Transactional Analysis Journal

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Book Review: Diseasing of America: Addiction Treatment Out of Control

William F. Cornell
Transactional Analysis Journal 1991 21: 51
DOI: 10.1177/036215379102100107

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 Book Reviews
Barton W. Knapp, Editor
Diseasing of America: Addiction Treatment
Out of Control
Stanton Peele
Lexington Books, 1989
321 pp., $19.95
Reviewed by William F. Cornell
Stanton Peele, a social-clinical psychologist
who has devoted many years to research on ad-
diction, has written a blunt, forceful book
challenging the use of the concept of addiction
as a disease and of treatment models based on
addiction as a disease. Peele states his challenge
to the disease model clearly:
My view of addiction explicitly refutes
this (the disease) theory's contentionsthat
(1) the addiction exists independently of
the rest of a person's life and drives all
of his or her choices; (2) it is progressive
and irreversible, so that the addiction in-
evitably worsens unless the person seeks
medical treatment or joins an AA-type
support group; (3) addiction means the
person is incapable of controlling his or
her behavior. . . . Everything I oppose
in the disease view is represented in the
passive, 1984-ish phrase, alcohol abuse
victim, to replace alcohol abuser. On the
contrary, this book maintains that peo-
ple are active agents in-not passive vic-
tims of-their addictions. (p. 3)
The addiction treatment industry in the
United States is indeed out of control. Robert
Coles was quoted recently in the New York
Times as speculating that the addiction move-
ment might ultimately be offering support
groups for cousins of excessive sherry drinkers.
Recently I have been reading various books on
alcoholism and addiction in order to clarify my
own understanding and to help clients who are
often strongly influenced and confused by the
Vol. 21. No.1. January 1991
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explosion in the media and in print of addic-
tion/disease/co-dependency .,explanations" of
emotional, interpersonal, and behavioral
difficulties.
At the end of this review I have listed several
other books that offer carefully reasoned alter-
natives to the disease model of addiction and
to the misuse and oversimplification of the ex-
perience of addiction; each is worth reading.
I have chosen to focus here on Peele's book for
several reasons: It is well researched and
reflects many years of experience in the field;
he moves beyond a focus on alcoholism to ad-
dress the nature of the addictiveexperience; and
most importantly to me, he challenges the
political and economic basis of the current
popularity of addiction and disease. In addition
to his perspectives on addiction and its treat-
ment, Peele presents an eloquent challenge to
the politics and philosophy of mental health
care.
There is no doubt that Peele takes the ex-
perience of addictionand its often dysfunctional
consequences seriously. He does not deny the
existence of addiction as a phenomenon, but he
argues that it is a phenomenon that has little
to do with biology and nothing to do with
disease. According to Peele, "There is no
biological urge to form addictions, one that we
will someday find under a microscope and that
will finally make sense of all these different
cravings and idiocies" (p. 4). He mentions
George Vaillant's conclusion that we are as
likely to find a biological "cause" for
alcoholism as we are to find such a "cause"
for basketball playing.
Peele refers to the current trend toward ad-
dictive diseases as creating a third wave of
diseases in which behavior is the disease:
Disease conceptions of misbehavior are
bad science and intellectually sloppy.
Biology is not behavior, even in those
51
BOOK REVIEWS
areas where a drug or alcohol is taken in-
to the body. Alcoholism involves a host
of personal environmental considerations
aside from how alcohol affects the bodies
of drinkers. (p. 26)
He points out that the enormous range of ex-
periences that can become addictive argues
against the existence of a "disease" or genetic
defect. Recent books would have us believe that
we can become addicted not only to consum-
ing alcohol, but to using heroin, airplane glue,
cocaine, marijuana, numerous prescription
drugs, gambling, overeating, undereating,
shopping, exercise, being controlled by others,
controlling others, being abused by others,
abusing oneself, having sex without love, hav-
ing love without sex, or being in a symbiotic
relationship. Will researchers find a biological
marker, a genetic predisposition, for each of
these poor habits, or maybe just one big bad
gene?
Peele argues that addiction can take place in
any human activity, that addictions require ap-
petite and behavior. Addiction accomplishes
something for the addict, providing "ways of
coping with feelings and situations with which
the addict cannot otherwise cope" (p. 146). For
Peele, the addict chooses "easier, powerful,
and more immediate ways of gaining certain
crucial feelings such as acceptance by others,
or power, or calm . . . [rather than] . . . the
ordinary ways of gaining these feelings that
most other people rely on, such as work or
other typical forms of positive accomplish-
ment" (p. 147). He stresses that addiction in-
volves three necessary components-the per-
son, the situation or environment, and the ad-
dictive involvement or experience. He also
stresses that addicts as a group tend to feel
powerless and out of control in various aspects
of their lives, often before the onset ofany ad-
diction. He counters the premise that all addicts
carry a lifelongtendency or genetic vulnerabili-
ty to addiction.
In discussing the situational and environmen-
tal factors that increase the probability of ad-
diction, Peele sees difficult phases of life as in-
creasing the probability of addictive behavior
for anyone, and he outlines a variety of en-
vironmental, social, and cultural factors that
create addictive pressures (using the high fre-
quency of narcotics addiction during the Viet-
nam War as a frequent illustration). Peele ex-
52
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tensively quotes longitudinal research, blind
studies of alcohol and heroin addiction, and
cross-cultural studies to effectively debunk the
disease model beliefs that an alcoholic is an
alcoholic from the first drink and once an ad-
dict, always an addict. Peele sees addictive
behavior, to a substance or an activity, as
chosen behavior and behavior chosen repeated-
ly: "Addicts must indulge their addictions with
sufficientabandon to achieve the addicted state.
In so doing, they place less value on social pro-
perties or on their health or on their families
and other considerations that normally hold
people's behavior in check" (p. 148).
Peele's understanding of addiction is, of
course, clear in his approach to treatment. He
is a harsh critic of AA and of such hospital and
treatment "chains" as CompCare and
Hazelden, which began as alcohol treatment
programs and expanded the disease-based treat-
ment centers into such areas as drug
dependence, eating disorders, PMS, and sex-
ual addiction. Peele provides an interesting
history of the Alcoholics Anonymous move-
ment from its beginnings as a voluntary, self-
help, self-responsibility group through its
changes into an increasingly coercive and
medicalized approach. I found his critique to
be overly harsh and one which emphasized the
worst aspects of AA. In my own professional
experience, I have seen a number of AA
members who appeared to be as dependent on
endless meetings, smoking, and the availabili-
ty of their sponsors as they ever were on
alcohol, and I cannot say that their lives sober
looked much more effective or autonomous
than when they drank. I have, however, seen
more people-especially those who truly
"work" the Twelve Steps-make significant
improvements in their lives.
I consider Stephanie Brown's book, Treating
the Alcoholic: A Developmental Model of
Recovery, to provide a more balanced perspec-
tive on AA and a clear approach to integrating
AA with psychotherapy in order to facilitate
both sobriety and autonomy. Peele himself is
adamant that treatment approaches to addiction
need to provide "the opportunity to develop the
self-image of a 'regular person' -a person with
a normal range of problems, but not one ready
to go off the deep end of addiction at the
slightest provocation" (p. 198).
Peele sees the crucial ingredients for
Transactional Analysis Journal

transcending addictive appetites as the develop-
ment of self-efficacy (the feeling that a person
can control the outcomes in life that matter to
him or her), intrapsychic change (reconcep-
tualization of who you are, what is good for
you, and how you wish to live-script analysis
and redecision in TA language), and real life
changes in values and coping skills. Peele thinks
that the most effective approaches to addiction
treatment are rarely used in the United States
because they require a basic challenge to social
and political forces: "The few therapies that are
effective succeed because they work to change
real socialforces in people's environments. These
forces include work opportunities, family and
community supports, and the moral and values
atmosphere (and rewards and punishments) in
people's lives" (p. 250).
I could not read this section of the book
without thinking of the profound absurdity of
Ronald and Nancy Reagan's "Just Say No"
solution to the drug problem in America while
modeling and sanctioning utterly self-indulgent
life styles with no attention paid to the economic
and social consequences.
The model Peele presents for addiction treat-
ment is based on the model developed for the
treatment of family violence, centering on three
elements:
(1) Hold the violent (addicted) person
personally responsible for his or her
violent (addictive) actions and stress that
the person is capable of ceasing;
(2) Monitor the violent (addictive) per-
son's behavior;
(3) Create a moral atmosphere in
counseling sessions that clearly indicates
that physical violence and emotional
abuse (addictive behavior) are not ap-
propriate or excusable.
Peele stresses that counseling techniques
should "enhance people's ability to cope with
their environment and to express constructive-
ly their feelings and problems," that the legal
system "must express direct disapproval ...
while accepting-and demanding-that abusers
can change, and local communities should help
... deal with marital and family stress" (p.
261). Peele outlines, in his chapter entitled
"Creating a World Worth Living In," a group
of values which he sees as clear antidotes to
addiction and as necessary attitudes in a treat-
ment program: achievement and competence;
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BOOK REVIEWS
consciousness and self-awareness; energy and
activity; health; responsibility and self-
regulation; self-respect; intimacy; and
community.
In the chapter I found most moving, "How
We Lost Control of Our World, " Peele writes
that "having faith that the world is a place
amenable to our control and that other people
are well-meaning and can be befriended is an
essential component of mental health and nor-
mal human development" (p. 252). He refers
to the long-term epidemiological research of
Leonard Sagan-reported in The Health ofNa-
tions: True Causes of Sickness and Well-
Being-in identifying the two key human fac-
tors in the extension of health and well-being:
community and family supports, and the sense
that people have developed that they can con-
trol their destinies, both as individuals and as
communities or societies. I was often touched
by Peele's writing about community and the
sharing of communal and individual
responsibility.
I thought back on my initial attraction to TA,
to Eric Berne's emphasis on group supervision
and group treatment, collegiality, and respect.
Berne wanted TA therapists to be "real doc-
tors," not because he thought clients were
•'real sick" as in the disease model, but because
he knew there was real work to be done with
real responsibility. I was drawn to the com-
munal models of Asklepieion, Cathexis, and the
Radical Therapy movements, wildly differing
in technique but conscious of the power of
social forces and interpersonal responsibility.
The closing chapters of this book provoked a
period of deep self-reflection. Even therapists
with no particular interest in addiction-though
addiction is hard to escape in the current
climate-should find the closing chapters of this
book thought provoking.
I close this review of The Diseasing of
America with a quote from the opening pages
of the book:
I propose in this book a vision of life op-
posed to the disease-infested one that we
are being sold. In so doing, I discuss the
scientific, psychological and moral
underpinnings of the two views of being
human. I argue that the human being and
society are self-correcting mechanisms,
that knowledge and experience are the
best ways people have for learning how
53
BOOK REVIEWS
to behave healthily, that interactions with
parents are the most important influences
on children, and that the best way to curb
misbehavior is to insist on standards of
decency. If we cannot persuade our
children that they have the capacity to
manage their lives and that the world is
worth living in-and then work to create
a world in which this is true-medical
treatments will expand endlessly but will
not be able to help us. (p. 29)
BIBLIOGRAPHY
Brown, S. (1985). Treating the alcoholic: A developmen-
tal model of recovery. New York: Wiley-Interscience.
Fingarette, H. (1988). Heavy drinking: The myth of
alcoholism as a disease. Berkeley: University of Califor-
nia Press.
Levin, J. (1987). Treatment of alcoholism and other ad-
dictions: A self-psychology approach. New York:
Aronson.
Sagan, L. (1989). The health of nations: True causes of
sickness and well-being. New York: Basic Books.
Steiner, C. (1979). Healing alcoholism. New York: Grove
Press.
Volger, R., and Bartz, W. (1982). The better way to drink:
Moderation and control ofproblem drinking. Oakland,
CA: New Harbinger Publications.
William F. Cornell, M.A., is a Certified
Transactional Analysis Instructor and Super-
visor. He maintains a private practice in TA
treatment and training in Pittsburgh and Gib-
sonia, Pennsylvania, USA.
Getting The Love You Want: A Guide
For Couples
Harville Hendrix
Harper & Row, 1990
296 pp., $8.95 (paper)
Reviewed by Barton W. Knapp
Many transactional analysts recognize that
people fall in love and marry for reasons that
are often obscure to them. A colleague and I
have frequently remarked that "marriages are
made in script-not in heaven," and this is a
basic tenet of Getting The Love You Want. Hen-
drix's position is that many people enter into
what he calls" 'The Unconscious Marriage'
... a marriage that includes all of the hidden
desires and automatic behaviors that are left
over from childhood and that inexorably lead
couples into conflict" (p. xvii).
The primary focus of this book is on the
54
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"relics of the past" in each partner which im-
pact a relationship and on identifying tools that
can help reduce the negative influence of these
relics. Hendrix, who has a bachelor of arts, a
bachelor of divinity, and a doctorate in
psychology and religion, is a Certified Member
of the ITAA, a full member of the American
Group Psychotherapy Association, and is a
Diplomate of the American Association of
Pastoral Counselors. He has also been married
twice. He draws upon his educational
background and his professional training/ex-
perience as well as on his personal experiences
as he talks to the reader.
In his introduction, Hendrix says:
In today's society, you are encouraged
to view marriage as a box. First you
choose a mate. Then you climb into a
box. Once you've had a chance to settle
in, you take your first close look at your
boxmate. If you like what you see, you
stay put. If you don't, you climb out of
the box and scout around for another
mate. In other words, marriage is viewed
as an unchanging state, and whether it
works or not depends upon your ability
to attract a good partner. The common
solution to an unhappy marriage, the one
chosen by nearly fifty percent of all
couples, is to divorce and start allover
again with a new and, hopefully, better
mate. (p. xiii)
In Part I Hendrix explores and identifies
some important aspects of relationships-the in-
itial attraction, romantic love, and a power
struggle. He suggests that the familiar details
of married life can be viewed as an emerging
psychological drama: "I call this drama 'The
Unconscious Marriage,' and by that I mean a
marriage that includes all the hidden desires and
automatic behaviors that are left over from
childhood and that inexorably lead couples in-
to conflict" (p. xvii).
He develops this theme in an appealing way,
one which expands the reader's understanding
of the complex psychological, social, and
neurological processes involved in human
development. For example, he contrasts the
functioning of two areas of the brain. The "old
brain"-the brain stem and the limbic
system-has no concept of time, only a hazy
awareness of the external world, and has as one
of its basic functions ensuring the individual's
Transactional Analysis Journal