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Stanton Peele Stanton Peele

Why Liberals Love the Disease Theory of Addiction, by a Liberal Who Hates It

The disease model is convenient to liberals because it spares them having to say negative things about poor communities. But this conception of addiction harms the very people we wish to help.

23 Substance

Because they can’t draw unfavorable inferences about life in poor ghettos or poor rural communities (to which they have little exposure), liberals are drawn to the belief that drugs cause addiction.

I couldn’t disagree more. But as a card-carrying liberal myself, I’ll swallow my bile and try to understand.

A desire to think the best of people, particularly those less fortunate than ourselves, is admirable: We mustn’t blame people for being addicted, goes the well-intentioned thinking, so addiction has to be caused by an irresistible force. A theory that ascribes near-magical malevolent properties to drugs—involving a 12-step-inspired belief in the “powerlessness” of individuals in the face of this scourge, in cahoots with some neuroscientists’ portrayal of addiction as a function of brain chemistry “hijacked” by drugs—thus fills the bill for liberals.

Indeed, we don’t need to blame anybody for being addicted. As Ilse Thompson and I wrote in our recent book, neither shame nor blame contributes to recovery. But that doesn’t mean we should deny the social factors that contribute to addiction, or deny that addicted people can improve their lives through their own thinking and action. The widespread belief of oversensitive liberals in the disease theory, however well-meant, undercuts and demoralizes the very people liberals wish to help.

Of course conservatives usually dislike drugs and drug use even more than liberals. But when liberals do argue—often with surprising vehemence—against liberalized drug policies, they inevitably base their opposition on disease ideas. (Whenever I debate the disease theory on a political punditry show, it’s the liberal—here Colmes of Hannity and Colmes—who will attack me all-out. On the other hand, I can always get to a dyed-in-the-wool conservative around drugs by accusing him of backing the disease theory, as I did with Bill O’Reilly here.)

Among arch-liberals, Patrick Kennedy, former Rhode Island Congressman and son of legendary liberal Ted Kennedy, heads Project SAM, an anti-marijuana-legalization group whose principle is “Our country is about to go down the wrong road, in the opposite direction of sound mental health policy” since more people will be exposed to drugs and become addicted. When CNN’s Dr. Sanjay Gupta interviewed Patrick Kennedy about his various stints in rehab, Kennedy definitively declared: “It’s a disease of the brain…this is totally a neurological disorder.”

There’s a trap that the privileged and enlightened find very hard to escape: We are frightened to say that people in our country who are disadvantaged economically, socially or, alas, racially, are more likely to become addicted. That would mean that they are different from us in a bad way.

Along with prominent liberal politicians like Kennedy, one of the most influential opponents of legalizing marijuana and other drug policy advances has for many decades been that bastion of liberalism, the New York Times. True, the Times has just come out with a major policy statement in favor of legalizing marijuana. But they continue to stigmatize addiction and to test their own prospective employees for marijuana. Here’s what Tony Newman of the Drug Policy Alliance has to say about their record:

“Some people think of the Times‘ editorial page as a liberal mouthpiece—but when it comes to marijuana prohibition and the drug war, they’ve been extremely cautious and conservative. In previous decades, the Times did as much as any other media outlet to legitimize drug war hysteria and its disastrous policies.”

Most conservative politicians strongly oppose marijuana legalization. But the Obama administration, of which we might expect better, is no better, and continues to fight legalization in the face of growing awareness of its inevitability. How often, after all, do politicians oppose policies that a majority of Americans favor? That this opposition is steeped in disease theory beliefs comes through in Obama’s drug czars’ attitudes.

Obama’s first drug czar, Gil Kerlikowske, after some initial verbal feints, opposed medical marijuana and other liberalized policies. As the conservative National Journal noted:

“Kerlikowske had paid considerable lip service, promising in his first interview as drug czar to end the ‘war on drugs’ and, later, to promote public health solutions and a ’21st century’ approach. People on the enforcement side of things worried that would come at the expense of law enforcement. As it turns out, they needn’t have worried.”

Kerlikowske was a former police chief. But Obama has now selected a new drug czar, Michael Botticelli, with a public health background. At the same time, the White House proudly announced: “He is also in long-term recovery from addiction, celebrating more than 24 years of sobriety.” By “sobriety” the White House means abstinence. So, a quarter century after kicking an unspecified addiction, does Botticelli believe that a glass of wine would immediately put him back on the path to addiction? I don’t.

Meanwhile, Botticelli’s views on marijuana legalization are clear. He expressed four-square the administration’s opposition in February. He then proceeded to argue against the New York Times’ editorial support for legalization by referencing all of the old anti-drug, gateway bromides favored by, well, recovering people. In the words of Ethan Nadelmann, executive director of the DPA: “Unfortunately even the Drug Czar’s office responded to the editorial by perpetuating the sorts of myths that the Times’ editors have clearly considered and rejected.”

Why, indeed, has the New York Times itself been so traditionally opposed to legalization and other drug policy innovations? It is due to the Gray Lady’s inexorable support for the disease theory, including AA and its 12 Steps, as well as swallowing every claim of neuroscientific revelation about the source of drug addiction in the brain. Here, see how Times star Benoit Denizet-Lewis combines in one heady mixture the latest neurochemistry mish-mash (this was in 2006, and we still haven’t quite got that promised anti-addiction pill) with the good old 12-step spiritualism that Denizet-Lewis favors. And Times columnists from liberals Nicholas Kristoff and Maureen Dowd to chief conservative David Brooks have also endorsed AA and other disease standard-bearers.

Meanwhile, the single greatest advocate for the disease theory in Washington is Vice President Joe Biden. Just before leaving the Senate, Biden actually proposed the “Recognizing Addiction as a Disease Act of 2007.” He was concerned that people might think that drug users intentionally “abuse” substances, rather than being in the throes of their disease.

The tendency for liberals to endorse the disease theory of addiction has strong wellsprings. You see, there’s a trap that the privileged and enlightened find very hard to escape: We are frightened to say that people in our country who are disadvantaged economically, socially or, alas, racially, are more likely to become addicted. That would mean that they are different from us in a bad way. Much safer is to play up that drugs are bad, that drugs trap unfortunate people, and that these people have diseases against which they are powerless.

Back in the media, no one supports the disease meme more than the liberal commentators on MSNBC. Consider the strange pas de deux of Chris Hayes and Carl Hart. Hart is an associate professor of psychology and psychiatry at Columbia University and the author of High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society. The book lives up to its claim. In a phrase, Hart says, “Drugs aren’t the problem.”

Hayes loves Hart. But, unfortunately, he can only love one part of Hart’s story. Hart rose out of the Miami ghetto through his interest in science, which Hayes continuously cites.

The second part of Hart’s story is really hard for Hayes and MSNBC to swallow: that drugs—and particularly meth, which Hart researches (he points out that methamphetamine is chemically almost identical to Adderall) are not unusually powerful forces in people’s lives. Nearly all users can quit or cut back. Hart’s experiments prove this, as do many real-life examples. Unfortunately, the ghetto which Hart came from has remained just as dysfunctional since he left, he reports. Hart knew it pre-crack; he knows it after crack. He sees little change.

But if you can’t buy Hart’s version, how to explain the broken homes and communities and ruined lives? There is the rub. Hayes and fellow commentators (including the extremely smart panel on MSNBC’s The Cycle) rely on this narrative: Drugs have overpowered communities, just as they hijack an individual’s brain chemistry. And, yes, sometimes these happen to be deprived communities. But actually, drugs are so bad—especially heroin, painkillers, meth and crack—that they overpower everybody. “Addiction Does Not Discriminate,” liberal disease theory acolytes typically trumpet.

Except it does.

Thus liberals excuse themselves from addressing the havoc in poor urban and rural communities which turns them into centers for addiction. Instead, they satisfy their instinct for equality by emphasizing that people in upper-middle-class communities also take drugs—conveniently ignoring the very different rates of problematic drug use.

That Hayes et al. know many people—probably including themselves—who have taken powerful painkillers and then simply quit when their pain subsided, say post-operatively, means nothing to them. They ignore their own experiences, which tell them that people well-situated economically and socially routinely take drugs safely. (Of course, as both Hart and I note, people with deep personal problems from any walk of life, think Phillip Seymour Hoffman, may form drug and other addictions.)

Thus liberals excuse themselves from addressing the havoc in poor urban and rural communities which turns them into centers for addiction. Instead, they satisfy their instinct for equality by emphasizing that people in upper-middle-class communities—like college campuses, playground resorts like Colorado, and the good old Golden Triangle of New York, San Francisco and Los Angeles—also take drugs. “See, marijuana use rates are the same for blacks and whites,” they cry, conveniently ignoring their very different rates of problematic drug use.

Look at alcohol: Those in the upper-middle class far more often drink (about 70% of college grads) than those in lower socioeconomic groups (only 35% of those lacking a high school diploma do). But, of those who do drink in both groups, far more of the socially disadvantaged have drinking problems. They also smoke more—despite smoking’s now-exorbitant costs. For example, 12% of college grads smoked in the last month, compared with 34% of those without a high school diploma.

“But look,” liberals protest, “middle-class kids sometimes take heroin!” Then comes the fast shuffle, parenthetically or under the breath: “so middle class people are addicted as much as people in Appalachia, inner cities, and poor white New England neighborhoods.”

But they’re not, you know. Poverty is conclusively linked with a greater risk for addiction, and with the probability of worse consequences for people who become addicted.

I turn to my good colleague at, the often prescient Maia Szalavitz. After announcing in her piece, “These ‘New Face of Heroin’ Stories Are Just the Old Face of Racism” that, of course, middle class kids use heroin and painkillers, so everybody’s equal on that score, she sneaks in:

“Addiction rates are higher in poor people—not because they are less moral or have greater access to drugs, but because they are more likely to experience childhood trauma, chronic stress, high school dropout, mental illness and unemployment, all of which raise the odds of getting and staying hooked.”

Wait a second, run that by me again? After we discard the chaff—poor and black people are less moral and have more access to drugs—we come to the crux of addiction: Underprivileged people are more likely to “experience childhood trauma, chronic stress, high school dropout, mental illness and unemployment, all of which raise the odds of getting and staying hooked.”

That’s a rather important fact to bury near the end of the article, don’t you think? Especially considering that Maia worked with Hart on his book. And certain psychological dispositions come along with those deprived situations. I’ll quote Maia again, this time making an important point in another article about the ability to delay gratification:

“Follow-up studies on these preschoolers found that those who were able to wait the 15 minutes (to eat a marshmallow) were significantly less likely to have problems with behavior, drug addiction or obesity by the time they were in high school, compared with kids who gobbled the snack in less than a minute.”

Hart identified this search for instant gratification with an upbringing in an underprivileged setting: When you are uncertain of what life holds for you, you grab what you can, when you can.

Meanwhile, NBC and MSNBC, as Maia points out, love to feature white middle-class addicts and drug scares in supposedly middle-class communities (which, on closer inspection of the video, are more often deprived areas).

While Maia objects to their claiming heroin use by these people is a new phenomenon, I have a different critique: It’s just so easy to portray middle-class heroin addicts. Their homes are so much more pleasant, and—given their advantages—they usually recover, unlike those in Appalachia, inner-city ghettos and similar communities, whose lives are much more frequently marked by lifelong addiction, poor health, crime, joblessness and despair. As Granfield and Cloud point out, the biggest factor aiding people in recovery from drug addiction with or without treatment is their “social capital”—their life resources.

Here is how the Times—in an article not self-consciously about addiction—described McDowell County, West Virginia:

Towns are hollowed out as people flee, and communities are scarred by family dissolution, prescription drug abuse and a high rate of imprisonment
. . . .
He had another seizure the other night,” Ms. Bolden, 50, said of her son, John McCall. John got caught up in the dark undertow of drugs that defines life for so many here in McDowell County, almost died of an overdose in 2007, and now lives on disability payments. His brother, Donald, recently released from prison, is unemployed and essentially homeless.

Perhaps Hayes and The Cycle could interview this family? Aren’t they good representatives of the disease of addiction? Instead, I watch with disbelief as these normally critical thinkers accept claims that violate their own knowledge about and concern over the consequences of inequality. They have credulously bought the cant of the disease sellers—as if skeptical examination would make them heartless bigots. How will we ever solve addiction problems if such worthies care more about having the “right” opinion than about understanding a social problem at its source?

And so, in Hart’s Miami and McDowell County in West Virginia, addiction scars generation after generation, hardly raising the consciousness meters at MSNBC and other liberal media outlets. Meanwhile every celebrity “addict” gets full bore coverage—even when, as in the case of Robin Williams, they haven’t actually exhibited the symptoms of addiction for decades.

The disease theory has everything the media demands: star power, drama and a personal moral lesson linked to tragedy. It also suits politicians by endorsing their instinct to try to suppress drug use and their wish to be seen as uncompromising against a public menace. And strange to say, the moral lesson many liberals derive from those who become addicted—since they can’t lay it at the feet of social forces—is the same just-say-no temperance message that they mock when it comes from the likes of a Nancy Reagan.

Stanton Peele, a columnist for, has been at the cutting-edge of addiction theory and practice since writing, with Archie Brodsky, Love and Addiction in 1975. He has since written numerous other books and developed the online Life Process Program. His latest book, with Ilse Thompson, is Recover! Stop Thinking Like an AddictHis website is