February 17, 2015

Another addiction book claims to have "the answer" and doesn't

A few months after reviewing, and strongly critiquing, Carl Hart's "High Price" for, among other things, vastly overselling the "dopamine hypothesis" in particular, as the prime physical cause for alcohol or drug addiction, we're at it again.

Johann Hari claims to have a mix of this, libertarian-driven legalization (also touted by Hart) and theories of two people in the addiction field to have "the answer" in his book.

First, as I've noted elsewhere, legalization is no guaranteed solution, or even a guaranteed partial solution.

Second, it's time to critique Hari's other two ideas and their sources.

Chasing the Scream: The First and Last Days of the War on DrugsChasing the Scream: The First and Last Days of the War on Drugs by Johann Hari
My rating: 3 of 5 stars

Hari's thesis, that one can mash up Gabor Mate's loneliness with Bruce Alexander's Rat Park, add a dash or two of Carl Hart's acculturalization, and voila, explain, or at times, explain away, addiction, is simplistic at best.

I've critiqued Hart's book here and on my blog, and some of Mate's and Alexander's ideas elsewhere.

First, Mate.

Many people are lonely yet don't become addicted. Some are alone, but not necessarily lonely. Others embrace even some degree of loneliness in an existential way. To the degree that addiction is an emotional disease, it's a far more complex one than just about loneliness.

Alexander? Skeptical question No 1 is, "Which came first, the rat cage or the addiction"? Often, and especially to the partial degree loneliness is intertwined with addiction, the rat cage only comes after a certain point down the road of addiction and is caused by it.

Hart? His "dopamine" ideas are very simplistic. As with others of the "big four" neurotransmitters, our brain cells have several different types of dopamine receptors. Which cause addiction and why? Plus, there's about 100 total neurotransmitters, depending on how you count them.

Beyond that, Hart and Hari both strike me as a little bit of blowhards.

Finally, within the book, Hari contradicts himself.

He talks about US heroin addicts calling methadone bland mush, yet touts Portugal's use of methodone. And, beyond that, he doesn't look carefully at the issue of placebos at all.

View all my reviews

Finally, though I see no actual plagiarization, given Hari's documented history of that, as Wikipedia notes, I have more reason to note the seeming shallowness of this book.

Also, the pompousness of someone who really thinks that, before the age of 25, the world really cares about his opinion on the Iraq War (he was wrong), and the higher pomposity of thinking that, when he changed his mind before 30, he needed to cover his tracks, is a bit — or more than a bit — off-putting.

Beyond that, which was my official Goodreads review plus two added paragraphs about Hari, none of this looks at a BUNCH of other addiction-related issues.

These include:
  1. Genetic heritability of a disposition to addiction;
  2. Epigenetic heritability of a disposition to addiction;
  3. Genetic heritability of tendencies toward high levels of certain emotional states, such as anxiety, which may contribute to a desire to control them by drug or alcohol use that eventually becomes addictive;
  4. Epigenetic heritability of tendencies toward high levels of certain emotional states, such as anxiety, which may contribute to a desire to control them by drug or alcohol use that eventually becomes addictive;
  5. Chronic emotional affect beyond loneliness, based on sociological family or cultural history, and distinct from genetic or epigenetic tendencies, that may contribute to addictive behavior, or, beyond that, 
  6. Family or cultural social learning about addiction itself.
  7. More thoughts about physical addictiveness.
Now that I've ticked those off, let's look a bit more at each one.

Genetic heritability, to the degree we can tell so far, not only by separating it from No. 5, cultural and familial tendencies, but No. 2, epigenetic tendencies, and steer away from simplistic "dopamine hypothesis" ideas, has some variability from drug to drug. That, in turn, may have some connection to No. 6, and the relative physical/physiological addictiveness of each. But, given the fact that we don't know a lot about epigenetics of addiction yet, and thus covering No. 2, this is hard to say with much precision.

No. 3 and 4, as paired, fairly parallel No. 1 and 2. How genetically heritable is a disposition to anxiety? The story of someone like Atlantic editor Scott Stossel, painful to read, especially if you have some struggles with anxiety yourself, sounds like it's tailor-made to prove genetic heritability.

But, is it? Epigenetic tags are also heritable, and something like anxiety seems ready-made to be passed along epigenetically. Plus, there's Point 5. If Scott Stossel learned that being a "true Stossel" was to be anxious over a lot of things, social learning has played some part. (I also reject the idea that anxiety, at anywhere near the level he has it, might have some "redemptive" value. I know that it's become a part of sociological human nature to look for such silver linings, but, you know, sometimes they simple don't exist.)

That, in turn, leads to Point 5 further. Is it possible to become "addicted" to depression, or to anxiety? That may sound harsh, but I don't think we should discount it.

Take Stossel, even if it's a bit harsh. If a fair amount of his own severe anxiety is generated by public speaking, then why doesn't he just quit public speaking? It's kind of drastic, but not THAT drastic. And, as editor at the Atlantic, I'm sure he's reasonably fixed financially without public speaking fees. He notes that he has many specific phobias, too. Nonetheless, if he could safety-proof his life more, it might help, I'd think. I don't think he's addicted to it himself, but, nonetheless, the idea of being a "true Stossel" maybe exactly the "redemptive value" he seeks and desires.

That said, Stossel has one damned good thing to say to the likes of Hari, Hart and even Mate and Alexander:
The truth is that anxiety is at once a function of biology and philosophy, body and mind, instinct and reason, personality and culture.

Change “anxiety” to “addiction,” and that shows that this isn’t a “magic solution issue. A good example is Scott's brother, John. I've not heard him discuss having extreme-level or even medium-level anxiety problems. So, heredity, epigenetic heredity and family social psychology, all three, aren't perfect predictors.

Beyond that, on major issues of emotional affect vs. addiction, it's often chicken-vs-egg and hard to determine which is which.

On physical addictiveness, it can be overblown by some, but underplayed by others.

Take nicotine, probably the most addictive drug in use today, whether legal or illegal.

Beloved, but edge-of-the-wire New York Times columnist David Carr died recently from cancer. He was still smoking less than two months before his death, and smoking regularly, not just "chipping." That's despite the fact that, due to previous cancer surgery, he had, to be blunt, just half a neck left.


On the governmental side, believing there is "one right answer" to drug use, if wrong, could be very wrong. Let's add in that the US is much, much larger on both size and population than the Netherlands or Portugal, and much, much more ethnically diverse. A "one-size" idea is less likely here.

As far as treating addiction? People who support options in sobriety support should remember that the 12-step movement touts "one answer." Enough said.


Simon said...

Haven't been able to read the book so I've only had his interviews to go by. :) Was hoping you would pick it up.

I suppose for me the proof is in the pudding with Portugal. After all aren't we after evidence based policies? Has that been a failure? Doesn't appear so.

OFC as you say it's a complex situation and true the US hasn't the social welfare policies that places like Portugal have. But I would have thought any sensible policy frame work would see it as just one of many policy tools to end this stupid and wasteful -lives and money- war on drugs.

Personally I see treating it as a health and not a criminal matter a step forward and hope Australia takes it on.

Also from listening to the interviews what I took away that it wasn't mainly about being lonely or the addictive qualities of a drug, but how 'SOME' individuals in a socially and environmentally deprived situation fixate on that drug to alleviate that deprived existence.

On the issue of his misdeeds I have often wondered how many or what type, destroys an individuals credibility and whether that can ever be regained? Should their earlier or later work be judged on its own merit or forevermore tainted by any indiscretions?

Gadfly said...

I'm not a prohibitionist myself, to make clear. I just want to make sure that here in the US we don't have too much expectation of any decriminalization.

On Hari's plagiarism, etc., I think it in part depends on how much a person did before getting caught, how severe, etc., as to how much time a writer has to spend on probation. Eventually, one may escape that shadow, but I don't think it happens overnight.

Simon said...

Np there.

The other part of it that I did have an inkling of was the race angle.

For a fuller account of US drug policy you should also combine business interests e.g. Rockefeller/Prohibition, Hurst/Cannabis, plus racism with immigrant Mexicans and black Americans which continues to this day.

Gadfly said...

Oh, the race angle is part of why I think a Portugal or Netherlands solution isn't a "hey presto" answer for the US. Those issues have to be overcome along with the drugs issue.

Simon said...

It would be interesting though take away the drug war and wouldn't the rationale of stop and frisk go with it?

Then again, did you see the video of the 57 year old Indian guy smashed into the sidewalk for 'resisting' arrest? Take away the drug war and I bet that still happens.

Don said...

Hi, just came here from your Amazon review. Your addition of the 7 additional factors is all good, but it doesn't really answer the question.

Given that all 7 factors are potentially present in any society, why does addiction occur so much more in some cultures than others?

it seems to me the once you look at it that way (all other things being equal) the contributing factor of loneliness and social disconnection (as part of a larger, disconnected society, one in which, as Putnam reminds us, large numbers of people don't even have one confidant) looms much larger.