Wednesday, February 4, 2015

Social Capital and Addiction

According to the Oxford Dictionary, social capital refers to 'the networks of relationships among people who live and work in a particular society, enabling that society to function effectively.'
The World Bank has recognised the contribution of social capital to the well being of a country.

Mutual trust, wilful reciprocity of help and participation in civic society are described as three particular markers of social capital.

"When social capital is high , individual coping capital increases, but when it is low, crime rates, divorce and family violence increase"  (Sheila Hollins, Past President, Royal College of Psychiatrists. )

Addiction leads to a massive loss of social capital.  It also increases where there is a lack of social capital.  While addiction is understood to be predisposed by a "dopamine reinforcement deficiency' genetic marker there is an environmental contribution best described in 'anomie' research.  Anomie research overlaps clearly with the work on social capital.

Addiction is associated with brain atrophy and specific loss in the limbic system and frontal lobes. Using McLean's Triune Brain model, the frontal lobes are the latest brain development and are associated with what we most consider to be the 'human' brain, all that which is distinct from animal.  The limbic system is considered part of the 'emotional brain' and well developed in the animal. The first and oldest brain structures are akin to the lizard.

Reciprocity is not a capacity noted in the lizard or the psychopath. The psychopath is considered as clever but lacking the capacity for empathy, a particularly overlapping consideration akin to reciprocity.  The psychopath can 'chameleon' emotion but lacks true feelings. They're rare.  In contrast the 'sociopath' is developmental an animal like creature who can relate to it's particular 'tribal' association but can not go beyond 'blood' association to the more abstract and civilized associations noted by humans.  Just as psychopaths can "chameleon' emotions, sociopaths can 'act' human and survive in 'human' societies though commonly their relation is 'parasitic' and at best 'symbiotic'. 

Reciprocity at it's most 'human' is 'love your neighbour as yourself.'.  Naturally lizards lack this capacity and animals are more driven, with exceptional moments, by self gratificaton and species and tribe specific behaviour.  We celebrate the dog and cat "playing" together and the bird and cat "playing" together because they are exceptional.  Normally these 'enemies' would be at each other in competition for survival.  By contrast it's not uncommon for humans to 'play together' and we celebrate most when humans actually at war 'play together' such as the German/Allied Christmas festivities during WWI and WWII.  Such behaviour is furthest from the lizard.

Alcoholics and addicts devolve with increasing slavery to addiction.  They become 'religious' in their relationship to their substance of abuse and worship the addiction. Cinema has long used the models of 'vampires' and 'zombies' to represent the addictive process in the end stage.

Research on successful outcomes in recovery have pointed to the importance of 'participation' in society.  Addiction is isolation. Recovery is participation.  Indeed 'individual therapy' was consider ineffective by Freud and Jung.  AA in 1935 offered the first 'reproducible' success and offered a 'group process' model.

"The results of treatment outcomes studies indicated that the 12 step method is an effective for mof treatment for Alcohol/Drug Disorder (Harrison 3t al 1991). Overall abstinence rates for 1 year were 68% in 1,663 outpatients and 60% in 8,087 inpatients in a study derived from 35 different treatment sites (Hoffman and Miller 1992). The abstinence rates increased to 82% and 75%, respectively with regular attendance at AA."
- Textbook of Traumatic Brain Injury, American Psychiatric Association 2005
(More recent studies have supported the earlier research.  Cochrane Reports in contrast have been shown to have limitted validity in mental and behavioural health research due to an inherrent design flaw).

The key consideration is the need for 'socialization' of the addict and for increasing their social capital. Hence education such as the 12 steps have been successful in bringing individuals who have lost or never had a 'moral compass' back on track. Rehabilitation only begins when the 'substance' is stopped. Abstinence is the precurser for the reconstructive treatment that is 'resocialization'.  Resocialization in turn increases long term 'abstinence.'

Central to this is as noted above, "participation in civic society' and "wilful reciprocity of help". AA is considered in research terms as a 'peer support' process and early in the 12 step program individuals are encouraged to take on a sponsor and then sponsor someone else. This is like the classic 'see one , do one, teach one' model all medical students know.  In the process of learning the real key is the ability then to teach the learned subject.  Further participation in the 'fellowship' results in relearning of often lost on unlearned 'socialization' activities.

Mutual trust is commonly lost in the addict. This is consequence of the excessive 'trauma' that follows more often than precedes addiction. Further the addict has been predominantly associating with drug dealers whose moral development is likened to pedophiles.  There is no reason to expect an addict to have the capacity for 'mutual trust' at the beginning of their journey of recovery.  However only in the 'risk taking' of making new relationships can a person unlearn the long history of abuse that comes from being the slave to the drug dealers.  Drug dealers are simply classic sociopaths, some indeed psychopaths but all of the 'predator' class.

Psychopaths, sociopaths and predators all believe they can 'take' without 'consequence'.  Their arrogance and immaturity are central to their antisocial behaviour.  Like a gambler on the beginner's winning streak they do not need to accept 'compromise' and 'barter' as long as their 'bullying' tactics work out.  Limit setting is a central first stage in interatcting with these individuals before any hope of progress in their learning can be achieved.

Addicts learn 'reciprocity' by association with those more socially advanced than their addicted 'culture' of deviance and 'parasitology'.  More advanced cultures have inherrent internalized reciprocities such as health care.  For example, no drug dealer or cartel holds themselves accountable and provides insurance programs for those who overdose on their product.

It behooves everyone in the addiction field to consider 'social capital' in terms of treatment and recovery.  Along with this new models are using a '5 year abstinence' assessment cut off as used in other chronic disease and when this is used the power and success of models of therapy that, like 12 step programs, incorporate consideration of social capital shine.  Indeed, the term spiritual values used in 12 step programs and other areas of treatment is to some extent overlapping with the term 'social capital'. 

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