THINKING ABOUT DRINKING: THE POWER OF SELF-FULFILLING PROPHECIES [Presented at the 1995 Conference for Treaty 6 First Nations of Alberta entitled "Alternative Approaches to Addictions & Destructive Habits," at Edmonton, Alberta, November 7, 1995. Reprinted by permission from The International Journal of Drug Policy, Volumbe 7, No. 3, 1996, pp. 187-192] Jeffrey A. Schaler, Ph.D. Adjunct Professor Department of Justice, Law and Society School of Public Affairs American University Washington, D.C. Summary Self-efficacy is people's confidence in their ability to achieve a specific goal in a specific situation. For example, the more people believe in their ability to moderate their use of drugs, the more likely they will be able to moderate. The inverse is true too: The more people believe in their inability to moderate their use of drugs, the more likely they will not be able to moderate it. These facts are important because most treatment programs focus on abstinence, and they teach people to believe that they lack the ability to moderate their drug use because of a mythical disease called drug addiction. Unfortunately, the more treatment programs convince clients that this is true, the more likely the clients are to prove them "correct." Teaching that addiction is a disease creates a self-fulfilling prophecy: If people believe they are powerless they are likely to act powerless. This article focuses on the importance of teaching people that they have the power to change their behaviors and the political environment they live in. We need to create a new self-fulfilling prophecy: If people believe they are powerful they become powerful. Thinking About Drinking: The Power of Self-Fulfilling Prophecies The beliefs people have about addiction--what they think about drinking, for instance--have a powerful effect on their behavior. This relationship between belief and behavior is known as a self-fulfilling prophecy. The more people believe in their ability to moderate their consumption of drugs and alcohol, the more likely they will moderate. The inverse is true too: The more people believe in their inability to moderate their consumption of drugs and alcohol, the more likely they will not moderate. The beliefs of addiction-treatment providers are important as well. What we believe about drugs, addiction, disease, authority, and personal and "higher" powers largely dictates our behavior toward clients. Knowing more about the beliefs treatment providers hold dear can thus help us to build better treatment policies. In my research on the beliefs addiction-treatment providers have about addiction, I have observed a conflict about what addiction is and isn't, which is known as "the disease-model controversy." Regardless of whether treatment providers' beliefs about addiction are true or false, rational or irrational, those beliefs largely shape their actions. One example is the influence of adults' beliefs on the nature of drug-use prevention programs for children. Our children are taught false information about drugs and addiction. They are the targets of scare tactics by anti- drug fundamentalists. We know that many children discount anything adults tell them about the dangers of drug use. That's because children know that much of what they're taught is false. They see their friends and others using drugs with consequences different from the ones they're taught to expect. As a result of that misinformation, adults' credibility with children is diminished, with dangerous results. In other words, by teaching certain myths about drugs in often coercive ways, e.g., that drugs are universally-addicting substances and that drug users are sick, anti-drug propagandists succeed in teaching children something completely different from what they originally intended to teach them, i.e., that people cannot hurt themselves with drugs. Moreover, they fail to understand that children learn more from the way adults think and behave than from what they say. Something similar has happened in our attempts to help drug users in what is called addiction "treatment." Because treatment is based on certain beliefs people assert as truth about addiction, treatment is a disaster--it's a problem masquerading as a solution. In other words, our inaccurate and essentially religious-based beliefs about addiction become self-fulfilling prophecies (Schaler, 1996). Yet the prophecies created are the exact opposite of those treatment providers allegedly intended to create. We are moving in reverse in the name of moving forward. It is important to clarify two terms: addiction and self-efficacy. The literal definition of addiction simply means someone likes to do something, moves toward something, someone, etc. It means we choose to say yes to something, to some experience or activity (Schaler, 1991). As Alexander and Schweighofer (1988) pointed out several years ago, addiction can be positive or negative, drug or non-drug related, and characterized by tolerance and withdrawal or no tolerance and withdrawal. A positive addiction enhances the values we hold dear. Through a positive addiction we pull our life together, creating meaning and purpose. Obviously, that sense of meaning and purpose varies from person to person. A negative addiction pulls our life apart. By engaging in a negative addiction we live in conflict with ourselves, which again bears on the sense of meaning and purpose in our lives. One of the most powerful addictions we almost all experience at one time or another is of course love. Peele and Brodksy (1975) have written extensively about this. Love is a non-drug experience, and it is certainly characterized by physical symptoms of tolerance and withdrawal. As in a relationship characterized by love, many people use allegedly addicting drugs for long periods of time, choose to give up those drugs, and experience virtually no symptoms of withdrawal and tolerance, let alone irresistible cravings causing them to continue to use drugs at any expense. Another important concept in contemporary psychology is self-efficacy. Technically, self-efficacy is people's confidence in their ability to achieve a specific goal in a specific situation. It refers to the capability people believe they possess to effect a specific behavior or to accomplish a certain level of performance. Self-efficacy is not the skills one has but rather one's judgment of what one can do with those skills (Bandura, 1977, 1986). As Bob Dylan sang: "You don't need a weatherman to know which way the wind blows." You don't need psychologists to know that having confidence in your ability to achieve something for yourself has a lot to do with whether you will actually make the effort to succeed at something you set your mind to do. While self-efficacy is a scientific concept, tested by psychologists in various settings, it is also common sense. When you believe you can do something, you are more likely to be successful at it. When you believe you cannot do something, you are more likely to be unsuccessful at it. That sounds simple enough. We tend to do what we believe we can do. We tend not to do what we believe we cannot do. This thinking can be applied to the consumption of drugs and alcohol. Doesn't it make sense to say that the more people believe in their ability to moderate their consumption of drugs and alcohol, the more likely they will be to moderate? The inverse is true too: The more people believe in their inability to moderate their consumption of drugs and alcohol, the more likely they will be not to moderate. Most treatment programs for drug addiction teach people to believe they lack the ability to moderate their consumption of drugs. The more treatment programs convince clients this is true, the more likely the clients are to prove them "correct." That's because consuming drugs irresponsibly (like consuming drugs moderately) involves the intention to do so. There is no force alien to oneself that is responsible for one's behavior. Believing a disease makes people drink is illogical; it ignores empirical findings on self-efficacy. It goes against common sense. It also individualizes and de- politicizes the cultural context within which drug consumption occurs. While treatment providers routinely "diagnose" drug users as being in denial, they deny the fact that treatment generally doesn't work. At best, treatment tends to be as effective as no treatment at all (Edwards et al., 1977). This failure likely has a lot to do with the beliefs of treatment providers and their attempts to brainwash clients. It might be useful to look at the development of their beliefs historically (Levine, 1978). In Colonial America there was no such thing as alcoholism. People drank a lot and drinking was encouraged by ministers and physicians alike. Alcohol was called "the good creature of God." Problems with excessive consumption were attributed to social interaction, i.e., who the drinker was drinking with and where they drank, e.g., a particular tavern. Gradually, religious leaders started calling excessive drinking a sin, an indication the drinker was indulging in "lust" and "passions." In 1785, Benjamin Rush, a signer of the U.S. Declaration of Independence and the "father of American psychiatry," invented (not discovered) the idea that alcoholism is a disease. This was part of a trend of Dr. Rush's to medicalize socially deviant behavior. Religious leaders pushing the "sin" model of alcoholism welcomed his authority. Then the members of what came to be known as the "temperance movement" integrated those sin and medical models of alcoholism, claiming Rush as their founder. This new view of alcoholism culminated in Prohibition. During that time alcohol was considered universally addicting. Anybody who drank would become an alcoholic. Drinking problems were attributed to the alcohol itself. Drinking was a sin that caused a disease. The "good creature of God" had become "demon rum," "that engine of the devil." Since alcohol was universally addicting, prohibition was the only "cure." Prohibition failed for many reasons. One seldom mentioned is the myth that alcohol was universally addicting. People realized that most people drank responsibly. People did not believe the temperance movement's propaganda about alcohol and drunkenness. Next, alcoholism was decriminalized through re- medicalization. Immediately after the repeal of Prohibition in 1933, Alcoholics Anonymous (AA) was founded as a self- help, spiritual fellowship for heavy drinkers. AA advanced "new" beliefs about alcoholism that actually weren't new at all: They were recycled beliefs from the temperance movement masquerading as medical discoveries. AA did invent the idea that 10 percent of the population had something wrong with their bodies which was called the disease of alcoholism. It allegedly kept people from being able to control their consumption of alcohol. For them, prohibition was still needed, only this time it was politically incorrect to call such a recommendation "prohibition." So AA and others called it "abstinence." Ever since, AA members and supporters have been seeking scientific validation for the idea that alcoholism is a disease. The cornerstone of the disease concept of alcoholism (and now addiction generally) is that the person afflicted with this mythical disease can never learn to control his or her consumption of alcohol and other universally- addicting drugs. That part of the disease concept is the loss-of-control theory. While it remains a potent idea in most addiction-treatment practice and policy today, it has been repeatedly disproved scientifically since the early 1960s. AA and other 12-step recovery programs are the foundation of most addiction-treatment programs in the United States and Canada today. Many people consider these treatment programs to have more in common with religious indoctrination than with objective medicine. And U.S. courts are increasingly viewing state involvement with 12-step programs as violating the U.S. Constitution's First Amendment--the free exercise and establishment clauses guaranteeing separation of church and state (Luff, 1989; Murray, 1996). Here's the "holy trinity" of the disease concept of addiction: To get better you must turn over your life to a "higher power." This "higher power" can be anything as long as it is not you. (Ironically, self-empowerment is a sin according to the disease concept.) You must "admit" that you are powerless and that you have a disease. And you must never consume drugs again (prohibition or abstinence). Today, the main beliefs of disease-model thinking are (Schaler, 1995, 1997): 1. Most addicts don't know they have a problem and must be forced to recognize they are addicts. 2. Addicts cannot control themselves when they drink or take drugs. 3. The only solution to drug addiction and/or alcoholism is treatment. 4. Addiction is an all-or-nothing disease: A person cannot be a temporary drug addict with a mild drinking or drug problem. 5. The most important step in overcoming an addiction is to acknowledge that you are powerless and can't control it. 6. Abstinence is the only way to control alcoholism/drug addiction. 7. Physiology, not psychology, determines whether one drinker will become addicted to alcohol and another will not. 8. The fact that alcoholism runs in families means that it is a genetic disease. 9. People who are drug addicted can never outgrow addiction and are always in danger of relapsing. It's important to understand that none of these beliefs has been proved scientifically. Not one of them. In fact, they are consistently proved false. Yet these beliefs dominate addiction-treatment programs throughout the world. Now consider each of these beliefs within the common-sense context of self-efficacy principles. Believing in the above myths is likely to cause treatment failure. In other words, teaching people in treatment for addiction problems that they "don't know they have a problem" creates a problem for them. Teaching them that they cannot control themselves convinces them that they cannot control themselves. Teaching them to believe that treatment is the only solution to their problem convinces them that they cannot solve problems on their own. It reinforces dependency. Teaching them that addiction is all- or-nothing brainwashes them into believing they can never be anything other than sick. Teaching them that they are powerless enables them to act powerless. Teaching them that abstinence is the only way to control their addiction convinces them that whenever they are not abstinent, they are out of control. Then, when they drink, they do go out of control. There is no middle ground. Teaching them that they are physically different from "normal" people gives them permission to act irresponsibly when they consume too many drugs or too much alcohol, as does teaching them that alcoholism runs in families. Teaching them that they can never mature out of their addiction and are always in danger of relapsing makes them feel hopeless and helpless. Their behavior is determined by their beliefs. There is nothing they can do about it! In fact, there is nothing they can ever do to change their behavior except abstain and pray. The common-sense concept of self-efficacy is consistent with the Navajo concept of "hozho, the most important concept in traditional Navajo culture, which combines the concepts of beauty, goodness, order, harmony, and everything that is positive or ideal" (Carrese and Rhodes, 1995). Navajos say "'Think and speak in a positive way.' This theme is encompassed by the Navajo phrases hoshooji nitsihakees and hoshooji saad. The literal translations are 'think in the Beauty Way' and 'talk in the Beauty Way.' The prominence of these themes reflects the Navajo view that thought and language have the power to shape reality and control events...[They reflect] the Navajo view that health is maintained and restored through positive ritual language." Providers should "avoid thinking or speaking in a negative way. This theme is approximated by the Navajo phrase, 'DooUdjiniidah.' The literal translation is 'Don't talk that way!'" (ibid.). Reconsider the nine beliefs integral to disease-model thinking, and reconsider treatment failure--and even consider irresponsible drug use. From the self-efficacy, scientific and Navajo points of view, not only are disease-model beliefs inaccurate, they are destructive. The disease model creates more of the very problems it allegedly solves. In other words, its nine beliefs become self-fulfilling prophecies. What can we replace those beliefs with? How about the truth about addiction and recovery? How about ideas consistent with the self-efficacy, scientific, and Navajo points of view? The following beliefs based on the free-will model of addiction meet those criteria: 1. The best way to overcome addiction is to rely on your own willpower. 2. People can stop relying on drugs or alcohol as they develop other ways to deal with life. 3. Addiction has more to do with the environments people live in than with the drugs they are addicted to. 4. People often outgrow drug and alcohol addiction. 5. Alcoholics and drug addicts can learn to moderate their drinking or cut down on their drug use. 6. People become addicted to drugs/alcohol when life is going badly for them. 7. Drug addicts and alcoholics can find their own ways out of addiction, without outside help, given the opportunity. 8. Drug addiction is a way of life people rely on to cope with the world. The prevailing treatment policy should not only be changed on the basis of identifying negative beliefs that lead to self-fulfilling prophecies but also replaced by beliefs proved to be scientifically valid and culturally consistent with Navajo principles of positive thinking. Those self-fulfilling prophecies we can live with. Those prophecies encourage people to recognize the will- power they have to control their life. As people come to believe they can develop other ways to deal with life instead of relying on drugs or alcohol, they gain confidence in their ability to determine their own destiny. As they come to believe addiction has more to do with the environments they live in than with the drugs they use, they may further realize they have the power to change those environments in order to help themselves. They may recognize they are the "higher power." And that, of course, is the most sacrilegious idea to disease modelists. When people realize how many people outgrow drug and alcohol addiction, they realize their own addiction problems are solvable. When heavy drinkers and drug users learn they have the ability to moderate their drinking or drug use, they are naturally more likely to fulfill that belief in their ability. When they recognize drug and alcohol addiction is a behavior they choose to engage in when life is going badly, they are more likely to do something to improve their life. When people believe they can rely on themselves to overcome an addiction, they are more likely to mobilize the necessary inner strength to change their behavior. When drug addicts and alcoholics believe they can find their own ways out of addiction, without outside help, given the opportunity, they are more likely to wake from their drug-induced despair and build a life they value more than a life of drugs alone. Most importantly when people believe drug addiction is mainly a way of life, a behavior people engage in as a way to cope with the world--and not something they are hopelessly imprisoned in--they may be more inclined to make the necessary changes not only in their own world but in the world they live in. People can learn what's necessary to live a meaningful life and put that knowledge to positive effect. Each of these beliefs results in a more positive and common-sense outlook consistent with scientific principles established through self-efficacy research and consistent with the Navajo concept of hozho. We all create self- fulfilling prophecies for ourselves based on our beliefs. What people believe to be true about themselves dictates how they behave in the world. Our task is not to indoctrinate people with religious or pseudo-scientific myths about addiction as a disease. It is to recognize the common-sense truths supported by scientific research over the past 35 years and to encourage heavy drinkers and drug users to recognize those truths. Changing their behavior is then up to them. But recognizing those truths, the likelihood will increase that they will create new self-fulfilling prophecies based on accurate recognition of their own personal power (not some alien "higher power," or the power of some fanciful disease said to govern their behavior, or the power of a drug). That's the Navajo way. ACKNOWLEDGMENT I thank Mr. Wayne Sowan and Ms. Doris Greyeyes of Treaty 6 First Nations of Albert for inviting me to speak at their "ground-breaking" conference; and Joel E. Schaler, MD, for introducing me to the Navajo concept of hozho. REFERENCES Alexander, B.K. and Schweighofer, A.R.F. (1988). Defining Raddiction.S Canadian Psychology, 29, 151-162. Bandura, A. (1977). Self-efficacy: Towards a unifying theory of behavioral change. Psychological Review, 84, 191-215. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, New Jersey: Prentice-Hall. Carrese, J.A. and Rhodes, L.A. (1995). Western bioethics on the Navajo Reservation. Benefit or harm? JAMA, 274, 826-829. Edwards, G., Orford, J., Egert, S., Guthrie, S., Hawker, A., Hensman, C., Mitcheson, M., Oppenheimer, E., and Taylor, C. (1977). Alcoholism: A controlled trial of treatment and "advice." Journal of Studies on Alcohol, 38, 1004-1031. Levine, H.G. (1978). The discovery of addiction: Changing conceptions of habitual drunkenness in America. Journal of Studies on Alcohol, 39, 143-174. Luff, E. (1989). The First Amendment and drug alcohol treatment programs: To what extent may coerced treatment programs attempt to alter beliefs relating to ultimate concerns and self concept? In Arnold S. Trebach and Kevin B. Zeese (Eds). Drug policy 1989- 1990: A reformer's catalogue (pp. 260-266). Washington, D.C.: Drug Policy Foundation, Inc. Murray, F.J. (1996). Courts hit sentencing DWIs to AA, fault religious basis. The Washington Times, 4, November: A10 (news item). Peele, S., with Brodsky, A. (1975). Love and addiction. New York: Taplinger. Schaler, J.A. (1991). Drugs and free will. Society, 28, 42-49. Schaler, J.A. (1995). The Addiction Belief Scale. International Journal of the Addictions, 30, 117-134. Schaler, J.A. (1996). Spiritual thinking in addiction- treatment providers: The Spiritual Belief Scale (SBS). Alcoholism Treatment Quarterly, 14, 7-33. Schaler, J.A. (1997). Addiction beliefs of treatment providers: Factors explaining variance. Addiction Research, 4, 367-384. Dr. Jeffrey A. Schaler, Silver Spring, Maryland USA. Internet: email@example.com
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