Addicted to Disease Theory

It's a week old now, but I just caught up to a pretty fascinating piece in Maclean's - one of those stories that I like because it challenges accepted conventional wisdom. It's a Q&A with Harvard researcher Gene Heyman, who's come to the conclusion that addiction to drugs and alcohol isn't a disease, it's a matter of choice.

I expect it'll generate a ton of excited response, both from people who agree and disagree with Heyman's viewpoint. The comments section underneath the web version of the story frames the kind of reaction that will likely continue to reverberate. Some will see this as validation of the idea that addicts are simply irresponsible fuck-ups who deserve whatever misery their substance abuse brings upon them, while others will angrily defend the notion of dependency as a medical issue. 

Much of the reaction on both sides will be based on the headline alone, I imagine, which is a shame because Heyman actually takes a very nuanced view on the subject. He doesn't condemn drug addicts, but concludes that addiction is the result of several small, individual choices that are in many cases influenced by underlying issues ranging from clinical depression to poverty. His data tells him that when people eliminate these underlying conditions, they are in most cases able to end their addictive cycle of their own free will. That undermines the disease model, he says, because if addiction was truly an illness, changes to these underlying factors wouldn't make any difference. He shows great empathy for addicts and an understanding of why people make self-destructive choices - he just thinks that they are choices.

What's most valuable about this article is that it introduces a new, more intellectually evolved way to think about addiction. As Heyman notes, the disease theory of addiction has taken root because people tend to have only two conceptual buckets in which to place self-destructive choices - they're either evidence of evil or weakness, or they're evidence of illness. He's right about this, I think, and I don't imagine either option in this binary system portrays addiction or addicts with much accuracy. 

Nor does it serve addicts particularly well in terms of recovery. Being shunned and lectured by those who see substance abuse as purely an issue of free will isn't likely to steer an addict onto the recovery road, especially if mental health issues such as depression and low self-esteem are at the root of their dependency. And the medical model, while it has undeniably helped millions of addicts kick their habits, probably doesn't work the way folks think it does. Defining addiction as a disease frees a lot of people from the guilt they associate with their substance abuse, and when the guilt goes, self-esteem returns and the need to self-medicate goes away. 

You can't argue with results, however they're achieved, but I'm guessing there's a whole population of drug addicts for whom disease theory makes their addiction seem inevitable or unbeatable, and thus hopeless. Furthermore, I imagine many addicts don't get to the underlying problems - the real illnesses - that led to their drug use once their addiction - more likely a symptom than a disease in itself - goes away.

Heyman's conclusions are sure to be controversial, but I hope they get some serious consideration. Treatment of addiction has been hampered by an either-or way of looking at a problem that more likely results from a mix of personal circumstance, general mental and physical health issues, genetics and, yes, personal choice. That the latter factor could be part of the equation shouldn't be dismissed out of hand by the medical community, nor should it be used as grounds for condemnation by self-appointed moral authorities. 

Gotcha!

Canada's Finance Minister Jim Flaherty and his boss, Prime Minister Stephen Harper, apparently took quite a grilling on Parliament Hill today following Flaherty's announcement yesterday that the federal deficit would be in the neighbourhood of $50 billion. That's $16 billion more than he predicted four months ago, and a full $50 billion more than his crystal ball told him back in November, when he insisted no deficits were coming. 

When a Finance Minister is that far off - as in, completely off - on his figures, he turns himself into a big, fat target for the Opposition. Sure enough, Liberal leader Michael Ignatieff has called for Flaherty's job, and he and other members of his party, as well as the New Democrats, have labeled Flaherty as incompetent.

All of this may be true - really, how could any Canadian economic leader stand up six months ago and say there would be no recession in this country - but these criticisms are more than a little dodgy. First off, Flaherty's inability to see into the financial future is an affliction that had been pretty contagious for most of the past few years, a blindness shared by politicians from most nationalities and political stripes. The fact that almost nobody saw it coming is the main reason the recession hit so hard and so quickly.

Secondly, it's a bit rich for the Liberals and New Democrats to paint Harper and Flaherty as incompetent, reckless money wasters when they themselves have lobbied so consistently, and in many cases effectively, for the very spending that's ratcheting the deficit up. The Opposition hasn't been urging the Conservatives to tighten their belts, they've been asking for more spending.

They know this, of course, but they're perfectly okay with the cognitive dissonance. That's what's so disheartening about the current state of political discourse - that the advocates of social spending become Scrooges and the champions of fiscal management turn into free-spenders based on the prevailing winds of political opportunism. Either side is willing to pull an ideological 180 if it they see a chance to serve up a gut punch to their opponents. 

Not that I feel an iota of sympathy for Flaherty and Harper or a Conservative party that has been littering the airwaves with cheap attack ads on Ignatieff. They deserve whatever beating they get. I just wish it was on more honest terms, rather than the result of the tired old political "gotcha" game.

Two Wheels Trump Four

It's been a slow couple of news days, what with North Korea doing another nuclear test, Barack Obama nominating the third woman and first Hispanic to the U.S. Supreme Court, the Globe and Mail replacing its editor, California upholding a ban on same-sex marriage and Canada's Governor-General eating a seal heart. Nope, nothing much happening at all.

I'll probably muster up something on one or all of the above-mentioned stories in the next few days, but today I'm fixed on Toronto City Council's decision to install bike lanes on one of the city's bigger downtown north-south streets, and in so doing eliminate one lane of car traffic.

It's quite entertaining to check out the reaction to this ruling, which seems to have pissed off people on all sides to some degree or another. Some of the more car-happy councillors - and citizen groups - are complaining about how this change will make driving in downtown Toronto an even slower, more soul-destroying slog than it already is. Meanwhile, the head of the Toronto Cyclists Union is more irritated with how long it took council to come to this conclusion than she is excited by the fact her side won the day.

As someone who only took up cycling a couple years ago, I can't claim to be a bike junkie. And I don't ride to work, meaning I'm not usually pedaling around during the rush hours. But I can appreciate the feeling of security a dedicated bike lane affords. And while I can also appreciate how cyclists can confuse, hinder and distract drivers, knowing that bikes have their own space actually makes it easier to negotiate the roads as a motorist. When I think back to occasions when cyclists rattled my nerves while I was behind the wheel, I can see that the problem would have been either reduced or eliminated by bike lanes.

I hope Jarvis St. is just the first of many more Toronto streets to get the bike lane upgrade. It's long overdue. And if drivers think this is a way to force them out of their cars and onto bikes, public transit or their own feet, that's fine with me. In fact, I hope they're right.

Obama v. Cheney: Like I Did, Only Way Better

A couple of days back, I wrote a post about the incredible shrinking industry of journalism, in which I stated my preference for deep, hard-boiled reporting by seasoned professionals versus well-intentioned, even well-written opinion pieces from citizen journalists and bloggers. Yesterday, I slapped together a few words about the national security speeches given by President Obama and former Vice President Dick Cheney, taking the latter to task for his evasiveness and intellectual dishonesty.

Turns out the second post has helped to prove the point made in my first. See, I am a reporter by trade, but I don't cover politics or world events for a living, so I freely admit that my Obama-Cheney post was based on distillations of the speeches in the National Post. Truth be told, I haven't had the time to view or read either speech in its entirety. So while I stand by what I wrote yesterday, I have to acknowledge that it's an incomplete work. In my full-time gig, I like to think I'm scrupulously thorough in my reporting. In this role as a citizen blogger, I have certain limitations and my reach often exceeds my grasp.

Not so for Slate's Fred Kaplan and John Dickerson, who fill in the many gaps in my blog post with their artfully written and supremely informed articles about the Obama-Cheney faceoff. Kaplan's authoritative Cheney takedown and Dickerson's clever analysis of the where each side's arguments succeed and fail are effective not because the writers are empirically correct or impossibly brilliant, but because they carry the weight of years of solid journalistic digging. 

By all means, read what the bloggers have to say, because there are quite a few out there - I obviously hope I'm one of them - who add something to the conversation. But in my view, the seasoned pros are still the ones who best frame that conversation.

Un-Cheneyed Melody

It's one thing to talk about reaching a higher moral ground, but another thing to get there. That's one thing Barack Obama has certainly learned since assuming the U.S. presidency. Case in point: he's encountered resistance to delivering on one of his most widely-supported promises, made almost immediately after taking office, to close the detention facility in Guantanamo Bay. Resistance from the Democrat-controlled Senate, no less, which won't fund the closure until Obama's administration outlines a comprehensive plan detailing just what's going to be done with Guantanamo's 240 residents.

That kind of resistance is entirely fair. As much of an outrage as Guantanamo, indefinite detention and torturous interrogation has been, and as much as it's cost the U.S. and the entire Western world in credibility and goodwill, the fact is that there are almost certainly a few among the Guantanamo prisoners who would immediately set about planning an attack if they were ever to get free. Maybe more than a few. The administration does have an obligation to deliver a real plan that addresses how the terrorist true believers and those who stepped more innocently into the American military dragnet will be identified, separated and treated accordingly. It's a process that will require careful thinking and shouldn't be unduly hindered by a politically motivated deadline - although Obama's January 2010 goal does seem reasonable.

The kind of resistance that isn't so fair is the kind offered up by former vice president Dick Cheney, who today followed an Obama speech reiterating the call for Guantanamo's closure with an address to the right-wing think tank American Enterprise Institute chastising Obama for compromising U.S. security. It's clear that Cheney, who largely drove the Bush Administration's national security policy, isn't about to let his legacy die quietly. 

Nor is he going to be any more bound by the rules of logic in his criticism than he was by the rule of law in giving the go-ahead to torture. Taking a dig at those who say that the Bush Republicans abandoned American values in prosecuting the "war on terror," Cheney said, "...no moral value held dear by the American people obliges public servants to sacrifice innocent lives to spare a captured terrorist from unpleasant things."

Here are three reasons why this one sentence constitutes a remarkably brazen rhetorical dodge:

1. "Captured terrorist." One of the fundamental problems with the Bushies' detention and torture philosophy was that it flouted the presumption of innocence. Imagine denying everyday citizens the right to a fair trial because the very fact of their arrest makes them "captured criminals."

2. "Unpleasant things." Cute. Waterboarding is certainly unpleasant, so much so that it's been recognized for centuries as a form of torture. If Cheney really stands behind torture, he should have the guts to call it by its true name.

3. The whole construction of the sentence conjures an image of a public servant that allows innocents to die in order to prevent "unpleasant things" from happening to "captured terrorists." In reality, the proactive element has worked the other way - U.S. interrogators, supported by Cheney and his ilk, were the perpetrators of the "unpleasant things." Public servants certainly don't have an obligation to throw innocent civilians in front of a bus in order for the bus to swerve away from detainees, but they do have an obligation not to be the ones who use the bus as a weapon.

What makes Cheney's objections all the more laughable is that he's now said more in the few short months of Obama's presidency than he did in eight years as vice president. He built these detention and interrogation policies behind a veil of secrecy unlike almost any other in U.S. history, and after so much time spent refusing to be held publicly accountable, he's ill-deserving of his role as Obama's harshest public critic.

Citizen Pained

A colleague of mine forwarded this article from the Christian Science Monitor this morning, thinking that me and my fellow reporters would be incensed by it. In his piece, Robert Picard, a media professor at a Swedish university, claims that journalists should quit arguing that their work is inherently sacred and that they should be compensated accordingly. In Picard's view, mainstream journalism offers consumers little value over and above what they can get from the ever-growing number of alternative information sources, and thus journalists deserve the low pay that they generally receive.

Thing is, I wasn't incensed at all. In fact, I mostly agree with Picard. Mainstream media outlets have become complacent, unoriginal, repetitive and dull. They've been almost comically slow to adjust to the digitization of the world. And, faced with competition and the pressures brought on by decreased advertising revenues and a generally awful economy, they've mostly elected for safe, antiseptic storytelling or mindless partisanship. In a time when innovation, creativity and risk is required, the MSM has instead chosen to double down on the exact type of drivel that's rendering it obsolete.

Where I diverge from Picard is the placement of responsibility. His article focuses on journalists themselves, whereas I believe the problem lies higher up, at the ownership level, where the bean-counters count beans. It's all well and good to demand that reporters produce more value, but the suits have to understand that "value" in the journalistic sense isn't as easy to determine as it is for any old widget. The survival of the MSM in the digital age will require a fair amount of trial and error, as journalists slowly learn what they can do to differentiate their content and make it more valuable to consumers. That kind of experimentation tends not to go over well in boardrooms where the horizon extends no further than the next quarterly report. 

And as snobbish and bitter as it sounds, some blame also lies with consumers themselves. While entities like The Huffington Post have shown us that determined citizens can produce high-quality reportage and commentary, they've also highlighted the limits of citizen journalism. Sure, it's nice to know what Alec Baldwin thinks of the illegal sex trade and the crumbling auto industry, John Cusack's thoughts on Obama and terrorism and Kim Cattrall's support of military veterans, but what new light, beyond the glare of the celebrity spotlight, does their HuffPost work shed on these topics? I don't disagree that famous faces can generate welcome attention for important issues, but beyond that, the real value is created by seasoned reporters armed with reams of sober, relatively anonymous research. Even though HuffPost features many journalists who fit this bill, how can they compete with the celebrities and the trash? As I write this, two photo features - one debating the relative "hotness" of different celebrities while soaking wet, the other a "name-those-celebrity-breast-implants" guessing game - top the list of the site's most popular articles. If this is what consumers want to read, then maybe mainstream journalism really isn't marketable.

But ultimately, I don't subscribe to that pessimism. I agree with Picard that journalists need to do more to earn their keep, but I believe that, if given the mandate, the resources and the freedom from media owners to create more value, they will. 

A Czar - And A War - By Any Other Name

The Huffington Post led today's brief with a piece by Arianna herself, one that urged the Obama Administration to end America's futile, decades-long War On Drugs and replace it with a system that provided treatment for, rather than criminalization of, non-violent drug users. Huffington noted that it was - cough - high time to halt the epidemic of incarceration (which disproportionately affects visible minorities) and other collateral damage resulting from the government's law-and-order approach.

Huffington praised the Obama camp for some of the promising statements it's made in this direction, including an announcement that medical marijuana grow houses would no longer be raided and new drug czar Gil Kerlikowske's proposal to stop using the term "war." She also called the Administration out for its hypocrisy, pointing out that a medical pot dispensary in California had been raided just days after Obama's anti-raid statement and that the Obama budget leaned even more in favour of enforcement - as opposed to prevention - than its predecessors.

Huffington is right to hold the Democrats' feet to the fire, but it's not surprising that Obama has taken tentative steps forward, then retreated. The main enemy in the establishment of a sensible drug policy in the U.S. has always been the lack of political will - it's simply bad politics to talk too loudly of relaxing drug laws, lest a politician be tarred as soft on crime. And there has never been any shortage of politicians to shriek their moral outrage from the opposite side of the issue. It feels to me like Obama's just testing the waters here - floating a few cautiously radical ideas out there like wet fingers into the wind. If these notions are met with a collective shrug from the American populace, look for him to get more aggressive on this issue. If they're rebuked, he's still got a toehold in the status quo and can retreat there without suffering too much political damage.

In this corner, we're hoping for the shrug.

Levants and Tigers and Coles, Oh My!

I was late reading this due to my sojourn to New York last week, but the other day I caught up Susan G. Cole's article in Toronto's lefty free weekly, Now Magazine. In the piece, Cole ripped into former Western Standard publisher Ezra Levant, who's parlayed a trial in front of the Alberta Human Rights Commission - brought about by his publishing of the infamous "Danish cartoons" that depicted the Muslim Prophet Muhammad - into a bestselling book. I referenced Levant's adventures in a post a couple of months back, and Levant himself kindly responded.

Cole wonders why mainstream media outlets like the CBC have given Levant a platform to promote his book, and why he's being considered such a free speech hero. In her mind, Levant deserved every ounce of the blowback, claiming that he published the cartoons solely to offend and inflame, not to pursue truth. She wonders why he didn't try to "build bridges" instead.

To which I have to respond by calling bullshit. Levant's intent in publishing the cartoons was irrelevant. There was no legal basis to keep him from doing so, and regardless of how odious he is, he's under no obligation to check with any group to make sure they approve of the content he puts out. There are specific guidelines in place that identify hate crimes, and when they occur, they should be prosecuted to the fullest. But the presence of an extra-legal organization whose purpose is to shame and financially bleed individuals who commit the "crime" of offending someone does nothing to promote equality in Canada. In fact, the grain of truth in Cole's article is that the whole process has served to elevate Levant to a pedestal he doesn't deserve.

And boy, does he ever not deserve it. Cole reports that, in a CBC interview, Levant said that racism "isn't a big problem" in Canada. Easy for Levant to say, but impossible to defend when one takes a look at the results of a study, reported in the Toronto Star, that indicates that not only is skin colour the single biggest barrier to acceptance among immigrants in this country, but also that second, third and fourth-generation descendants of immigrants may face even worse discrimination than their forebears who first came to Canada. Levant might scoff that the study is based on self-reporting from minorities, but with a sample size of more than 41,000, these results are impossible to ignore.

Any doubters might also want to look at the fallout from the Tamil protests that have grabbed so much attention in Toronto in recent weeks. Articles about these events have elicited dozens of comments from Torontonians, the majority of them angry at being inconvenienced and decidedly lacking in compassion for the victims of the Sri Lankan slaughter and their families. Witness some of the choice words readers had in response to a Rosie DiManno article that argued that maybe, just maybe, the Tamils have some semblance of a point.

I initially had some ambivalence myself - Tamils may very well be an oppressed minority in Sri Lanka, but protesting under the banner of the Tamil Tigers, a group that has committed scores of terrorist atrocities in that country's decades-long civil war doesn't exactly generate a lot of sympathy. Nor does blocking traffic repeatedly on major streets in a major city's downtown core. But I've moderated my viewpoint a little bit, having realized that, if it was my family being slaughtered in my old country, I'd certainly consider a little civil disobedience to get my new country to pay attention. And for all the people who've said the diaspora Tamils are actually hurting their cause by disrupting the city, it's worth noting that at least one politician has promised to raise the Sri Lanka issue in response to the protests. 

Sadly, history shows that without violence, or at least a bit of annoyance, it's difficult for minorities to make their concerns heard. That research study, as well as the response to the Tamil protests, proves that those concerns haven't magically gone away, no matter what Ezra Levant thinks.

But he's free to think it. Really, if the likes of Susan Cole want to stifle someone like Levant, they should let him hang himself on his own self-evidently stupid words.

Care for Cash

Last week I had the privilege of going to New York City to report on a conference for my trusty employer, a trip I had hoped would afford me the chance to blog all kinds of fascinating insights about that lovely burg. As it turned out, work kept me pretty busy, and while I did take a couple of decent-size hikes and took in a Mets game, I didn't get a chance to split any arrows.

Instead, I had to wait for the end of my trip for an unfortunate bit of inspiration. I had a bit of a medical emergency on the way through security for my flight back, an episode that landed me in a New Jersey hospital. It took me a while to fully realize what was going on, but once I did, the first thing I thought was - how much is this going to cost?

Indeed, it's one thing to compare the Canadian and American health care systems from a vantage point on the north side of the border, quite another to find yourself in the clutches of a system that's frightening and unknown to you. From the ambulance ride to all the various pokes with needles, I was acutely aware that a cash register was ringing up the various elements of my care. Terrified, I made sure they let me out of the hospital sooner than I think the doctors would have liked.

I have nothing but great things to say about the staff - the care was first rate and everyone from the emergency technicians to the nurses to the treating physician seemed to have my best interests at heart. And as it turns out, I believe my employer will probably cover all, if not most, of the cost of treatment.

But the experience was a window into what life must be like for the millions of Americans who either have inadequate insurance or none at all. I've always been a supporter of single-payer health care, and never more so than I am now. No one should be forced to opt out of the care they need for fear that it will drive them into poverty.

Actually, that raises another philosophical question, the answer to which I think tips in favour of universal care: If doctors are bound by the Hippocratic oath to do everything they can for a patient, and poverty is a root cause of innumerable health problems, isn't universal health care a must?

What's Up, Docs

Enjoying my first real dedicated foray into the Hot Docs festival, held annually in Toronto. Last year, a business trip cut into my viewing schedule, and I only managed to see one film. In the past three days, however, I've seen four documentaries, all of them outstanding, and gained a renewed appreciation for the special role that visual journalism can play in society. As a print journalist, I love the written word, but some stories only truly hit home when accompanied by arresting images.

It would certainly be impossible to convey the deep love shared by Australian sheep farmer Chris Rohrlach and his quadriplegic wife Rachel - who suffered a massive stroke at 21 while pregnant with the couple's first child - without seeing the way they look at each other in A Good Man, a documentary that follows the couple as they open a brothel in an attempt to support their farming income. Nor could words fully encapsulate the struggles of Michael Levin and Kendell Campbell, the two youths from Toronto's Regent Park neighbourhood featured in Invisible City.  Those who believe that one's circumstances in life result entirely from good moral choices would do well to witness this film, which shows just how difficult it is to make the right choices when dozens of voices are pulling at you from every direction, your hopes and dreams are discouraged by the very people that are supposed to help you and no clear path to a bright future is visible. Along the same lines, A Hard Name gets into the heads of several ex-convicts and shows how abuse and neglect are disturbingly common landmarks on the path to prison - and how difficult it is to discard the hard shell one must develop to survive while locked up.

While these films all washed down their difficult material with at least some hint of hopefulness and redemption, Eric Daniel Metzger's Reporter doesn't offer up much in the way of optimism. The film follows New York Times op-ed columnist and Pulitzer Prize winner Nicholas Kristof as he visits Congo to report on the civil war that has killed more than five million people in the past decade. The situation on the ground there is dire - with several militias battling for territory and resources, the civilian population has been decimated by violence, disease and starvation - and has been largely ignored by the West. Kristof struggles to write about the conflict in a way that will make people care, but the currents of the Western cultural river are clearly working against him. Reporter also serves up a sobering warning about the future of journalism, as Kristof laments that fewer and fewer media outlets are supporting the kind of expensive investigative work that he specializes in. Here in the West, we find it difficult to relate to the suffering a half a world away and, if we do care, we are frustrated by the fact that it's unclear how, exactly, our nations can improve the situation (do we use force to stop the militias? How much? Against which ones?). But imagine how much worse it will be when we no longer even hear about these atrocities.

If there is a common takeaway from these four films, it's that choice based purely on morality is a luxury, and those that divide the world into simplistic categories of good and evil need to dig a little deeper. And while pens like Kristof's do valuable digging, we need cameras like Metzger's to make these stories completely, viscerally real.