Laura Miller

Addiction is not a disease: A neuroscientist argues that it's time to change our minds on the roots of substance abuse

The mystery of addiction — what it is, what causes it and how to end it — threads through most of our lives. Experts estimate that one in 10 Americans is dependent on alcohol and other drugs, and if we concede that behaviors like gambling, overeating and playing video games can be addictive in similar ways, it’s likely that everyone has a relative or friend who’s hooked on some form of fun to a destructive degree. But what exactly is wrong with them? For several decades now, it’s been a commonplace to say that addicts have a disease. However, the very same scientists who once seemed to back up that claim have begun tearing it down.

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Addiction Is Not A Disease, and It's Time to Rethink the Roots of Substance Abuse

The mystery of addiction — what it is, what causes it and how to end it — threads through most of our lives. Experts estimate that one in 10 Americans is dependent on alcohol and other drugs, and if we concede that behaviors like gambling, overeating and playing video games can be addictive in similar ways, it’s likely that everyone has a relative or friend who’s hooked on some form of fun to a destructive degree. But what exactly is wrong with them? For several decades now, it’s been a commonplace to say that addicts have a disease. However, the very same scientists who once seemed to back up that claim have begun tearing it down.

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United States of Inc.: Corporations As Nation-States in Silicon Valley’s Latest Utopian Management Scheme

During my desultory post-graduation years in San Francisco, I lived in a big duplex with three roommates. We had bands, fledging writing gigs and other financially unpromising passions, until one of us threw over la vie bohème to work at a consulting firm. We teased him mercilessly for using nonsensical catchphrases like “think outside the box” and for getting a job telling other people how better to run their companies when he’d never actually run a company himself. In the years since, he started an airline in a foreign country, and everyone else began talking about thinking outside the box, too.

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Neuroscientist: Why It's Dangerously Wrong to Approach Addiction as a Kind of Disease

The mystery of addiction — what it is, what causes it and how to end it — threads through most of our lives. Experts estimate that one in 10 Americans is dependent on alcohol and other drugs, and if we concede that behaviors like gambling, overeating and playing video games can be addictive in similar ways, it’s likely that everyone has a relative or friend who’s hooked on some form of fun to a destructive degree. But what exactly is wrong with them? For several decades now, it’s been a commonplace to say that addicts have a disease. However, the very same scientists who once seemed to back up that claim have begun tearing it down.

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Why 'Game of Thrones' Wouldn't Have Been Possible Without J.R.R. Tolkien and C.S. Lewis

For nearly 20 years in the middle of the 20th century, a small group of men met twice a week in the British university town of Oxford. They drank, they smoked, they told the occasional off-color joke and they sang a lot of very old songs. They also read aloud to each other from works they’d written, stories and papers that they believed to be radically out-of-step with their time. Everything about the greater world around them conspired to persuade them that what they valued and enjoyed was either doomed or already obsolete. One of them happily described himself as a “dinosaur.” Yet they would go on to shape global culture in ways we still feel today.

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Heroin is a White-People Problem: Bad Medicine, Economic Rot and the Enterprising Mexican Town that Turned the Heartland on to Black Tar

If you happened to live near a certain clinic in Portsmouth, Ohio, in the early 2000s, you might find yourself regularly answering your doorbell to people asking to buy your urine. The town, once awarded All-American City status by the National Civic League, stands across the Ohio River from the site of America’s first “pill mill” — a medical office, usually posing as a “pain clinic,” where people can easily obtain prescriptions for pain-killers — opened in 1979.

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When Buddhism Goes Bad: How a Yoga and Meditation Retreat Turned Cult-Like and Deadly

When the public learned of 38-year-old Ian Thorson’s death in a cave in the Arizona desert three years ago, the details behind the tragedy were both jarring and ominously familiar. Thorson had belonged to a religious splinter group, headed by a charismatic leader, that had holed up in a remote, isolated enclave. There were rumors of sexual shenanigans, weapons and highly secretive practices. In that respect, it was an old story.

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Down and Dirty Fairy Tales: How This Rediscovered Stash of Darker-Than-Grimm Stories Destroys our Prince Charming Myths

In 2012, readers around the world were intrigued to learn that a researcher in northern Bavaria had discovered hundreds of never-published fairy- and folktales collected by the 19th-century folklorist Franz Xaver von Schönwerth. Working just a few decades after the Brothers Grimm, Schönwerth considered scholars his natural audience, and as a result the tales he recorded are bawdier, racier and significantly more scatological than the collection the Grimms published under the title “Children’s and Household Tales.” Everyone knows that the Grimms’ fairy tales are much darker than the cleaned-up Disney versions, but with Schönwerth’s, the action gets even more down-to-earth.

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No, America Has Never Been a Christian Country -- Why Does the Myth Persist?

As Peter Manseau, author of “One Nation, Under Gods: A New American History,”would have it, nothing has done more damage to the ideal of American religious pluralism than the “stubborn persistence of words spoken more than a century before the United States was a nation at all.” Those words are “a city upon a hill,” preached by the Puritan John Winthrop to his fellow colonists as they prepared to leave their ship at Massachusetts Bay in 1630. Most strenuously invoked by Ronald Reagan, the city on the hill, according to Manseau, has for the past 50 years “dominated presidential rhetoric about the nation’s self-understanding, causing an image borrowed from the Gospels to become a tenet of faith in America’s civil religion.”

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Nuns Gone Bad: A Lurid Tale of a Lesbian Nun Sex Gang

In the summer of 1859, a desperate nun in the Roman convent of Sant’Ambrogio sent a letter to her kinsman, a bishop in the Vatican. She pleaded with him to rescue her, claiming that she had been the target of several poisonings and was in mortal danger. When her cousin the bishop answered her call and arrived at Sant’Ambrogio, he promised to rescue her and soon delivered on that promise. From his estate in Tivoli, the relieved but traumatized Katharina von Hohenzollern-Sigmaringen began to draft a denunciation of her one-time sisters back in Rome. It was an accusation more lurid than any popular anti-clerical satire, full of sexual transgressions, heretical practices and homicidal schemes. Furthermore, the case against the convent of Sant’Ambrogio had tendrils that climbed up to the highest reaches of the Church and entwined around the great Catholic controversies of the day.

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This Is the Absolute Worst Way to Teach Your Kids to Read

Recently, while cooling my heels at the airport, I overheard a boy of about 6 begging his mom to let him play with the family iPad. “No screen time until you do an hour of reading first,” was her reply. The child flung himself back in his seat and opened a paperback book with a disgruntled sigh.

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My Dad, the Pot Smuggler

“If you smoked Colombian weed in the 1970s and 1980s,” writes Tony Dokoupil in his new book, “I owe you a thank-you card. You paid for my swim lessons, bought me my first baseball glove and kept me in the best private school in south Florida, alongside President George H.W. Bush’s grandkids, at least for a little while.” That “little while” matters, because Dokoupil, whose father smuggled tens of thousands of tons of marijuana into the United States during those decades, would, by the 1990s, be living a hand-to-mouth existence just one step above a trailer park with his mother.

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"Zealot:" The Real Jesus

Very little is known about the historical Jesus, as opposed to the Jesus of myth who appears in the New Testament. He is mentioned by the 1st-century historian Flavius Josephus in reference to his brother, James, who led Jesus’ followers after his death. Two second-century Roman historians, Tacitus and Pliny, also refer to Jesus’ arrest and execution in discussing the movement he founded. Other than that, we have to rely on biblical writings, particularly the gospels — the earliest of which (Mark) was written down almost 40 years after Jesus’ death. None of the gospels were written by eyewitnesses to the events described; they’re based on oral and perhaps some written traditions. Much of contemporary biblical scholarship involves parsing and triangulating the various accounts to surmise which bits are the oldest and most likely to represent some real event or statement by Jesus himself.

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Rachel Kushner’s Ambitious New Novel Scares Male Critics

In 1963, Esquire magazine’s July issue was about the American literary scene, and featured an essay by Norman Mailer. Titled “Some Children of the Goddess: Further Evaluations of the Talent in the Room,” the piece was a repeat of a survey of his “rivals” that appeared in “Advertisements for Myself.” Few American novelists have ever been more invested than Mailer in the mystique of the Great American Novel, and it’s no coincidence that his list of the authors likely to produce such a work (William Styron, James Jones, James Baldwin, William Burroughs, Joseph Heller, John Updike, Philip Roth, J.D. Salinger and Saul Bellow) consisted of exactly zero women.

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What Everyone Should Know About the South

Tracy Thompson, a former newspaper reporter born and raised in Georgia, first got the idea for her book, “The New Mind of the South,” when a cousin passed on a startling bit of family history. Their shared ancestor, Thomas Thompson, was a Union man. Thompson clan legend held that Thomas had briefly pretended to support the Union, but only because he hoped to be reimbursed for property confiscated by General Sherman. Thomas was in truth a staunch anti-Confederate according to documents held in the National Archive. Furthermore, he wasn’t alone; Thompson found two dozen similar cases from the same small county when she visited the archives herself. “I’d always wondered why, unlike every other Southern family I knew, ours had no Civil War stories, ” she remarks.

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Were Early Christians Really Persecuted? Historian Reveals the Surprising Truth.

In the immediate aftermath of the Columbine High School massacre, a modern myth was born. A story went around that one of the two killers asked one of the victims, Cassie Bernall, if she believed in God. Bernall reportedly said “Yes” just before he shot her. Bernall’s mother wrote a memoir, titled “She Said Yes: The Unlikely Martyrdom of Cassie Bernall,” a tribute to her daughter’s courageous Christian faith. Then, just as the book was being published, a student who was hiding near Bernall told journalist Dave Cullen that the exchange never happened.

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“Going Clear”: Scientology Exposed

Several years ago, for a series of Salon articles about Scientology, I was asked to review the founding text of the church, “Dianetics” by L.Ron Hubbard, first published in 1950. The book seemed so clearly the work of a man suffering from particular and pronounced mental health issues that I became, for the first time, curious about its author. Like most self-help books, “Dianetics” frequently invokes case histories or hypothetical scenarios, but unlike most self-help books, Hubbard’s stories featured an alarming amount of violence, specifically domestic violence.

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The Tyranny of the Happy Ending

British librarians recently tallied up the number of times they’ve loaned out 50 classic novels over the past 20 years. They found that some authors — specifically Charles Dickens and Jane Austen — are more widely read than before, while others — George Eliot and Thomas Hardy — have suffered a decline in popularity. Determining what people are actually reading (as opposed to which books they merely buy or download — with the best of intentions!) is a lot trickier than you might think. But if anyone has a decent grasp on which literary works are standing the test of time with the average reader, it’s librarians.

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“Dreamland”: Inside the Mystery of Sleep

The opening scene of Marcel Proust’s “Swann’s Way” is one of the most famously difficult to get through in literature. That’s not because of its style, which is sublime, but because it describes the experience of falling asleep. Many susceptible readers nod off the first few times they attempt it. All writing about sleep has this problem; of the fundamental human appetites, it’s the least exciting. The better you invoke it, the more likely you are to incite it, and because it can’t be remembered, sleep can’t be described. Nothing could be duller than watching someone else do it. Only people who can’t sleep spend much time thinking about it, and if there’s anything more tedious than witnessing another person’s nap, it’s listening to a keyed-up, obsessive insomniac go on and on about how they can’t.

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Why We Should Fear Amazon

Late last week, the Justice Department warned Apple and five of the nation’s largest publishers that it was planning to sue them for price fixing. At issue is the agency model, a method of wholesaling e-books in which the publisher sets the retail price and the retailer takes a 30 percent cut. Most print and many e-books are sold under the traditional wholesale model, in which publishers sell books at a discounted price, and the retailer can resell them for whatever price it likes.

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The Mortifying Private Lives of Great Writers

Just how relevant is an author’s private life to our appreciation or understanding of his or her work? Many would argue that we should disregard it entirely. Others (myself included) might point out that while you can thoroughly enjoy a novel or poem without knowing who wrote it, any deeper grasp requires at least some basic information. It matters that Edna O’Brien is Irish, certainly, and it’s almost impossible to imagine how the writings of Jack Kerouac or Charles Bukowski could be separated from their life stories.

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The Fix Behind Fixing Social Security

In late February, deputy White House chief of staff Karl Rove, National Economics Council director Al Hubbard, and Barry Jackson, a special assistant to the president who is handling Social Security reform, met with administration-friendly lobbyists for a "rah-rah" cheerleading session on Social Security privatization. According to The Hill, representatives from the conservative 60 Plus Association, the business-funded Coalition for the Modernization and Protection of America's Social Security (COMPASS), America’s Community Bankers, the National Retail Federation, the Mortgage Bankers Association and the Business Roundtable heard the trio reiterate George W. Bush's commitment to "reform" Social Security. ''Karl Rove talked about its importance to the president's agenda, and Al Hubbard talked about its importance to the economy,'' a spokesperson from the Roundtable told Bloomberg News.

''The White House is running this as if it's a political campaign,'' Free Enterprise Fund president Stephan Moore told Bloomberg. "There are regular meetings the White House has with all the groups to make sure everyone is singing from the same hymnal."
To finance the campaign, business and trade association lobbyists are pressing their corporate members to fill the privatization collection plate. The New York Times' Glen Justice reports that althought "most groups are still raising money, and the spending figures they quote are still often just targets, the lobbying could amount to more than $100 million."

COMPASS, which counts the Business Roundtable, the U.S. Chamber of Commerce and the corporate funded USANext as members, just launched its "Generations Together" outreach effort, on which it expects to spend $20 million. The "grass-roots" campaign will try to recruit more than 100,000 volunteers to voice their support for President Bush's Social Security plan at town hall meetings and rallies as well as make phone calls and write letters to members of Congress, demanding action on Social Security.

Collaborating with COMPASS in its aggressive push for privatization is Progress for America, a group closely tied to the White House that spent nearly $30 million on Bush's re-election. As part of its $20 million Social Security reform campaign, PFA has recruited Texas A&M University economics professor Thomas R. Saving as an advisor and spokesman. Saving, however, was appointed by Bush as one of seven trustees for the U.S. Social Security Administration. The trustees issue reports on the current and projected financial status of the program, raising questions about potential conflicts of interest between his advocacy work at PFA and his role as a trustee.

Other PFA recruits include former U.S. Treasurer Rosario Marin and 9-year-old Texan Noah McCullough, whose "encyclopedic command of presidential history" has earned him five appearances on Jay Leno's Tonight show, according to New York Times reports. McCullough, whose mother describes him as "very patriotic and very Republican," has become a highly visible volunteer spokesman for the White House, traveling to several states ahead of the president's planned visits and doing radio interviews, answering trivia questions and pitching Social Security privatization.

PFA, which claims nonprofit status, was set up in 2000 and shares staff with the Washington lobby firm DCI Group. Records show that the PFA Voter Fund paid DCI about $800,000 during 2004 for work on the Bush re-election campaign. McCullough's media tour was "a brainchild" of Stuart Roy, a former aide to Rep. Tom DeLay (R-Texas) who recently joined the DCI Group. "We'll have Noah there as the face of Social Security reform," the Times reports Roy as saying. "It's about the next generation."

PFA has also been airing television ads, one of which features footage of Franklin Delano Roosevelt. The ad, which has drawn criticism, shows FDR signing Social Security into law while the voiceover says, "It took courage to create Social Security." Over an image of Bush signing a bill, the ads says "It'll take courage – and leadership – to protect it."

Adding to the campaign-like tone, Bush continues a nationwide tour, speaking at carefully orchestrated town hall meetings where he is relentlessly promoting personal retirement accounts. "I'm going to keep saying it all around the country," he told an audience of hundreds of supporters at the New Jersey Army National Guard Armory in Westfield, the Times reports. "I like doing this, by the way – like going around the country, saying, 'Folks, we have got a problem.'"

The real problem, however, is not with the Social Security program.
The so-called Social Security crisis is largely an invention of ideological think tanks and corporate-funded groups. The liberal foundation-funded Center for Economic and Policiy Research writes, "Social Security is more financially sound today than it has been throughout most of its 69-year history." The real problem is how the lobbyist-driven campaign to privatize Social Security marginalizes and renders irrelevant actual democratic discussion on Social Security and its future solvency.

"We're setting up an operation that is employing a campaign-type infrastructure, campaign-style tactics and really bringing election-year intensity to the debate," Republican National Committee communications director Brian Jones, referring to Social Security, told Bloomberg News. But as we've seen, "election-year intensity" rarely, if ever, allows thoughtful dialogue on political issues. Instead, voters get the hard sell.

At this point, it looks like there may be little else privatization's supporters can do as their product – Bush's "personal accounts" – becomes less appealing the more voters learn about it. Bush and company face an uphill struggle similar to the challenge they faced when selling the Iraq war. Convincing the public to go along with the dismantlement of a popular 70-year-old program is no small feat. And unlike Iraq, this time Americans can see a direct threat to their own wallets. Afraid of even less money for retirement, voters are asking tougher questions. And their congressional representatives, afraid of mid-term losses, are starting to pay attention to those concerns.

The 2004 Falsies Awards

This year marks the beginning of a new tradition for the Center for Media and Democracy. To remember the people and players responsible for polluting our information environment, we are issuing a new year-end prize that we call the "Falsies Awards." The top ten finalists will each receive a million bucks worth of free coupons, a lifetime supply of non-fattening ice cream, an expenses-paid vacation in Fallujah, and our promise to respect them in the morning. The winners of the Falsies Awards for 2004 are:

1. I'm Karen Ryan, reporting

Let's hear it for video news releases finally getting a smattering of the public scrutiny they deserve. A video news release or VNR is a simulated TV news story. Video clips paid for by corporations, government agencies, and non-governmental organizations are commonly passed off as legitimate news segments on local newscasts throughout the United States. VNRs are designed to be indistinguishable from traditional TV news and are often aired without the original producers and sponsors being identified and sometimes without any local editing.

When a VNR touting the controversial Medicare reform law ended with "In Washington, I'm Karen Ryan, reporting," Senate Democrats called foul. The VNR, which aired on 40 stations between January 22 and February 12, 2004, was paid for by the U.S. Department of Health and Human Services. Ryan, the "reporter," was in fact employed by a production company contracted by the Ketchum PR firm to create the VNR for HHS. An investigation by the U.S. General Accounting Office concluded that the VNR had violated a ban on government funded "publicity and propaganda." According to The Hill, a newspaper based in Washington, D.C., "VNRs are standard practice in the public-relations industry and local news reports often rely on them. ... However, the GAO said in its decision, 'our analysis of the proper use of appropriated funds is not based upon the norms in the public relations and media industry.'"

Karen Ryan was back in the news in October, when the liberal-leaning People for the American Way identified another Ryan VNR. This time Ryan "reported" on the Bush Administration's No Child Left Behind law. A Freedom of Information Act investigation revealed that the U.S. Education Department paid $700,000 to the PR firm to produce two VNRs as well as to rate newspaper coverage according to how favorably reporters described No Child Left Behind. "A number of local stations ran the VNR as is, and added a local twist by simply having their own reporter read the script," reported CampaignDesk.org, a journalist watchdog website. "The stations that took the time to have their own reporters record the script of the No Child Left Behind VNR had to have been fully aware of what they were doing: knowingly deceiving their viewers about the origins of the story – not to mention committing plagiarism – by passing off as their own original reporting words actually written by a PR company hired by the Bush administration."

2. War Is Sell

The formerly exiled Iraqi Ahmed Chalabi and his Iraqi National Congress were exposed as hucksters who befriended powerful men in Washington and played an instrumental role in selling the Iraq War. The U.S. major media finally examined the extent to which the INC and Chalabi used funding provided by the U.S. Congress to position themselves as a central source for much of the now-discredited "intelligence information" that the Bush administration used to justify the March 2003 invasion.

“The former Iraqi exile group that gave the Bush administration exaggerated and fabricated intelligence on Iraq also fed much of the same information to newspapers, news agencies and magazines in the United States, Britain and Australia," Knight Ridder reported in March 2004. "A June 26, 2002, letter from the Iraqi National Congress to the Senate Appropriations Committee listed 108 articles based on information provided by the Iraqi National Congress's Information Collection Program, a U.S.-funded effort to collect intelligence in Iraq. The Information Collection Program was financed out of the at least $18 million that the U.S. Congress approved for the Iraqi National Congress, led by Ahmed Chalabi from 1999 to 2003."

"Chalabi appears to have recognized that the neocons, while ruthless, realistic and effective in bureaucratic politics, were remarkably ignorant about the situation in Iraq, and willing to buy a fantasy of how the country's politics worked. So he sold it to them," John Dizard wrote for Salon.com in May 2004. In a detailed profile of Chalabi and the INC, the New Yorker's Jane Mayer included some fairly candid admissions by Francis Brooke, the INC's PR guru. Without Chalabi, he said, "This war would not have been fought." Beginning in the late 1990s, Chalabi and Brooke had designed a campaign to influence "only a couple of hundred people" in Washington with the ability to shape Iraq policy – people like Trent Lott, Newt Gingrich, Richard Perle and Dick Cheney. Following 9/11, their marketing strategy switched to terrorism and weapons of mass destruction. Brooke claimed, "I sent out an all-points bulletin to our network, saying, 'Look, guys, get me a terrorist, or someone who works with terrorists. And, if you can get stuff on WMD, send it!'"

Following the toppling of Saddam Hussein, the U.S. gave Chalabi one of the 25 seats on its hand-picked new Iraqi Governing Council. The Pentagon's $335,000 monthly payments to the INC's intelligence program continued until May 2004, when U.S. intelligence agencies began reporting that Chalabi may have actually been a double agent working for Iran. American troops raided Chalabi's headquarters and home in Baghdad, arrested two of his aides, and seized documents. "Only five months ago," observed Andrew Cockburn, "Chalabi was a guest of honor sitting right behind Laura Bush at the State of the Union. What brought about this astonishing fall from grace of the man who helped provide the faked intelligence that justified last year's war?" According to Newsweek, "Bush administration officials say the latest intelligence indicates [Chalabi] may have been supplying the Iranians with information on U.S. security operations in Iraq that could 'get people killed.'"

Chalabi responded by demanding that the U.S. leave Iraq. "Let my people go," he said, adding, "It is time for the Iraqi people to run their affairs." More recently he has aligned himself with Muqtada al-Sadr, the radical Shiite cleric whose militia battled U.S. troops in August in the Iraqi city of Najaf.

3. The Hidden (in Plain Sight) Persuaders

Stories of so-called "guerrilla marketing" abounded in 2004. From martinis to cell phones to TV programs, this stealthy form of advertising usually features paid agents subtly promoting a product to an unsuspecting audience. According to Shawn Prez of the marketing agency Power Moves, stealth techniques are especially effective with teens. "By the time the message gets out, they don't even know they've been hit; they don't know that theyve been marketed to. All they know is that their interest has been piqued," Prez said. Our favorite examples of guerilla marketing include the following:

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The Obesity Gap

On Sept. 12, 2001, according to Greg Critser's "Fat Land," one of the few news stories to break through the coverage of the previous day's attacks "was one about the latest obesity statistics (the national rate had jumped again -- to 26 percent)." Overweight will kill far more Americans each year than any terrorist would dare dream of taking out, and Critser is rightly incensed about the death toll racked up by cardiovascular disease, hypertension and especially diabetes, along with all the other fat-related illnesses.

Still, it has taken a while for the true proportions of the epidemic to penetrate my own consciousness, and to shock me it took a number like 26 percent (and that's just the obese; about half of us are merely "overweight," at least enough that health problems start to kick in). Sure, most of the people I know want to lose a few pounds, but none of them are actually obese or even significantly overweight. There's a guy from the University of Colorado's Health Sciences Center, a physiologist named James O. Hill, who's been running around pronouncing that "almost all Americans will be overweight by 2050," but from my little urban corner of the world, the fattening of the land has been nearly invisible.

That's Critser's point. Obesity, he points out, is a condition that "disproportionately plagues the poor and the working poor," while public discussion and policymaking on the topic get steered by the middle and upper classes. A health journalist, Critser decided he needed to lose 40 pounds a few years ago. To do so he enlisted a competent doctor, the prescription weight-loss medication Meridia, jogs in a congenial neighborhood park, a wife who cooked him healthy food, and access to plenty of information. "And money," he adds. "And time." He lost the weight, but "the more I contemplated my success, the more I came to see it not as a triumph of the will, but as a triumph of my economic and social class."

By contrast, he covered the opening of a Krispy Kreme doughnut store in Van Nuys, Calif., a largely working-class Latino area, for Harper's magazine in 1999. The store manager explained to him, "We're looking for bigger families ... Yeah, bigger in size," meaning, I suppose, that Van Nuys residents have more kids, as most Latino families tend to do, but also that they're likely to be heavier than non-Hispanic whites. African-Americans are more likely to be overweight than either group. And the poorer you are, the more likely you are to be obese.

The association of fat with a lower social status is probably intuitive for most Americans, but so far that has mostly been treated as a cruel stereotype of the overweight, representatives of whom have gone on TV talk shows to tearfully protest that they are not "lazy" or "low class." The innovation Critser brings to the literature of obesity is to take what turns out to be a valid perception after all -- working-class and underclass people are more likely to be fat -- and pull a switcheroo. Rather than regard class status as a stigma unfairly affixed to fat people, he presents fat as a health liability unjustly foisted on the poor and insufficiently addressed by the affluent.

It's a refreshing argument and often quite persuasive. Critser also traces some developments in international trade, agriculture, social customs, marketing and food sciences that, he maintains, have conspired to boost the calorie content of the average American's diet. High-fructose corn syrup, a sweetener that fosters diabetes, and palm oil, said to enjoy many "molecular similarities to lard," have become pervasive in prepared foods since the 1970s, and they are two of the nastiest, most fattening concoctions known to man. The portion of the average American's food dollar spent on meals obtained away from home jumped from 25 percent to 40 percent between 1970 and 1996. Restaurant food not only tends to be higher in calories (it adds 197 more per day, to be precise), it also comes in increasingly humongous portions, especially if you supersize your order. A regular serving of McDonald's French fries contained 200 calories in 1960; now it has 610. Then there are the between-meal snacks and the sedentary lifestyle.

As you might guess, "Fat Land" is packed with numbers, and while much of this is familiar stuff, some of the studies Critser digs up are fascinating. People, including children 5 and older, eat more food when presented with more of it, which pretty much dispenses with the notion that the body just naturally knows when it has had enough. On the contrary, natural selection has designed many of us to eat as much as we can get, as insurance against future deprivation. In fast-food restaurants, we eat more food when we get larger amounts of it at discount prices, and simply knowing that a greater variety of high-calorie snack foods has been made available to us apparently spurs us on to consume vast quantities of them. Critser debunks the idea that brief bouts of moderate exercise during the course of the day can make you as fit as sustained periods of vigorous activity, and that it's healthy to gain a few pounds as you get older.

But the really interesting and provocative aspect of Critser's book concerns class and poverty, which he insists several times are the "key determinants of obesity and weight-related disease." That's a strong-enough assertion for a magazine article, but he doesn't take it far in this slender book. He speculates a bit about why blacks and Latinos are more prone to overweight, but he doesn't really talk to any of them -- not, for example, a customer amid the crowd packing that new Krispy Kreme store -- about how they feel about eating and exercise, whether they're aware of how deadly obesity can be, whether they try to diet and exercise and, if not, why not. For a champion of the dispossessed, he doesn't seem to want to have much contact with them.

Instead, beyond delivering a well-earned indictment of corporate junk-food mongers, Critser expends a lot of his ire on "baby boomers," a group he blames for creating a social climate in which fat has flourished. The guy is a journalist, so he knows how to pick his straw men; you can get a lot of mileage out of boomer bashing, even with boomers themselves. But Critser's conception of just who these rascals are is hazy and contradictory. Boomers, he says, are elitist and individualistic, overly permissive when it comes to both their kids and themselves, and full of crackpot notions. He blames them for California's pioneering 1979 ballot measure, Prop. 13, which cut property taxes and drastically reduced education expenditures, and for Title IX of the federal Education Amendments of 1972, which mandated that equal money be spent on boys' and girls' physical education programs in schools.

But Prop. 13 was largely supported by older white Californians (the state is rich in retirees) who resented having their (admittedly draconian) property taxes spent on educating the increasing nonwhite kids in the state's schools. If it was a "generational temper tantrum," as Critser says, it wasn't boomers who pitched the fit. And the connection between Title IX and any decline in school P.E. programs seems pretty dodgy to me; all Critser has to support it is the grousing of some school administrators in a Department of Education survey, a fairly predictable bureaucratic response to change. Anyway, the point of Title IX was to spread around the P.E. resources and benefits to more of the students; what could be more elitist than the old-style boys-only programs that focused most of the schools' time and money on a handful of the most athletic children? Critser implies here that the old emphasis on "group participation and peak performance" in competitive team sports somehow produces more fit students, but later he praises P.E. programs that allow kids to choose the activities they prefer -- a far more sensible approach in a world where many prefer cycling or hiking to soccer.

Given his tendency to slant the story, I'm not sure I can trust Critser when he accuses upper- and middle-class critics of putting the kibosh on anti-obesity programs for kids because of overblown fears they will trigger eating disorders. He's right that the threat from obesity dwarfs that from anorexia and its ilk, which he calls "legitimate (and also epidemiologically small) health issues." But it's bizarre to claim that the medical system has been "skewed" so far in "favor" of anorexia that it has produced safe, effective drugs for eating disorders while the cause of weight loss has comparatively languished. Could the lack of anti-obesity drugs be due to the fact that it's simply a lot harder to medicate against the tens of thousands of years of evolution that have built our bodies to efficiently store fuel than it is to correct a mental illness that drives people to starve themselves? I'm willing to bet a year's supply of Big Macs that more is spent on research into how to slim us all down than on how to fatten up a few teenage girls.

Still, "Fat Land" is a lively book with more than a few worthwhile points to make, and you can't help but appreciate a writer who comes up with a line like "In the early 1990s supersize had met Super Mario with a vengeance." At the very least, it has taught me to think twice before I say the words "I'll have the Super Value Combo" the next time I step up to the concession stand at the movies. By now I really ought to know that if I do, I'm going to eat the whole thing.

Laura Miller is Salon's New York editorial director.

The Nightmare of Recovery

Those who believe, as most sensible people do, that the current war on drugs is a boondoggle and a disaster also usually say that we ought to be spending our dollars on treatment, not law enforcement, if we want to diminish the trade in illegal drugs. As long as rampant demand -- in the form of a buzz-hungry populace with fistfuls of ready cash -- waits inside our borders, enterprising individuals and organizations in other countries will find a way to supply it, no matter how many helicopters we send to Colombia or smugglers' boats we seize off the coast of Florida. Menacing teenagers will shoot each other on street corners and grizzled bikers will cook up methamphetamine in backwoods sheds provided there are enough people, in the end, willing to pay enough money for those little packets of white powder. (Or at least as long as selling that white powder remains against the law, but let's stay in the realm of political possibility.)

But if "treatment" has become a buzzword for citizens tired of seeing billions of their tax dollars wasted on hunting down South American drug lords and warehousing nonviolent offenders in prisons, Lonny Shavelson, a physician and journalist, argues that it's often not a whole lot more than that. In his new book, "Hooked," which follows five addicts through the torturous process of getting help for their substance abuse problems in San Francisco in the late 1990s, he makes a powerful case that America's drug treatment program is hopelessly flawed. Despite "a burgeoning movement in states across our nation to shuffle drug offenders from prison to treatment," he writes, "before we shift hundreds of thousands of addicts into rehab, we must first treat the treatment system."

As these five stories unfold -- at times "unravel" seems the better word for what happens -- the truth behind Shavelson's prosaic play on words becomes agonizingly clear. Lives are ruined and lost, hearts shattered, precious second and third chances squandered, trusts betrayed, hopes stubbed out. And, in a few rare cases, people do manage to miraculously pull themselves out of the pit. Shavelson wants to see those exceptions become the rule, and in figuring out how we can make that happen, he overturns a few of our most cherished notions about addiction and recovery.

The five people he writes about in "Hooked" are part of the kernel of hardcore substance abusers whose lives, according to Shavelson, constitute the front line of the drug war: "the most resistant, demanding, often unlikable, and arguably the least deserving of treatment service ... precisely the type of difficult junkie that rehab programs must succeed with if they are to make a dent in the crime, violence, and craziness that comprise the drug problem." Although the number of illegal-drug users in the U.S. declined from 1979 to 1998, the number of drug-related hospital visits and deaths went up, and most people picked up by the police for criminal offenses test positive for drugs. The Justice Department says drug users account for "an extraordinary proportion of crime."

Shavelson documents their blasted lives: Darrell is a lonely, homeless alcoholic and crackhead who has flunked out of several rehab programs, attended thousands of Alcoholics Anonymous meetings and been hospitalized for countless injuries, including falling out a window, while wasted. Mike is a skilled plumber whose unendurable memories of being molested as a child send him back to heroin again and again despite his heartbreakingly fervent desire to redeem himself in the eyes of his kids and girlfriend. (In the book's opening pages, Mike is described as shooting up while driving a truck down California's Highway 101 -- steering with his knees -- getting in a wreck and then, once ascertaining that he's uninjured, continuing to shoot up in a ditch beside his totaled pickup.) Glenda is a tiny, sweet-natured Native American who has been drunk and homeless since age 16 and looks 60 instead of 37, her actual age. Crystal is a cocky crackhead who boasts of her fearsome street reputation until she trusts Shavelson enough to confess that she was a streetwalker and a "victim." Most daunting of all is Darlene, whose auditory hallucinations ("noises," she calls them) could be caused by psychosis, or by the speed she injects as often as twice a day, or by the brutal conditions of her life in various homeless encampments, each makeshift shelter eventually bulldozed by the authorities without warning.

However desperate their situations, these five people entered treatment at an opportune moment. In 1996, the new U.S. drug czar, Gen. Barry McCaffrey, shifted a bit of the nation's drug policy focus from law enforcement to rehab, declaring that "effective treatment can end addiction" and that drug policy goals "can only be accomplished with a significant expansion of capacity to treat the nation's drug users." (Most of the money, however, still goes to enforcement.) And San Francisco had launched a much-ballyhooed "treatment on demand" policy that promised to get all addicts seeking help into a treatment program within 48 hours. You'd think that seeking rehab just at the time when officials had recognized the importance of treatment would give these addicts a boost -- but you'd be wrong.

According to Shavelson, the main factor causing people to abandon their search for rehab is basic bureaucratic disorganization on the part of treatment providers. That's not the kind of ideological beef that makes for chest-thumping Op-Ed columns, but it's the kind of problem that causes vast sums of money to be sucked up into a system that offers scarce positive results. Addicts have to make their way through a chaotic patchwork of services and programs, each covering a small, specific need and each looking for a reason to refer difficult clients elsewhere. Negotiating this thicket of paperwork and conflicting agendas makes dealing with the average HMO seem like a snap and -- guess what? -- organization and persistence are not common traits in drug addicts.

For example, the question of whether Darlene's aggressive, incoherent behavior results from mental illness or substance abuse (speed can induce psychotic symptoms) -- a question that, as Shavelson points out, isn't particularly relevant to helping her -- stymies her progress through the system. He describes her experience as "a cyclonic quest for rehab: referred to and then immediately kicked out of three drug treatment programs ... referred by the city's mental health counselors to the substance abuse counselors; referred back to mental health again in circles that have spun me dizzy just watching."

For another example, Glenda, joyfully sober for the first time in decades after three months in a terrific Native American-run inpatient program, steps out of it and into a treatment vacuum. The room found for her is in a "clean and sober" Salvation Army housing facility, but it's three blocks from the place where she used to hang out all day drinking with her street pals, and no one supervises her recovery beyond the Salvation Army's weekly drug tests. Two days later, she's drunk again and kicked out of her room and onto the street. A year and a half after that, she's dead.

Shavelson convincingly argues that all the money spent on treatment programs will go to waste unless each addict is assigned a case manager, someone who can guide him or her through detox (which "provides medical social services during those days it takes to get sober and withdraw"), then rehab (a program that seeks to resocialize the addict in a clean and sober environment) and finally getting the housing and employment he or she needs to become a functional member of society. Instead, he observes irately, "the seeming lack of any management that could impose order on the myriad substance abuse programs and services that have proliferated since the mantra of rehab took hold across the country" means that people get briefly cleaned up and then dumped back into the nightmare from whence they came, without anyone accounting for their need, as Mike puts it, "to learn how to live all over. Like from the beginning."

Mike, though, ran up against more than just bureaucratic hassles and inadequacies. After weeks of waiting to get in (during which time he almost died of an overdose), he became a model member of the famous San Francisco "therapeutic community" Walden House, but then relapsed shortly after moving on to transitional housing. Afraid of going back to Walden to plead for readmittance, he went on a heroin binge, then tried, without much success, to stay clean on his own. Shavelson sees this, too, as an avoidable calamity. Walden adheres to a common rehab philosophy that Shavelson calls "abstentionist." It imposes a long list of regulations on house residents, and punishes even the slightest infraction with long periods of "reflection" time on a bench in the communal hallway. A major violation like Mike's relapse means automatic ejection from the program -- unless the prodigal submits to a grueling group meeting in which he must sit in a chair in the middle of the room while the entire community pelts him with accusations and abuse.

This militaristic, "tough love" approach has disreputable roots in the scary Synanon movement that started in the late '50s and flourished in the '70s. Synanon, which practiced a form of "attack therapy" called "The Game," eventually was discredited when its cultlike antics expanded to include stockpiling weapons and placing a live rattlesnake in the mailbox of a lawyer who'd sued the group. Nevertheless, with some significant toning down of its more extreme aspects, the Marines-like, zero-tolerance model persists in therapeutic communities like Walden, which claim that the addict is like an irresponsible child whose personality must be broken down and rebuilt from the ground up in a highly structured, rigorously sober environment.

While it no doubt works for some people, Walden's strategy spectacularly failed Mike. Shavelson considers it abusive and self-defeating and points out that Mike's underlying psychological problems (particularly intrusive, recurring memories of being raped as a child) never got treated at Walden. The constant demands of the community's daily routine kept Mike distracted from his demons much as heroin once did, and the harsh, humilation-based methods used to reinforce the house's regimented lifestyle discouraged him from opening up about a past he remembered with tremendous shame. Worst of all, when he relapsed -- which most recovering addicts do -- the emotional ordeal that is the price of returning to Walden was more than he could face.

Not surprisingly, a new treatment philosophy has emerged in recent years, called "harm reduction." One advocate tells Shavelson that harm reduction defines what it wants from addicts as "any positive change." Its first commandment is "Meet the clients where they're at." Instead of jettisoning addicts from the program if they don't stay clean, harm reduction offers them different kinds of services, congratulates them for using fewer drugs and does whatever it can to help them "have less violent lives, steal from fewer people, become somewhat less crazy, and even, possibly, a bit happier." The zero-tolerance side considers harm reduction to be an unconscionable betrayal of the addict, who is engaged in a life-or-death struggle in which halfway measures don't work. (One of the drug users Shavelson interviewed, Darrell, agrees.) McCaffrey condemned harm reduction as a plot devised by drug legalization advocates.

Whichever approach works best, the existence of these competing approaches has resulted in a "drug treatment world ... divided into two armed, deeply entrenched encampments that to this day continue to fire bullets of contempt at each other's rehab philosophies." Shavelson clearly favors harm reduction, particularly in the case of someone like Darlene. Remarkably eloquent despite the utter confusion of her life, at one point she drags Shavelson into a store and shows him the cover of a comic book:

It's a busy, medieval scene. Dark, ominous castles are surrounded by wooden carts filled with dozens of blood-soaked, nearly naked women's bodies. Men in armor, holding swords, gawk at their exposed, bloodied flesh. I look at Darlene, puzzled. "Shrinks always want to know about the noises in my head," she says ... "That's a picture of my noises. It's the place I don't want to go no more."

She later explains that she's afraid to stop shooting speed because the "noises" might not go away and she'd be proven to be crazy. Darlene may indeed need structure in her life, but first she needs intensive professional psychotherapy.

Yet Darlene does, eventually, make it to Walden (albeit in a special program -- one that wisely combines full psychiatric care with drug rehab). So does Crystal, a rehab candidate who, while free of psychosis, is almost as unpromising as Darlene because she enters the system without the slightest desire to get off drugs. Shavelson, ever the pragmatist, doesn't think much of the bullying ways of attack therapy, which addicts voluntarily endure. But he finds himself, to his astonishment, endorsing a practice that superficially seems even more disrespectful: coerced treatment. The reason is simple: He has seen it work. Glenda, the most "pitiful, disheveled, near-death, long-term street alcoholic" he had ever known, was kidnapped and forced into rehab by concerned homeless service workers and came out "three months later -- cleaned up, sober, and healthy."

The system ultimately failed Glenda, but it succeeded with Crystal, who was charged with selling crack and sent to San Francisco's drug court instead of criminal court. Drug courts, originally established in Florida while Janet Reno was the state's prosecuting attorney, supervise an addict's recovery in much the same way that Shavelson envisions case managers doing it, from detox to rehab and on through getting a GED, getting out of debt and finding employment. The addict is required to take regular drug tests and report to the court every two weeks. If the addict doesn't comply, he or she is sent back to criminal court to face jail time. There's ample evidence that drug courts have the highest success rate -- that is, the lowest dropout rate and recidivism -- of any method of dealing with addicts, therapeutic or criminal. And this despite the fact that they fly in the face of one of the recovery movement's core truisms: that a substance abuser has to be truly ready and willing to quit in order to get sober.

Boasting from the start that "I can fake my way through any program. I'll take 'em for what they got," Crystal graduates two years later a changed woman. Shavelson attributes this success to the fact that despite her relapses and occasional truancies, the drug court judge and rehab team "simply [stuck] to her like glue." More an exquisite piece of theater than it is anything else, a drug court walks its charges through a predictable series of rebellions and transgressions, intensifying treatment when they start using again instead of kicking them out, manipulating them into the kind of program they need. The threat of being sent back to criminal court is the drug court's stick, and lavish praise for those who clean up their acts is its carrot. Crystal's stint in Walden is predictably "stormy" and she shrewdly observes that "when things get deeper at Walden than 'Don't do dope,' they don't know how to deal with it. But I talked to the judge and my Drug Court case manager and they're insisting I have a therapist at Walden 'cause I need some real help with this depression or I'll be back on the crack pipe."

The great irony of drug courts, though, is that you have to be a criminal to end up in them. Darlene, who supported herself with petty thefts but never got caught, managed to get the care she needed only because Shavelson went to bat for her, getting her a meeting with a gifted psychiatrist and pleading her case when his clinic tried to have her kicked out for threatening a worker. Mike does eventually wind up in jail for burglarizing his sister-in-law's house for drug money, but stands little chance of getting into drug court because the break-in was residential, not commercial, and prosecutors don't want to seem to be coddling offenders who have been "terrorizing the community." Not only that, but because he has been convicted of a couple of other minor, nonviolent felonies in the past, he faces a three-strikes penalty of 25 years to life -- a grotesque travesty of justice, given how badly he wants to be a responsible husband and father and how well he might do with the right kind of help.

"Hooked," with its tales of lives horribly mangled by everything from childhood abuse to mental illness to bad luck and, of course, addiction, gives the lie to the boot camp mentality that prevails in our public conversation about drug abuse. You need only look at the "before" and then the radiant "after" photos of Darlene and Crystal (beaming as she graduates from drug court) to see the kind of results that playing drill sergeant will never get us. Drug courts -- derided by some as "hug courts" -- don't coddle addicts, but they don't abuse or abandon them either. Shavelson has good things to say about a recent judicial mandate in New York that would send nearly all nonviolent drug-addicted offenders into rehab, but cautions that California's recently passed Proposition 36 doesn't insist on the kind of coordinated monitoring needed to make its similar directive pay off.

If you believe, as I do, that the war on drugs is really just a job creation program for people who'd otherwise be out of work now that the Cold War is over (the spooks and soldiers go to Colombia and the weapons-plant workers go to the prison-industrial complex), then, alas, it's hard to see the kind of revelations found in "Hooked" having much effect on public policy. Despite McCaffrey's own endorsement of the drug court model, you just have to do the math to see that things haven't changed that much. As McCaffrey left the Office of National Drug Control Policy at the end of 2000, the 2001 budget allocated $50 million to drug courts, $420 million to new prisons and $1.3 billion to fight the drug war in Colombia.

Laura Miller is Salon's New York editorial director.

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