that destroyed the will power of those who used it, leaving them permanently “hooked” to drug cravings that would eventually ruin their lives and their families, and feed the rapidly growing “crime wave.” In the 1970s, the demon drug was heroin in my part of the world, but earlier it had been cocaine, and before that morphine and alcohol. In other parts of the world, other drugs had been demonized at various times, including tea and tobacco in early modern Europe. I call this way of thinking the Myth of the Demon Drug partly because the North American Temperance movement so dramatically anathematized alcohol as “Demon Rum” (Fisher, 2022, pp. 71-92) and passed this way of thinking on to the illicit drugs as they came into public consciousness over the decades. When I entered the field, heroin users were still being called “drug fiends.”
             
            Within the Myth of the Demon Drug, drug addiction is the only kind of addiction that really matters because it is taken to be more dangerous than addiction to any other habit or pursuit. The Myth has been endlessly proclaimed to justify the War on Drugs and is still used for that purpose in some countries today.
            The accumulated evidence against the Myth in its strong form is overwhelming and conclusive by normal standards of evidence. Much of the critical evidence and support for conflicting theories is cited in Evaluatingthe Brain Disease Model of Addictionand reviewed in many earlier books and articles. (e.g., Chein et al., 1964; Peele & Brodsky, 1975; Szasz, 1975; Slater, 1980; Heather & Robertson, 1981; Zinberg, 1984; Khantzian, 1985; Davies, 1997; Alexander, 1990; 2008, esp. chap. 8; Erickson et al., 1994; Kalant, 2009; Reinarman & Levine, 1997; Granfield & Cloud, 1999; Maté, 2008; Heyman, 2009; Satel & Lilienfeld, 2013; Ahmed, Lenoir, & Guillem (2013); Hart, 2013; Heim et al., 2014; Hall, Carter & Forlini, 2015; Lewis, 2015). Some critical researchers have concentrated on specific aspects of the Myth, and some have attacked the Myth as a whole, including the redoubtable Norman Zinberg, Stanton Peele, John Davies, Thomas Szasz, Harry Levine, Craig Reinarman, and Carl Hart.
 
4.   Why We Have Not Gotten Unstuck: Ghostly Remnants
            Although critical researchers have striven mightily to dispel the Myth, they have not fully succeeded. Although it is now indefensible in its original form, the Myth still flourishes as what some historians of science call “rescue hypotheses” that protect a once-dominating idea from complete collapse in the face of strong counterevidence (Lakatos, 1973; Heim & Monk, 2022). I think of these rescue hypotheses metaphorically, as a swarm of ghosts.  In these diluted, ghostly forms of the Myth, drugs are no longer said to permanently and catastrophically “hook”everyonewho uses them, as they were in the original Myth. They are only seen to undermine the will power of those drug users who have the right combination of genetic, environmental, mental illness, or traumatic risk factors enough to induce a chronic disease or disorder of addiction, that can only be relieved with professional or spiritual treatment. Drug use produces this insidious transformation most frequently, but other habits can mimic addictive drugs to some extent.
            I see the current form of the Brain Disease Model of Addiction (aka the BDMA) as one of the ghostly remnants, but not the only one. Just as the BDMA translates the imagery of the Myth of the Demon Drug into the language and logic of deterministic neuroscience, other ghosts translate it into the language of not-quite-so-deterministic cognitive or learning theory. Another ghostly remnant is the view that the theory applies only to that small fraction of the addicted population that does not eventually recover before their death, but not to the majority that does recover, with or without treatment. Another is the view that drug addiction is not a total loss of will power but a treatable disorder of choice that makes healthy decisions extremely difficult. Another is the spiritually-focussed disease view of addiction that is promoted within AA and other 12-step groups.  
            Although the BDMA and the other ghostly remnants dilute the earlier Myth of the Demon Drug, the mythic core remains. Today’s culture still proclaims at deafening volume that the essential problem is the individual drug addicted person. When a person is addicted, his or her ability to resist chronic, maladaptive drug use is still said to be impaired to some significant degree by unseen forces and the solution can only come from expert treatment (e.g., Interlandi, 2022; Jorandby, 2022). Is this not still a watered-down version of demon drugs possessing individual’s souls?
            I believe that the widespread acceptance of the current ghostly remnants, like the earlier acceptance of the original Myth, prevent any useful understanding of addiction at a time when it comprises an existential threat to global society. The full danger of addiction is also currently obscured by constant focus on drug addiction, despite dramatic surges of diverse addictions, many of which do not involve drugs at all, in various human populations (Alexander, 2008, chap. 6).
            I am convinced that the original Myth and all its ghostly successors are unsupportable by the normal standards of scholarship. However, I am no longer convinced – as I once was – that the ghosts can be laid to rest. Because the ghostly remnants are diluted and insubstantial, they are harder to flatly disprove than the original Myth, even though the evidence runs against them. Moreover, ghosts, in general, are difficult to eliminate when they serve important emotional functions for the people who believe in them. The functions served by the ghostly remnants of the Myth include relieving the guilt of addicted individuals by explaining why they continue their harmful addictions; relieving the guilt that parents inevitably feel over their children’s problems; relieving the fears that our homelands may be addictogenic; bolstering some truly useful paths to recovery (while obscuring other paths); and legitimatizing compassionate therapeutic treatment for addiction. These eminently serviceable ghosts can also serve darker political functions, such as providing failing governments with tangible scapegoats, simplifying bewilderingly complex social problems in times of mass panic, and, sometimes, providing justifications for racial suppression.
            I have examined one cultural bulwark of the Myth at length.  My chapter 15 in Evaluating the BDMA(Alexander, 2022a) explores the mental gymnastics necessary to support a doctrine that historians call the “American Grand Narrative.” This doctrine justifies endless American imperial wars by depicting the USA as a bastion of democracy, equality, and brotherly love that must extend its indispensable institutions everywhere. But if the USA is such an indispensable society, what demonic force or disease process draws so exceptionally many of its citizens into drug addiction (Fig. 1) and “deaths of despair” (Sterling & Platt, 2022)?
 
Figure 1. Share of Population with Drug Use Disorders, Selected Countries. Our World in Data.
 
The Myth and its ghosts shelter the American Grand Narrative from critical examination by attributing drug addiction to exposure to drugs that eliminate or reduce people’s will power regardless of what kind of society they inhabit, leaving no need to ask whether American society itself is in any way addictogenic. Perhaps this is why these myths are taken most seriously by US governments and professional organizations (Fisher, 2022, Chap. 6), why they are portrayed so brilliantly in American media (e.g., McCauley, 2009; Jorandby, 2022) and why the US has most blatantly censored scientific evidence against the Myth and its ghosts (Jelsma, 2003; Wikileaks, 2009)
            In chapter 15, I urge the international community of addiction scholars to be more skeptical of addiction theories that are championed by the American institutions. However, I am aware that my political heresy is unlikely to rouse much enthusiasm in the western world during the current deadly superpower confrontation in eastern Europe. Nor will any of the other cultural supports of the Myth and its successors be easily undone, for other powerful cultural and emotional reasons. I predict continuing ghostly manifestations long into the future.
            Is there any reason to suppose that professional scholars are less susceptible to cultural influence than anybody else? I have seen none whatsoever in a professional lifetime of association with scientists and academics. And surely it is a lesser evil that scientists and academics are fully human, culturally embedded beings, rather than just the objective, evidence-driven, automated thinkers that we sometimes proclaim ourselves to be!
            But how could we addiction professionals think of our opinions as being solely “evidence based” when most of us have been formed by confused and terrified cultures as well as by intensely painful addiction experiences, either in our own lives or the lives of those near and dear to us? Our humanity is part of the reason that addiction scholarship is an intellectual disaster area – although it does not mean there is no way out of it.
            The history of science offers direction here. When science bogs down it is time to expect a paradigm shift. You will recognize the strong influence of historian of science Thomas Kuhn (1970) in the next part of this presentation. My – perhaps immodest – ambitions have shifted at the end of my career from being a demon myth slayer to helping to trigger a tectonic shift of paradigms within the field of addiction and popular culture.
 
5.   We Need a Paradigm Shift
            I believe that an “Adaptive Paradigm” should become the primary framework of addiction research and theory. I have developed this idea in Evaluatingthe BDMA (Alexander, 2022b), in my book, The Globalization of Addiction(2008), and in articles and chapters in between (See my website: www.brucekalexander.com).
            The Adaptive Paradigm begins with a recognition of the fully-documented, but frequently neglected, fact that even the most dangerous addictions serve vital emotional and cognitive functions, (Chein et al., 1964, chap. 9; Khantzian, 1974; 1985; Alexander, 1990, pp. 280-288; 2008, chaps. 4, 6, 7; Satel & Lillienfeld, 2013; Weinberg, 2022). The Adaptive Paradigm also recognizes that people use addictions – even the most destructive ones – to cope with the dislocation and loneliness of their personal lives. (Alexander, 2008, chap. 7; Hart, 2013; Morgan, 2019). Even the most dangerous forms of addiction are notbest understood as maladaptive diseases, disorders, or biases of behavior or choice, but rather as desperate and sometimes tragically unsuccessful attempts to adapt to intolerable life situations in a chaotic and fragmented society. The cause of addiction does not lie in addictive drugs or in reckless hedonism, but in the tragic failure of modern society to meet some of the deepest human needs and in the desperate measures that people use to try to compensate for their unfulfilled needs. 
            Instead of dwelling interminably on involuntary aspects of drug addiction, or doggedly hunting for elusive disease mechanisms, the Adaptive Paradigm poses quite different questions: 1) what functions do addictions serve? 2) why is addiction such a pervasive and urgent problem is the world right now?  and 3) how great is the danger posed by today’s flood of addiction? Within the Adaptive Paradigm, addiction returns to the broader field of psychology, rather than being cordoned off as either a demonic or medical anomaly. The question becomes “What benefits are people seeking from their addictions (despite the costs that they bring)?” rather than “Why do people not refrain from costly addictions (even though they might have some benefits)?”      
            Philosophically, the Adaptive Paradigm switches the focus from Aristotle to Plato: That is, from Aristotle’s eternal question about akrasiaor “incontinence (Aristotle circa 350BC/1941, Book 7; Heather, 2017) to Plato’s discussion of the growing dominance of “master passions” in failing democratic societies and budding tyrannical societies in the Republic(Plato, circa360B.C./1987, 571d-578c) and to Plato’s broader argument in Protagoras, that people always act in pursuit of their own well-being (Plato, circa388
BC/1956, 357c-358d; Alexander, 2008, 323-329). If people are aware of the dangerous consequences of their addictions and nonetheless continue, it is because they are pursuing benefits from the addiction that outweigh the costs, even if these are invisible to the philosophical observer.
A familiar fact can concretize this Platonic abstraction. A fox caught in a leg-hold trap during a freezing blizzard might behave adaptively by gnawing off its own foot to escape, rather than dying immediately of exposure. This desperate, painful, adaptive behaviour could only seem maladaptive to an observer who cannot see the trap beneath the snow.
And even the fox may not see the trap beneath the snow. It may only sense that it is caught and must break free at any cost. Some addicted persons may sometimes not see the hidden trap that debilitates them but may only perceive a fatal attraction to a harmful lifestyle that is inexplicable, even to them. Other addicted persons may perceive their own trap, but still see no alternative to using dangerous addictions to cope with or escape it.
            The Adaptive Paradigm points us to the need for fundamental changes in modern society that will make enable more people to flourish without needing dangerous addictions. The intellectual work of identifying what kinds of social changes will be needed to reduce the number of traps in our world should be at the forefront of our attention now. 
            Of course this is an immense undertaking. But it is time to get on with it. We have already wasted too much time searching for shortcuts! Addiction professionals influenced by the Adaptive Paradigm are finding improved ways of treating addicted individuals and these may make a real difference, But I hope to convince you that even the very best treatment cannot be enough at this time in history (see also Morgan, 2019, chaps. 9, 10).
            I hope you will read more extensive summaries of the Adaptive Paradigm and pay particular attention to detailed historical projections of a self-propagating feedback loop in which dangerous addictions only result from an increasingly fragmented society but cause of additional social fragmentation and, hence, more addiction in the future (Alexander, 2008; 2022b; Alexander & Holborn, 2019; Mishra, 2017). The flood of dangerous addictions will continue to swell uncontrollably unless there are structural changes in the modernizing world to reduce the continuing, toxic fragmentation of stable communities and families.
 
6.   We Have Ignored the Greatest Threats that Addiction Poses to Modern Society (continued from 1. above)
            Most of us in the field of addiction center our attention on addictions to illicit drug and alcohol addiction. These tragedies and the current unprecedented levels of opioid overdose deaths provide reason enough to redouble our efforts. However, I am convinced that some addictions that we normally ignore are ultimately far more dangerous and that these raise the stakes in our field further still.
            Earlier I asked you to think about what you would consider the most dangerous addiction to modern society. The answer of course depends on how addiction is defined. In asking myself the question, I decided to use the closest thing to universally accepted definition – the meaning of the word in the English language. I turned to the online Oxford English Dictionary (2022), which I take to be the Supreme Court of Dictionaries. Unfortunately, I found two current definitions there (as well as three others that are listed as either “Obsolete” or “Historical”)

“1a. The state or condition of being dedicated or devoted to a thing, esp. an activity or occupation; adherence or attachment, esp. of an immoderate or compulsive kind.
   In later use frequently influenced by sense 1b.
1b. Immoderate or compulsive consumption of a drug or other substance; spec. a condition characterized by regular or poorly controlled use of a psychoactive substance despite adverse physical, psychological, or social consequences, often with the development of physiological tolerance and withdrawal symptoms...”

Figure 2. Oxford English Dictionary Online Edition: Definition of Addiction
 
Definition 1b is close to definitions that most people use in our field, and is clearly linked to drugs. However, it is a Johnny-come-lately definition, having been added to the OED in 1933, during the full vigour of the Temperance Movement and the early stages of the War on Drugs.
Definition 1a is the time-honoured, traditional usage of the last 500 years. The wording in the dictionary has changed over time, but the fundamental meaning remains the same. The traditional definition reflects the way that Shakespeare, Christopher Marlowe, the King James Bible, David Hume, Charles Dickens, and other masters of the language used the word (Lemon, 2018; The King James Bible (1611), 1 Corinthians 16: 15-18)
This traditional usage, which encompasses both admirable and abhorrent forms of addiction to “activities or occupations” that include, but go far beyond, drug use is far from obsolete, despite today’s intense concentration on dangerous drug addictions. The celebrated scientist and inventor Edwin Land wrote eloquently about the “necessity and opportunity” of being personally addicted to laboratory research in Sciencemagazine (Land, 1971). Thad Ziolkowski has provided a brilliant exploration of the joys, sorrows, and mortal dangers of addiction to both drugs and ocean surfing (Ziolkowski, 2021). Many contemporary Christians welcome being seen as addicted to Jesus (Licciardello, 1991; Barlow, 2021). In each case, both admirable and abhorrent functions of addiction can be easily envisioned. Using the word “addiction” in this encompassing, traditional sense, recognizes broad wisdom that is built into the English language, by contrast with the narrowed definition 1b that grew out of the moral panics of the Temperance Era and the War on Drugs.
            For our discussion, I am hoping that you will answer the question of what you consider the most dangerous addiction forboth definitions, as well as any other definition you may choose. Although the traditional definition can be used in a positive as well as a negative sense, I am asking you to use it in the negative sense, by identifying the currently most dangerous addiction of all.
            Here are my own answers: By definition 1b, the most dangerous addiction is to tobacco. I have come to that conclusion from the grim worldwide death statistics (Institute for Health Metrics and Evaluation, 2021; Figure 3) and from watching my own father, an intelligent and prudent human being, choking from emphysema until it killed him one day at age 65, with an open pack of cigarettes on his bedside table.


Figure 3. Worldwide deaths from tobacco, alcohol, and drugs. Our World in Data.
 
            By the traditional definition, I believe that the single most dangerous addiction is fanatical mass devotion to political cult leaders like Adolf Hitler, Josef Stalin, Anwar al-Awlaki, Jair Bolsonaro, and Donald Trump. In World War II, this kind of addiction led to the death of tens of millions of European people.  Although it has not yet precipitated megadeath on the same scale in the 21stcentury, today’s mass, fanatical devotion to political culsts seems equally intense, and it could well lead to a nuclear war and/or environmental apocalypse.
Running a close second, I would put the addictions to wealth and power in the leaders of an utterly ruthless fossil fuel industry who are willing destroying the earth’s sustaining ecosystems in their quest for profits. Third, I would put mass addictions to consumption that are producing an insatiable market for disastrous quantities of fossil fuels, plastic products, and other destructive merchandise.
            Those are my answers to my question. But the addictions that I consider most dangerous – by either definition – are not the primary focus of the current professional addiction literature! So I am assuming that your answers may be quite different. What do you think?...
            The mid- 20thcentury provides an exhaustively documented example of addiction to political cult leaders and of the existential threat that they pose to our civilization: In the words of the traditional definition, millions of Führer-addicted European men and women lavished immoderate devotion and dedication on Adolf Hitler and experienced compulsive attachment to him (Riefenstahl, 1935; Fromm, 1941; Arendt, 1968, chaps 10-13; 1963; Kershaw, 1998; 2000).  Hitler mobilized this mass addictive support in ways that almost destroyed Europe.
 In eastern Europe, multitudes of Russians were similarly addicted to Stalin in the mid-20thcentury. They loved and revered him even after he destroyed millions of their fellow citizens in massive purges and catastrophic economic reformations (Arendt, 1968, chaps. 10-13).  Currently, millions of devoted Trump- and QAnon-addicted Americans may well bring about the downfall of the American constitutional voting process and could precipitate World War III (Shephard, 2022).
            The conclusion that Hitler and his followers were dangerously addictedjumped out at me intuitively, when I recently struggled through Adolf Hitler’s Mein Kampf (1925/1999) and British Historian Ian Kershaw’s encyclopedic two-volume study of Hitler and his adoring followers (Kershaw, 1998; 2000). Hitler himself was “devoted,” “dedicated,” and “attached,” from an early age to German nationalism, racial purity, and to personal domination of friend and foe alike. Albert Speer, said to be Hitler’s closest approximation to a personal friend during World War II, said that Hitler “had become addicted to power, fame, untrammeled domination…” (quoted by Bullock, 1980). Hitler’s Nazi followers were “immoderately” or “compulsively” dedicated to der Führerand to Nazi dogma, as well to destroying the official enemies of the Reich (Kershshaw, 1998; 2000).
A lifetime of working with people who are dangerously addicted to drug use has given me a feeling for their unrealistic, fantasy expectations, and for the impenetrable blindness that shields addictive denial from critical examination. I sense the presence of these familiar qualities of addiction in the detailed historical records of both Hitler and his political base of millions of addicted followers. Moreover, history shows that most of these followers suffered from intense social and political dislocation before becoming addicted to Hitler and found meaning and purpose in Naziism, as expected within the Adaptive Paradigm (Arendt, 1968, chaps 10-13).
            I also sense these patterns in the contemporary statements of the most fanatical Trump followers (e.g.,Cohen, 2020), including the members of the QAnon Cult, which currently has 10s of millions of followers in the United States alone (Shephard, 2022). Most long-term members of QAnon appear to be entirely content with their ideological addiction, although large numbers have reported a desire to quit. Some of those who wish to quit find it impossible to overcome their addictions even with help from therapists or counselors (Stanley, 2021). An online group called QAnon Casualties is used by thousands of people who feel abandoned by their family members who have become addicted to QAnon (Carrier, 2021). It is quite common for people to have histories of serious drug addiction before dedicating themselves to QAnon (e.g., Thanawala, Dazio, & Martin, 2021). These same addictive patterns emerge in accounts of the numerous fanatical spiritual, sex, and conspiracy cults that bedevil our times (Sullivan, 2010; Grigoriadis, 2018; Berman, 2021; Cogan, 2022).
            Hitler never recovered from his own addictions. Unrepentant, he shot himself only shortly before he would have been captured in his Berlin bunker. Although some of his fanatical followers lost faith as German armies were all defeated, millions remained addicted to him and to his doctrines to the very end, as they lost everything, including often their own lives. Many of the most faithful declared that life was not worth living without their Führer and, after receiving the news of Hitler’s death, committed suicide themselves (Kershaw, 2000, chap. 17 and Epilogue).
            World War ended almost 8 decades ago, but the defeat of Nazi Germany and its allies was not foreordained. Hitler never lost political control of Germany, even in total defeat (Mazower, 2011). What if Germany had successfully developed nuclear weapons, as its best physicists were trying to do? What if the German jet-powered bomber had been developed successfully two years earlier than it eventually was? We can only shudder at these possibilities. What if the next country in which mass addiction brings a Hitlerian demagogue to unchallengeable power already leads the world in nuclear weaponry and space technology?
            I would argue that, if potentially catastrophic addiction to political cults is not one of our primary concerns in the field of addiction, it can only mean that we do not take our field seriously enough to absorb its full implications and to concentrate our attention on the most dangerous forms of addiction.
 
7.   Yes, We Can Seriously Call Political Fanaticism “Addiction.”
Many people find it strange to think of the fanaticism of World War II Nazis as an addiction. After the unspeakable horrors of the war, it is still almost impossible to understanding the Nazis of that era as anything other than political evil incarnate – and, thus, incomprehensible as human beings.
However, Nazi’s intense devotion, dedication, and attachment to der Führerand their country fit the traditional definition of addiction perfectly. This has been documented by historians and by the testimony of World War II Nazi’s. Moreover, the history of the last few centuries shows that fanatical addiction to seemingly infallible political cult leaders regularly provides meaning and purpose to masses of human beings who are severely dislocated due to the fragmentation of their societies, including Islamic, Christian, and Jewish fundamentalist zealots (Mishra, 2017). I believe that it will be necessary to understand addiction to political cults on a more psychological and less moralistic level, if it is ever to be brought under control.
            Almost inevitably, the argument is being made now that Nazi evil can be attributed to drugaddiction (See Tharoor, 2014). However, the evidence for this view is scanty and vague compared to the massive evidence of Hitler and his followers’ addictions to Nazi ideology and personal power. Moreover, Hitler’s use of opioids did not begin until late 1943 (Ohler, 2016, 135-144) and his use of cocaine until 1944 (Ohler, 2016,159-162), many years after his ideology and power addictions had reached their murderous peaks (Hitler, 1925/1971; Kershaw, 2000). It is important not to obscure the deep psychological and historical roots of past and future Hitlers and their fanatical followers by gratuitously attributing their addictive violence to demon drugs.
Of course, this whole terrifying story of political fanaticism can be, and usually is, told without ever using the contested word “addiction.”  Freudian and Jungian terms, for example, can be reasonably used to analyse it. It is not my aim to insist that one psychological vocabulary is more valid than another.  However, I am convinced that using the word “addiction” within the Adaptive Paradigm and the traditional English definition of the word is far more than just another academic variation, because it leads to vital insights both about people addicted to political cults and about the future.      
 
8.   Fresh Questions Grow from the Adaptive Paradigm and the Traditional Definition
            Beyond highlighting the existential threat of addiction to society, the Adaptive Paradigm and the traditional definition raise new questions that, I believe, offer the bogged-down field of addiction a fresh start.
The word “addiction” wasusedat leastas oftenin early modern Englandto describe admirable lifestylesas to describeabhorrent ones (Lemon, 2018; King James Bible: 1 Corinthians 16: 15-16). This should not be a surprise. Whether or not we choose to call it “addiction,” most of us know the both the deep satisfaction and the social benefits immoderate devotion, dedication, or attachment to a beloved person, a family, an occupational or artistic pursuit, a god or spiritual tradition, scientific research, or even a sports team (Roy, 2004; Yates, 2022).  Often these everyday addictions have a flavour of transcendence and spirituality.  For a single, perhaps surprising example, high performance athletes speak of their devotion and dedication to their sports in terms that include transcendence and spirituality in addition to more predictable desires for physical exertion and winning (Roy, 2004, pp.90-110; Ziolkowski, 2021).
Advertisers are fully aware of the appeal of addiction in this traditional sense of the word and often use the word “addictive” to draw in new customers. One example, among many, is an advertisement for one of my wife’s and my favourite British video dramas (Figure 4).
 
 
Figure 4. “Doc Martin” advertisement.
 
Addiction, in this broad and traditional sense, more than a social asset and a personal pleasure. Widely recognized scholars have described the basic human need for strong feelings of devotion, belonging, purpose, identity (Fromm, 1941, chap. 1; 1973; Frankl, 1959; Erikson, 1968; review by Alexander, 2008, chap. 4). Without experiences of devotion, dedication, and attachment people do not feel whole. Do the addictions to illicit drugs that we see as diseases or disorders in our treatment clinics also serve human needs far deeper than the evanescent pleasures of the drug “high?” (Pryor, 2003; Dunnington, 2011, chap. 4).
Individuals who fail to establish the kinds of addictions that make us whole and create membership in our society can only adapt, in desperation, by cultivating alternative forms of addiction that are dangerous and socially unacceptable. Is the key to successful treatment for harmful addictions the cultivation of healthful ones?
Why do so many millions of people in the 20thand 21stcenturies turn to dangerous and self-destructive forms of addiction rather than the socially acceptable and even admirable forms of addiction that appear to be open to everybody? A full answer requires a deep analysis of the modern era itself. The traps and snares of modernity go far beyond the intolerable economic inequalities that plague poor and marginalized people. Dangerous forms of addiction occur in dislocated people at all levels of society (Slater, 1980; Polk, 2016; Alexander, 2008; Mishra, 2017, e.g., pp. 75-76; Cockrell, 2021) and are at least as common in rich societies as in poor ones (Fig. 1). Why are the wholesome forms of addiction that are the natural alternatives to dangerous addictions so difficult to achieve and maintain in the modern world?
If fanatical attachment to political cults is the most dangerous addiction by the traditional definition and if smoking tobacco is the most dangerous addiction by definition 1b, why does the professional literature in addiction theory not focus primarily on these two addictions, rather than on addictions to illicit drugs and alcohol? What social function does our field serve? Could it be that one of our functions has been to help society maintain an ongoing collective denial of one terrifying aspect of our current reality?  Perhaps by fostering illusion the that illicit drug addiction is the most dangerous form of addiction, we distract society from a raging flood of dangerous addictions of which illicit drug addictions are only a part.   
            The word “addiction” is used to describe dangerous forms of devotion and dedication that, in more prosocial forms, are normally considered desirable, as in the case of religious fanaticism or a ruthless ambition for success. What, beyond the difference in social acceptability, is the essential difference between admirable and reviled forms of addiction? How do my own intense, but socially acceptable, political passions differ from the addictive zeal of Hitler’s followers?
            Many people’s work and achievement addictions are beneficial to society and to the addicted person’s well-being, while imposing neglect and pain on their families at times. Some of you may have personally experienced this kind of conflict, as I have. My wife is unhappy when I neglect our family life while writing a book. So I promised her that I will never write another one in 2014, and I have kept my promise. Addictions like this can be temporary and time-limited. Nothing in the Adaptive Paradigm or the traditional definition says that addiction cannot be time-limited, even though it may also a lifetime. What are the conditions under which addiction becomes interminable?
I am finding the question of the degree of voluntary control over addiction to be strangely persistent. My own book writing addiction had both voluntary and involuntary qualities. Sometimes I chose when to write and when to rest. But sometimes the words kept coming into my head during dinner, or during the night, occasionally forcing me out of bed and into my writing chair. But at other times, no words would come, no matter how I tried! If not a demon or a disease, what could have given my writing addiction this involuntary quality at those times? The question of free will and determinism, remains fascinating, although it is important not to let it obscure more important questions.
           
Conclusion
Addiction, as depicted in the Adaptive Paradigm and in the traditional definition, is far more interesting, and, in its worst forms, far more dangerous than addiction as depicted in the Myth of the Demon Drug, definition 1b, and the Brain Disease Model of Addiction. The emerging world society of the modern age has failed to face its addiction problem in a realistic way, and there are many indications that the flood of dangerous addictions of all sorts is steadily rising.
            I propose that the field of addiction must not only undergo a theoretical paradigm shift, but also a change of social role. It cannot be enough for addiction professionals to function as healers and theoreticians. We are needed also as agents of social change.
            We are in a unique position to see the societal threat of the most dangerous addictions as well as the cultural snares and traps that make it so difficult for masses of people to flourish without reliance on them. We must find a way to broadcast what we see, knowing in advance that a fresh, but daunting and uncomfortable, view will encounter serious opposition. Many people will be more comfortable if we just continue jostling with ghosts.
Can we be as brave as the policemen who testified against the War on Drugs, decades ago, by confessing that we cannot “arrest our way out of” the addiction problem (Puder, 1998; Frohne, 2014)? Can we confess that we cannot therapize or theorize our way out of it either, nor overcome it with harm reduction or new drug legislation or social housing?
I do not know how a world society of 8 billion people facing jet-propelled technological modernization, political chaos, and ecological disaster can function well enough that most people can put together the reasonably full lives that can protect them from dangerous addictions. I do know that this question must be faced, because the dangers of mass addiction are so enormous. I propose that the task of deep social analysis and realistic advocacy is now the foremost responsibility of professionals in the field of addiction.   
 
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