Stoic advice column: the problem of addiction

Advice_column.jpg[Feel free to submit a question for this column, but please consider that it has become very popular and there now is a backlog, it may take me some time to get to yours.]

G. writes: “I am currently an addiction psychiatrist and that means 100% of the people I see have one or more serious addictions. While I operate from the neurobiological perspective with regard to addiction, phenotypic plasticity is operative. I would estimate that 40% of the population is at risk for addiction if exposed to a matching intoxicant. Availability of drugs as seen in the current opioid epidemic is always a significant factor. It is hard to ignore the cultural biases that lead to this exposure. It seems to be part of the American culture that people expose themselves to drugs and alcohol at an early age. In Middle School and High School as well as college there is peer pressure. People who abstain from intoxicants are viewed as being square or possibly closet prohibitionists. The former President of Mexico Vincente Fox suggested the entire reason for the War on Drugs was “America’s insatiable appetite for drugs.” I think that he was right. I think that an important public health strategy would be to intervene at the “philosophy for living stage” that currently seems based on hedonism before the significant neurobiological effects from the intoxicants takes over. Is there any advice that Stoics may have to offer in this situation? I guess I see the problem as a lack of a reasonable plan for living at the bare minimum when it comes to excessive drug and alcohol consumption. There is not much of a window between that and a full blown addiction.”

This is a very difficult question, as a lot of factors enter into addiction, from social and psychological ones to possibly genetic contributions. I will try to stick to a Stoic perspective, without pretending to provide a general solution to the problem of addictive behavior.

To begin with, let us separate two components of the issue, as outlined by G. himself: the societal environment vs what individuals can do.

As far as the first is concerned, right, I would agree that the fact that we broadly do not teach our kids about virtue and how to develop a meaningful path in life is a serious problem, and possibly a significant contributor to the high levels of addiction we see in American society. I don’t think it is by chance that the US in particular suffers from this plague, being one of the most consumerist societies on the planet. While I don’t expect any dramatic societal change in that direction — especially given the current political climate — I support efforts to teach Stoicism or other virtuous philosophies of life (Buddhism, for instance) to young people. For instance, I am at the moment exploring the possibility of co-writing a graphic novel-type book for kids that introduces them to the basics of Stoicism by exploring a series of problems that potential readers may experience, including bullying and the sort of peer pressure toward drugs and alcohol that G. is talking about. I’m not sure when it has gone out of fashion to teach sound principles to the next generation, both at home and at school, but it seems way past the time to reverse the trend.

The second issue, that of individual choices insofar as adults are concerned, can itself be split into two components: on the one hand, people who have not engaged in potentially addictive behaviors but are at risk of doing so; on the other hand, those who are already addicts to substance abuse, gambling, or other destructive behaviors and are trying to get out of them.

I would wager that embracing Stoicism is a very good preventive measure for people in the first category. While Stoics have no objection to the enjoyment of a variety of pleasures (they are preferred indifferents), they do object to any pleasure that takes over and begin to own us. Here, for instance, is Diogenes Laertius on alcohol:

“[The Stoics] will take wine, but not get drunk.” (Lives of the Eminent Philosophers, VIII)

Even the pleasure of everyday food is an occasion to practice the Stoic virtue of temperance, according to Musonius Rufus:

“The more often we are tempted by gastronomic pleasure, the greater the danger it presents. And, indeed, at each meal, there is not one chance for making a mistake, but several.” (Lectures XVIII.B4)

About mode dangerous pleasures, modern Stoic Bill Irvine says:

“There are some pleasures, the Stoics would argue, from which we should always abstain. In particular, we should abstain from those pleasures that can capture us in a single encounter. This would include the pleasure to be derived from certain drugs: Had crystal meth existed in the ancient world, the Stoics would doubtless have counseled against its use.” (A Guide to the Good Life, p. 114)

So I would say that someone at risk of becoming addicted to something, but who is considering Stoicism as a philosophy of life, or has already began her training as a prokoptousa, is equipping herself with good tools to resist temptation, especially if her practice is supported by a local, or even an online, community of Stoics.

The situation of people who is already addicted is far more difficult, of course. That person may be first and foremost in need of medical attention, and if so, then she should seek it immediately. But as my colleague Lou Marinoff, author of the bestselling Plato, not Prozac! reminds us, do take medications (the Prozac of the title) if you need to, in order to bring your brain back to a sufficient degree of stability and be able again to think straight — the Stoics would say that you need to restore your “ruling faculty,” as Marcus called it. But the medications aren’t going to do the thinking for you, they simply allow you to regain some degree of agency so that you can think and make decisions. At that level, embracing Stoicism, studying it and practicing it, are good ways to manage whatever problem, not just addiction.

Incidentally, on the topic of Stoicism and mental health in general, I recommend this excellent article by Zachary Augustine, entitled “Dis-ease (Mental Health),” published over at the Modern Stoicism site.

I’d like to bring up one additional point. We are all familiar with the famous Serenity Prayer, used nowadays at meetings of Alcoholics Anonymous:

God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.

In preparation for my forthcoming book, I have done some research on it, given its strong Stoic connotations. I found that the prayer in its modern form is attributed to Reinhold Niebuhr, an American theologian who used it in his sermons as early as 1934. The same sentiment is detectable, however, across centuries and cultures. Solomon ibn Gabirol, an eleventh-century Jewish philosopher, expressed it this way: “And they said: At the head of all understanding is realizing what is and what cannot be, and the consoling of what is not in our power to change.” Shantideva, an eighth-century Buddhist scholar, similarly wrote: “If there’s a remedy when trouble strikes / What reason is there for dejection? / And if there is no help for it / What use is there in being glum?”

Yet there is an even more ancient version: “Make the best use of what is in your power, and take the rest as it happens. Some things are up to us and some things are not up to us. Our opinions are up to us, and our impulses, desires, aversions — in short, whatever is our own doing. Our bodies are not up to us, nor are our possessions, our reputations, or our public offices, or, that is, whatever is not our own doing.” That one, of course, is found in Epictetus’ Enchiridion, right at the beginning. It is not just a guide to dealing with the sort of problem that Alcoholics Anonymous focuses on, it is a guide for life more generally, and — just to come back full circle to my first suggestion — ought to be taught to our kids.

Advertisements


Categories: Stoic advice

18 replies

  1. This is a major problem and a good response from a Stoic perspective

    But, I disagree.

    I disagree because it ignores the root of the problem. This first became apparent to me when I started working in China. This is a wonderful world of striking contrasts. I went to learn about Chinese culture and unexpectedly found myself learning about Western culture. That is because one is forced to examine one’s own culture more clearly before one can understand the contrasts.

    Of all the contrasts, the one that struck me the most vividly was the total involvement of the Chinese parent in the care and education of their children. By contrast I felt downright negligent.

    From this experience I have perceived that Western parents, by comparison, are only minimally involved in the upbringing of their children. They take care of material needs very well but effectively delegate the care of their emotional and spiritual needs to the media, to the schools and even to the child’s peers. Thus they are exposed to unformed and inchoate philosophies of life that lack direction or coherence. The stresses of adolescence multiply the problems. In this confusing world they have one sure compass, and that is their own pleasure. Consequently they make choices that heighten pleasure. Because they are made early in life they become addictive and self sustaining.

    The root of the problem lies with the parents(who have abdicated responsibility in the pursuit of their own pleasure) and this is the problem that must be addressed.

    Thus I propose instead that all parents be required to undergo parenthood training programmes. They can be enforced by making certification necessary before children can be enrolled in kindergarten, primary or secondary schools. There would thus be three or four levels of training and certification. The schools themselves could provide the training to the parents and this could become the beginning of a long partnership between school and parents.

    There are a multitude of things a parent must learn to enable him to navigate the complex web of child rearing. I was taught none of these thing and winged it, learning as I went along. I made many mistakes.

    One of the important things that should be taught is a solid grounding in virtue ethics and the means of imparting this to children(through personal narrative). This would then be reinforced by similar teaching in schools. The parent’s involvement with their children would be deepened and they will develop a mutual language that describes their expectations of principled behaviour. The co-involvement of parents and schools will create a narrative that principle(virtue ethics) is the compass that supplies direction in a world of confusing choices and is the means to regulate the experience of pleasure so that pleasure does not become its own end or become destructive.

    Like

  2. Labnut,

    Did you miss the part where I said that kids should be taught virtue at home and at school?

    Liked by 2 people

  3. Massimo,
    You are referring to this:

    I’m not sure when it has gone out of fashion to teach sound principles to the next generation, both at home and at school, but it seems way past the time to reverse the trend.

    No I did not miss it. Your passing reference hardly seemed to address the problem.

    By contrast I put forward a hypothesis as to the root cause and made a proposal to directly address that root cause in a practical way.

    Of course, given the fractious educational system in the US, any proposal would provoke opposition from every kind of stakeholder. This is why I used the term ‘virtue ethics’. It is neutral enough that most belief systems would not feel threatened by it.

    Like

  4. There are exceptions to everything, though, if we take the example of Cato, who was both considered to be an exemplary Stoic and, minimally, a binge drinker who bordered strongly on alcoholism.

    Liked by 1 person

  5. Oops, you can’t edit comments! By the way, there is an REBT book on alcoholism, Alcohol: How to Give It Up and Be Glad You Did (1996) by Philip Tate (Author), Albert Ellis (Introduction) https://goo.gl/l6eVJk

    Liked by 1 person

  6. I knew a lot of recovering addicts growing up, so the Serenity Prayer was my first exposure to the dichotomy of control. “You can plan plans, but you can’t plan outcomes,” they’d also say, further illustrating acceptance of what is out of our hands. Growing up in that environment went a long way in informing my standards of conduct and ethical improvement, before I started studying philosophy in earnest.

    Albert Ellis called the AA Big Book “complex and profound”, but although he had some misgivings–primarily with the program’s emphasis on a higher power–it’s worth noting that these are far from impossible to reconcile with a naturalistic worldview. There are plenty of atheists in AA, who often conceive of higher power in numerous ways, such as group synergy (God as “Group of Drunks”), or the healthy structure of the program (God as “Good, Orderly Direction”). Finally, a more Stoic approach can be found here:

    http://aaagnostica.org/2012/08/12/an-atheists-guide-to-12-step-recovery/

    Liked by 1 person

  7. Professor I believe that Epictetus’s advice that we choose our company well is relevant to this topic both in perhaps reducing the prevalence of substance addiction, and reducing the rate of relapse among addicts that are in recovery.

    In your Stoic Exercises you cite Epictetus from the Enchiridion XXXIII.6

    “Avoid fraternizing with non-philosophers. If you must, though, be careful not to sink to their level; because, you know, if a companion is dirty, his friends cannot help but get a little dirty too, no matter how clean they started out.”

    I am a retired physician and a cocaine addict who is in recovery. I have had nearly 8 years of sobriety. The two times that I relapsed since 2006 occurred in circumstances in which I was in the company of cocaine addicts. I avoid associating with people who have addictions to substances of abuse so that I can avoid triggers that might lead to a relapse.

    Liked by 6 people

  8. Ronald, indeed! And congratulations for your 8 years of sobriety.

    Liked by 3 people

  9. I read through the comments here with great interest.

    I am the author of the original question in this post and I think about the parenting problem and the issue of childhood environment, whether or not that environment was “adverse” in any way, and whether there were any temperamental or innate factors operating that affected the child-parent dynamic. I typically think about that with every adult that I see (I only treat adults).

    There are numerous scenarios that can be observed clinically based on birth order and other factors that will affect whether children accept their parents’ advice about living or reject it. I have asked myself whether these factors as well as the limitations that we know exist in the brains of children and adolescents would be a limiting factor in imparting a useful philosophy to many – especially in a society where there are a large number of social variables.

    In terms of American society, religion is a useful example. Americans attend churches at much higher rates than European countries, but by other measures seem far less concerned about their countrymen. The for profit American healthcare system and the rationing of some sectors to enhance profits while denying care is the case in point. Is this a case of dissociating Christian moral guidelines and teachings to fuel capitalism? I think that might be a reasonable argument.

    It seems that a fairly intense focus on values and what Massimo describes as the “virtuous philosophies” is a lot of hard work – relative to the quick fixes that are out there. That may exceed the capacity of most adolescents and even 20 year olds. In the case of addiction there are relatively few parents who want their kids to makes the same mistakes they made when they were young, but they have a hard time getting that point across.

    I have seen young people who can reason that they need to avoid addictive compounds because their father was an alcoholic and their paternal grandfather was an alcoholic, but there are not the norm. Most 20 year olds think that there is always time to recover, settle down and at some point lead a normal life.

    I am hoping that Massimo and his Stoic colleagues will continue to make this approach to life widely available so that some of these young people can discover it for themselves as an interesting and dynamic way to conduct themselves.

    George Dawson

    Liked by 4 people

  10. George,
    Americans attend churches at much higher rates than European countries, but by other measures seem far less concerned about their countrymen

    The data suggests the exact opposite is true, that the USA is the second most giving country in the world and significantly outranks the European countries, on the aggregate of three measures:

    1) helped a stranger, or someone they didn’t know who needed help,
    2) donated money to a charity,
    3) volunteered time to an organisation.

    These three measures are a good indicator of concern for other people.

    Please see the World Giving Index:
    https://en.wikipedia.org/wiki/World_Giving_Index
    and
    https://www.cafonline.org/about-us/publications/2016-publications/caf-world-giving-index-2016

    The World Giving Index (WGI) is an annual report published by the Charities Aid Foundation, using data gathered by Gallup, and ranks over 140 countries in the world according to how charitable they are

    The top ten results(Rank, Country, Score) – 2016

    01, Myanmar, 70
    02, USA, 61
    03, Australia, 60
    04, New Zealand, 59
    05, Sri Lanka, 57
    06, Canada, 56
    07, Indonesia, 56
    08, United Kingdom, 54
    09, Ireland, 54
    10. United Arab emirates, 53

    The next 10 European countries:

    13, Netherlands, 52
    14, Norway, 50
    16, Malta, 49
    17, Iceland, 54
    20, Denmark, 47
    21, Germany, 47
    23, Switzerland, 46
    24, Finland, 46
    25, Sweden, 45
    30, Austria, 43

    Like

  11. The biggest problem is the addiction that happens after the addict has consumed the substance. The craving is so powerful there is very little control an addict has to avoid the substance, even just to feel normal. At this time, there is no effective treatment available, hence addicts often relapse. I agree with Massimo that the best direction for Stoicism is to teach it before the problem arises, so that people realize not to fall into the trap of believing that all pleasure is good.

    Like

  12. Remember that the US figures are inflated by the fact that even the most congregation-serving religious activity is presumed to be charitable giving

    Like

  13. Paul,
    Remember that the US figures are inflated by the fact that even the most congregation-serving religious activity is presumed to be charitable giving

    On what grounds would you say that? How can you know they are inflated? Are you not the one who is making a presumption?

    These figures are the results of extensive international surveys done by Gallup. As you know, they are a large, well respected and very experienced polling company. All polls are subject to polling errors but we can have confidence in these numbers because of their high degree of internal consistency. They reflect substantially the same result for 2013, 2014, 2015 and 2016 with the USA occupying either the first or the second place in all four years and the European countries coming in substantially down the list in all four years. This is important because entirely different sets of people were sampled in each of the four years. The fact that completely different sets of people over four years say substantially the same thing gives us a high degree of confidence in the data.

    Remember that Gallup asked people which of the following three charitable acts they had undertaken in the past month:
    1) helped a stranger, or someone they didn’t know who needed help?
    2) donated money to a charity?
    3) volunteered your time to an organisation?

    These are simple, direct question from a recent period of their past(one month) which is easily remembered.

    There are no presumptions at all in this. It is a simple direct question asking individuals if they had done one or more of three things in their very recent past.

    So where is the presumption?

    Like

  14. I do indeed presume that the US figures include giving to churches, since the tax code will have cued people into regarding such giving as charitable, and active church membership in the US is high. (And, relatedly, many other acrivities are considered charitable in the US that may not be so regarded elsewhere, such as political activity considered educational for tax purposes). This is a presumption, but one credible enough to make me hesitate to draw conclusions from the questionnaire data until I see whether this factor seriousy distorts the data.

    Like

  15. Thus I propose instead that all parents be required to undergo parenthood training programmes.

    That would be an opportunity for ideologically-oriented parenthood training sponsored by the State. I do not believe there is an institutional response to the problem since it may easily be corrupted in its original intentions. Neocons and cultural marxists are on the loose and ready to poison everything, selling the idea that political engagement is a substitute for virtue. In my opinion, reading and discussing about these matters in a sober way, along with observing responsible parents in action are more important, irreplaceable activities.

    Thinking about the case of the US, perhaps neighborhood associations could be used as platforms for parenthood counseling/training by voluntary psychiatrists and other professionals. Churches could open their doors to that kind of programmes, too, provided that those initiatives remained devoided of specific theological contents. Americans should use their fabulous structures of organized society at their benefit more often, and if parenthood is becoming a problem, i do not know why it is not discussed in the small scale. Let me borrow a slogan from a French protestant sociologist: “Think globally, act locally”.

    Unfortunately, we cannot oblige anyone to be a good parent. That was a drama in the time of Plato; that is a huge drama nowadays.

    (Sorry for my mistakes.)

    Liked by 1 person

  16. Nano,

    Right, prevention is the best course, as always. However, there are several testimonies from modern Stoics to the effect that Stoicism is also useful in recovering from addiction or other mental conditions. What it can’t do is to stabilize your mind at the peak of the problem, for that one needs medication and/or therapy. Then again, seems to me that would be too much to ask of a philosophy.

    Like

  17. Labnut,

    I have to agree with Paul here. Yes, it is certainly the case that Americans are very generous. But quantitative comparisons like those are too crude. First because, as Paul points out, straight donations to churches count as “charitable” regardless of how they are then used, and Americans donate a lot to churches.

    Second because the typical European attitude (in which I count myself) is that one lives in a civil society where the State is deputized by the people to take care of social issues, which is why Europeans pay much higher taxes than Americans.

    Indeed, I have noticed a dramatic change in my own behavior after I came to America: I started donating much more money (not to churches…) precisely because the US government is so bad at doing its job (and because taxes are much lower, which leaves me with more disposable income).

    Please, however, let’s not turn this into a discussion of the relative merits or libertarianism vs social-democracy…

    Liked by 2 people

  18. It is also true that nobody, nobody can grow up and be mature without crossing some kind of very particular hell. Continuing in my dantesque simile, I would like to add that the role of all adults should be guaranteeing the journey in the inferior world most youngsters will take is not without the possibility of finding a guide. When in Hell, it is impossible to learn anything if there is not a presence — a Virgil! — to explain us there is a way out from (useless) suffering. And Virgil, in the work of Dante, stands for reason, nobility, virtue and lessons from the past (through literary and philosophical tradition).

    Culturally speaking, our negligent actions are contributing to obscure Virgil’s presence in the midst of the darkest hell. Young people are suffering more than what is reasonable because adults refuse to be like Virgils to them. In sum, they refuse to be adults.

    Liked by 1 person

%d bloggers like this: