Cultural Baggage 9

Cultural Baggage 9/21/04

Hosted by Dean Becker

Engineered by Steve Nolin

Transcript by Diana Hajer

Guests: Stanton Peele, PhD, JD – author of 7 Tools to Beat Addiction

(Audio Track) Introduction

Dean: Hello, my friends, this is Cultural Baggage. Our guest for tonight will be Dr. Stanton Peele. He’s the author of Love and Addiction and a new book, 7 Tools to Beat Addiction, and we’ll be talking with him here in just a few moments. I don’t know if you had a chance to listen today to Montel Williams’ show, but they had a great discussion about medical marijuana and here’s a little clip from that for you right now. This is an extract from today’s Montel Williams’ show. You will first hear Dr. Donald Abrams, the author of Marijuana As Medicine and the lead of an ongoing federally-approved study of medical marijuana.

Abrams: But I just wanted to talk to your point about Schedule I, Schedule II – I’m a cancer doctor and an HIV doctor and you know if I have a drug that gives people relief of pain, increases their appetite, decreases nausea, and perhaps improves their mood, you know that’s an important drug to be able to give people, especially with cancer who are at the end of their life. In 1997 after the laws were passed in California, Jerome Kassirer who was editor-in-chief of the New England Journal of Medicine at that time, wrote an editorial calling for medical marijuana, “Federal Foolishness” and saying, “We know this drug works. Everybody has their anecdotal experience of people who have benefited from it. Get over it. Reschedule it. Make it Schedule II.” Unfortunately, he very shortly thereafter became no longer the editor-in-chief of the New England Journal of Medicine.

Montel Williams: It got to the point with me that I didn’t even want to get up and put my feet on the floor. I started looking into using medicinal marijuana on a daily basis, and I say now publicly, let the whole state of New York know, I’m breaking the law every day and I’m going to continue to break the law every day. Because it is the only way that I get up every single morning and continue to be a contributing member of this society. A part of compassion is understanding that we may not have all the answers. All it has to do is a basic change from Schedule I to Schedule II. And I’ll go back to say this again: We think our doctors are smart enough to prescribe to people morphine, cocaine, OxyContin, Percocet, Vicodin, Oxycet – I’ll go down the list of all those pain pills. If our doctors are smart enough to do that, the same doctors are smart enough to be able to say, “I think this patient should utilize medicinal marijuana, and I should be able to prescribe it to him.” Guarantee, make it as hard as you want to make it, just give it to me. I would hope that everybody who watched the show, if you agree, you know what, I’m just going to ask you – take a pen, piece of paper, get the name of your local congressman, and I want you to write him a letter, tell him enough is enough.

Dean: To be fair, I’ll close with the words of another guest on today’s Montel show, here speaking about medical marijuana, Andrea Grubb Barthwell, the former deputy director of the White House Office of National Drug Control Policy.

Barthwell: We’re on the verge of a major scientific breakthrough that will probably take 10 to 15 years to complete, and our …

Dean: OK, there you have it. That’s the best that the drug warriors have to offer – another 10 or 15 years before they will look at medical marijuana. Ethan Nadelmann the executive director of the Drug Policy Alliance recently had an article published in National Review titled “Going to Pot.” The drug czar responded and Ethan had a chance to do a rebuttal. This is part of a discussion I had earlier today with Ethan Nadelmann.

Nadelmann: Well, the piece I had published, the cover story in National Review over the summer – it basically called for an end to marijuana prohibition, and what was new about it, I think, was that it described and gave the reasons not just why marijuana prohibition should end in the United States, but also how it is likely to come about, and what is the relationship between the medical marijuana issue and the broader issue of marijuana decriminalization and, ultimately, regulation. One of the things I suggested, Dean, was that the medical marijuana model that’s emerging right now – the idea of having local control and IDs and such may, in fact, become a workable model for making marijuana available for non-medicinal purposes as well. And the other thing I put in the article was really updating some of the arguments for ending marijuana prohibition. We hear the drug czar going on about how the marijuana today is much more potent, and how there is new evidence about its addictiveness or its dangerousness, and what I did in the article was to refute all of that. Now if people want to see it, they should go to our website which is drugpolicy.org/nr. If you pick up this week’s issue of National Review what you will see is a debate between John Walters, the drug czar, responding to my piece and then my rejoinder to his comments. And basically, Dean, all I do want to say about Walter’s comments is it’s extraordinary how weakminded and lame and dishonest the comments by the drug czar are. Actually, I probably got more emails commenting not on how nicely people liked my article, but how incredibly weak his piece was. Some of the stuff is just outright dishonest about medical marijuana; and he also launched an attack on George Soros, who has been, you know, the major philanthropist supporting my organization and drug policy reform. No other individual has supported human rights around the world as much as George Soros. No other individual did as much – no other private individual did as much to bring down communism in the Soviet Union and Eastern Europe. One of the reasons for Soros opposing the war on drugs is that he sees in today’s war on drugs many of the same things that he saw in communism and fascism – you know, growing up in Europe and thereafter.

Dean: One last thought. Ethan, I had the chance today to catch Montel Williams’ latest airing and it was astounding. Andrea Barthwell says in 10 to 15 years they may have studies done on medical marijuana. They are just totally disingenuous are they not.

Ethan: Well, Andrea Barthwell, the former deputy drug czar, I basically think was about as dishonest as could be, you know, in these statements and other statements about marijuana.

Dean: OK, we are proud to have with us today, Dr. Stanton Peele. He’s the author of groundbreaking books including Love and Addiction, Diseasing of America, and The Truth About Addiction, and this one that I’m reading now, 7 Tools to Beat Addiction. Welcome, Dr. Peele.

Peele: Good evening.

Dean: Good evening, sir. Yes, sir, we’re glad to have you with us here on Cultural Baggage. Sir, we had a bit of a discussion last week, and I kind of want to start off with a point we were making at that time and that is, I was able to overcome my addiction to methamphetamines not through a treatment center, not through going to prison, but through realizing that I could do better things with my life. And if you will, tell us how that coincides with your new book.

Peele: Well, 7 Tools to Beat Addiction is about how people give up addictions not because of their involvement in a 12-step group or because of some treatment they received, but because of the fact that like you said, they developed better options in their lives. They have values that support more important activities, they have relationships that are more important to them, they have higher goals – and these provide motivation for them to change their behavior.

Dean: You know, sir …

Peele: Go on.

Dean: No, please go ahead, sir.

Peele: And that dictates a whole different way of looking at addiction and treatment for addiction. Instead of thinking we need to funnel everybody into the nearest treatment center, you know those results have often been very iffy at best – and actually in my book 7 Tools to Beat Addiction, I point out that people who believe, for example, in the “disease” theory of alcoholism are more likely to relapse after treatment than those who don’t believe in it. So you might actually say the treatment is actually convincing people to believe something which is more harmful to them. Instead, when people are able to graduate away from addiction because of developments in the rest of their life, that is the most firm and the most secure way to overcome addiction.

Dean: Yes, and I did have a problem with alcohol some 19 years ago, as well, and I did go to Alcoholics Anonymous, and I did find it beneficial in the first few weeks to hear some of these other stories, to learn how it is possible. And I did find that after a point, though, that my attitude – I guess toward medical marijuana – kind of put some distance between me and most of the other members, and I did stop going. But I carried forward some of those thoughts of building a better life that they were able to give to me.

Peele: How did they react when you said you were going to leave?

Dean: Well, it was more that I was somehow abandoning them; but then again, because of my mention of occasional use of medical marijuana, some thought it best that I would leave.

Peele: Well, that’s a funny kind of treatment program, don’t you think? And that is true of a lot of treatments in the United States – they are very, very prescriptive in treatment. If you go for treatment for a disease, a real disease, generally they are going to say to you, “We would like you to X and Y, but we are here to treat your problem, not evaluate you as a human being.” In the United States, when you go for treatment, the first thing they tell you is – well, you are going to have to abstain from alcohol and all other substances. And of course, if you could do that, then you wouldn’t really need the treatment in the first place. So they sort of demand that you cure yourself, and only then do they permit you in treatment. And of course, if you don’t commit to that or if you are not able to commit to that, like you, then they just say – well, we’re not going to treat you. Although it is claimed to be medical treatment, in fact it is just the opposite of medical treatment because it is so quick to rule people out and, in fact, the vast majority of people with substance abuse problems are not able to abstain. They are saying, “Oh, we are going to try to treat people, but of course we are not going to treat people that are difficult to treat. We are only going to try to treat people who are easy to treat.” And, remarkably, they don’t do that well with those people either.

Dean: And I have heard it said by the government that once a person tries some of these drugs, that they are addicted – there is no way they can escape on their own, that is necessary that they go to a treatment center. And that is just not the case, is it?

Peele: Yeah, the former director of the National Institute on Drug Abuse, Alan Leshner, went around the country showing how your brain becomes trapped into addiction and how you can never quit. And he made speeches announcing it was a myth that people gave up addictions on their own. Of course, right up front we probably could ask people at the NIDA how many of them have quit smoking, which most people report to be the toughest drug addiction to quit. And the answer happens to be 55 million Americans. So if Alan Leshner isn’t aware, and the NIDA and the United States government aren’t aware, that people quit addictions all the time, they really have to have their heads up their butts. But here’s a secret …

Dean: Yes, sir?

Peele: A higher percentage of people who have been addicted to alcohol, heroin, and cocaine quit than the percentage of addicted smokers who quit, because those are much harder addictions to maintain when you are an adult, and actually people quit them even more readily at a higher percentage than those who quit smoking.

Dean: Yes, sir, and in your book, you say that you don’t discourage people from perhaps finding some salvation, if you will, from the 12-step programs, at least for a little while, or perhaps a visit or two to a psychiatrist – that it is sometimes helpful to get pointed in the right direction.

Peele: Sure. I’m actually a psychologist and I work and I help people. I actually treat people. I guess it’s the attitude that people bring to treatment that is most crucial. As long as the treatment realizes that the person has to quit on their own. As long as the treatment encourages the person’s feeling of powerfulness and their feeling of what we call “self efficacy.” As long as the treatment doesn’t abuse the person and tell them they are limited and they can’t do things – as long as that’s true, then treatment can be helpful and supportive, and I welcome it on the landscape. But at the same time, we really should make a part of our message in the public health field: “Listen, whether you go to treatment or not, you can quit addictions from smoking to gambling to alcohol to overeating. You can do it. People have done it all along throughout history before we had the Betty Ford Center, and you have the power to do it. If you feel you need help, if you want to look around for help, there’s a variety of things you can use. We welcome you exploring different options.”

Dean: Yes, now, and if a person were to set their mind and want to quit one addiction or another – as you say, it may run the gamut from sex to food – but if they backslide, if they eat too much or they happen to have sex or otherwise step outside the bounds they set for themselves, that doesn’t mean they should just give up at all, right?

Peele: You know one of the predictions of who is going to succeed in quitting smoking is how many times you have quit before. That’s kind of – you know, you might think that doesn’t make sense – if you are already failing at quitting, that’s a bad sign. But really what it shows is that your motivation is critical and eventually, if you want to quit and you keep at it, you are going to more often than not, far more often than not, succeed. You know, backsliding, missing the mark – it will happen. You shouldn’t put yourself down. Others shouldn’t put you down. Just try to get on beam as quickly as you can again.

Dean: Yes, sir, now in your book here you talk about the most effective therapies and what they have to tell us. Would you like to discuss that aspect?

Peele: Well, the most effective therapy in the field of alcohol abuse – it has been shown to be brief interventions and motivational interviewing. They are almost the opposite of standard treatment in the United States. Instead of coming down hard on people, dictating goals for them, and shunning them, motivational interviewing and brief interventions instead place the ball squarely on the user’s side of the net. And say, “Listen, you are going to have to make the changes yourself; you have the capacity of make them. I’d like to give you some guidelines - here are some suggestions. I would like to support you in this, but really, it is up to you to make the changes yourself. Why don’t you come back in a little while, 6 months or whatever, and we will check and see how you are doing.” And both brief interventions and motivational interviewing accept reduced drinking as a goal. Of course, this is the opposite of conventional treatment in the United States. By the way, do you still drink?

Dean: No, sir. May 8, 1985, my last day.

Peele: You haven’t had a drink since then?

Dean: No, sir.

Peele: But you still occasionally use marijuana?

Dean: Oh, yes.

Peele: Oh. Well, it’s too bad you can’t get the good hard effects of alcohol, but I guess nothing is perfect in life.

Dean: No, for me it has been a blessing. I think my liver would have gone out much sooner than now.

Peele: You deal better with marijuana than alcohol?

Dean: Right.

Peele: It happens all the time.

Dean: Yes, and it’s not that uncommon, right? I mean …

Peele: Sure, people quit drinking and if you feel that you really weren’t successful in trying to cut back or you can’t cut back, and you are able to live without alcohol, God bless you.

Dean: Well, my life has been much cleaner. Before that point in time I had car wrecks, I was in fights, I had traffic tickets, and not one instance since that point in time.

Peele: You feel if you drank now, you would drink excessively?

Dean: I think there is that potential, and at this point and time why take the chance is how I look at it.

Peele: How has your life changed since you quit drinking? Have you – do you have a family?

Dean: I do. I have two sons. Since that point in time, I actually changed from being a construction worker to becoming a project analyst for major companies here in town, after I gave up alcohol. Again, without an education, I just kind of bluffed my way into the job.

Peele: Oh, well, you gave up a good hardworking job, huh? For – no, I’m only kidding. But of course, obviously, your kids are something which are very important in achieving your new behavior. That’s a real good example of how people – in 7 Tools to Beat Addiction I tell about how people change in treatment or out of treatment by maturing, and developing responsibilities like a family is a perfect example of that, of why people change their behavior, why they are motivated to and how they are able to keep their new behavior in place.

Dean: Yes, sir, Dr. Peele, give me one minute here. We are going to take a short break and when we come back, I have a question perhaps outside the realm of your book. But I’m thinking with a Harvard-educated person on the line, perhaps you can give me an answer. We’ll be right back.

Drug czar of the Americas, John Walters, tells us that marijuana is illegal because it is harmful.

“Some of the most dangerous drugs aren’t on the street. They’re under your sink – household products kids sniff to get high. Protect your kids. Tell them never to sniff inhalents because the first time can kill. – A message from the Partnership for a Drug-Free Texas and America.”

Dean: The Partnership for a Drug-Free America is an enormous fraudulent enterprise, but in this one instance, they did get it right. It’s time to play “Name That Drug By Its Side Effects” – permanent damage to the liver, eyes, bone marrow, heart and blood vessels, convulsions, impaired mental function, neurological damage, kidney damage, irregular heartbeat, unbearable stress, sudden death. Time’s up. The answer: gasoline. There’s a vending machine in your neighborhood.

“Dr. Leo Cigarroa. I’m the chairman of the Council for Scientific Affairs for the Texas Medical Association. We definitely encourage additional research into the use of medicinal marijuana.”

Dean: What will it take to motivate? Please visit drugtruth.net.

Dean: Hi, Dr. Peele. The question I want to ask, sir – see if I can keep it from becoming too convoluted. Basically, the drug war runs on this screed, this hysteria, and money, at its heart, but I think the predominant number of people are starting to realize that it’s obvious, it’s glaring, that they’re battling the truth on this matter. And I talk to people and they say, “I understand, Dean, what you are doing. I support it. I want it.” But they are unwilling to write that letter to their congressman. They are unwilling to speak up in public. It is a quasi-religion? What is it that holds this drug war together, sir?

Peele: Well, it is interesting that we have been talking about how people see drugs and how the national view on drugs, despite its own evidence, claims that people become eradicably addicted to different substances. The idea of addiction and its inescapableness is really a big part of the drug war. People go around and they say, “Well look, if you ever try any of these drugs – cocaine, heroin, crack, or marijuana – you are going to get addicted. And that’s why we have to prevent them from entering the country.” Of course, the government’s own research again shows this: of all the people who have ever taken heroin, crack, or cocaine in their lives, only 6% of each of those people have taken those drugs in the last month. What it tells us is that people will try a lot of things over their lifetimes, but in general if they have a good enough life to lead, if they have enough things going for them, then they are not going to give their lives over to drugs. That’s the small, hard secret of the problem. We have to be able to give people reasonable lives to lead, and only then can they overcome or avoid addiction. The idea that we can prevent drugs from entering the country – of course alcohol is legal in the country, so really people don’t need drugs to become addicted in any way, shape, or form. And we have become increasingly aware – like I outline in 7 Tools to Beat Addiction, people have become increasingly aware of addiction to prescription drugs. So we don’t lack for things for people to become addicted to. The issue is, do we have enough to offer people to make their lives worthwhile enough so that they won’t choose to become addicted? That’s the critical question.

Dean: Yes, sir, the second chapter of your book, “Activating Your Desire to Quit” – they say people have to hit rock bottom, but perhaps not necessarily so. How does one activate that desire?

Peele: People quit drinking or smoking at all points in their lives. To say you have to hit rock bottom, of course, is just preordaining for them that they have the worst life possible. What really causes people to quit – and I describe how to do this – is when they can clearly see that their behavior is challenging critical values that they hold more important to them than the desire to continue to be high or intoxicated. People can do that in a variety of different ways, but one way to do that is to list the most important things in your life – your health, your family, your image of yourself, your sense that you are in control of your life – and match that in your mind against every habit you have. When you can do that, and you see that perhaps your behavior is leading in the wrong direction, then you don’t have to be told by other people to quit or to cut something back, you’ll be driven on your own to do that. It’ll be something created – not something created from the outside, it’ll be something driven by yourself.

Dean: Yes, sir, you spoke earlier about those situations of quitting. Your possibility of quitting tobacco depended on how many times you had quit before. And I recall an instance where – this is, gosh, 20 years ago – one of my times quitting tobacco; and I found myself early one morning after an all-night poker game, buying cigarettes again. Because it had been a, you know, alcohol and tobacco night, and it had just slipped up on me. How does one avoid those situations of slipping back into an addiction?

Peele: Well, there’s two basic things – prevention is an important skill learned. You know, in many situations you can always predict when you are going to start doing something again. If you knew you were going to go out all night and play cards, drink all night, you could have bet yourself $100 and won the bet, that you would be tempted to start smoking again. And so, situations that lead you to reorient, to regain your addiction, are not mysterious. They are predictable, they are knowable. And you already probably know them. Now when I’m a therapist, I ask people, “When is the most likely – give me a situation or scenario when you are going to resume your addiction. You tell me.” And people can do a very good job – like when I go out with my old friends, like you said, when I go to the corner bar I start drinking. Of course I’m going to start smoking again. So that’s part one is to identify those situations. The second point is to prepare. If you can’t avoid those situations – like playing poker all night, you probably could avoid. But in situations you enter in, like finals week where you know you are very likely to resume an addiction like smoking, or after finals when you are thinking you want to go out and celebrate, take drugs or drink, what you need to do is be specifically prepared, to develop alternative responses to those situations. You know what you are going to do – you have to lay it out four square what you are going to do instead of doing that. You have to know what you are going to do. You have to know which direction you are going to go to. There are no mysteries about it, but a little homework and preparation required.

Dean: All right, sir, and we have just got a couple of minutes left. A couple of points I wanted to get into, maybe we can combine them. The fact that for certain cultures, certain nationalities, there may be a familial procedure. A learning to drink, of learning to regulate and control one’s consumption. It ties into moderation, am I right?

Peele: Well, we now have become very sophisticated in doing international epidemiologic studies, and there have always been rumors or popular myths about how people drink differently in different countries. Well, in many cases those myths are remarkably true. The country in Europe where people drink the least regularly but are most likely to binge – can you guess what country that is?

Dean: Would that be England?

Peele: It’s Ireland. Only 3% of men drink alcohol daily and yet almost one-half binge drink at least once a week. And the country that has the lowest level of binge drinkers and the highest level of regular drinkers is Italy. We have seen, actually – there have been studies conducted in the United States, one by George Vallien, which compared Irish and Italian men who grew up in the same neighborhood in the north end of Boston, and Irish-Americans were 3-1/2 times as likely to become alcoholics over the course of their lives. These cultural habits of imbibing are extremely strongly ingrained, and the difference between Irish- American and Italian-American approaches, and Irish and Italian approaches, to drinking are that Italians introduce their children to alcohol at an early age. They demonstrate and model moderation; they show drinking as something that is done in a family context. They are very punitive and prohibitive – against excessive drinking and especially misbehavior when you are drinking. Whereas in the Irish culture, even though alcohol is less regularly a part of life and is not consumed usually during a family setting, when men go out and drink together in bars, they are often given an excuse and permission to act out and drink excessively and to engage in bizarre and sometimes violent behavior. So we have very different cultural templates for drinking, and they are very useful to keep in mind when you are thinking about how you are going to introduce alcohol in your own family, to your children.

Dean: Dr. Peele, we are out of time. Folks, if you would like to learn more, please visit his site www.peele.net. Dr. Peele, thank you so much.

Peele: Don’t forget to tell them about my book.

Dean: OK, yes, 7 Tools to Beat Addiction. Yes, sir, we certainly have. Next week, our guest will be Paul Wright, editor of Prison News. As always – because of drug prohibition, you don’t know what is in that bag. Please be careful.

Dean: For the Drug Truth Network and on behalf of my technical producer, Steve Nolin, this is Dean Becker for Cultural Baggage, the unvarnished truth. This show is produced at Pacifica studios of KPFT, Houston – tap dancing on the edge of an abyss.