“Once I Start, I Can’t Stop” – Part 3

Stop Drinking

Priming Dose Experiments

No proof of substance-triggered loss of control has ever been found. Not once. I realize this might be hard to believe, but it’s true.

Furthermore, the best scientific research ever carried out to test the loss of control theory shows the exact opposite to be true, and some of this research took place nearly 50 years ago! (Merry, 1966) The basic research model used to test for loss of control is called a priming dose experiment, and it’s quite simple to understand. Since the theory is that the first dose of a drug or alcohol pharmacologically triggers off uncontrollable use, then we simply need to give “alcoholics and addicts” an initial dose (hence, priming dose) of their favored drug in a laboratory, tweak the conditions under which they receive the dose, and monitor the results. Does uncontrolled use follow? There are important twists to these experiments, for example, what happens when the subject drinks alcohol without knowing it? Such twists allow researchers to sort out any supposed zombie-like alcoholic behavior from run of the mill choices.
Alcohol Priming Dose Experiments

The basic priming dose experiment has been carried out several ways with alcohol. For example, one experiment gathered alcoholics who had previously been begging for alcohol on the streets. They were brought into the hospital for an extended stay to detoxify and be nursed back to health. They were given vitamin drinks each morning and questioned afterward about their level of craving. On some days, the researchers put a drinks-worth of hard alcohol into the vitamin drink – disguised in taste and unknown to the alcoholic. The results? They didn’t crave alcohol more on those days when they had been “primed” with a shot in their morning vitamin drink than they did on the days when they weren’t slipped alcohol. Nor did they proceed to check themselves out of the hospital so that they could continue drinking. They did not become drinking zombies.

Another priming dose experiment invited “alcoholics” to taste-test a new brand of tonic water. As you can imagine, there was alcohol mixed in to a degree where it would be undetectable, and they were unaware that they were drinking alcohol. They had access to a pitcher of the mixture and were allowed to drink as much as they want. Again, they didn’t proceed to “uncontrollably drink” once they got a drinks-worth of alcohol in their system. And when compared to a group whose tonic was really just tonic – with no alcohol – they didn’t drink more. The only group who proceeded to drink greater amounts were those who were told that it contained alcohol – whether it really contained alcohol or not! What this shows is that heavier drinking is not a chemically triggered zombie behavior – in fact it is a simple goal driven behavior. When the test subjects believe that drinking the drink will get them drunk (and this is a state that they desire), then that’s when they are motivated to do so, and tend to follow through.

One review of 9 such experiments showed the same basic finding repeated again and again: an initial dose of alcohol (the “priming dose” i.e. “first drink”) doesn’t result in extreme drinking/craving for alcohol, when the alcoholic doesn’t know they’ve had the drink. Thus, we have no reason to believe that this seemingly “uncontrolled” drinking is the result of either some special power of alcohol, or a biological/genetic weakness of the individual. Instead, it is a choice, ruled by cognitive factors like any other choice. As the reviewers noted:

The more important point about these experiments is the implication that drinking behaviour conventionally described as loss of control is mediated by cognitive processes and not by a physico-chemical reaction to ethanol. (Heather & Robertson, 1983)

Drug Priming Dose Experiments

In the decades since the initial alcohol priming dose studies blew up the “loss of control” notion of alcoholism, similar, but not identical experiments have been done with various other drugs. Most notably, neuroscientist Carl Hart PhD of Columbia University has discussed his work in this area in the media recently. His experiments were different, but just as illuminating.

For example, he gathered confirmed “crackheads” as subjects in an experiment where he would give them a dose of crack cocaine (a priming dose), and then offer them another hit, or a small amount of money that would go into an account that they could access several weeks later. So for example, he’d present them with the option of another hit of crack, or 12 bucks two weeks from now. He’d vary the prices and the dose sizes, offering as much as $20 as an alternative to another hit of crack, and found that he could find a price at which he could essentially buy some abstinence from so-called crack addicts.

How does this fit with our concept of crack and crack addiction? We’ve been led to believe that a single hit of crack will make you addicted. We’ve been led to believe that once you smoke some crack you can’t stop until you crash and burn. We’ve been taught that in crack addiction, you become a zombie who will lie, cheat, steal, and do anything you have to do to get more crack. We’ve been taught that crack addicts are incapable of choosing a delayed reward, and that all they can do is ceaselessly pursue the quick highs of more crack. Yet even they have their price.

The point is simple. If you can say “It might be a good idea to take 8 bucks in the bank that I can use a few weeks from now rather than to have another hit of crack right now”, well then you are making a choice. You are not out of control. And what we can safely assume is that when crack addicts are behaving as if they are “out of control” they are really just pursuing what they believe to be their best option at that time. They are choosing. They are “in control” of all of it. Crack has no special power, and crack “addicts” have no special biological or genetic weakness – or mental illness called addiction. What they have is the perception that heavy crack use is their best option for how to spend their time. That’s not a disease – it’s a thought, a judgment, a belief, a cognition – and every individual is the master of their own thoughts.

Carl Hart PhD had this to say about his 15 years of research as a neuroscientist at Columbia University:

The more I studied actual drug use in people, the more I became convinced that it was a behavior that was amenable to change like any other…

In one study, we gave methamphetamine addicts a choice between taking a big hit of methamphetamine (50 mg.) or five dollars in cash. They took the drug on about half of the opportunities. But when we increased the amount of money to twenty dollars, they almost never chose the drug. We had gotten similar results with crack cocaine addicts in an earlier study. This told me that the addictive potential of methamphetamine or crack was not what had been previously claimed; their addictiveness wasn’t extraordinary. Our results also demonstrated that addicts can and do make rational decisions… (Hart, 2014)

Researcher Nancy K Mello had previously carried out experiments that were similar to Hart’s, but with alcohol. “Alcoholics” living in a hospital were given various allowances of alcohol that they could drink per day, and allowed to earn extra alcohol credits for drinking at moderate levels. Some of the same basic results showed up, and more. First, these men who normally “lost control” of their drinking while living on the streets showed a clear ability to drink moderately when they saw a sufficient reason to do so. Second, their behavior demonstrated that they were making cold, calculated decisions to maximize their happiness – in this case by limiting their daily drinking so that they could save up for a binge. So in principle, these skid row drunks were just like our more well-off examples of Kevin, Debbie, and Tommy. (Mello, 1972) (Schaler, 2011) (Heather & Robertson, 1983)
What’s Really Going On?

Some people say they lose control of their drinking and drugging, yet their own experience usually conflicts with this narrative, and the science hasn’t even come close to confirming that they truly can’t control themselves. On a whole, the experimental evidence with alcohol and other drugs (even those with the most extreme reputations) shows control and normal elements of choice are fully operational with supposedly addicted users. In the case of alcohol, the science shows that if they didn’t know they had consumed it then they wouldn’t feel compelled to drink more. Yet if they knowingly drank alcohol, or had been lead to believe they’d drunk alcohol, they’d feel compelled to drink more in certain situations. So what gives?

People most likely aren’t lying when they say that they lose control of their drinking and drugging. They’re honestly describing their experience to the best of their ability, after the fact, given what they’ve been taught about “addiction.” They just happen to be incorrect though. They feel like they’ve lost control, but unbeknownst to them, this loss of a control is only a cognitive product – a creation of their previously learned knowledge and their present thoughts – rather than a biological reality. This difference is highly important.

The myth of loss of control creates a strong expectancy of it, and then people live it out. In fact, this too has been shown in carefully controlled research that tested the degree to which people believed in the disease model and statements such as “one drink equals a drunk.” The results were clear, the more strongly an individual believed such things, the more likely they became to “relapse” (Miller, Westerberg, Harris, & Tonigan, 1996). Other research shows that these beliefs lead to higher rates of binge drinking as well (Brandsma, 1980).

People want to drink and drug to excess for all the reasons that people want to do anything – they believe it will bring them happiness through various perceived benefits. But the more they believe that drugs and alcohol are the only practical way for them to attain these benefits, the more intense and desperate their want for drugs and alcohol will become. Many perceptions and beliefs factor in to fuel this desire, so we’re not here to downplay it as simple; but we are here to say that the individual can change this strong desire.

The loss of control myth is an obstacle to the task of understanding and changing your desires. People who believe in powerlessness and “once I start I can’t stop” take their massive desire for substance use for granted as an unchangeable fact of reality, a handicap, a burden that they’ll have to live with and fight for the rest of their life. They proceed to fight this desire with fear. They frame their path as the lesser of two evils in a choice between destruction or fear-fueled self-deprivation. And worst of all, they lower their hopes for happiness, and try to learn to live with this crippling feeling of deprivation. This is all the antithesis of working to understand and change ones desires. Remember, the PDP drives us for greater satisfaction. But if you learn that your options are limited to either live with “addiction” or fear it, well, those options are mirrors of each other. Hence the reason people vacillate between fear and use. They are so close to each other when you weigh the payoffs of each that when one option gets tiresome you switch back to the other and vice versa. It is only when a third more attractive option comes into focus that your PDP will kick in and drive you to explore that one. For now, simply seeing the loss of control idea as well as the fear of substances for the paper tigers they are will begin to build instant doors to more fulfilling options. It is tough to see past “addiction” if you remain believing in its core concepts of fearing it and seeing it as all powerful.

While some small portion of people change their substance use habits with a fear based approach, most people do not find such a change satisfying, because it comes with a feeling of deprivation, isolation, and a constant sense of impending doom. After all, that approach requires that you keep a fear of substances constantly alive in your heart.

After reading all of this, some of you will still be thinking to yourself:

“Ok, I get it, it’s not a disease. But once I start, I can’t stop, so I just need a way to make sure I don’t take that first drink.”

And if that’s where you are, you’re missing the point completely. The fact is that loss of control doesn’t exist. Because loss of control doesn’t exist, then the feeling of being out of control is just a feeling based on untruths you have learned. And because loss of control doesn’t exist, then the fear-oriented strategy focused on neurotically avoiding the first drink or first hit is unnecessary – and brings an unnecessary feeling of helplessness or weakness. There is another approach possible, if you’re willing to think outside the realm of fear.

More Fulfilling Options – Always the Solution

And now we present you with two important options on how to frame your substance use, as well as how to frame your reasons for change:

1. The Fear Frame: I am an “addict/alcoholic” who can be overpowered by triggers, experience overwhelming impulses to use, and will then drink or drug uncontrollably once I take a single sip or hit – leading me to inevitable disaster. I am a believer in the substance-will that can and does take over my thoughts. I am literally powerless to this personification of substances. I see drugs and alcohol as living enemies bent on my emotional and mental destruction. I am powerless to this substance-will. Therefore I must build a support network, avoid triggers, and never forget how dangerous drugs and alcohol are to me, so that I never take a single sip or hit again.
2. The Happiness Frame: I have been freely using substances to achieve happiness. For better or for worse, I have been in control. If I come to realize that I’d be happier making a change in my substance use habits, I can do this, and happily move on.

In order to move directly from the Fear Frame to the Happiness Frame, it is incumbent to see your “addiction” from a factual stance. If you desire to lean on a view that substances have any power whatsoever over your mind, you will always fall back to a default fear-based position. Let go of the mythology! Just because you learned that loss of control was possible does not make it so. If you believe you have the ability to think, then you have just moved past the loss of control theory for one simple reason; substances, in fact, cannot think. Therefore you have been in control all along! The question now is simple – are you ready to live in a happier more fulfilling state of mind? If so, keep reading to learn more and move past the “addiction” myths.

Citations:

National Institute on Drug Abuse; National Institutes of Health. (2008). Comorbidity: Addiction and Other Mental Illnesses (No. 10-5771). Retrieved from http://www.drugabuse.gov/sites/default/files/rrcomorbidity.pdf

Merry, J. (1966). The “loss of control” myth. Lancet, 1(7449), 1257–1258.
Hart, C. (2014, March 10). What Is Addiction? The New York Times. Retrieved from http://www.nytimes.com/roomfordebate/2014/02/10/what-is-addiction/as-with-other-problems-class-affects-addiction

Mello, N. K. (1972). Behavioral Studies of Alcoholism. In B. Kissin & H. Begleiter (Eds.), The Biology of Alcoholism (pp. 219–291). Springer US. Retrieved from http://link.springer.com/chapter/10.1007/978-1-4684-0895-9_9

Schaler, J. A. (2011). Addiction Is a Choice (1st ed.). Open Court.

Heather, N., & Robertson, I. (1983). Controlled drinking. London; New York: Methuen.

Miller, W. R., Westerberg, V. S., Harris, R. J., & Tonigan, J. S. (1996). What predicts relapse? Prospective testing of antecedent models. Addiction (Abingdon, England), 91 Suppl, S155–172.

Brandsma, J. (1980). Outpatient Treatment of Alcoholism: A Review and Comparative Study. Univ Park Pr.

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