Thursday, April 30, 2009

Kilroy Café #42: "In Defense of Placebos"

Here is the latest Kilroy Café philosophy essay. You can click on the image above for a larger version or print it out on a single page via the pdf file. The full text is also below. Also see my other Kilroy Café newsletters.

In Defense of Placebos


In previous writings I have claimed that all addiction treatment is a fraud. I am referring not just to drug treatment, but also the weight loss industry, relationship counseling, Oprah, Dr. Phil, the DARE program and any kind of class or advertizing campaign intended to address an impulsive behavior. I contend that, in the long term, these products, programs and services do nothing to reduce recidivism rates or improve the health of their clients.

I admit my claim is impossible to prove in a broad sense, but it's fairly simple for individual products. You compare three groups of addicts: one receives the product (like the nicotine patch to stop smoking); one receives what looks like the product but without the supposedly active ingredient (the nicotine patch without the nicotine); and the third receives no treatment.

In the short term, there may indeed be positive results: The group with the nicotine patch may have reduced their smoking, as the patch provides the drug their body craves. More surprising, however, is that the group wearing the ineffective patch also improves, at least in comparison to the untreated group.

This phenomenon is called the "placebo effect." It illustrates the power of human belief: If people believe something will help them, it often does, regardless of its content.

In the long term, though, both patches fail to significantly reduce smoking. Two to five years down the line, any kind of addiction treatment offers at best only marginally better results than a control group. (Or at least that's my contention. I welcome research evidence to the contrary.)

This doesn't neglect the fact that many people do manage to quit their addictions over 2-5 years. Some drug addicts get sober and stay sober. Some obese people lose weight and keep it off. There are always success stories, and often they are attached to a specific treatment. "I owe my life to Alcoholics Anonymous," someone might say, or "I lost 50 pounds with Jenny Craig.

How do we reconcile this with the dismal epidemiological results for AA, which seem to contend, as I do, that long-term prognosis for new members is no better, and possibly worse, than a control group? There's no conflict, really. It's just that what successful AA members think has cured them isn't what really cured them.

There is only one thing that can be proven effective against addiction: consequential pain. If you get drunk and embarrass yourself at a party then get a splitting headache the next day, this is going to do far more than any product or service to discourage you from drinking again. It's not a 100% solution by any means. Plenty of people continue to drink no matter how much pain it causes them, but the recidivism rates for actual pain are much better than for any outside treatment.

Basically, people quit their addictions when they get so beaten up by the effects that they finally become ready to change. Once they are ready, almost any form of treatment will work, even a placebo or no treatment. If they are not ready, then no treatment will work.

If people need things to believe in during the transition, that's fine. Maybe Jesus got you through this hard time, or perhaps it was gardening or acupuncture or a voodoo charm. You're probably going to latch onto something as a substitute for the drug—a placebo—and that's okay. The real initiative, however, must come from within.

There are a lot more addictions in our lives than just drugs, drink, cigs and food. There are addictive relationships and activities that we know deep down aren't good for us. You can get addicted to video games or crossword puzzles or just about any other repetitive activity. Generally speaking, people don't stop these behaviors until they cause too much pain or are simply taken away.

In all addictions, there is a chemical component: the physical anxiety you feel when you withdraw from the activity. But the more powerful component is philosophical: a fundamental belief system that supports the activity. This private processing system is deeply engrained and cannot be educated away by cognitive means, only by actual effects.

Behind every addiction is some form of fatalism. The addict believes that he "has no choice" but to continue his behavior and that he isn't strong enough to overcome it by himself. This belief becomes a self-fulfilling prophesy whenever the physical pain hits. When hungry, he feels he has no choice but eat.

To stop the addiction, you have to overcome this internal fatalism, which by definition no external force can do. No one can really teach you to be more responsible for yourself; they can only encourage it by forcing responsibility onto you.

The central notion behind every form of treatment is outside rescue: "We are going to cure you." Even when the message is "You have to be more responsible", the program insists it can show you how. Almost every treatment program has a powerful motivation to sign you up—profit usually but also the egos of people already in the group. More important than actually curing you is making sure you buy the product.

But an outside product isn't what you need. All you really need is that little switch inside you to go from "I can't do it," to "I can."

—G .C.

©2009, Glenn Campbell, PO Box 30303, Las Vegas, NV 89173. See my other philosophy newsletters at
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