The 12-Steps 2.0

A tid-bit.

Humans are not Rats

“As a human, you are not a being, you are a becoming, an ongoing process. Nothing is fixed – you can be whichever way you want to be.” ~ Sadhguru

Let’s start with a little background on how our old school medical professionals took the initial idea that addiction was “disease-like” to that of it becoming an actual “disease.” Despite the fact that AA claimed alcoholism was a disease back in 1936, alcoholism wasn’t recognized as an illness by the American Medical Association in 1956. Then it wasn’t until 1987 that the AMA declared “addiction” itself to be a disease. If alcoholism was seen as a disease, and addiction was seen as a disease, why do you think there was a 30-year gap?

It might be interesting to note that in 2013 the AMA also declared obesity a disease (another chronic issue that the medical field is failing at by only addressing surface symptoms and not root issues). Why did the AMA declare obesity a disease, you might ask? They publicly stated that “Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans” ~ Dr. Patrice Harris, AMA board member. Now ask yourself if perhaps the AMA may have done that very same thing to help bring more light to the overwhelming addiction issues of crack back in the 1980s.

Now let’s back up and see what was going on in the 1950s with alcoholism in our nation. Why was there this big push by just a few in the medical field to make alcoholism a disease? Perhaps it was because many of the inpatient treatment facilities for those dealing with alcohol were going under due to being empty. Perhaps it was some of those very doctors who were the owners of these very same inpatient facilities that were making the biggest push and loudest advocacy for making alcoholism a disease. Perhaps, like the reasoning of the AMA about obesity, the movement was to help bring more of a spotlight on the issue of alcoholism. For whatever the ‘real’ reasons, the constant advocacy for the disease label was finally enough for the medical community to declare alcoholism a disease.

This change in terms doesn’t really mean anything scientifically any more than the AMA classifying obesity as a disease changes any research findings on obesity. However, it did have an impact on research funding, as now that alcohol (and later addiction) was a “disease,” it could be treated with medications. And, of course, as a disease, it could also be more readily billable by insurance. But with doctors having such high ethical standards, I’m sure that the mere opportunity to make a boatload more money would have never swayed anyone’s professional decision on supporting its classification … right?

The “Research” for the Disease Model

Much of the research for the disease model comes from research that was done on lab rats, as it’s extremely hard to do human research due to liability and ethical concerns (which is why the gov oftentimes just does it without the awareness or consent of the individuals). Without getting too scientific and boring you to death with all the clinical ins and outs of the studies, here are the cliff notes. Basically, the researchers put rats into cages with a bottle of water and a bottle of drug-laced water. What the researchers found was that the rats would very oftentimes start to only drink the drug-laced water, and in many cases, the rats would do so until they died. Hence the idea that if you start doing drugs, they will end up killing you.

They did the same type of research with brain stimulation. They attached electrodes to the rats’ brains and linked them to a lever that the rats could press. What the researchers found was that the rats would very oftentimes stimulate themselves continuously until they passed out and, in many cases, until they died. This again reinforces the idea that if you start doing drugs, you will use them compulsively until they kill you.

This initial research is what helped lead to the idea and creation of the disease model. They based the idea of the repeated and constant use on the hijacking of the person’s dopamine reward path. Basically, if you started using drugs, the drugs would have such a positive impact on your life that you would be compelled to keep using the drugs compulsively and obsessively until you eventually died because of them, as you wouldn’t want to do anything else in life. The treatment model of abstinence and medication stems from the idea that the only effective treatment is to medicate the brain in an attempt to try and rebalance the person’s neurochemicals while the person totally abstained from using their drug of choice.

Overall, much of this seems pretty straightforward and even logical enough. However, much like the medical treatment model, in that it is only addressing the symptoms on the surface, this theory misses all of the person’s underlying, initiating, and maintaining issues. No one stopped to ask why the rat went from drinking water to drinking the drugged-laced water, they just assumed it was due to the drugs.

Enter Rat Park

Perhaps not too surprisingly, it was a psychologist (because we are trained to look at things differently than MD types) who noticed that there was NOTHING else for the rat to do while in the cage but either drink the normal water or drink the drug-laced water. So out of curiosity and the understanding that environments play a vital role in behavior, the researcher created what was eventually labeled as “rat park.” Instead of just being alone in a cage with nothing else to do all day but stand there and drink the drug-laced water, rat park was full of other rats to interact with, play with, mate with, and it had lots of colorful balls and tunnels for all the rats to play with. The “test” part of the research was still the same, in that the rats had regular water and drug-laced water to choose from. The interesting thing was that in rat park, the rats almost never drank from the drug-laced water, none of them ever drank from it obsessively, and none of them ever died from drinking it.

And like a cheesy infomercial … but wait, that’s not all! In a later research study, they expanded the rat park hypothesis by taking some of the rats from the isolation cages who were already ‘addicted’ to their drug-laced water and placed them in rat park to see what would happen. To the surprise of many in the scientific field, the ‘addicted’ rats did not exclusively continue to drink the drug-laced water. Instead, the rats went back to living their normal lives playing and socializing with the other rats and went back to preferring the regular water to that of the drug-laced water.

This SHOULD be amazing news! This SHOULD be on the cover of all addiction treatment programs! People SHOULD be shouting this from the rooftops that recovery is not only possible but that getting back to a regular life is the norm! Yet that’s not what happened then, nor is it what’s currently happening. Government agencies dismissed (and continue to dismiss) these findings, along with many other studies that highlight issues with the disease model. The mainstream professionals simply continue with the same old zombie-like mantra that addiction is just a disease … here’s your prescription … see you next month … next.

Vietnam’s Rat Park Validation

The real irony is that the people who dismiss the findings in THIS rat research study go on to cite findings in different rat research that backs their own views. For those that do not know, this type of behavior is called professional bias. Thankfully, we have a real-life human version of the rat park study to help provide even more validity and reliability to the original rat park findings! During the Vietnam war, hundreds of thousands of veterans used heroin in excess while deployed to the combat zone. Based on the disease model of addiction, if you used heroin even just once, you could and should become addicted. As many soldiers were using heroin on a regular and daily basis while in Vietnam, many people were worried that when those soldiers rotated back stateside, they would end up overrunning the streets as dangerous heroin addicts.

However, the reality of the situation was very different than what the ‘experts’ expected. As the hundreds of thousands of soldiers came back home and re-engaged back into their regular life of love and friendship and reduced stress and fun things to do, the drive to use heroin simply went away. What we saw in humans was much like what was seen with the drug ‘addicted’ rats that were introduced to rat park. In the extensive monitoring and research done by the military on returning vets, it was found that only about 5% of those who had used heroin excessively continued to have addiction issues once they returned home. The other 95% of those who used heroin simply went back to living their normal lives.

These previous findings also hold true to the current researched understanding that only about 10% of those who use even hard drugs actually become addicted to them and that about 75% of those in addiction find their own way out without any professional help. In my own understanding, addiction doesn’t just happen simply because you use drugs. Addiction happens when you no longer love yourself and or the life you are living, and you have given up hope that it will ever change, aka learned hopelessness. People in addiction use drugs as an escape or a coping mechanism to avoid the psychological pain of life. This means that the opposite of addiction is not abstinence or even sobriety. This would mean that opposite of addiction is love, acceptance, non-judgment of yourself and the world around you, and the hope to truly live again.

The Reality of Drug Use

Have you ever broken a bone? Have you ever had a surgery? Ever been in a severe accident? Ever had dental work done? Ever had to deal with chronic pain? If you answered yes to any of these questions, then you have more than likely already had pharmaceutical-grade heroin. And yet you, like the vast majority of those who get these very same drugs for their intended purposes, did not turn into a raging pill fiend (there is a big misconception that dependence and addiction are the same … they are not, but we will get to that).

Similarly, have you ever had a drink of alcohol? Have you ever had some wine or champagne at a party, or New Year’s, or for your birthday? Maybe a few beers during a ball game, while at the lake, or while tinkering on a car? Gone out drinking at the bar with the guys or gals on a Friday or Saturday night or perhaps while busting a move at the dance club? And yet again, like the vast majority of the 200+ million people who drink alcohol on a regular basis, you did not become raging alcoholics. How do you suppose that happens?

As I mentioned above, only about 10% of those who use drugs, including cocaine, heroin (pain pills), and even meth (or the white-collar version of meth called Adderall), actually end up with an addiction issue. This known research reality shoots the SHIT out of the disease model hypothesis in that if you use a strong drug long enough (and some like heroin, cocaine, or meth just once), you will become addicted to it. But don’t just take my word for any of this. All these researched findings to the opposite of the disease model idea are there for anyone to read who chooses to dig into a variety of research and not just ignorantly accept what NIDA (National Institute on Drug Abuse) shoves down our throats as ‘truths’.

A quick tidbit about NIDA for a quick frame of reference before we move forward. This organization’s entire job is to find ISSUES with drugs, so they are a bit biased in their research, to begin with. This is one reason why THC is still a schedule one drug, which means they (NIDA) think that it is more harmful than cocaine, meth, and heroin and that it has no medical or therapeutic benefit. This, of course we as a society now know to be total horseshit, yet NIDA has yet to change its official stance on the topic. I wonder what a quick look into what the criminal charges for the largest population of inmates in our current ‘for profit’ prisons would reveal as to why THC is still considered a schedule one drug? Perhaps I’ll tackle that question along with some others in another book.

Another reality about drug use and the opposing view of the disease model of addiction doesn’t just come from empirical or clinical research. The stories from the thousands of people that I’ve personally spoken with also back up this idea in the timelines I do with them. Their own testimonies about the reality of their lives highlight three major understandings about drug use and the creation of addiction. First, from the time they first started using drugs, even hard drugs, to the time when they “had” to have it to get out of bed was ALWAYS several years. In many cases, the timespan that the person ‘used’ drugs on a social, regular, or even abusive basis to that of ‘addiction’ spanned more than a decade! Second, EVERYONE had a catalyst type “life-changing” event that happened just prior to their drug of choice becoming an addictive issue. Across the board, in relation to their timeline, the area just before the start of addictive use was explained by the commonly used phrase “life was shit.” And third, 99% of all those that I spoke with had endured some form of childhood trauma (emotional, physical, sexual, spiritual).

However, I’m not the only doctor who has chosen to actually listen to the people they work with and follow where the unbiased research leads. Dr. Gabor Mate has his book In the Realm of Hungry Ghosts, Dr. Marc Lewis has his books Memoirs of an Addicted Brain and The Biology of Desire, and Dr. Carl Hart has his books High Price, Drug Use for Grown-Ups, and his textbook Drugs, Society & Human Behavior all advocate that the disease model is off. Of course, there are many other professionals who all talk about the same or similar things in reference to the disease model, but these were a few of my favorites on my own journey. In reading everyone’s ideas, the main two components of all those opposing the disease model seem to be that the ‘drug’ itself is NOT the main issue and that drug use becomes an addiction when it is used as the primary escape from emotional or ‘mental’ pain and/or the reality of life.

Why People are NOT Rats

So why is it even more important to understand that humans are not rats? First and foremost, because of the size of our prefrontal cortex. The rat brain might be similar in some structural aspects, but how many rats do you see that sit around and enjoy the classics, ponder quantum physics, debate the validity of Freud or Yung, contemplate the philosophies of the Stoics or Vedas, ruminate about past traumas, replay emotional videos over and over in their heads, stress about the bills, and on and on. Meaning that the human thought processes, as well as the depths of our emotions (as far as we know), are much greater than that of a rat. For example, a rat doesn’t appear to care who the president is, or what pronoun you might associate with, or what your sexual preference might be, or what your religion or political affiliation might be, or what is or is not on your social media platform, but humans sure do, and they can have a total meltdown and even commit suicide if it’s perceived as ‘wrong’!

Second, the human being itself is much greater than the sum of all of its parts. This means that my thoughts and behaviors are influenced by more than just the current level of neurochemicals (that constantly changes) flowing in my brain. My thoughts and behaviors are influenced by more than just my current neurological wiring (that constantly changes). My thoughts and behaviors are influenced by more than just my current levels of brain activity (that constantly changes). My thoughts and behaviors are influenced by more than what foods I’ve recently eaten, what substances I’ve digested, my hydration levels, sleep patterns, monthly cycles … and on and on and on. Everyone is always talking about dopamine this or serotonin that, like those current levels, solely dictate ‘who’ that person is and is the limit of their current potential. But the reality is, the majority of those advocating these things don’t actually understand what the hell they are actually talking about.

What do you think is one of the things that actually release those neurochemicals that can then influence a person’s thoughts? Their thoughts. What do you think is one of the things that make those neurological changes? The person’s experience and/or the person’s thoughts and valence of those very thoughts and experiences! For example, the physical reaction to getting into very hot water or very cold water is very similar but depending on how one is thinking about the water (their valence), “this is bad” vs. “this is good,” the person will feel (chemical release) a very different emotion (the downstream of thinking) and therefore have a very different experience based on all that upstream thinking (assessment, judgment, valence).

The neurochemicals are important in understanding a person, but it is also important to understand that they are not the only thing that influences how a person is thinking, feeling, or behaving about things. Remember, people can be scared and still think, depressed and still choose to move, anxious and still do things to calm down. Their current chemical levels are not the end all be all of understanding the human condition. The old idea that depression is just caused by a chemical imbalance is simply incorrect.

A person is greater than the chemical make-up of their blood screen. The reality is, the blood work on someone could look very similar even though one person is excited while the other is worried. And of course, those chemicals will all be different due to a person’s sleep, nutrition, exercise, relaxation, a multitude of environmental influences, a multitude of psychological influences, all variances of stressors … and on and on. This is not to say that blood work can’t be beneficial in diagnosing many things, but in understanding human behavior, blood work is only an insight, not a causation.

Here is a teachable moment on the overall flow of things. Energy (are you ‘open’ or ‘closed’) drives beliefs, then beliefs (your morals, values, biases, judgments, etc.) drive thoughts, then thoughts drive emotions/feelings (the neurochemical release), then emotions drive behaviors, and behaviors drive outcomes … outcomes then reinforce one’s original beliefs. However, there is a caveat here as well in that those feelings can also drive thoughts (part of how a panic attack spins up), and behaviors can drive thoughts (hence why holding a piece of ice works to adjust a person’s thinking). All of this is a bit (and by a bit, I mean a lot) more complex than just what are your chemical levels at.

As ‘energy’ is a bit deeper than I want to get for this book, let’s start with beliefs. Unfortunately, beliefs are not just installed by our logical self or those that have our best interest in mind. Beliefs are installed by our limited experience, ignorance, judgments, biases, and fears. They are installed during states of anxiety, depression, stress, and anger and supported by an entire list of cognitive distortions. It would be bad enough if that was the end of the list, but it gets much, much worse! In addition, our beliefs are also installed by interacting with our environment, our social and peer groups, television media, and social media, schools, governments, religions, and so on. And to add fuel to the detrimental fire, they can ALL be faulty, negative, and/or detrimental. This means, in short, that everything downstream from a ‘faulty’ belief can also be detrimental or limiting to the person.

Next in the line of progression are thoughts. It’s important to understand that your thoughts are NOT feelings, they are not facts, and they are not real. It is also important to understand that most of your thoughts are subconscious or unconscious. Research suggests that a person spends about 95% of their day on autopilot, meaning you aren’t thinking about what you are thinking about. The feelings you get from your thoughts are simply from your ‘assessment’ or ‘judgment’ of the ‘thought’ in the moment. This is why something can be scary or funny one moment or one day and then not the next.

Feelings themselves are fleeting unless one continues to ‘think’ or ‘dwell’ on the thought that created the feeling, and then it can eventually grow into an emotion. Emotions can be short-term as well, but if one continues to put the same thoughts and same energy into the same emotions, then those emotions will become long-term and can sooner or later evolve into moods. Moods, which are just long-term emotions, if not redirected, will eventually become a person’s temperaments. And temperaments, if not redirected, will eventually become part of the person’s personality traits.

It is very important to understand that humans, due to being blessed with their prefrontal cortex, can make their imagination (aka thoughts) just as real and just as powerful as a real-world experience in reality itself. This means that humans have the ability to make their inner world of the mind just as real to the brain as the outer world that they actually live in. If you have ever had a nightmare, a sexual fantasy, or a dream that seemed very real, then you know exactly what I’m talking about. One could also suggest that the outer world only seems ‘outer’ because of our perception, but in reality, as it is all processed ‘in’ the brain, it’s not too much of a stretch to understand why the brain might not make the distinction of what happens ‘in’ versus what happens ‘outside.’

Now to make the mental jump and link all this information. This knowledge about the ability to make ‘false’ realities ‘real’ leads to a very different understanding of why a human might use a drug verse why a rat might use a drug (remember Rat Park). A human can ‘fade out’ and mentally exist in a different reality where their world isn’t burning down, or where they don’t feel like a total failure, or where their child is still alive, or where they don’t feel hopeless or alone, or whatever it is that they are running from. It is no coincidence that the choice to use to create a change in perceived reality (inner narrative) is the very story of the thousands that I’ve spoken with over my many years of trying to help people.

This understanding of perceived reality and inner narrative also helps to explain what the Buddhists mean when they say that life is ‘pain,’ but ‘suffering’ is optional. The root of human suffering, as the Buddhists and Stoics advocate, is not really about the ‘thing’ that happened in our lives but in how someone continues to ‘negatively think’ (suffer) about the thing that happened. We all have an immediate reaction to something, and then our continued feelings are driven by our valence or assessment of how we are ‘thinking’ about whatever it is we are thinking about. It is our judgments and attachments to how life “should have been” that continue those destructive narratives.

This means that very oftentimes, the “thing” that is driving the desire to “use” resides in the person’s ability to use metacognition and ruminate about their past, their future, and/or the self and what “could” or “should” have happened … in their own biased opinion. Then it is the person’s valence or assessment of how they feel about these feelings that perpetuates their emotions, which is what they are longing to escape and which creates their desire to use. This means that addiction, in no small part, is driven by the person’s resistance (judgment) to what “is” or has been and is used as an aversion to the acceptance of the same (hence the reason that acceptance and commitment therapy (ACT) works so well at helping people in recovery).

Ultimately what all this means is that addiction is NOT about using the drug and “getting high for fun” but rather about the temporary mental/emotional relief that the high of the drug provides. This understanding falls in line with the new stress model of addiction, especially when one adds in the much newer understanding of dopamine. In relation to recovery, this means that an effective recovery program MUST also include ‘fixing’ the mental attachment (judgments & biases) to those thoughts that are driving the aversion, as failure to do so will eventually result in relapse. Not because of some chronic ‘disease’ that the person is suffering from but rather because of the true mental driving force behind the creation of the addiction was never really addressed.

One could wrap up this idea about the difference between rats and humans with a quote from the character Neo in the movie The Matrix Revolutions. The character Smith asks Neo why he keeps getting up even though he knows that doing so is pointless, and Neo replies, “Because I choose to.” Meaning that one of the major reasons that humans are different from rats is because we have the ability to choose to do things despite all logic, reasoning, or understanding.