Thursday, February 12, 2015

The Baby and The Bathwater

In late January Johann Hari wrote a piece on The Huffington Post titled The Likely Cause of Addiction Has Been Discovered and It Is Not What  You Think.  Almost immediately several friends contacted me to see what I thought about it. Not a great deal, in short.  I fumed and fussed a bit, but didn’t write about it until I saw this essay by a friend of mine, David Cooke. Go here both to read David’s essay and to learn about his good work through 100 Pedals.  While you’re at it check out his podcasts.  I’m proud to say I was a guest of his recently.
Dave’s writing moved me to learn about Mr. Hari’s work and to respond to Dave.  There is a fair amount of reading involved here.  The original Hari piece.  Some well thought out responses by Dave and Peg O’Connor, plus my response to Dave below.  I think it’s worth your time as we continue to sort out what substance use disorder is, how it should be treated, and its impact on individuals and their families. 

 My response:

I am responding to Dave Cooke, a man I admire and consider a friend.  We’ve shared similar, if not congruent, journeys with our sons.  I write here to Dave, but also to others who have read any or all of the essays and articles mentioned.  I am NOT; repeat NOT attempting to start an argument with Dave here. 
If I understand Dave correctly, or Peg O’Connor, or Dr. Drew, their message in response to the Hari essay is “Don’t throw out the baby with the bathwater.” Hari makes useful and valid points.  Unfortunately the title of his piece is ill conceived.  By stating that  “The Likely Cause of Addiction Has Been Discovered…” he both oversimplifies and misleads.  
As a father who has lost a son to heroin addiction, I can vouch from personal experience to the complexity of the disease.  No sooner had Hari’s article appeared in The Huffington Post than I had friends asking for my opinion of what Hari had to say.  In turn, I corresponded with more friends and family about the article.  One, Barry Walsh wrote the following, which I thinks explains nicely how Hari oversimplifies.  Barry wrote me:  Anything as complex as addiction is multi variate. People like simple solutions - especially the press because it's always move on to the next story... Some people have brains that are especially vulnerable to addiction and then there are all the psychological and environmental contributors. As a therapist for 40 years I've found people are more complex than rats ... Thank god...”
The key to what Barry is saying, as do Dave and Peg O’Connor is that addiction is multi variate.  Neither the cause nor the treatment for each and every individual is as simple or easy as we might like to make them.  My son has been dead for over two years and our family still wrestles with identifying the various causes and actions that led to his overdose death.  We’ll never know it all, but our attempt to gain clarity might help others.  We do know there are things he could have done differently and things he had no control over.  The same goes for his parents and those who treated him along the way.  We might gain easy satisfaction in assigning blame.  We do better to find out what we can learn from a personal tragedy, a tragedy becoming all the more common in other households in this country.   
Unfortunately the bathwater with Mr. Hari’s baby is murky.  He makes it difficult to spot the baby and hang on to it.  What do I mean?  He is a sloppy journalist.  An easy trip to Wikipedia yields this:  Johann Eduard Hari (born 21 January 1979) is a British writer and journalist who wrote columns for The Independent (London) and The Huffington Post and made contributions to other publications. In 2011, he was suspended from The Independent after charges of plagiarism. He was also accused of making improper edits to several of his critics' Wikipedia pages under a pseudonym. [2][3] The news led to his returning his 2008 Orwell Prize[4] and later was a contributing factor in his leaving The Independent.”  We all make mistakes, and Mr. Hari has worked hard publicly at atoning for his.  He says as much on the website for his new book Chasing The Scream: The First And Last Days of the War on Drugs.  In particular he and his publisher go to great lengths to document all his sources properly.
That said, I believe he is making some new mistakes.  The Rat Park experiments were conducted and published in the late 1970’s.  To suggest “the likely cause of addition has been discovered” leads readers to perhaps believe that the discovery is fresh, not work done 35 or more years ago. The Wikipedia entry for Rat Park includes the following:  “The two major science journals, Science and Nature, rejected Alexander, Coambs, and Hadaway's first paper, which appeared instead in Psychopharmacology, a respectable but much smaller journal in 1978. The paper's publication initially attracted no response. [4] Within a few years, Simon Fraser University withdrew Rat Park's funding.”  To extrapolate from work done with rats decades ago to the likely cause of addiction is a leap of gigantic proportion.
Mr. Hari sidesteps mainstream science.  Or current science.  On his own website he refers to Bruce Alexander and Gabor Mate, both of whom he cites in his article, as “dissident scientists.”  Nora Volkow, the current head of the National Institute on Drug Abuse (NIDA) rejected his request for an interview.  I’d like to know more about that story.  I think it is safe to say that NIDA’s research over the span of time since the Rat Park experiments is exponentially wider and more sophisticated than the evidence Hari marshals to support his claim. There are many places to hear Nora Volkow speak on addiction science.  She recently spoke before the U.S. Senate Forum on Addiction and Collateral Damage.  Go here:
Hari does attempt to incorporate NIDA into his argument by consulting Robert DuPont, the first director of NIDA.  DuPont is a medical doctor, a psychiatrist.  He served from at NIDA from 1972 to 1978 and was also the second White House Drug Czar from 1973 to 1977 under former Presidents Richard Nixon and Gerald Ford.  It was President Nixon who launched the War on Drugs, shortly before DuPont became Drug Czar.  It is also worth noting that much of the brain imaging capability now being used to help understand addiction either did not exist or was in its infancy during DuPont’s tenure. I have no idea how conversant Dr. DuPont is with current NIDA research or how wedded he may be to the prevailing ideas of his time.  It would be helpful to have some clarity in this regard.    
On his book’s website Mr. Hari states:  “I would be very happy to include the response of the current head of NIDA to these theories, alongside those of the previous head that are described here. I am keen to offer the fullest possible response, and to explore all sides of this really important debate about what causes addiction.”  I submit that the greatest failing of his article, and indeed his book, is that he has failed in his exploration or, at the least, jumped too quickly to a conclusion.  If we throw out the bathwater, we might want to give this baby a clean rinse. 


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