Time for a couple of quotes:
‘Nothing is so dangerous to the progress of the human mind than to assume that our views of science are ultimate, that there are no mysteries in nature, that our triumphs are complete and that there are no new worlds to conquer.’
– Sir Humphrey Davy – as quoted by David Knight (1998). Humphry Davy: science & power. Cambridge University Press. p. 87.
‘There is a principle which is a bar against all information, which is proof against all arguments, and which cannot fail to keep a man in everlasting ignorance-that principle is contempt prior to investigation’.
– William Paley, [but famously misattributed to Herbert Spencer] in Appendices II: Spiritual Experience of The Big Book of Alcoholics Anonymous
They’re both good, wise quotes and they both warn against the dangers of narrow-minded confirmation bias. I particularly like the Davy quote which was dusted off a few years ago by the famous English physicist Brian Cox for his documentary series Wonders of Life.
Herbert Spencer William Paley quote is (mis)used to defend the religiosity of Alcoholics Anonymous 12 Step against the ‘prejudice’ of atheism and agnosticism, by the way.
…In any case, they both seemed fitting for this exploration of the resistance to The Sinclair Method (commonly abbreviated to TSM).
You could say that confirmation bias is the overriding theme of this article, in fact.
Though most of the resistance has come from the 12 Step lobby I wanted to examine the viewpoint of what could be termed as ‘free will activism’ from authors such as Jeffrey Schaler and Stanton Peele – the latter being very much a vocal critic of The Sinclair Method.
This is why I’ve split my analysis into two parts, with (because it doesn’t often get discussed) more of an emphasis being in fact on the the resistance from the free will lobby, as popularised by the anti-AA/harm reduction movement.
If this seems unfair (journalistically unbalanced) then I apologise. The fact of the matter is that Roy Eskapa already explains the resistance from the 12 Step lobby quite well in his book The Cure for Alcoholism, so I didn’t want to just duplicate what he’d already written. Hence why my analysis of AA is much shorter in comparison to my analysis of free will activism.
In any case, without further ado, let’s explore the motivations behind the resistance to TSM, shall we?
Part 1: Resistance from the 12 Step lobby and why they have a ‘my way or the highway’ attitude towards abstinence
Though I think Roy Eskapa does a really good job with his book The Cure for Alcoholism of explaining the challenges with acceptance of The Sinclair Method within the American treatment industry (an industry is predominently influenced by the 12 Step model of Alcoholics Anonymous) and how theirs is largely a position of financial self interest given that theirs is a multi-billion dollar industry, it’s worth looking at AA’s history to consider just why we have the situation of there being such an unbending abstinence-only approach.
An approach that is, of course, at odds with The Sinclair Method’s protocol of gradual tapering off through a process of pharmacological extinction using naltrexone or nalmefene.
Looking at history, there are two figures who are largely responsible for the current popular viewpoint on this.
The first is Benjamin Rush, an 18th century physician who would have a big influence upon the temperance movement, but the most most notable is William Duncan Silkworth, author of The Doctor’s Opinion in The Big Book of Alcoholics Anonymous.
Silkworth was a medical doctor specialising in the treatment of alcoholism and he would come to have a profound influence upon Bill Wilson (co-founder of Alcoholics Anonymous) in the 1930s.
It was Silkworth who first introduced the notion of alcoholism being a combination of a mental compulsion and physical allergy only treatable through a combination of a ‘psychic change’ and abstinence.
‘…they cannot start drinking without developing the phenomenon of craving. This phenomenon, as we have suggested, may be the manifestation of an allergy which differentiates these people, and sets them apart as a distinct entity. It has never been, by any treatment with which we are familiar, permanently eradicated. The only relief we have to suggest is entire abstinence.’
By the way, given that it is eighty something years since the book was written, I really do have to pause to smile at the line within The Doctor’s Opinion containing the words ‘What with our ultra-modern standards, our scientific approach to everything, we are perhaps not well equipped to apply the powers of good that lie outside our synthetic knowledge’, just because of how badly out of date that scientific approach is. It’s far from ‘ultra-modern’ or hi-tech by contemporary standards.
It’s an important point to make because scientific approaches change. Scientific knowledge is constantly challenged and, where appropriate, updated and what is accepted by ‘ultra-modern standards’ becomes eventually revised with the passage of time. It’s self-correcting, in other words. Or at least it’s supposed to be.
It’s supposed to be challenged. Not preserved in amber like a prehistoric mosquito.
Malpractice from beyond the grave
In fact, this is why I was inspired to design a petition on change.org (see HERE) because I think that it’s deeply unjust that The Doctor’s Opinion in The Big Book is unrevisable given contemporary scientific knowledge that challenges the conventional medical wisdom of the 1930s.
I despise the way how outdated 1930s medical knowledge is still presented as indisputable fact in AA. And, upon talking to Roy Eskapa about this, it was he who pointed out that the suppression of new medical knowledge is not an ‘outside issue’. It is criminal – that by presenting outdated literature as still-valid fact in light of newer, more effective medical techniques (such as The Sinclair Method) what it essentially amounts to is a very weird form of posthumous malpractice taking place.
‘Malpractice from beyond the grave by proxy’.
As I recall from our e-mail messages, Eskapa, ever a considerate and caring man, seemed to be deeply concerned about the ramifications of this. He felt that a grave injustice was taking place because Silkworth (being long dead) has no ability to revise his position and thus vindicate himself.
Contempt for ‘an easier, softer way’:
Machismo and masochism
From Chapter 5: How it Works of The Big Book of Alcoholics Anonymous –
‘If you have decided you want what we have and are willing to go to any length to get it-then you are ready to take certain steps.
At some of these we balked. We thought we could find an easier, softer way. But we could not. With all the earnestness at our command, we beg of you to be fearless and thorough from the very start. Some of us have tried to hold on to our old ideas and the result was nil until we let go absolutely.’
Notice the tacit insult in there? The implicit message is that this is supposed to be hard work – that recovery is supposed to be earned. It’s quite a macho stance. One of punitive tough love that is directly at odds with the medical philosophy of ‘do no harm’.
No wonder The Sinclair Method is as welcome as flatulence in an elevator by some 12 Step advocates. Schadenfreude is a common, barely concealed thread that runs right the way through AA: show me a tough love sponsor and I’ll show you a closet sadist.
Hence why a dignifed, safe treatment such as TSM whereby you can independently gradually reduce your drinking is anathema to such people.
But, to end this section of my analysis on a positive note, some attitudes within the treatment industry are slowly changing.
Hazelden – one of the most famous rehabs in the United States – is embracing the concept of ‘gradual recovery’ using buprenorphine for heroin addicts. So how long before they do the same with naltrexone/nalmefene using The Sinclair Method for alcoholics?
Another factor worth considering is Bill W’s advocacy of niacin (AKA “the B3 therapy”) as a potential cure for what he saw as the physical component of the mind/body/spiritual illness of alcoholism. As I discuss in THIS article, early AA wasn’t completely anti-science or necessarily anti-pills and he put a lot of time and energy into trying to promote it, writing three pamphlets on the subject. He also famously asked the well respected physician and methadone treatment pioneer Vincent Dole to create a ‘methadone for alcoholism’.
Check out my article for an explanation of how this historical precedent – Bill’s interest in pharmacology – could be used to combine a 12 Step approach with pharmacological extinction using The Sinclair Method.
Part 2: Resistance from the Anti-AA and Harm Reduction lobby and the ludicrous absolutism of the Free Will / Disease Model argument
Time for yet another a quote:
‘If it were ever to be shown that there existed a genetic disease causing a powerful craving for a drug, this would not demonstrate that the afflicted person had no choice as to whether to take the drug. Nor would it show that the action of taking the drug was itself a disease.’
– Jeffrey A. Schaler, Addiction Is a Choice
Why did I pick out that isolated paragraph? Because I happen to agree with it.
As I myself found a few years ago, the problem that many advocates of The Sinclair Method find is that we’re victims of the two narrative paradigm that is the disease model of Alcoholics Anonymous versus free will debate. An all or nothing argument (in reality an example of the excluded middle fallacy) that continues to rage in the addiction field.
Schaler’s book Addiction is a Choice has informed much of the thinking on this. And also, it has to be said, has – on a personal level – caused me several headaches when I’ve been unjustly accused of being a disease model advocate on many heated debates on internet forums – largely because many people that I argue with confuse determinism (i.e. physiological causality) with fatalism and say that The Sinclair Method inadvertently promotes AA’s concept of powerlessness. This faulty logic is analogous to the Reductio ad Hitlerum and Reductio ad Stalinum association fallacies in the manner that it unjustly seeks to smear TSM.
I first became aware of Schaler’s writing during my days in the wilderness – back when I was still drinking in the noughties.
I was really digruntled after a bad experience with my local Alcoholics Anonymous group and latched onto the anti-AA site The Orange Papers* which helped me to achieve a sense of vindication about my own issues with the fellowship. To know that there were other people out there who could see the contradictions was really liberating and I hungrily consumed everything that site had to say on both the subject of the fellowship and ‘real recovery’.
Which is how I first came across references to the Penn & Teller: Bullshit! episode on the 12 Steps in which Jeffrey Schaler features prominently. This blew my mind and I recall it being really affirming at the time. I’ve only become more critical of it in recent years – since reading about and then going onto The Sinclair Method.
(* as a sort of footnote, I have to pause out that I actually owe a debt to The Orange Pages website and the gentleman who runs it for my discovery of The Sinclair Method which I first heard of in the letters page on that site. See HERE.)
Time for another quote from Schaler:
‘There are various skin rashes, for example, which often arouse a powerful urge to scratch the inflamed area. It’s usually enough to explain the harmful consequences of scratching, and the patient will choose not to scratch. Though scratching may cause diseases (by promoting infection of the area) and is a response to physiological sensations, the activity of scratching is not itself considered a disease.’ [my emphasis]
I agree, but the key here – when it comes to resisting the choice to ‘scratch the itch’ – is will power and the fact of the matter is that (a) we only have so much of it and (b) some people have more of it than others.
The fact is, there are degrees of voluntary control. Some people can abstain from alcohol through will power alone whilst others (like myself) have a fight on their hands.
As Roy Eskapa writes in The Cure for Alcoholism:
‘The fact is that not all behaviors [sic] are chosen rationally. There is a behavior [sic] continuum ranging from those over which we do have conscious control – like going to get a cup of coffee – down to autonomic reflexes – like having your heart beat or your stomach contract…
…In between the extremes are behaviors [sic] that are partially under rational control. In many cases, the response initially is almost completely voluntary, but control is lost with the duration of deprivation. For example, you can easily start to hold your breath, but the response (to breathe) then becomes progressively more automatic and after a minute or so is no longer subject to conscious control.’
Back to Addiction is a Choice, Schaler further writes:
‘A simple test of a true physical disease is whether it can be shown to exist in a corpse. There are no bodily signs of addiction itself (as opposed to its effects) that can be identified in a dead body. Addiction is therefore not listed in standard pathology textbooks.’
So following this reasoning alcoholism is not a true physiological illness and therefore must be (according to his false dichotomy) a choice, right?
Except that, as history proves, simply because the technology doesn’t yet exist to identify a disease that does not mean that it won’t happen. Case in point: it wasn’t until the advent of the microscope that malaria was able to be identified.
Likewise, (as Schaler himself concedes) migraine cannot currently be diagnosed from a post mortem either. But to reductively say that migraine is not a true physical illness with a real physiological cause, but instead ‘a choice’ is absurd beyond words.
An unfortunate legacy that Schaler and to a certain extent both the anti-AA lobby and ( – I’m sad to point this out – ) the Harm Reduction movement all share is their debt to the influence of Thomas Szasz… Szasz being a chief architect of the anti-psychiatry movement… an execrable, now largely discredited quack who had the most offensive notions about the reality of mental illness (labelling mentally ill people as ‘malingerers’). And someone who is very popular with The Church of Scientology and whose writings are used to defend some pretty abominable notions about mental illness.
To borrow from legal language: talk about fruit from a poisoned tree.
Witchfinder General: The McCarthyism of Stanton Peele
On the subject of legalese, it’s interesting to note that both Jeffrey Schaler and Stanton Peele (author of Love & Addiction, Diseasing of America and Recover!: Stop Thinking Like an Addict and Reclaim Your Life with The PERFECT Program) are, in addition to being psychologists, qualified lawyers.
I mention this because Stanton (a prolific firebrand writer and, like Schaler, very much a free will activist) is particularly prone to bullish behaviour and appeals to emotion in the way that he constructs his arguments, often using straw man tactics against his chosen opponents. Language and behaviour much more befitting a courtroom bully than what you would expect from the cautious scientific language used by most addictions researchers.
Very much an anti-AA polemicist and a critical darling in both the harm reduction and anti-AA movements, he has in recent years written some pretty venomous dissections of The Sinclair Method which have largely gone unchallenged thanks to the fact that we’re a nascent movement and most advocates of The Sinclair Method are still too hard at work concentrating on spreading the word to indulge Peele’s desire for conflict at the drop of a hat.
But here’s the thing about Stanton: it seems like he cannot ever be wrong. It’s his super power. He IS the I-am-always-right-and-you-are-always-wrong man. Which must be hard work.
…So just where does this hostility come from? Why is he so threatened by TSM?
Well, just to get an idea of the motivation behind this here’s a quote for you from one of his most celebrated books:
‘No medical treatment will ever be created to excise addictions from people’s lives…’ [my emphasis]
– Stanton Peele (1989). Diseasing of America. Lexington Books. p. 4
So, you see, given his own hubris on the matter, any disconfirming evidence is abhorrent to Dr. Peele. Hence the need to dishonestly cherry pick only the least favourable studies out of the scores of studies that do demonstrate the efficacy of The Sinclair Method.
Recently Peele, no doubt feeling desperate, published an article on The Influence website (see HERE), putting a lot of effort into supposedly demonstrating that behind every success story with TSM is an example of the placebo effect. That’s to say such people get well on their own without any real need for the pill.
A bold statement considering the many thousands of people across the world who have seen positive results with The Sinclair Method.
Dr. Peele is quite a powerful, persuasive speaker so it is easy to be almost convinced, given the sense of authority behind his words… and brazenness can be quite a good, persuasive tool in debate… except that what Stanton has not considered is the success of the hundreds of animal trials (using specially bred rats that would crave alcohol once exposed) that were conducted before the method was ever tested on human beings.
My question is this: just how exactly does Stanton’s placebo hypothesis apply to rats? Whilst the power of suggestion is a factor with human beings, I doubt that it’s such a factor with rats!
It’s clear that there’s a lot of conflict in this arena with a lot of people with very binary outlooks heavily invested in their own favoured addiction theories.
It gets very political. And, if I’m honest, quite tiresome. This article has been a bit of a headache to write.
There’s simply too much ego on the part of certain threatened parties.
But with 3.3 million people dying as a direct result of Alcohol Use Disorder each year isn’t it about time for a new outlook? One that (to paraphrase), isn’t so contemptful prior to investigation when it comes to newer treatments like The Sinclair Method?
Okay, I’ve just about ran out of steam. Thanks for reading.