Friday, February 26, 2010

Book Review: Thinking Simply About Addiction

Of bicycles, swimming, and drugs.

Back when I first became interested in the science of addiction, I was fascinated by an article in Parabola magazine by Dr. Richard Sandor, a Los Angeles psychiatrist with many years of experience treating alcoholics and other drug addicts. In the article, Sandor suggested that a good deal of addictive behavior could profitably be viewed as a form of dissociation. I quoted from that article in my book about addiction, and now he has published a book of his own.

Thinking Simply About Addiction: A Handbook for Recovery, focuses on the current controversy over Alcoholics Anonymous and its 12-Step variants, and takes a reasoned, thoughtful approach to the so-called spiritual aspects of recovery.

Happily, this is not another southern California feel-good self-help tome, though the author does not shy away from tweaking the neuroscience establishment for “delving deeper and deeper into the biochemistry of the alcoholic and drug-addicted brain, endless promising a ‘cure’ and yet never quite delivering the goods.”

While acknowledging that addiction is “correctly understood as a disease,” Sandor diverges a bit from the mainstream disease theory of addiction, believing that addictions are “diseases of automaticity—automatisms—developments in the central nervous system that cannot be eliminated but can be rendered dormant.”

As examples of simple automatisms, Sandor cites bicycle riding and swimming, two behaviors it is impossible to “unlearn.” Consider swimming: If, for some reason, it became extremely dangerous for you to swim (pollution, a heart condition, sharks), the problem is that “you literally cannot choose not to swim. Your only reliable choice is to stay out of the water, to become abstinent.”

Much of the confusion over addiction, the author maintains, is that “we miss the essential quality that defines addiction as a disease: Something someone has rather than something they’re doing.”

What his addicted patients frequently tell him, Sandor writes, is that “the core experience of being addicted is powerlessness, the experience of having lost control over the use of alcohol or a drug.” As one addiction expert put it, addicts “have lost the freedom to abstain.” Like other forms of rehabilitation, says Sandor, “treatment doesn’t work or not work. The patient works. It seems obvious. If the very nature of addiction is automaticity—the loss of control—then recovery is the restoration of choice, not handing choices over to someone else.”

On controlled drinking, or a return to social drinking, Sandor writes that “studies that have followed reliably diagnosed alcoholics for long enough periods of time reveal what clinicians and AAs have known for a long time: Abstinence is necessary for recovery…. If you follow true alcoholics for years, you discover that those who continue to drink get worse and those who remain abstinent don’t. Presumably, the same is true for all other addictions.”

Problem drinkers who do return to moderate drinking “were people who had had enough problems with drinking to land in treatment but who were never physically addicted and therefore didn’t have to become abstinent in order to stop the progression of the disease.”

Where does the “Higher Power” concept fit into all this? Sandor endorses the wider view taken by many psychologists and thinkers, from Gregory Bateson to C.G. Jung. In line with his theme of keeping it simple, Sandor suggests that thinking about a Higher Power may mean coming to realize that “the body’s capacity to restore itself is part of something much larger than our operations and medications… If you like, it comes from God. If you don’t like, it comes from a Higher Power, from Nature, from five billion years of the evolution of life on Earth, from the created universe, from whatever you want to call it.”

It is the simplest of simple ideas: “We all belong to something beyond ourselves.”

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Anonymous said...

Reading is good example of automatism; i can't look at word without reading it. Getting drunk is for me same kind of thing, drinking just one drink is practically imbossible. I will get drunk if i drink at all.

Bobby said...

Thank you for your insights. The notion that addiction is one of those behaviors that cannot be unlearned but only rendered dormant is a powerful one. The idea definitely deserves respect and some extensive research. It seems to make sense when considering the complexity of treating addiction. Thanks again for your input.

Dean S said...

Thank you for your thoughtful comments on addiction. The notion that behavioral change for addiction includes abstinence has been much debated, yet it is worthy of further exploration.

Senta said...

Thinking Simply about addiction is the best book I have read on this subject. The automaticity concept is just brilliant.

vstanner said...

I agree that Sandor's book is original and persuasive. The automaticity concept makes enormous sense. DNA analysis seems to be offering insight into the different "problem" users versus true addicts.

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