I hear a single voice as I walk up the steps to the meeting room. It reminds the men and women gathered in a half circle that, yes, they admitted powerlessness over alcohol, and that only a power greater than themselves could restore their sanity. Drunks-R-Us is held in a sunlit room at a liberal church in Berkeley, California. Inside, there are more than 30 people, most looking like they just arrived from the farmer’s market. They confess to numerous trespasses against strangers, friends, family and themselves – betrayals wrought by a lifetime of addiction. A tanned gentleman, nearing 60 years old, dressed in a lime-green button-up shirt and khaki pants, describes four court orders for driving under the influence, time spent in San Quentin prison, owning his own business, years of sobriety lost to ‘a damn quart of vodka’. But, first, he says: ‘I ask God that his words come out of my mouth.’
Almost 2 million people in some 80 nations currently claim membership in 12-step programmes. Members belong to what’s called the fellowship, a convening of men and women trying to recover from addiction through peer support. There are no membership fees, no formal membership, no official leadership. The adherents of Alcoholic Anonymous (AA) live by 12 principles first set out in 1939 in what’s known as the Big Book, a conversion story written largely by a layman, Bill Wilson, a Wall Street stockbroker from rural Vermont who wrenched himself free from the clutches of alcoholism.
Wilson’s 12 steps are a set of spiritual principles meant to teach alcoholics how to tame their darkest impulses. The first step involves admitting powerlessness over the addiction. The second and third steps involve turning oneself over to a higher power, some form of God. Other steps include a ‘fearless moral inventory’ of the self, a deep relationship with a higher power through prayer and meditation, and subsequent reckoning with those who have been harmed. The act of making amends, step eight, is perhaps the best known of the 12. A final step involves carrying the message to other alcoholics and practising ‘these principles in all our affairs’.
Wilson’s treatise has long served as a template for deliverance, and not just from the bottle, but also drugs (Narcotics Anonymous), gambling (Gamblers Anonymous), overeating (Overeaters Anonymous) and other destructive behaviours. The teachings of the Big Book are the basis for treatment at many rehab facilities operating today. Across these programmes, the onus of recovery rests with the addict – if he fails, he must not have worked the steps hard enough and should try again.
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Throughout the 20th century, before the addict’s plight could be explained by neuroscience or subdued by medication, the AA philosophy of liberation was embraced. Compelling tales of recovery were justification for the 12-step programme’s adoption into the criminal justice system as well. In towns and cities that lacked drug courts or funding for substance abuse treatment, AA and NA were the affordable choice.
The surprising thing is how dominant the approach remains. Even though the literal circuits of addiction in the brain have since been found, and a host of new cognitive and drug therapies can help those with specific issues such as impulse-control, or with accompanying psychiatric disease, AA remains the overwhelming treatment of choice. ‘Standing up and saying AA doesn’t work at a science meeting is like standing up at an atmospheric conference and saying climate change doesn’t exist’, said the Stanford University psychiatrist Keith Humphreys, who takes a more nuanced stance. Humphreys told me that the programmes can work, but calls it ‘terrible’ to ask people to rely on a single recovery method, including AA, when there are so many variations and causes of this neurobiological disease.
Despite a revolution in addiction research, the latest version of the Big Book stays firmly rooted in the past – a time-capsule that hasn’t updated its science at all. Instead of outtakes from the latest peer review, the tome still features a letter from the late physician William Silkworth, who describes alcoholics as uniquely sensitive to spirits: ‘These allergic types can never safely use alcohol in any form at all…’ Wilson portrays the required vigilance as a matter of will. Even one slip, one drink, can bring the addict tumbling down. ‘Opinions vary considerably as to why the alcoholic reacts differently from normal people … we cannot answer the riddle,’ Wilson wrote in 1939.
addiction is a habit rooted in brain circuitry, and frequently a consequence of a traumatic experience from childhood
Yet, by 2014, this curious thing known as addiction has been pinned down. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (NIH) in the US, has written at length about how alcohol and drugs work on the brain. By over-engaging the reward system – the circuitry of brain networks that send pleasant chemicals coursing through the body – drugs and alcohol can trigger a stress response, he told me. The brain then begs for relief, which is often delivered in the form of more mind-altering substances. And every time that respite comes, the body and brain are a little more sensitive to stress. ‘Alcoholics are drinking to control a system that’s out of control,’ Koob said.
The one-size-fits-all therapy of AA can’t possibly address every facet of the disease: addiction is a habit rooted in brain circuitry, but also frequently a consequence of a traumatic experience or exposure from childhood onwards. Most of us just flirt with addiction, stopping our habit without any formal treatment or intervention from self-help groups such as AA. Others struggle mightily over a lifetime, their addiction a spectre – an ever-present haunting.
Addiction, moreover, often exists in tandem with other neuropsychiatric disease – a find that the Big Book has not been revised to include. Nearly a third of adults who experience mental illness have an addiction. This number skyrockets for jail and prison inmates. Three quarters of those with mental health problems also have a substance use disorder.
This dual suffering is palpable at AA meetings. A young woman wearing a coral sundress at the Drunks-R-Us gathering seemed to gently shake, holding back tears, as she spoke of relentless depression and anxiety. She didn’t want to sacrifice several years of sobriety, but she’d found little success with the mood stabilisers recommended by her doctor. ‘They don’t know jack about the brain,’ she said. Heads nodded in agreement.
When participants share their life stories at an AA meeting, they often reflect on psychological terror or physical trauma at the hands of people who were supposed to protect them as children. At another meeting in Berkeley, a woman spoke of her ‘rage-a-holic’ father who drunkenly lumbered around the house, smelling like ‘metabolised vodka’ and swinging his fists into the walls. It wasn’t long before she turned to booze as a teenager and spent decades trying to break free.
Her multiple relapses, according to recent science, are no ethical or moral failing – no failure of will. Instead, they are the brain reigniting the neurological and chemical pathways of addiction. Ruben Baler, a health scientist at the National Institute on Drug Abuse in the US, told me that, once the circuitry of habituation is in place, it cannot be destroyed or fully overwritten. ‘The brain will never go back to a pristine, naïve, drug-free state,’ Baler said. It would be like reversing time itself.
This permanence is the result of a process that researchers call ‘chunking’: a person using drugs or alcohol experiences a burst of the activating neurotransmitter, dopamine, encoding memories and stimuli associated with that high in the brain. As substance use turns chronic, that same networks in the brain are increasingly engaged, and eventually the habit becomes automatic. Baler likens it to riding a bicycle – once the brain knows what to do with the pedals, brakes and handlebars, the action is inevitable. When any part of this chain, or chunking, is triggered – maybe it’s a visit from an addict friend, or the sight of a McDonald’s where you once got high in the bathroom – it can lead to a full-blown relapse. That’s why lifelong abstinence can be such an impossible goal for even the most committed of recovering addicts.
In an AA meeting, such setbacks are often seen as an ego out of control, a lack of will. Yet research describes a powerful chemical inertia that can begin early in life. In 96.5 per cent of cases, addiction risk is tied to age; using a substance before the age of 21 is highly predictive of dependence because of the brain’s vulnerability during development. And childhood trauma drives substance use in adolescence. A study of 8,400 adults, published in 2006 in the Journal of Adolescent Health, found that enduring one of several adverse childhood experiences led to a two- to three-fold increase in the likelihood of drinking by age 14.
Perhaps because the latest round of research is so new, therapies emerging from it are too green to claim potent results. Compared with more recent behavioural and motivational therapies, AA – folk medicine or not – holds its own. In one ambitious trial published in BMC Public Health in 2005, researchers from the University of Miami School of Medicine compared three approaches: 12-step facilitation; cognitive behavioural therapy focused on dealing with urges; and motivational therapy, designed to provide feedback about substance use and increase a sense of individual agency. According to the study, all three therapies improved abstinence by some 10 per cent – hardly a stellar result.
Alleviating the suffering of even a small percentage of addicts in voluntary programmes is surely significant – and until new therapies are developed and improved, the folk-medicine approach of AA deserves as much clinical credence as anything else. But those results don’t shed light on efficacy for offenders forced into treatment by courts, a population currently in the cross-hairs of the 12-step debate.
Lee Ann Kaskutas, a senior scientist at the Alcohol Research Group in Emeryville, California, says ideally a clinical trial could show how well 12-step programmes work for this second group – and there is reason to think it falls short. ‘I’ve wondered if it really makes sense to ask a court-mandated drunk-driver to be abstinent all the time,’ she said. In other words, sending someone who is not alcohol-dependent but made a regrettable decision to AA might not be the most effective thing to do. That person might benefit more from cognitive behavioural therapy, a skills-based intervention that helps a patient identify both the triggers that lead to excessive drinking and the coping skills to defuse those trying moments. ‘We need to think about what the problem is,’ Kaskutas said.
The criminal justice system has deferred that task. Take the case of Barry Hazle, who was convicted of methamphetamine possession and had already served a year in a southern California correctional facility by February 2007. Prior to his release, he told officials that, as an atheist, he could not abide a treatment programme that asked him to submit to a higher power. Still, he was assigned to a 12-step residential facility for 90 days.
He attended the programme, but implored state and clinic officials to find a secular alternative. ‘Let me begin by assuring you that my aim in this endeavour is not to get out of having to complete my parole requirements,’ Hazle wrote. ‘I have committed myself to a full and lasting secular recovery and complete abstinence from illegal drugs.’
But the recovery centre told Hazle’s parole officer that he was ‘sort of passive aggressive’ and ‘disruptive, though in a congenial way, to the staff as well as other students’. Correctional officers deemed Hazle in violation of his parole and sent him back to prison for 100 days. Demanding that Hazle participate in a religious-based treatment was unconstitutional at the time, according to previous federal court cases, but the correctional officers claimed that they had no other alternative for Hazle. Later in 2007, California courts affirmed the unconstitutionality of coerced AA, NA and 12-step rehab in a separate case.
His request to attend a non-12-step programme at his own expense was devastating: the legal battle sent him into bankruptcy and the board suspended his licence
The California Department of Corrections and Rehabilitation (CDCR) is taking note. Bill Sessa, a spokesman for the CDCR, told me that the agency has recently reviewed its addiction treatment programmes to ensure that they are based on clinical and scientific evidence. ‘The only programmes that we mandate for inmates and parolees are based on that criteria,’ he wrote in an email. ‘As a result, none of our sponsored or contracted drug or alcohol treatment programmes are “religious based”.’
Yet the perspective is hardly widespread. In recent years, even physicians have been forced by other doctors to take the 12-step route. In one recent North Carolina case, an emergency medicine doctor voluntarily reported a single arrest for driving under the influence to the state’s physician health programme, which is designed to help clinicians with psychiatric and substance abuse disorders. The doctor, James David Fenn, was subsequently diagnosed an addict and ordered to undergo expensive treatment at one of three out-of-state 12-step facilities. He disagreed with the board’s assessment, but failing to comply would cost Fenn his licence. Like Hazle, Fenn’s request to attend a non-12-step programme at his own expense was devastating: the legal battle sent him into bankruptcy and the board ultimately suspended his licence.
Without consensus over science-based addiction treatment, chaos abounds: a 2012 report from the National Center on Addiction and Substance Abuse at Columbia University holds that most doctors are ‘uninformed’ about addiction and can rarely diagnose, treat or refer patients to specialists. Staff at treatment facilities often lack training in addiction, and programmes aren’t held accountable for delivering treatment that works.
Optimal treatment for addiction, of course, is still a work in progress. Even neuroscience, with its sophisticated understanding of the brain, has yet to deliver on the promise of a radical new surgical intervention that might repair the damaged circuits that rev on the addict. Every circuit, Baler explained to me, has several functions, and we don’t yet possess the technology to repair the defective ones. The best hope so far might be deep-brain stimulation and transcranial magnetic stimulation, which use electrodes and magnets, respectively, to help moderate neuronal activity. But this research is in the very early stages for treating addiction.
Instead, Baler told me, patients should look to prescription drugs to help create the ‘space where long-term healing can occur’. These include methadone and naltrexone, which pre-emptively bind to receptors in the brain to block the effects of the drug or alcohol, and disulfiram, which prevents the body from metabolising alcohol, causing unpleasant symptoms such as vomiting, sweating and vertigo. Some AA members don’t look kindly on prescription drug use, insisting that it replaces one substance with another. But Baler has his own perspective: a patient cannot begin to curtail his habit while experiencing craving or withdrawal. Drugs that provide even a brief reprieve from the intensity of addiction are key to starting that process.
What these patients require, he says, is a holistic approach that accounts for forces such as mental illness, unemployment, chronic stress, and childhood abuse. This might look something like the science-based treatment that patients receive at a Minnesota clinic called Alltyr, founded by Mark Willenbring, the former director of the Division of Treatment and Recovery Research of the National Institute on Alcohol Abuse and Alcoholism at the NIH. The wounds of addiction, Alltyr holds, must be tended along with the disease itself before an addict can be restored to health. And that, Baler says, happens most effectively through adopting new coping skills and behaviours developed and tested by researchers.
Some argue that AA offers just that opportunity, with its steps, affirmations and peer support. Back in that sunlit room in Berkeley, surrounded by recovering addicts who share testimony about the salvation of AA, I can see their path to redemption. The suffering in the room feels like the movement of a wave – that moment when the ocean’s water is pulled back into the abyss and the sand disintegrates beneath your feet. The hour-long ritual of sharing and grieving and lamenting is a way of resisting the void, of pushing it back so that it doesn’t consume you again. With newer therapies so emergent, with research ongoing and trials incomplete, this seems a proper way.
Outside of this room, though, there are many whose lives were touched by alcohol or drugs but somehow remained whole. Even if those lives cracked, conversion to the AA way of life might not be the answer. And that must be acceptable. Those who suffer must be afforded the right to mend and atone according to their own beliefs.
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is a features writer at Mashable who covers gender and equality issues. She has also written about the military, technology, science and mental health. She lives in the San Francisco Bay area.
This fall, PBS will broadcast ''Faith and Reason,'' a documentary written and narrated by Margaret Wertheim and partly financed with $190,000 from the Templeton Foundation, featuring interviews with scientists about God. In the last two years, a steady stream of books has appeared with titles like ''Cybergrace: The Search for God in the Digital World'' and ''God & the Big Bang: Discovering Harmony Between Science & Spirituality.''
A Universe With Purpose
The Templeton Foundation also gave the Center for Theology and the Natural Sciences $1.4 million for a heavily promoted conference called ''Science and the Spiritual Quest,'' held this month in Berkeley, Calif. For four days scientists, most of them Christians, Jews or Muslims, testified about their efforts to resolve their own conflicts over science and religion. All seemed to share the conviction that this is a purposeful universe, that there is a reason to be here.
''Theology is not some airy-fairy form of metaphysical speculation,'' said John C. Polkinghorne, a Cambridge University particle physicist turned Anglican priest whose books include ''Quarks, Chaos & Christianity'' and the newly published ''Belief in God in an Age of Science.'' Like science, he said, religion is rooted in encounters with reality -- though in the latter case these include spiritual revelations whose truths lie in the unreachable realm of the subjective. The pervading question was whether this kind of experience could ever be studied scientifically.
For most of the century people have espoused the view that science and religion should be kept apart to avoid the inevitable combustions. But to logical minds it has always been troubling that two opposing ways could exist to explain the same universe. Science and religion spring from the human obsession to find order in the world. But surely there can be only one true explanation for reality. Life was either created or it evolved. Prayer is either communication with God or a psychological salve. The universe is either pervaded by spiritual forces or ruled by nothing but physical laws.
One way out of the dilemma has been to embrace a kind of deism: The Almighty created the universe according to certain specifications and then left it to run on its own. ''God'' becomes a metaphor for the laws that science tries to uncover.
Or religion can be explained away scientifically. ''There is a hereditary selective advantage to membership in a powerful group united by devout belief and purpose,'' Dr. Wilson wrote in ''Consilience.'' He warned against letting this genetically ingrained drive overpower the intellect. ''If history and science have taught us anything, it is that passion and desire are not the same as truth. The human mind evolved to believe in the gods. It did not evolve to believe in biology.'' It is important not to confuse the universe as it is with the universe as we wish it would be.
Limits of Science Can Lead to Religion
For many researchers, the whole point of science is to replace religious teachings with verifiable theories, and to pretend otherwise is self-delusion. ''We're working on building up a complete picture of the universe, which, if we succeed, will be a complete understanding of the universe and everything that's in it,'' Richard Dawkins, a University of Oxford biologist, said in a preview copy of ''Faith and Reason.'' He found it baffling that some of his colleagues struggle to keep God in the picture. ''I don't understand why they waste their time going into this other stuff, which never has added anything to the storehouse of human wisdom,'' he said, ''and I don't see that it ever will.''
But others, like the cosmologist Allan Sandage, have found that their search for objective truth has led them to questions that science cannot answer. ''The most amazing thing to me is existence itself,'' Dr. Sandage said at the Berkeley conference. ''Why is there something instead of nothing?'' This impenetrable mystery, he said, drove him to become a believer. ''How is it that inanimate matter can organize itself to contemplate itself? That's outside of any science I know.''
Science, like religion, is ultimately built on a platform of beliefs and assumptions. No one can prove that the universe is mathematical or that the same laws that seem to hold in the here and now can be applied to the distant quasars or to the first moments of time. These are among the tenets of the faith, marking the point at which reasoning can begin. ''Science is not able to question these issues,'' George Ellis, a professor of applied mathematics at the University of Capetown and a Quaker, said at the conference. ''It takes them for granted as its bedrock.''
It is not just the coincidence of the approaching millennium that is inspiring hopes for what would be the grandest of unified theories. Faced with science's success in modeling the world, people find it harder to accept religious teachings that cannot be verified. Many Christians were disturbed when radiocarbon dating suggested that the Shroud of Turin was not Jesus's burial cloth but a medieval forgery, and they hope that new scientific data, not religious fiat, will overturn the old research. Even the creationists realized long ago that they can't sway the opposition simply by asserting that their beliefs are true because they are written in the Bible. They proffer scientific proof -- pseudoscientific, those outside the faith would say -- that life and the universe were created as described in Genesis.
But science, too, is feeling its limits, leaving a vacuum that religion is happy to rush into. Neuroscientists can explain the brain, on a rough level, as networks of communicating cells called neurons. But it is hard to imagine a satisfying theory of the conscious experience -- what it is like to be alive. And no amount of theorizing is apt to converge on a persuasive explanation of where the mathematical laws are written or what happened before the Big Bang. For all its powers to observe and reason, the mind ultimately encounters chasms. Then the only choice is to retreat or take the great leap and choose what to believe.
Dollars Fuel Effort To Put God in Science
For all the genuine philosophical longings, the recent drive to put God back in science would not be nearly so intense without the millions of Templeton dollars looking for places to land. ''We are searching for a serious rapprochement between science and religion,'' Charles Harper, the executive director and vice president of the Templeton Foundation, said at the beginning of the Berkeley conference.
The money and the inspiration come from the investor John Marks Templeton, founder of the Templeton Growth Fund and other ventures, who retired in 1992 to work full time on his philanthropy. The most prominent of Sir John's endeavors (he was knighted in 1987) is the annual Templeton Prize for Progress in Religion, guaranteed to exceed the Nobel Prizes in monetary value. (Mr. Templeton thought Alfred Nobel snubbed spirituality.) Early winners of the Templeton award, first given in 1973, were usually religious leaders like Mother Teresa and Billy Graham. More recently the prizes, now more than $1 million, have gone to the political scientist Michael Novak and the physicist and science writer Paul Davies.
The Center for Theology and the Natural Sciences in Berkeley is receiving $12.6 million from Templeton to help develop science and religion programs at universities worldwide. The American Association for the Advancement of Science received $1.3 million ''to help establish a science and religion dialogue.''
Last year the foundation's announcement that it would award grants of $100,000 to $200,000 for a program in ''forgiveness studies'' sent behavioral scientists scrambling to write proposals. Among the work being funded are ''Forgiveness and Community: A Game-Theoretic Analysis,'' ''Assessment of Forgiveness: Psychometric, Interpersonal, and Psychophysiological Correlates'' and ''Does Forgiveness Enhance Brain Activation Associated With Empathy in Victims of Assault?''
Those who submitted proposals were asked to include a section about how their research would address the issues clarified in Mr. Templeton's books ''Discovering the Laws of Life'' and ''Worldwide Laws of Life: 200 Eternal Spiritual Principles.'' A major focus of the foundation is publishing some 20 works by and about Mr. Templeton and encouraging scientific research on what its literature describes as ''optimism, hope and personal control.''
Polite Talk, But No Passion
Judging from the conference, no amount of money is likely to succeed in blending science and religion into a common pursuit. A kind of Sunday school politeness pervaded the meeting, with none of the impassioned confrontations expected from such an emotionally charged subject. ''Many of the speakers have been preaching to the choir,'' Dr. Sandage complained. ''There are no atheists on the program, only strict believers.''
Many of the speakers avoided grappling with religion directly, content to ponder mysteries that have disturbed scientists for decades. The Stanford University cosmologist Andrei Linde speculated on the tantalizing possibility that consciousness, the very hallmark of humanity, could be an intrinsic part of the universe -- as fundamental to the warp and woof of creation as space and time. After all, he said, our subjective experience is the only thing each of us is really sure of. All else is speculation.
''Our knowledge of the world begins not with matter but with perceptions,'' Dr. Linde argued. ''I know for sure that my pain exists, my 'green' exists, and my 'sweet' exists. I do not need any proof of their existence, because these events are a part of me; everything else is a theory.'' It is to explain the source of these perceptions that we posit the existence of an outside reality, forgetting that this is just a supposition.
The existence of a real world is another of the tenets of the scientific faith. It is impossible to proceed without it. But many scientists would find the view that consciousness is the root of everything to be hopelessly anthropomorphic and even solipsistic. The conference might also have booked prominent scientists, like Stephen Jay Gould, who argue that consciousness, as powerful as it necessarily seems to its holders, may be just an accident of evolution. Behind the face of consciousness, one can choose to find God. Or not. Without a decisive experiment, it is a matter of personal belief, not of science.
The astrophysicist John Barrow of the University of Sussex spoke of another longstanding mystery: the dazzling cosmological coincidences that make life possible. If certain physical constants had slightly different values, stars would not have formed to cook up the atoms that made the biological molecules. Since early in the century, some truth seekers have taken this sort of argument as a reason to believe that the universe was created with people in mind.
But one is also free to choose the opposite belief: that the coincidences simply show that life is indeed an incredible fluke.
It was hard to know what to make of some of the presentations. Mitchell Marcus, chairman of the computer science department at the University of Pennsylvania, speculated that the craft of artificial intelligence -- designing thinking computers -- is a modern realization of the school of Jewish mysticism based on the Kabala. According to this ancient teaching, it is not quarks and leptons but the first 10 numbers and the 22 letters of the Hebrew alphabet that are the true fundamental particles: the elements of the divine utterance that gave rise to creation. ''Computer scientists,'' he declared, ''are the Kabalists of today.'' The ancient rabbis are said to have used magical incantations to create beings called golems. The programmers create their simulated creatures with incantations of computer code.
The audience politely applauded after each presentation. But there was little sense of intellectual excitement, that people were coming to grips with the disturbing issue of whether there really is a God.
Most of the presentations consisted more simply of heartfelt testimonials about the difficulties of constantly being pulled by two powerfully conflicting attractions, the material and the spiritual, the known and the unknowable. And some of the speakers seemed to believe that, for all the efforts to bring them together, science and religion must inevitably go their separate ways. ''Would I do science differently if I weren't a Quaker?'' asked Jocelyn Bell Burnell, chairwoman of the physics department of the Open University in England and a Quaker. ''I don't think so.''
Dr. Sandage, the cosmologist, matter of factly put it like this: ''I don't go to a biology book to learn how to live. I don't go to the Bible to learn about science.''
As science continues to draw its picture of the physical world, each question it answers will inevitably raise more. So there will always be mysteries, the voids in human knowledge where religious awe can grow.Continue reading the main story