University of Maryland addiction researcher Clinton B McCracken PhD was arrested last year for growing marijuana plants in his home.  Police found the plants while responding to a 911 call – McCracken’s fiancee and research partner died while injecting what they thought was an opiate that they’d bought online.  They’d both been doing opiates for 3 years.  It’s a tragic story, and his attempts at redemption only seem to make it sadder, but it serves as a lesson about the dangers of the disease myth of addiction.

The May 19th edition of JAMA (Journal of the American Medical Association) contained McCracken’s swan song – a 2 page article better suited to be his speech at a 12-step meeting.  In it, he recounts his drug abuse history, as well as an explanation of the tragic events that ended his career, killed his fiancee, and may lead to his deportation.  Most importantly though, he uses the opportunity to put forth another giant lame excuse for the mess he created, and another excuse for substance abusers everywhere.

The excuse, is that he was too smart – he’s so smart that he was able to trick himself into believing he didn’t have a problem – or perhaps it was the disease of addiction that tricked him.  The article’s title: Intellectualization Of Drug Abuse

He starts off the article by showing that those in the medical field have a higher rate of substance abuse than the average person, which he follows up with:

given the intelligence, years of education, and high levels of achievement found in this group, the relatively high incidence of substance abuse may be somewhat surprising

With this line he sets us up for his thesis – that it’s their intelligence which brings them down, and thus brought him down.  Now this isn’t anything new, I’ve heard plenty of substance abusers express the idea that they’re just too smart, that they’re not satisfied with the boring life offered to them, and that drugs allow them to escape.  McCracken just gives as a new twist on the “too smart for my own good” theory, but it’s a very interesting one.  He basically says that in the case of medical professionals, they are so smart and so well educated about addiction and the effects of drugs that they think they can do drugs in a low risk way, and they can do drugs in a way in which they’ll never meet the official diagnostic criteria for addiction.  This is what he claims he did.  He thought he could use safely, and he made sure that he didn’t use frequently enough to technically be diagnosable as drug dependent or drug abusing.  He says:

By intellectually addressing the official criteria for abuse and dependence, I provided myself with the illusion of total control over the situation and was able to confidently tell myself that no problems existed. This was in spite of the fact that my ongoing drug use was jeopardizing not only my health, but my career.

Basically he’s putting forth a theory of self-deception.  I agree that he deceived himself (although we may disagree on the nature of the self-deceit), but I also believe he’s still deceiving himself to a higher degree, and hurting others in the process.
McCracken’s theory rests on the idea that knowledge about the medical views of addiction can be dangerous.  He sees it as dangerous because you can make sure you technically don’t fit the criteria.  I take issue with this – I see it as dangerous because if you end up believing the disease theory, then either you believe that you’ve got the disease or you don’t, that either it’s a compulsion or it’s a recreational choice.  If you do have it, then you end up believing your drug use to be compulsive (unchosen and uncontrollable), and give up hope of changing while you wait for a miracle or a cure (but part of the theory is that it’s incurable).  If you don’t believe you have it, either you worry about “catching” it, or you throw caution to the wind, thinking “I’m not one of those addicts, so I don’t need to worry about bad things happening, because those bad things only happen to addicts” (circular logic, I know, but the disease theory itself is based on circular logic, it’s catchy).

This story and his theory serve as an important lesson, and here it is: while we’re busy worrying about the disease of addiction, wondering whether we have it or not, awaiting the inevitable relapse that comes with it, waiting for a doctor to cure us, etc, we distract ourselves from the real questions that will help us.  We should be asking ourselves (and he should’ve asked himself): Do the benefits of this behavior outweigh the risks?  Is there something more fulfilling and less deadly I could be doing with my time?  Do I want to waste my life doing this?  These thoughts can lead us to change, while thoughts that fit the disease theory will only lead us to learned powerlessness.

It’s clear that McCracken wasn’t asking himself any of these things.  He was asking himself “how many times did I use this week”, “how long have I been clean”, “have I suffered any consequences in my career”.  He hadn’t suffered career consequences yet, and that question did him no good.  The only thing that would have done him good was to honestly weigh the risks and benefits and explore the alternatives to the behavior.

What troubles me, and what I hinted at before, is that he’s adding to the myth.  He never explicitly says in this piece that he believes the disease theory, but he spent his time researching the neurological dimensions of it, and it appears that he takes the official diagnostic criteria of it very seriously, which leads me to believe he does subscribe to the disease concept.  While he appears to be coming clean about some personal wrongdoings, he never really takes responsibility.  Instead, he suggests that the disease is even more wily and cunning than we previously thought, and he’s implicitly suggesting the scope of the diagnostic criteria is not wide enough because he never fit the diagnosis – yet the disease took hold and destroyed him.  Perhaps he would have us add another subjective criterion to the addiction diagnosis: “have you been intellectualizing your substance use for 2 weeks or more”.  McCracken is adding confusion to the situation, and he appears to be doing it in an attempt to deceive himself, he’s trying to absolve himself of guilt by blaming the imaginary disease which presumably, as we’re told so often, “hijacked” his super genius brain.  He basically suggests that this makes him and and other smart people undetectable as disease sufferers.

It’s time to get back to common sense and treat substance use like any other choice. We need to honestly assess for ourselves the possible consequences of the choice, consult our values, and decide whether it’s worth the risk.  Drug use is risky behavior, so is skydiving, every so often a parachute fails and someone dies, but people who don’t skydive don’t die of parachute failures, and we don’t blame a disease for those who do suffer such a fate.  McCracken’s chute didn’t open, and now he’s trying to convince us, and more importantly, himself, that he was pushed out of the plane.

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