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: jschale@american.edu
|
|