TRANSCRIPT

CULTURAL BAGGAGE

MAY 1, 2019

DEAN BECKER: All right, friends, this is Cultural Baggage, I am the Reverend Dean Becker. Here in just a moment we're going to bring in our guest, he's Doctor Stanton Peele. He's written a brand new book, I think it's going to hit the shelves, well, this month, certainly in a day or two I do believe.

The book is titled Outgrowing Addiction With Common Sense Instead Of Disease Therapy. And with that, let's go ahead and just bring him in. Doctor Stanton Peele, how are you, sir?

STANTON PEELE: Dean, it's great to talk to you all the way out in Texas. Fabulous.

DEAN BECKER: Well, it's good to hear from you. We've had our discussions over the years and I'm glad to say this new book really aligns with what I've been seeing, hearing, feeling, and that is we've way overdone it with this addiction.

STANTON PEELE: Well, it's -- some of [inaudible] says that it's common sense, and I agree it's common sense, but in other ways it so swings against the way that people think, that it's almost overwhelming for people to come to grips with it.

Let me ask you a question, for example, Dean.

DEAN BECKER: Okeh.

STANTON PEELE: Have you ever taken a painkiller?

DEAN BECKER: I have. I've been one of those who, I don't appreciate downers, I'll just put it that way. I had my alliance with speed there in my youth, but downers have never appealed to me.

STANTON PEELE: So, you took a painkiller. Did you become addicted to it?

DEAN BECKER: No, I did not.

STANTON PEELE: So, when I go to an audience of 500 people, I say has anybody in this room taken a painkiller, and sometimes a couple of people raise their hand, but often out of hundreds, nobody raises their hand, and then I go, wow, that's just unbelievable, because aren't opioids the model drug for addiction? Don't they cause addiction? How come you didn't become addicted?

And the percentage of people that are exposed to the standard opioid molecule, which is the panorama for addiction, the paradigm for addiction, is minor, and yet we're told constantly, been told our whole history -- I mean, obviously I'm aware that the title of your program is Cultural Baggage. We're carrying an albatross around in our brains that overwhelms us. The idea that narcotics are the cause of addiction, there's something in them that traps.

Even Sam Quinones, people that write -- have you ever had Sam Quinones on, by the way?

DEAN BECKER: I do not think so, no sir.

STANTON PEELE: So he wrote Dreamlands, and he has whole chapters describing how the heroin molecule, the opioid molecule, captures the brain. And yet, everybody knows that you take painkillers, and then you stop taking painkillers when your pain ceases, and when I ask you why that is, the best answer, which just came to me from a student at Leeds, because I had things to do.

Drugs don't capture people. Drugs and other addictive experiences provide an experience in which people can become immersed, that they find reassuring and comforting and predictable, that can overwhelm the rest of their lives.

And the failure to come to grips with that recognition forever dooms us. And when I say dooms us, that may seem, like, a bit extravagant, you imagine, but let me just point out one example. We consider the modern brain disease model of addiction, it replaced the old AA model, which was causing a lot of problems, people were becoming a little disgruntled around it.

And so they invented the brain disease model. Alan Leshner and then Nora Volkow, the head of NIDA, she came into office in 2003. Are you aware of how many drugs, how drug deaths had proceeded between 2003 and current time, Dean?

DEAN BECKER: It's a multiple factor, I do know that.

STANTON PEELE: You've got it. It's exploded, and in any other land, in any other area of knowledge, if somebody was in charge of something and its negative consequences exploded, you would think their job might be in jeopardy. But now Nora Volkow.

Nora Volkow stays through Democratic and Republican administrations. The website at NIDA says the modern scientific theory of a brain disease of addiction is conquering addiction, and yet more and more people die.

Now, how do I resolve that tiny little discrepancy? Let me do that for you.

DEAN BECKER: Okeh.

STANTON PEELE: By convincing people that drugs overwhelm you, that's cultural baggage. That cultural baggage determines that we become more and more vulnerable to addiction as we spread that idea, rather than telling people, and here's where I come in best with drug policy: drugs are one of the panoply of your experiences that can be handled better or worse depending on your involvement and your engagement in life, how the people around you behave, and what your belief system is.

And believing that drugs are uncontrollable in fact contributes to our addiction. Now here's the most -- if I've said anything too radical, you know, all these ideas are contained of course in my book with Zach Rhodes, Outgrowing Addiction With Common Sense Instead Of Disease Therapy.

But here's the most alarming, I'm going to say something so radical, I hope they don't take you off the air, Dean. Are you there, Dean?

DEAN BECKER: No cuss words. No cuss words.

STANTON PEELE: We don't care. We, people are more concerned to sound, believe what everybody else believes, they're more concerned to say, well, we're doing something scientific about it, and the death rate surging, it actually doesn't really concern us.

And here's one reason that it doesn't concern us. Dean, if you had to guess what state has the highest opioid death rate, where would you guess it would be located?

DEAN BECKER: I'm going to guess Florida.

STANTON PEELE: That's a good guess, because there's so many treatment centers in Florida, but that's a whole other topic. There are people who are herded there into treatment centers.

As somebody from -- a woman named Gross interviewed me for the Times about six years ago, I said isn't it great that they have communities of people who never leave treatment communities now, and that was like, Delray Beach, and those people stay there, they relapse time and again, they're tested time and again, they're money producers for the treatment centers, and they have a remarkably high death rate.

But the answer's no, there aren't enough of them. And, you have to go where -- let me ask you a quiz question: do you think rich or poor people die more often from drugs?

DEAN BECKER: Oh, probably poor. Less access to --

STANTON PEELE: That's always your best bet, isn't it?

DEAN BECKER: I guess so.

STANTON PEELE: That if something bad is happening, that's the way to go. The state with the highest death rate from drugs is West Virginia, one of the poorest states. They don't have the highest prescription rate for drugs. But they have the highest death rate, and the man who in -- [Rahul Gupta] was an Indian doctor who was brought into to become their health commissioner.

He studied every single drug death in 2017, in the state of West Virginia. Were they young or old, do you think?

DEAN BECKER: Just retired. I don't know, I'm guessing.

STANTON PEELE: They're middle aged, which goes against the whole idea, I mean, we're already talking about cultural baggage and misnomers, if it's really overdose deaths, young people would die more often. They're people 45 to 60, what's that indicate, when people like that are dying around drugs, what's that say to you?

DEAN BECKER: Boredom. I don't know. Could that be it?

STANTON PEELE: They're not bored. They're tragic. They're people whose lives have been decimated in general, they're unemployed, they never had good employment prospects. Do you think they're married or single?

DEAN BECKER: Recently divorced, I'm guessing again.

STANTON PEELE: They're single. They're people who are not connected to the world. Dean, you're going to have to -- just move with me now. They're human beings that -- the term that's popularly given to them now, which is very descriptive, they have deaths of despair. They're drug related, alcohol related, and suicide.

They're people with little to launch them into life, or connect them to life. And, we're sewing instead the idea that drugs cause death. And really, life causes death, a certain type of life.

But, why the disease model's so well liked, the disease model and the anti-drug model are the same model. You understand that, Dean?

DEAN BECKER: Yes.

STANTON PEELE: If you believe the disease model, you're buying into drugs are bad. A disease model is antithetical, fundamentally, to any drug policy reform, because they're telling people drugs cause you to get addicted, you can't stop, it doesn't matter, anything about your life. Why bother to help people get housing or become educated, or to give them support, or to strengthen their communities? The drugs will kill you.

And so, when they make a movie, a best-selling movie, and by the way, heroin deaths of course are greatest in two urban counties, Allegheny County outside of -- around Pittsburgh, and Baltimore County, where drug deaths are around 70 per hundred thousand a year.

In West Virginia, there are around 59 per hundred thousand per year. No state has anywhere near that level. And, we're not going to cure what is wrong with West Virginia. We're not going to cure what's wrong with Allegheny County, we're not going to cure what's wrong with Baltimore.

And in fact, we don't even try. We've disinvested in America, from trying to deal with giving people housing, we used to have work programs, you go and get education and housing, and we've divested that money, we've diverted that money to drug education -- drug education and drug treatment, which is the horse coming after the tail.

People whose lives are lost to drugs and addiction use -- and addictive circumstances, we then say, well, why don't we treat them, as opposed to doing the basic kinds of things that encourage human beings to be able to lead lives without addiction.

And now here's my worst -- I'm going to give you my worst piece of information, but it's got something of a silver lining.

DEAN BECKER: Okeh.

STANTON PEELE: In a large degree, the drug reform movement has followed the medical disease people down the rabbit hole.

DEAN BECKER: Yes, sir.

STANTON PEELE: The two biggest cures, proposed drug reform ways for dealing with drug deaths, are, and I go to these conferences in New York and elsewhere, and people say, we're doing really great. We've cut back the amount of opioids we're prescribing. So, that should do it, shouldn't it?

No more drug overdose deaths, right? Opioid prescriptions have declined steadily for the last five years, and not only have opioid deaths increased over the last five years, through to 2017 at least, we're still analyzing the 2018 data, but deaths due to cocaine, meth, heroin, synthetic narcotics, synthetic opioids, opioid painkillers, and even benzodiazepines have all increased.

We've got this great idea, it's a medical disease, let's cut back the amount of drugs that people have, let's tell them if they touch drugs they're going to be addicted, and more and more people are dying.

And yet, we can't come to grips with that, and we don't deal with it at all. So what do we -- go on.

DEAN BECKER: Yeah, Doctor Peele, I just wanted to interrupt to let folks know, we are speaking with Doctor Stanton Peele. He's author of a brand new book, just hitting the shelves I think in the next day or two. It's titled Outgrowing Addiction With Common Sense Instead Of Disease Therapy.

I want to say this, it's got an introduction and some references to a couple of guests that have been on the Cultural Baggage show, including Maia Szalavitz and Doctor Carl Hart, and last week's guest, had a recommendation for this book, Mister Ethan Nadelmann, as well.

I hesitate -- I'm sorry I interrupted you there, Doctor, but I want --

STANTON PEELE: No, go ahead, I looked over your programs, and I saw, you know, I just had dinner with Ethan a couple of weeks ago, we're both in New York now. Thank him for doing that.

DEAN BECKER: Well, yes sir.

STANTON PEELE: Of all those people that you mentioned, let's give a little bit more of my background while we're at it, if you don't mind.

DEAN BECKER: Well --

STANTON PEELE: Hard to believe ....

DEAN BECKER: Go ahead.

STANTON PEELE: I wrote a book called Love And Addiction in 1975, which, you know, people are always asking, is he still alive? And Love And Addiction, in general, people see there's a whole new route for thinking about addiction, and everybody you mentioned: Maia Szalavitz in Unbroken Brain talks about Love And Addiction. Carl Hart and Mark Lewis and Ethan Nadelmann, all three of them wrote what's called blurbs for my book, you can see them on the book.

They all said really good things, and here's what Mark Lewis said, bless his little heart: You were the pioneer. You put these ideas out there long before anyone else was thinking this way. These ideas continue to reverberate in the addiction world and influence many people, many besides me. They're proliferating, surging rather than evaporating.

And let me tell you what those ideas are that I -- I either introduced or popularized, or made aware in the community.

That addiction is not limited to drugs. Drugs don't cause addiction, and people still have a hard time coming to grips with it, but the diagnostic manual of the American Psychiatric Association doesn't call any drug addictive or dependence producing. They've gotten away from that terminology. But the word addiction does appear in the volume called DSM-Five. They call it behavioral addiction.

And if you look me up in Wikipedia, what they say is that I discovered or invented this process model of addiction. I think they mean, well, Stanton Peele says that you can become addicted to something that's not a drug, but that's not accurate.

People become addicted as we described in Outgrowing Addiction through a process of turning to an experience produced by and involved, and then drugs are a pretty good way to get that kind of experience, they're very predictable. If you inject heroin or snort cocaine, or smoke, you're going to get your onset of the experience pretty rapidly.

But that's not -- the addiction is to that experience in relation to the rest of your life as you turn to it, the fundamental gratification has become less connected to the rest of your life.

And the good news in Outgrowing Addiction is, contrary to what is told all over this universe, Dean, do you think most people outgrow addiction?

DEAN BECKER: I believe nearly all people do.

STANTON PEELE: God bless you Dean. Besides having a title like Cultural Baggage, that last statement puts you in my permanent hall of fame. Nearly all people do, over ninety percent -- we do national surveys of people's lifetime of drug and alcohol use, spend quite a bit of money doing that, over 40,000 people are randomly selected and interviewed face to face, and over ninety percent of heroin, cocaine, marijuana, and alcohol addicted people overcome it.

The only one that gets a little bit below ninety is smoking. So, that's a second constant, aside from the idea that addiction is not limited or determined by drugs. The fact is natural recovery is the normal course of events. Harm reduction is an idea that I've been endorsing and espousing since the early Eighties.

And now comes the harder part, that I'm still -- so you might say, this is my, I'm giving you my resume. I've been promoting and been on the cutting edge of ideas that are still just popping up now. Natural recovery's only just now becoming -- people are only becoming aware of it, and I've been describing them for, you know, I started writing Love And Addiction over fifty years ago.

But here are the tougher things to know. Environmental factors, community, people's involvement and engagement in life, are the most important determinants of overcoming addiction, and if we don't allow and encourage and enable people to do that, then they're not -- then we're going to have more addict -- addicts all the time, and therefore I'll make a broader point, one I know you're in line with.

To the extent that we have a deterioration of economic and community opportunities, inequality is one of the major sources of addiction. It's not an accident that the highest death rates from opioids and suicide occur in counties that voted for Donald Trump. Those are people -- and inner cities -- who are hurting the most, that's the way our society is organized, and they're the most likely to be addicted.

But let me give you one last, I know our time together's --

DEAN BECKER: But, let me interrupt you, I told you --

STANTON PEELE: Go ahead.

DEAN BECKER: I told you we're going to do 20 minutes, but if you have the time, I'm going to keep you around for about another eight as we wrap up this show.

STANTON PEELE: There's -- let me just tell you one tricky thing. I told you that the greatest drug policy reform efforts now are misguided.

DEAN BECKER: I'm with you there.

STANTON PEELE: Drug policy reform -- drug policy reform people think that we can solve addiction by cutting back on pain pills. I go to these conferences, people say we're doing so great cutting back on prescriptions for painkillers.

Unfortunately, and in New York this is true as well as around the country, in 2017 they reached peak levels of deaths, and the same is true for medicine-assisted treatment. Let me be clear, I mean, something like Narcan can save lives, there's no question about it.

And generally speaking, when people are administered opioids -- methadone, buprenorphine, and even heroin, they're unlikely to die because of being under supervision.

And yet, the places where MAT are most ensconced are inner cities, and the death rate in the last several years around heroin has been growing there despite the expansion of these programs.

How does that work? Because if people are convinced that the only way that they can overcome addiction is by relying on a substitute, at some point, most of them are going to get off that medication. That's just the way life works.

And then they're completely out of touch with their ability to regulate their own behavior. They're staying to themselves, and they're more likely to die at the end of that regime, of that medical regime.

And so, to a large extent, my message is, even a drug reform movement has bought into the magical solution that addiction is a medical disease that can be solved by a medical treatment, including drug -- either removing drugs or providing other drugs, and it can't be.

So let me just end with one positive note, and one other mention of what I've been talking about for the last seven thousand years. The Drug Policy Alliance -- I'm not at this conference but I'll speak about it -- the Drug Policy Alliance is having a workshop and conference series in San Francisco called, it's Alternatives To Coercion In Drug Treatment And Mental Health Settings.

And, its dates are I think May 16 to May 19, and let me just read to you the description of the conference. I don't know the people describing this, but: Today's treatment facilities too often mirror the cruelty of prisons and the asylum.

In other words, the assumptions underlying it -- I'm speaking now -- that drugs are the cause of the problem, as opposed to the institutional situation, is the same on these treatment regimes as they are in the putting people in jail regime, with little regard for the scientific evidence about what works.

It's Katherine Celentano, Policy Coordinator of the Drug Policy Alliance. The same indignities associated with criminalization are too often reproduced by public health and treatment interventions that fail to prioritize consent, and I might say they also fail to prioritize the dignity and respect and self-efficacy, agency of the human being.

And, I do beg to differ with one part of this description. It says, this is the first conference where this topic is being discussed. It's a novel thing, but I want to point out my little history with drug policy reform, which you may know about, Dean, we may have run into each other.

DEAN BECKER: Yes, sir.

STANTON PEELE: In 1996, before there was a Drug Policy Alliance, Ethan, my old friend that you interviewed, invited me to debate Bob Millman. And my topic was that results for drug reform goals of shifting from interdiction and punishment to treatment, and here's what I wrote, in 1996.

Stanton says that that won't work. Expanding the treatment system will, one, expand what is already largely coercive treatment, serving as an adjunct to the criminal justice system, which means people are forced into treatment all the time through drug courts. Two, this approach refuses to acknowledge non-harmful use, and force mainly non-problem users into treatment.

I mean, when you get people who are using drugs, you say, well, we want to put them into treatment, although most of them don't want or don't need treatment.

Three, here's the critical thing, they serve, the treatment movement serves to divert social resources from the worst off people in our society, and puts them into these intensive treatment regimes that are not effective.

And lastly, they have an overall negative outcome, impact on outcomes for drug users in the United States because they create the ultimate in cultural baggage, that we can't, I mean, drugs are everywhere.

People take drugs all the time, we're taking more and more antidepressants, we're taking more and more painkillers, we're taking more and more medications for bipolar disorder, obviously it's not hard to get -- marijuana is legalized, and people drink all the time, and they're not -- alcohol's a high end product, the better off people are the more likely they are to drink.

Escaping substance is not, and believing that substances control us, is not the root of either drug policy reform or to helping the individual.

By the way, I wanted to mention one other thing. My co-author Zach Rhodes also works with me on something called the Life Process Program, LifeProcessProgram.com, which is an online coaching program for people with addictive problems.

People overcome addictions or avoid addictions to the extent that they keep becoming engaged in life, develop positive and productive activities, feel okeh about themselves and deal with mental issues, form families and communities, and believe that they have the power, the agency, to avoid addiction, even when they are exposed to drugs or even when they choose to take drugs. And most of all that they deserve to lead a non-addicted life.

DEAN BECKER: Well, Doctor Peele, we're nearing the end here. I want to address this one thought, your book kind of rips the veneer off of Alcoholics Anonymous a bit. It leaves intact that in the beginning it may be of great use to some folks, but that it does not, I don't know, that AA is not required to continue that sobriety or even to remain sober, once one gains control of one's own thoughts.

STANTON PEELE: Well, the majority -- the large majority of people overcome alcohol dependence or alcoholism without treatment of any kind, three quarters of people.

Only about ten or twelve percent of them overcome alcoholism, according to the largest study even done, NESARC [National Epidemiologic Survey on Alcohol and Related Conditions], by going to AA. There are more negative outcomes from going to AA than positive outcomes, because the general impact for even the people that go to it is to convince that, you know, you've heard of this, that they're powerless.

DEAN BECKER: Right.

STANTON PEELE: That they need to go through their own lives to see what they've done wrong. It's not a skills training program, it does provide a community, which is never bad, but it's a community based on their own weakness, and their own belief of their inability to deal with life and the world, and more often than not, that's going to lead you down a garden path to despair and destruction.

DEAN BECKER: Yep --

STANTON PEELE: But I don't -- AA has been replaced in large part by the brain, chronic brain disease model, which sells the same American message --

DEAN BECKER: Yes sir.

STANTON PEELE: -- drugs are bad, they control you, you are incapable of escaping drugs and alcohol on your own, all of those are essential, fundamental addictive messages that you would never think unless you're wedded to some kind of, I inherited alcoholism model, that you would never think of giving your children, you -- Zach Rhodes is a developmental specialist, we have a lot about children in our book Outgrowing Addiction --

DEAN BECKER: Thirty seconds.

STANTON PEELE: -- the title expresses that if you were to create a child who's engaged in life and believes in his or her own efficacy is the best way to avoid addiction.

DEAN BECKER: Yes sir. Well, friends, once again, we've been speaking with Doctor Stanton Peele, author of a brand new book. I see the publication date is May 15, so two weeks from today, Outgrowing Addiction With Common Sense Instead Of Disease Theory -- Therapy.

STANTON PEELE: Therapy.

DEAN BECKER: Yes sir.

STANTON PEELE: Dean, we have to talk every five or ten years, we'll have to keep going, so stay healthy, you hear what I mean?

DEAN BECKER: I hear you, sir, and Doctor Peele, thank you for being with us. I do have to shut her down, I've got another show to do here in two minutes.

STANTON PEELE: Good to see you, Dean. Bye bye now, bye bye.

DEAN BECKER: It's time to play Name That Drug By Its Side Effects! Agitation, paranoia, hallucinations, face chomping, lip eating, heart devouring, brain slurping, ecstasy, suicidality, zombie-ism. It's bath salts. We didn't quite get there.

And as always, because of prohibition you don't know what's in that bag, please, be careful.