Prelude to a Paradigm Shift for Addiction - Chapter One: New Conversation
Need for a Paradigm Shift
We are in the beginning stages of a paradigm shift, a conceptual revolution in this country and even globally, concerning our fundamental understanding and treatment of substance use disorders, of individuals suffering from drug and alcohol addiction. This paradigm shift or conceptual revolution is much needed and long overdue in the industry where I work, our society, and the global community. As with any paradigm shift that has taken place in human history, this revolutionary process will likely take time and will be met with a great deal of resistance from many individuals, treatment programs, and organizations. Given the lack of effectiveness of current treatment methods and programs, the need for this conceptual change is undeniable. This document will be a prelude to our culture's inevitable need for a change and transformation concerning our understanding of drug and alcohol addiction and how to treat this disorder effectively and efficiently.
I use the word prelude to a paradigm shift for a specific reason. The current operating paradigm in service today has been in place and functional for many years and has successfully traveled the epistemic journey from idea, thought, or concept to belief to the truth. The foundation of our current understanding of drug and alcohol addiction and dependency and the programming it has generated is perceived by many individuals, not as conceptual or theoretical but as entirely factual. The reigning understanding of addiction and dependency is not only believed to be the truth but something fully supported by science and, therefore, beyond question. When I introduce the thought of a prelude to a paradigm shift, I fully acknowledge this situation and refer to this writing as the beginning of a conversation about a new way of considering and understanding addiction studies and treatment programming. This document presents more of a hypothesis for consideration, a proposed alternative explanation that will serve as a starting point and guide for further investigation and discovery.
Thomas Kuhn and a Paradigm Shift
In his book, The Structure of Scientific Revolutions, the American physicist and philosopher Thomas Kuhn first introduced the concept of a paradigm shift in 1962. A paradigm shift is a fundamental change in a scientific endeavor or discipline's theoretical assumptions or basic presuppositions. The need for change happens when various anomalies confront the predominant way of understanding an event or phenomenon, which is eventually altered or replaced with a new and different way of conceiving the discipline. When this new understanding is accepted, a paradigm shift occurs. Anomalies are a phenomenon that cannot be explained by the current operating paradigm, which eventually signals the need for a change in the perception of the discipline in question.
Regardless of the field of study, whether it be physics, medicine, psychiatry, or psychology, the need for a paradigm shift can also arise when the accepted or ruling paradigm used is proven or believed to be insufficient or inadequate based on its practical utility or the efficacy of that working paradigm. Epistemic and practical problems can necessitate the need for a paradigm shift. When a paradigm shift occurs, a fundamentally new way of thinking or cognitive framework is created concerning the discipline. At this point, the discipline in question begins to achieve a breakthrough. As Kuhn stated: "All significant breakthroughs are breaks - "with" old ways of thinking." Eventually, creating a new paradigm will necessarily influence the practical nature and operations of the discipline in need of change.
Specific facts prompt the need for a paradigm shift.
The need for a paradigm shift in addiction studies and treatment is being prompted by several critical factors, most noticeably by the rising number of individuals using drugs and alcohol each year, the steady increase in the daily death toll from drug and alcohol overdoses, and most importantly by the ineffectiveness of society and the treatment industry to be able to help resolve this devastating and escalating social problem. Every day, more individuals are starting to use drugs and alcohol, and more addicts and alcoholics are dying from drug and substance use overdoses than ever before.
According to the CDC's National Center for Health Statistics, it is estimated conservatively that 46,802 deaths were attributed to drug overdoses in 2018, 62,172 in 2019, and another 93,655 individuals died due to substance use overdoses in 2020. It is estimated further that another 107,622 individuals died from a drug overdose in 2021. Another 109,680 individuals are reported to have died in 2022 due to drug overdose. It is currently estimated that the death toll in 2023 will be even higher than in 2022. For various reasons, the death toll due to substance use overdoes is likely to be much higher than has been reported by treatment programs throughout the country, organizations, and governmental agencies.
What is being done to help does not work.
It appears that little, if anything, that is currently being done to help addicts and alcoholics has had any positive, lasting effect on stopping or even reducing the devastation that is now taking place in our society and throughout the world. According to the outcome studies that have been compiled, the treatment industry appears to be very inadequate in helping to provide any actual resolution to this serious, lethal, social, medical, and psychological problem.
The government estimates that at least 60% of those treated in programs relapse shortly after residential treatment, and up to 90% relapse during the first year after treatment. These percentages are uniform amongst treatment programs throughout the country. In addition, many treatment programs resist reporting accurate outcome data due to the negative impact it might have on their agency's financial viability. Efforts are being made to hide the truth about the treatment outcome from the public.
Nevertheless, as information is shared and integrated, we are slowly coming to understand and even admit that what we have been doing in the past and are currently doing in the present for those suffering from substance use disorders has not and will not work. Some professionals even believe that nothing can be done to change the trajectory of this disorder, leaving little hope for the addict or alcoholic suffering from addictive behavior. The future for those suffering from substance use disorders does appear dismal.
However, it is certain that if we continue to provide the same type of treatment we have offered in the past to those currently suffering from drug and alcohol dependency, we will inevitably continue to achieve the same poor results. While the fundamental problem of drug and alcohol studies and treatment is epistemic, I also believe the current dilemma can be changed and a solution created. However, doing so will ultimately require developing a different perception of the problem and a paradigm shift to resolve it.
The current understanding of addiction and dependency.
The current operating paradigm used to explain drug and alcohol addiction and that which necessarily influences the development of treatment interventions and programming is primarily physiological, essentially the same that is currently employed in the field of medicine. For example, many believe that the real problem of addiction is that of a diseased brain. It is thought that the brain of an addict and alcoholic is considered different from a nonuser and, with continued drug and alcohol usage, will become even more damaged. Various external factors, like trauma, stress, peer pressure, sexual and physical abuse, and exposure to drugs and alcohol, are some of the environmental events that are believed to help exacerbate the development of drug and alcohol dependency.
Our current understanding of addiction and drug and alcohol dependency also believes that an individual is not responsible for his addiction and dependency upon drugs and alcohol, that it is something that happened to him. In addition, the current paradigm does not believe that the addict or alcoholic has had any choice in creating his use and dependency upon drugs and alcohol and that his current situation has not been intentional or purposeful in any manner. Contemporary addiction theory and practice also believe that the addict or alcohol does not have the power to transform their life, that he is essentially powerless concerning his "disease."
As a result of our current paradigm for understanding addiction and dependency, there is also no cure or solution to the addict and alcoholic's present problem or dilemma. It is assumed that the addict and alcoholic have a disease and that this disease of the brain is the cause of their affliction. According to the accepted theoretical and practical orientation to substance use and addiction, no importance is given to our thinking or the human mind. Still, instead, the human brain is the primary problem. The current conception of drug and alcohol addiction states that the disorders or addictive behaviors result from a disease of the body with nothing to do with our thinking or the human mind.
Treatment evolves out of our understanding of the disorder.
.Regardless of the field of endeavor, all treatment modalities evolve initially out of the conceptual understanding of the disorder being treated. It is from what we believe the problem to be and precisely what we think is the fundamental cause of a disorder that we develop or create an intervention to resolve or heal the problem. Suppose our treatment of a particular disorder is ineffective with a low success rate. In that case, it is reasonable to assume that our understanding of the problem is inadequate and needs to be revised or changed.
The effectiveness of our current way of treating substance abuse disorders is no longer a debate but a fact. As stated, what we currently do to help addicts and alcoholics does not work and has not worked. The fundamental problem of drug and alcohol dependency is our understanding of addiction. As we continue to use the same way of thinking about addictive behavior and, as a result, utilize the same interventions to treat these disorders, we should expect to continue to generate the same disappointing results. As Albert Einstein once said: "Insanity is doing the same thing over and over and expecting different results."
The proposed paradigm will confront commonly held beliefs.
The specific nature of the paradigm that I will propose, which I believe is needed now more than ever in addiction studies and the treatment industry, will necessarily confront some of our consensually validated beliefs and basic assumptions about our current understanding and treatment of drug and alcohol addiction, about substance use disorders and possibly all other addictive behaviors. I believe that in the process of exploring their efficacy and, as a result, the inadequacy of the current foundation of substance use treatment, we will be better able to create a new and more adequate paradigm or framework for better understanding drug and alcohol addiction thereby allowing us to begin to develop more effective intervention modalities.
Further, we have come to a point in our history where this ideational confrontation is unavoidable. This confrontation will create a breakdown in our current way of thinking about addiction. With this breakdown, the space will be created for a conceptual breakthrough to emerge. It will be from creating a new, more adequate understanding of the problem of addictive behavior that more effective and efficient treatment modalities will eventually and necessarily arise. As stated above, our current problem with understanding and treating addictive behaviors and disorders is epistemic at its foundation. We do not have adequate knowledge of drug and alcohol addiction and dependency and, as a result of our collective ignorance, do not know how to help those suffering from these potentially lethal disorders to heal their life.
The resistance to change will be substantial.
The resistance to the change I am proposing concerns our present understanding of addiction and dependency, and the eventual creation of a paradigm shift that will transform our treatment of substance abuse disorders will most likely be substantial. Our currently accepted ideas, thoughts, and beliefs about substance abuse disorders and the treatment of drug and alcohol addiction will most assuredly continue to resist change regardless of what the empirical facts found in research have revealed.
Some of the resistance to a transformation of our thinking about addiction and dependency will be rooted in the ego of many individuals in society, in their desire to hold onto certain beliefs about the recovery process regardless of their validity and efficacy, and in the treatment industry, where much of the resistance will most likely have a financial, monetary basis. Even though the opposition to my proposed paradigm shift will be considerable, staying fully committed to the truth and its implementation is our only hope for a transformation that will be of genuine service to those suffering.
While resistance is inevitable and part of the process of change and progress, the old commonly accepted concepts and belief systems must be confronted and eventually let go of absolutely if we move forward in effectively and efficiently helping those afflicted with this dis-ease. We will not and cannot progress in addiction studies and the treatment of substance use disorders if we continue to utilize the same conceptual foundation that we have used in the past and are currently operating under in the treatment industry. For progress to be experienced, change must be inevitable.
A conversation about a new paradigm
In this document, I will also discuss some of the fundamental ideas of what I think the new paradigm will eventually need to be if we are to come to an adequate understanding of drug and alcohol addiction in our country and possibly throughout the world and most importantly of how to treat these disorders effectively. I believe that the concepts that must be confronted and changed involve our current beliefs about the addictive nature of drugs and alcohol, the disease concept that permeates society and the drug and alcohol industry, the accepted concept about the cause of addiction and dependency, the ideas and concepts of choice and responsibility concerning those individuals suffering from drug and alcohol addiction and finally, about the belief that there is no real solution or cure to substance abuse disorders.
The new paradigm will not rest on a physiological foundation but, instead, a psychological one that will be grounded in the psychology or mental health of the individual. The bottom line is that we need to understand the real cause of addiction. Until we do so, we will continue to treat ineffectively and incompetently those suffering. As expressed in some of the recovery literature, substance use disorders are of the mind and not of the body, and to heal from these disorders will require a transformation of thought and attitude. However, this critical postulate needs to be adequately understood and clearly articulated, and a distinction must be developed and accepted by the recovery movement and not ignored practically. Nevertheless, to continue to treat those suffering from drug and alcohol addiction in the same manner that we currently are today is inexcusable. We must change our conversation about substance use disorders so that we can stop today's self-inflicted slaughter.
The new paradigm will be based on three concepts.
The new paradigm I am proposing will revolve around three basic psychological concepts: responsibility, choice, and power. In the new paradigm, an individual will be perceived as entirely responsible for all his experiences, everything that he thinks, says, feels, and does, including and especially for creating his addiction to drugs and alcohol. It will also be suggested that this individual chooses all his experiences, including his drug and alcohol addiction and dependency. Given his responsibility for the creation of all of his experiences, the individual who suffers from drug and alcohol addiction also has the power to transform, to change the trajectory of his life, to stop using drugs and alcohol, and never use again.
I believe that our thinking, especially our thoughts and beliefs about ourselves, about our value and worth as human beings, our self-image, is that which determines and structures our sense of responsibility to ourselves and the world, the choices that we make from moment to moment and the belief about our inner power to change our life. When we create a positive self-image, we accept responsibility, choose choice, and fully experience and utilize our power to transform our life. Transformation is not determined by any external factor, by other people, places, or things, but rather by the proper operations of the individual's human mind. As such, transformation and recovery have an internal locus of control and not an external locus of control.
The actual solution for drug and alcohol addiction
The solution for those suffering from drug and alcohol addiction will happen when and only when the addict and alcoholic changes his self-image, which is primarily negative to one that is genuinely positive. When this cognitive or psychic change occurs, the individual suffering from a substance use disorder will come to authentically accept, approve, appreciate, respect, and, most importantly, love himself. While this change will take time, achieving it is possible, especially with a total commitment to the conversation of transformation.
The solution is not about changing any other person, place, or thing but only about transforming the individual's cognition, thinking, and beliefs about who and what he thinks he is. This transformation will occur when the addict and alcoholic experiences his actual value and worth as a result of him coming to believe and feel that he matters, that he is perfect, whole, and complete just the way he is in the present moment. This inner work is the proper foundation of the psychic transformation we seek and will create a consistent and lasting state of being happy, joyous, and free.
Rising number of individuals with substance use problems
I believe the acceptance and implementation of the new proposed paradigm for addiction studies and the treatment industry will also begin to have a positive, transformative impact on the rising number of individuals using drugs and alcohol each year. The new paradigm proposes that drug and alcohol addiction and dependency and all addictive behaviors, in general, are caused by a negative self-image and poor self-esteem. The root cause or genesis of all addictive disorders was born years before the individual created the harmful and destructive addictive behavior.
By focusing on helping the youth of this country improve their self-image and self-esteem, learn how to think positively about themselves, and, as a result, respect and love themselves authentically, I believe that the number of those who begin to resort to drugs and alcohol usage would eventually drop dramatically. The financial and emotional damage resulting from drug and alcohol addiction and dependency could be significantly reduced if we adopt a new paradigm for understanding and treating the foundation of the disorder. If we treat the real root cause of addictive behavior early enough, the social and personal devastation could be significantly reduced if not eventually eliminated.
The belief that addiction is complicated
Many people in society and the treatment industry also believe addictive behavior is very complicated and challenging to comprehend fully. Many also think the complex understanding of drug and alcohol addiction makes it difficult to adequately convert our current knowledge of substance use into an effective and efficient treatment program or intervention. I believe that part of our failure to help addicts and alcoholics effectively is also to be found in our reasoning about this issue, in our belief that addiction is complicated.
With our belief in the necessity of complication, I believe that we fail in our efforts to know about and effectively treat those suffering from addictive disorders. Feeling that something is so complicated is more about our collectively not knowing than the subject we refer to. I think that the issue of addiction is very simple to understand and that once it is adequately articulated, a clear path to change and transformation will be revealed to us. From this new understanding, we can finally provide powerfully effective treatment modalities for those suffering from substance use disorders.
Understanding addiction is simple.
I believe that understanding and treating addicts and alcoholics is not complicated but relatively simple. What if the cause and the solution of substance use problems were to be found within the same place, in the individual's mind, his thinking process, within the individual's thoughts and beliefs, especially with those thoughts and beliefs about the individual's value and worth as a human being? I believe that our obsessive focus on drugs and alcohol and our confidence in and attachment to a physiological disease model of addiction has distracted us from looking in the appropriate place to understand this problem correctly.
Dr. Wayne Dyer once stated that even though he dropped the keys to his car inside his house where there was no light, after becoming frustrated with not immediately finding them, he thought it would be easier to look for them outside where there was light under a lamp post. Dr. Dyer's point in his story was that we tend to look outside ourselves for the problem and its solution when both are only to be found inside us where they genuinely exist and were initially created. When we eventually look in the correct place, we will understand that addiction and dependency on drugs and alcohol are very simple to comprehend and that what is required to transform is simply a change in our current thinking, thoughts, and beliefs about addiction and dependence.
There is real hope that people can end their addiction.
I also believe that there is a real solution and cure to drug and alcohol addiction and dependency. A person can end and extinguish their use of drugs and alcohol forever if they are taught how to do so and how to accept that they are entirely responsible for their use through the choices that they make about the thoughts and beliefs that they come to accept and believe, especially those they have about themselves. Even though the thoughts they chose in the past continually tell them they are not good enough, they have the power to change and to think and believe positive ideas about themselves. When an individual comes to understand this process fully, they will be in a position to transform their life and end their addictive behavior.
Dr. Wayne Dyer also stated that when we change how we look at something, the something that we look at changes. We need a change concerning our understanding of what addictive behavior is all about and how to effectively treat and assist addicts and alcoholics in changing and transforming their lives. The new paradigm I am proposing will provide real hope to those suffering, hope that life can be different and that they do not have to continue the way they have been being and living their life. Those suffering from substance use disorders must know they have the inner power to change and transform their lives, to stop using drugs and alcohol forever, and that this power rests in them transforming their thinking, their thoughts, and beliefs about their value and worth as a human being.
Prelude to a Paradigm Shift for Addiction
Dr. Harry Henshaw
Book by Dr. Harry Henshaw is for sale on Amazon: https://www.amazon.com/Prelude-Paradigm-Shift-Addiction-Henshaw/dp/191718560X