HAMS: Harm Reduction for Alcohol

Myths From Drug And Alcohol Rehab

A great deal of mythology has grown up around the issue of heavy drinking and or drug use. A lot of these myths are perpetuated in rehab programs throughout the United States. Many of these myths have also entered the consciousness of the general public and can be found on web sites all over the internet. In spite of the fact that scientific research has demonstrated the untruth of these myths, many substance abuse counselors believe them to be true and pass these myths on to their clients. HAMS believes that individuals will be best able to make decisions about drug and alcohol use when they are armed with the facts. This page dispels these common myths.

MYTH 1) There Is A Gene For Alcoholism:

First we should note the simple fact that many traits are associated with multiple genes and do not show a classic mendelian distribution. Many traits are distributed across several genes. Pea color is a classic example of a trait associated with a single gene. When green peas are crossed with yellow peas the first generation is all yellow and the second generation is three quarters yellow and one quarter green. Intermediate shades between green and yellow do not appear. Human skin color on the other hand is distributed across several genes and when a black person has a child with a white person the result is a person of intermediate color. Human skin color is referred to as a quantitative trait and the mechanism of inheritance is called polygenic inheritance since more than one gene is involved. Just to keep things interesting--there is also the phenomenon of codominance . When a white carnation is crossed with a red carnation we get a pink carnation. Even though the color trait is on a single gene, neither allele is dominant.

Behaviors, however, are more complex than simple physical traits. Few behaviors are associated with a single gene. Habitual heavy drinking is a behavior. The best evidence for the heritability of habitual heavy drinking are Goodwin et al's adoption studies. However these same studies are also the strongest evidence against a single gene theory and against the idea that genetics is the only factor affecting habitual heavy drinking. Studies of infant children of alcoholics who were adopted by non-alcoholic families found that 20% of male adoptees and 5% of female adoptees became alcoholic. When we look at the incidence of alcoholism in the general population we find that 5% of males are alcoholics and 5% of females are alcoholics.

The problem here is that if alcoholism were a dominant trait on a single gene then we would expect 75% of the children of two alcoholics to be alcoholics. If it were a recessive trait on a single gene one would expect 100% of the children of alcoholics to be alcoholics. If it were a sex linked gene there should be no female alcoholics at all. The data do not agree with these predictions at all.

Researchers in genetics have identified 40 some genes which may have some connection with heavy drinking or addiction. But there is no simple predictable genetic combo which says that a person will be an alcoholic.

Ultimately the totality of evidence seems to tell us the following: there is some genetic tendency towards heavy drinking, however environment and personal choice are also essential factors.

Just one more example. If your mother spoke English and your father spoke English, chances are that you speak English, too. Languages run in families. Does this mean that there is an English-speaking gene? I think not.

Myth 2) All Addicts Are Cross-Addicted

The theory of cross-addiction states that if a person is addicted to one mood altering substance then they are automatically addicted to all mood altering substances—even ones which they have never tried. This theory also states that the use of any mood altering substance will automatically lead to a relapse into addiction to the original substance. It is ironic that very often the rehab counselors who teach this theory to their clients frequently chug coffee all day long and smoke cigarettes like chimneys. Both caffeine and nicotine are addictive mood altering substances.

The simple fact is that cross addiction is nowhere near so simple and clear-cut as it is often presented to be. There is a grain of truth to the concept and a lot of exaggeration as well. If one is addicted to an opiate like heroin then one does indeed automatically have cross tolerance to other opiates like codeine or morphine. This is because all the opiates affect the same neurotransmitter system. An opiate user is not automatically addicted to cocaine or alcohol, however, since cocaine affects a different neurotransmitter system and alcohol affects all neurotransmitters. If one is addicted to heroin and quits and tries to replace the constant opiate buzz with a constant alcohol buzz then one will indeed quickly develop a problem with alcohol. However many former heroin users do make major lifestyle changes and eventually decide to become moderate drinkers of alcohol. What is essential is the change in mindset.

Myth 3) Alcoholics Have THIQs In Their Brains

In 1970 Davis et al published experimental research on alcoholic rats which found the evidence of THIQs (tetrahydroisoquinolines) in their brains. Since THIQs are chemically related to opiates it was thought that this might explain the difference between alcoholic drinkers and normal drinkers. In 1983 Sjoquist et al published autopsy results on alcoholics which seemed to confirm the presence of THIQs. However, other researchers had difficulty replicating these results. THIQs were also found to be present in the brains of non-drinkers. While the academic debate raged workers at rehab centers began to tell clients that there was proof that their "alcoholic" brains were different than normal brains because of THIQs. Hazelden has at least one therapeutic videotape on the subject. I have seen a statement by one treatment professional saying in effect "It is good to tell clients that their brains are different because of THIQs even if the evidence does not bear this out because it helps them to accept that they are diseased." Lying to a client is okay if it makes them accept disease theory--hmmm.

A 2006 article by Quertemont and Didone notes that measuring the presence and quantities of THIQs in brain is not an easy task and that more sophisticated measures are needed. It is not a simple matter of "People with THIQs in their brains are alcoholics and those without are not". The good news is that the research on this topic is getting better.

On a side note we can observe just how badly word-of-mouth transmission of information can lead to total distortion of reality. There are at least a dozen sites on the internet which tell us "A medical scientist named Virginia Davis was doing cancer research in Houston, Texas. For her studies, she needed fresh human brains--which are not widely available. So she'd ride out with the Houston police in the early morning and collect the bodies of winos who had died on Skid Row the night before. The warm bodies were rushed back to the hospital, where the brains were removed.

One day Virginia was talking to some doctors in the hospital cafeteria. She was telling them about some finding of her laboratory studies, and she said: "You know, I never realized that all those winos used heroin as well as booze." The doctors laughed. "Come on, Virginia," they told her. "These guys don't use heroin. They can barely afford a bottle of cheap muscatel." She had discovered in the brains of those chronic alcoholics a substance that is, in fact, closely related to heroin. This substance, long known to scientists is called Tetrahydrolsoquinoline - or (fortunately) THIQ for short."

Virginia Davis was doing alcoholism research on rats--that is all. She was not researching cancer. She never performed autopsies on winos. Here we have an eyewitness account of an event that never happened.

References Davis V E, Walsh M J. (1970). Alcohol, Amines, and Alkaloids: A Possible Biochemical Basis for Alcohol Addiction. Science. Vol. 167. no. 3920, pp. 1005 - 1007.

Sjoquist B, Perdahl E, Winblad B. (1983). The effect of alcoholism on salsolinol and biogenic amines in human brain. Drug and alcohol dependence. Aug;12(1):15-23.

Quertemont E, Didone V. (2006). Role of Acetaldehyde in Mediating the Pharmacological and Behavioral Effects of Alcohol. Alcohol Research & Health. Volume 29, Number 4.
Full text

Myth 4) There Is An Addictive Personality Type

The whole idea that there is such a thing as an addictive personality type seems to stem from Bill Wilson's declaration that alcoholism is caused by "character defects", and that if one fixes one's character defects via AA's "Higher Power" then one will no longer be spending one's life in bars--one will be spending it in AA meetings instead.

Clarence S., one of the founding members of AA, gave us the following list of character defects, which seems to still be a standard in American rehab centers today:

  1. Self Pity
  2. Self Justification
  3. Self Importance
  4. Self Condemnation
  5. Criticizing
  6. Negative Thinking
  7. Vulgar Immoral Thinking
  8. Insensitivity
  9. Procrastination
  10. Dishonesty
  11. Impatience
  12. Resentment
  13. Hate
  14. Enviousness
  15. Jealousy
  16. Laziness
  17. Lying
  18. Gossiping
  19. Selfishness
  20. Fear

Some of these just strike me as normal--everyone does this stuff not just alcoholics. A few others don't fit me at all--I have never been a liar. And I have always considered my "vulgar immoral thinking" to be my best trait :-)

The fact is that things are a lot more complicated than simply being able to identify a clear cut "addictive personality type". People who tend to be obsessive about things can be obsessive about drinking alcohol or using drugs. That part is not problematic.

There is a good article online about traits often found in people who tend to abuse drugs or alcohol titled Is There an Alcoholic (Addictive) Personality?.

Note that it makes no absolute statements about "everyone". Rather it finds that they tend to be independent types---perhaps too independent.

Myth 5) All Alcoholics Need A "Higher Power" To Abstain

People who follow purely secular recovery programs such as SOS , SMART Recovery , or WFS are just as successful in abstaining as those who rely on AA's "Higher Power". And many people quit drinking on their own. If your religious beliefs help you to moderate, abstain, or practice harm reduction then go ahead and use them! If you don't believe in God then this is no obstacle to achieving successful abstinence, moderation, or harm reduction either.

Myth 6) Alcoholism Is An Allergy

An allergy by definition is a reaction of the immune system to a given chemical. Allergies are easily detected by a skin test. If "alcoholism" were an allergy it could easily be diagnosed by a skin test and no screening tools such as the MAST test would be needed. However, there is no skin test for people who sometimes drink too much.

Myth 7) Trying To Control Your Drinking Means That You Must Quit Forever

If someone were to say "I watch too much TV lately. I am gonna cut back and go to the gym more." would anyone react by saying "This is a sign of ADDICTION! You must never watch TV again in your lifetime!"? What if someone said that they were going to cut back on their coffee intake?

We never react this way if the subject is television or if it is the mood altering drug caffeine. Why does alcohol bring this reaction from people? It seems that alcoholism treatment programs have fostered this attitude in the minds of the American populace. Of course it is in their financial interest to have the maximum number of people go through their programs, but is it realistic? In Japan it is perfectly acceptable to tell people that you plan to cut back on drinking and then do so. In America most people who make the healthy decision to cut back on their alcohol intake are forced to hide and do so in secret.

Myth 8) The Only Way To Quit Drinking Is Lifelong AA Attendance

More people have quit drinking without AA or any other program than with it, as Stanton Peele tells us in his article AA's role in society.

HAMS will never threaten you with the necessity of lifetime attendance--the longer you have changed for the better the easier it gets. Dwelling on past alcohol experiences as AA does just keeps people stuck in the past.

We love our friends at HAMS and hope they continue to visit and catch us up on their lives. We would never suggest that they need to become addicted to us.

Myth 9) Only "Tough Love" Can Cure Addiction

Even the National Institute of Health has concluded that "tough love" programs do nothing but damage clients and lead to worsened addictions and other behaviors, as we can see from this article.

Myth 10) AA/Treatment Never Fails, Only People Fail AA/Treatment

If a doctor killed a loved one with a botched appendectomy would you justify him/her in this manner? Of course not. You would sue that doctor for malpractice. Perhaps it is time to hold treatment centers to an equal standard of responsibility. Many people learn how to be addicts at treatment centers, just as many learn how to become criminals in prison.

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