In England "binge drinking" can be a surprisingly small amount. Risky drinking can be as little as 2 glasses of wine a day. (One large glass of wine (200 ml) at 13 % would be about 2.5 units - two of those is 5 units. That over 5 days is 25 units).
We use a "unit of alcohol" as a public health measure. One unit is 125 ml of drink at 8% ABV (Alcohol by Volume).
Advice about sensible drinking says "no more than 3 to 4 units per day (men) 2 to 3 units per day (women), with some days drink free, and don't save up units to drink at once".
But problem drinking is much much larger quantities of alcohol. NICE guidelines say that 15 units per day get assisted withdrawal and 30 units per day (that's 750 ml of 40% vodka every day) is the threshold for medically supervised intervention.
The current English guidelines do not strongly recommend total abstinence, especially for people at the milder end of alcoholism. There are a variety of psycho-social interventions that are recommended.
Yes. It was for glasses of wine because at the time public health practitioners in England were worried about people having glasses of wine at work and in the evening.
Drugs 'train your brain' and we have many techniques for training our brains now that seem to actually work -- now under names like Cognitive Behavioral Therapy and meditation and brain games. This stuff used to go under names like hypnosis or mindreading.
It's amazingly underused and it's great to see modernizing approaches to the "command line" to the brain.
As I read these techniques for fighting addiction - "solving emotional and behavioral problems, rather than having abusers forever swear off the substance", "hourlong meetings once a week at which they discuss their goals for moderate drinking, as well as tips, challenges and progress on avoiding triggers" and "motivational interviewing, a goal-oriented form of counseling" I thought it bizarre that they are considered new and an alternative. Perhaps I found them an obvious improvement to the AA model simply because we now have the hindsight to see how ineffective AA is.
Please dont speculate on recovery unless you have first hand experience. I know many people who have improved their lives from AA and other meetings of the same type.
There are many people with addiction problems who do not trust doctors or religion and a place of like minded people is the only option for them (AA).
Agreed. (I don't know why you're being downvoted.)
I've never been in AA but I am close to someone who has. The primary benefit I see AA provide them is a group of like-minded people who will do fulfilling non-drug-related activities with them.
Addiction is as much social as it is physiological. It's very difficult to quit an addiction if you continue to hang out with the same people in the same environment in which you developed your addiction. Replacing that social environment with a new one composed of people who are sworn to avoid those substances and which is filled with fulfilling activities unrelated to your addiction is a superb way to keep from slipping back into old habits.
You're using your anecdotal experience to say that an entire profession of people who undergo many years of training don't understand the scope of the issue but that you do. That's why I downvoted you.
When doing scientific research, absolutely. When making a personal decision, it's foolish to ignore first-hand experience just as it's foolish to ignore advice from experts.
Not exactly. You can have the opinion that Homeopathy as a medical treatment is a complete sham and 'does't work' and back up that opinion with research, but while there is debate as to the relative merit of 12-step programs compared to other forms of treatment, it would be strange to assert that they simply don't work for anyone ever.
Good point. I think homeopath is a load of bunk, but behavior modification deserves to be in another category. Especially considering the independent variables (going to an AA program) and dependent variables (substance abuse) tend to be clear in this case.
For example, saying "I put cumin oil in a vaporizer and now I don't get colds as often" is different than saying "I joined an AA program and now I have been sober for 10 years".
* observation is simpler (are you in AA? are you still drinking?)
* so measurement is simpler (how much blortzroot do you add to your lotion to clear up that rash? can you show your rash is 65% better than last week?)
* AA attempts to provide a permanent solution, not a remedy for symptoms, so it's more clear when AA fails.
* Also the things homeopathy "cures" tend to be in a completely different class and severity than chronic substance abuse
Yes I'm sure you do and I too know many people who improved their lives without going to AA. We're not going to persuade anyone talking about our personal experiences and how this guy Bob we know is doing really well.
Also I'm not speculating and I do have personal experience since you ask, I didn't say you need a psychiatrist and a prescription but from years of talking to addicts and going through recovery myself I've found that setting goals and staying positive and within limits and simple things like looking at changes in a certain way is very effective compared to what seems like a New Years Resolution that you'll likely fail and beat yourself for failing to keep up. Such therapy mentioned in the article can motivate people more than AA-style regimes can and that's more important in the long run.
They're not necessarily new, but addiction (even for alcohol or gambling) is closely tied to drug use and thus it's sub-optimally political.
That's a shame because research is difficult and also ignored if politicians find it doesn't suit their view.
Substitution therapy (eg, methadone instead of heroin) has strong supporters and detractors and it's hard to get good quality research to see whether substitution is better than abstinence.
Indeed, Russell Brand (comedian, actor, addict) has been talking about the benefits of abstinence based treatment and asking why it's not more available in England, which suggests to me that most people don't get abstinence based treatment. (Although he's talking about drugs and not alcohol).
It is weird that cognitive behavioural models are really old now and are only just starting to get a lot of use.
> it's hard to get good quality research to see whether substitution is better than abstinence.
How about maintenance? There's ample evidence from the UK, Switzerland, and elsewhere showing that diacetylmorphine maintenance (treating heroin addiction with heroin) is incredibly effective[0][1].
The effectiveness of treating existing users is the primary concern, but a nice bonus is that it also seems to have served as a deterrent for new heroin users due to its social image as a medical problem, rather than a criminalized behavior[2].
(Remember that, when administered in a controlled setting and in predetermined quantities (and purity), heroin use carries few of the dangers commonly associated with its use on the street, and is fairly similar to the related drugs that you already receive in the hospital[3])
I really wish that there was political will and bravery to allow maintainence with heroin and clinical injecting rooms.
That's obviously better for users, but it's better for wider society too. People who are addicted to drugs will take drugs, so forcing them to do so hidden away in places without safe needle disposal means members of the public or cleaning staff risk needle stick injury.
Someone who suffers from "binge drinking" may not be a candidate for AA. I think a lot of people could benefit from programs that catch addiction in the beginning phases.
Most addicts dont start out abusing substances heavily from day one, if we had more programs that focused on the early addiction phase then we may be able help many people who are teetering on the edge.
The author misses the point of who AA is intended for. Not every person who goes through a period of overindulgent drinking is an alcoholic. Many college students in the US drink like alcoholics and, like the article says, 75% of binge drinkers cut way back when they get more responsibility. AA, in my opinion, is meant for those other 25%. AA is for the people who have a serious job, a family, or other responsibility and don't slow down.
There are people who hit rock bottom from drinking and realize they need help. For them the thought of getting back to that rock bottom point can be terrifying. Abstinence only isn't forced upon them, but rather it can be viewed as the only option.
This article also doesn't do anything to address drug addiction. I don't think moderating heroin intake is going to be a viable option for people with a heroin problem.
There is certainly a large group of people in the world who can benefit from the treatment described here, but I think the article oversteps a great deal by saying this is a more effective addiction treatment than AA.
> Eight trials involving 3417 people were included. AA may help patients to accept treatment and keep patients in treatment more than alternative treatments, though the evidence for this is from one small study that combined AA with other interventions and should not be regarded as conclusive. Other studies reported similar retention rates regardless of treatment group. Three studies compared AA combined with other interventions against other treatments and found few differences in the amount of drinks and percentage of drinking days. Severity of addiction and drinking consequence did not seem to be differentially influenced by TSF [Twelve Step Facilitation] versus comparison treatment interventions, and no conclusive differences in treatment drop out rates were reported. Included studies did not allow a conclusive assessment of the effect of TSF in promoting complete abstinence.
A really new technique for fighting addiction I've been hearing about lately is Ayahuasca. It is a psychedelic brew that originates from the Amazon. I remember watching an episode of Vice (which I can seem to find) following a heroin addict through his Ayahuasca trip to get rid of his addiction and they claimed that it worked and he didn't get back to it.
Ibogaine actually what you're thinking of and I have no idea in the world why you are voted down because it's actually been showing great promise under controlled conditions.
I wonder how much a nutritionally empty, low fat diet is setting kids up for the anxiety and depression that seems to drive so much alcohol and drug abuse. At a time when major structural changes and growth are happening in the brain, changes and growth that require a lot of fatty acids for creating nerve and other brain cells, kids are getting Fruit Loops and skim milk as their nutrition source.
It might actually be a legal issue too. At least here in Holland there are strict rules as to the naming of product.
That's why we call peanut butter 'pindakaas', for example, which means 'peanut cheese'; producers were not allowed to use 'butter' in the name if the product did not contain actual butter.
The galling thing about AA/NA in the US is that judges often mandate attendance as condition for release of a DUI. The problem being, this violates the defendants 1st amendedment rights by the state forcing a religion on him.
Forgive me, I'm not sure which right you're referring to.
The text of the first amendment of the United States of America reads: "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances."
AA (in my understanding) doesn't force any religion. The 12 steps (link http://www.aa.org/assets/en_US/smf-121_en.pdf) talk about "a power greater than ourselves". There's no reason that couldn't be the judge assigning the sentence, in this case.
I guess I'm nitpicking, but the amendment mentions Congress, not the judicial branch. I suppose you could challenge the judge with a separate case -- I'm pretty certain our legal system would support that.
> I think the alternative to AA meetings is usually jail time - so it probably is to some degree voluntary.
"Do this or go to jail" is pretty much the definition of something which is -- legally speaking -- compulsory, not voluntary.
Its voluntary in the trivial sense that a conscious choice is involved, but not voluntary in the legal sense (or the substantive sense of a free choice made without threat of force.)
I've been in AA for years, and I agree with this - not just because of the establishment clause (which is reason enough), but because on the AA side we specifically state in our preamble that 'AA is not allied with any sect, denomination, politics, organization or institution.' Making it a government-sanctioned and non-voluntary program violates one of the core organizing principles of AA that has allowed it to last this long. The judicial system should concentrate on medical/behavioral/psychological research and let the leave the twelve-step groups alone.
A state court forcing someone to do something is not Congress, nor is it making a law. You are reacting to what you want it to say, not what is actually written.
> A state court forcing someone to do something is not Congress
Which is why its not an independent First Amendment issue, but a Fourteenth Amendment issue, however, as it is well-settled law that the scope of the rights considered fundamental to the concept of ordered liberty and thereby incorporated against the States under the Due Process Clause of the Fourteenth Amendment includes the entirety of the protections of the Free Exercise and Establishment Clauses of the First Amendment, the usual legal analysis of religious freedom issues, whether state or federal, is under the First Amendment logic applied the same way whether the government involved is state or federal.
> nor is it making a law.
It is either (a) enforcing a law that Congress or a state legislature made (which law, if it violates First Amendment religious freedoms, violates the Due Process Clause of the Fourteenth Amendment when a State does it or the applicable clause of the First when the federal government does it) or (b) depriving someone of Constitutional liberty without a basis in law in the first place (which also violates the Due Process Clause of the 14th Amendment when a State does it, and the Due Process Clause of the 5th Amendment if it were a federal court.)
> AA (in my understanding) doesn't force any religion.
Your understanding is incorrect on two levels; first, AA are religious even if in a somewhat generically deistic way, and not secular in and of themselves, second, the actual AA groups in a particular area to which defendants are permitted to choose are often even more specifically religious than AA-on-its-own, to the point of being affiliated with specific established religious institutions other than AA itself.
For my pharmacology class, I had to attend multiple AA sessions. From my experience, in two separate regions, AA replaces the addiction with an addiction to social responsibility and moral responsibility (through a deity). In my honest opinion, judges are prescribing religion (or Kohlberg?) as a replacement addiction. My outside observation was cult behaviors with a climbable hierarchy of social power and control.
Note that this as a condition of release (which goes beyond just DUI) has over the last decade been explicitly struck down as unconstitutional where the person subject to the order has a religious objection to the program by at least the 2nd, 7th, and 9th Circuits -- and upheld, AFAIK, by no federal appellate court.
So, while it has been a common practice, the tide is turning fairly rapidly against it in the legal system.
The language of AA and other programs like them have failure as a built-in premise of attendance. Just by insisting on abstinence assumes that failure is the only possible outcome of non-abstinence, however moderated or controlled that non-abstinence is.
First and foremost obviously one has to clear themselves of physical addiction, which in most cases should be done with professional medical guidance. Afterwards comes the psychological compulsion to use. For me the best thing was to think rationally about the decision to use, and whether it was going to give me the benefit I sought. In most cases, having a drink doesn't help with the situations in which I wanted it, except for very short-term (hour or two); clearly not a long term solution to problems like anxiety, social awkwardness, depression. I think rational positive thinking like this can be made habitual with practice. Having group support from something like A.A can be beneficial in the early days of this process.
The issue with abstinence based programs is that they don't treat the underlying cause of the problem. Their focus is purely on a singular behavior which the problem led to. People in them are terrified of a single drink because it represents failure, but they don't identify what that single drink really means to them psychologically and how to address that problem in a rational way.
I know people who have benefited from AA, but their attitudes generally seem to be "don't throw the baby out with the bathwater." They take out the positives and ignore the negatives.
The entire point of AA is not to focus on the singular behavior of problem drinking, but instead to produce a complete psychic change. The central theme of the "Big Book" is that simply removing the alcohol from an alcoholic is not enough. The alcoholic must instead completely change their way of living and interacting with others. The program is designed to address the root cause of many specific issues the founders saw to be common among alcoholics.
Furthermore, it is highly encouraged to seek outside help (psychiatrists, therapists, etc.) if needed.
I've had this discussion before and it usually boils down to someone having a non-traditional view of the 12 steps. I read them at face value: Admitting one has no control over an addiction and relying on a higher power to address it is incompatible with my view of finding the underlying cause.
Whether what you say is official canon or not doesn't seem to matter to the reality of how it's managed at the group level. There seems to be for example a very wide variation in how people interpret the "12 steps," particularly amongst atheists or agnostics.
I am glad that medical assistance is encouraged at the very least.
The idea of a higher power is simply faith that life is good. many addicts have an auto response to everything in life as being shit, and this warps perception. Most non faith based people actually are quite faith based in that they believe things will work out well when they put their energy into it. That is faith. Many addicts do not have that innate understanding. The 12 steps is just a set of skills to obtain that world view.
The idea of a higher power is a deity and nothing else. AA spells this out further with 6 more steps that specifically refer to said deity. They encourage a group confessional and penance to be absolved of your behaviour or crimes while wasted. Abstinence is the only solution because religions do not tolerate anything else. For some people belief in superstition will help them get off the booze/drugs for others it won't work. Detox supervised by medical staff and a regular visit to a shrink to help you with impulse control is all that is needed. Unfortunately this costs money which many addicts don't have so they are stuck with AA who are unable to assess their program failure rate because it would be admitting that God has failed.
Sorry what? Have you read the 12 steps? The explictly refer to "God" and explain "his" role in "remove[ing] all these defects of character." How is that at all ambiguous?
The higher power may be explicitly christian many times, but the way it integrates with AA means you really only need faith that you don't need the substance and that you can live a good life without it. Many people find this idea easier to grasp in a spiritual context where they it's much easier to hold faith in spite of what their brain tells them.
What's your understanding of the inventory process? To me it's all about finding the underlying causes, and the behavioral and mental habits that underlie the addiction, and working on correcting them.
57 comments
[ 4.1 ms ] story [ 100 ms ] threadIt doesn't ever mention quantities.
In England "binge drinking" can be a surprisingly small amount. Risky drinking can be as little as 2 glasses of wine a day. (One large glass of wine (200 ml) at 13 % would be about 2.5 units - two of those is 5 units. That over 5 days is 25 units).
We use a "unit of alcohol" as a public health measure. One unit is 125 ml of drink at 8% ABV (Alcohol by Volume).
There's a handy chart at wikipedia here: https://en.wikipedia.org/wiki/File:Units_of_alcohol_chart.sv...
Advice about sensible drinking says "no more than 3 to 4 units per day (men) 2 to 3 units per day (women), with some days drink free, and don't save up units to drink at once".
But problem drinking is much much larger quantities of alcohol. NICE guidelines say that 15 units per day get assisted withdrawal and 30 units per day (that's 750 ml of 40% vodka every day) is the threshold for medically supervised intervention.
The current English guidelines do not strongly recommend total abstinence, especially for people at the milder end of alcoholism. There are a variety of psycho-social interventions that are recommended.
http://www.nice.org.uk/Guidance/QS11
http://www.nice.org.uk/guidance/CG115/chapter/1-Guidance
Extending both axises would be useful.
It's amazingly underused and it's great to see modernizing approaches to the "command line" to the brain.
Please dont speculate on recovery unless you have first hand experience. I know many people who have improved their lives from AA and other meetings of the same type.
There are many people with addiction problems who do not trust doctors or religion and a place of like minded people is the only option for them (AA).
I've never been in AA but I am close to someone who has. The primary benefit I see AA provide them is a group of like-minded people who will do fulfilling non-drug-related activities with them.
Addiction is as much social as it is physiological. It's very difficult to quit an addiction if you continue to hang out with the same people in the same environment in which you developed your addiction. Replacing that social environment with a new one composed of people who are sworn to avoid those substances and which is filled with fulfilling activities unrelated to your addiction is a superb way to keep from slipping back into old habits.
I didn't downvote but I have a knee-jerk reaction to want to downvote people using anecdotal evidence to support medical treatments.
Isn't this exactly the kind of thinking that makes people believe that homeopathy works?
For example, saying "I put cumin oil in a vaporizer and now I don't get colds as often" is different than saying "I joined an AA program and now I have been sober for 10 years".
* observation is simpler (are you in AA? are you still drinking?)
* so measurement is simpler (how much blortzroot do you add to your lotion to clear up that rash? can you show your rash is 65% better than last week?)
* AA attempts to provide a permanent solution, not a remedy for symptoms, so it's more clear when AA fails.
* Also the things homeopathy "cures" tend to be in a completely different class and severity than chronic substance abuse
Also I'm not speculating and I do have personal experience since you ask, I didn't say you need a psychiatrist and a prescription but from years of talking to addicts and going through recovery myself I've found that setting goals and staying positive and within limits and simple things like looking at changes in a certain way is very effective compared to what seems like a New Years Resolution that you'll likely fail and beat yourself for failing to keep up. Such therapy mentioned in the article can motivate people more than AA-style regimes can and that's more important in the long run.
That's a shame because research is difficult and also ignored if politicians find it doesn't suit their view.
Substitution therapy (eg, methadone instead of heroin) has strong supporters and detractors and it's hard to get good quality research to see whether substitution is better than abstinence.
Indeed, Russell Brand (comedian, actor, addict) has been talking about the benefits of abstinence based treatment and asking why it's not more available in England, which suggests to me that most people don't get abstinence based treatment. (Although he's talking about drugs and not alcohol).
It is weird that cognitive behavioural models are really old now and are only just starting to get a lot of use.
How about maintenance? There's ample evidence from the UK, Switzerland, and elsewhere showing that diacetylmorphine maintenance (treating heroin addiction with heroin) is incredibly effective[0][1].
The effectiveness of treating existing users is the primary concern, but a nice bonus is that it also seems to have served as a deterrent for new heroin users due to its social image as a medical problem, rather than a criminalized behavior[2].
(Remember that, when administered in a controlled setting and in predetermined quantities (and purity), heroin use carries few of the dangers commonly associated with its use on the street, and is fairly similar to the related drugs that you already receive in the hospital[3])
[0] https://en.wikipedia.org/wiki/Heroin_maintenance
[1] http://www.nejm.org/doi/full/10.1056/NEJMoa0810635
[2] https://en.wikipedia.org/wiki/Heroin_maintenance#cite_note-9
[3] Such as morphine (the similarity of the names "morphine" and "diacetylmorphine" is not a coincidence!)
That's obviously better for users, but it's better for wider society too. People who are addicted to drugs will take drugs, so forcing them to do so hidden away in places without safe needle disposal means members of the public or cleaning staff risk needle stick injury.
Most addicts dont start out abusing substances heavily from day one, if we had more programs that focused on the early addiction phase then we may be able help many people who are teetering on the edge.
There are people who hit rock bottom from drinking and realize they need help. For them the thought of getting back to that rock bottom point can be terrifying. Abstinence only isn't forced upon them, but rather it can be viewed as the only option.
This article also doesn't do anything to address drug addiction. I don't think moderating heroin intake is going to be a viable option for people with a heroin problem.
There is certainly a large group of people in the world who can benefit from the treatment described here, but I think the article oversteps a great deal by saying this is a more effective addiction treatment than AA.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005032...
It's a bit fitting: a bastardization of the spelling which underscores the bastardization of nutrition going on with the product.
That's why we call peanut butter 'pindakaas', for example, which means 'peanut cheese'; producers were not allowed to use 'butter' in the name if the product did not contain actual butter.
The text of the first amendment of the United States of America reads: "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances."
AA (in my understanding) doesn't force any religion. The 12 steps (link http://www.aa.org/assets/en_US/smf-121_en.pdf) talk about "a power greater than ourselves". There's no reason that couldn't be the judge assigning the sentence, in this case.
When you force people into a program that references some idea of God you are doing exactly that..
Doing a quick Google search, it appears that at least one court has found mandated AA unconstitutional: http://www.sfgate.com/bayarea/article/Appeals-court-says-req...
"Do this or go to jail" is pretty much the definition of something which is -- legally speaking -- compulsory, not voluntary.
Its voluntary in the trivial sense that a conscious choice is involved, but not voluntary in the legal sense (or the substantive sense of a free choice made without threat of force.)
Which is why its not an independent First Amendment issue, but a Fourteenth Amendment issue, however, as it is well-settled law that the scope of the rights considered fundamental to the concept of ordered liberty and thereby incorporated against the States under the Due Process Clause of the Fourteenth Amendment includes the entirety of the protections of the Free Exercise and Establishment Clauses of the First Amendment, the usual legal analysis of religious freedom issues, whether state or federal, is under the First Amendment logic applied the same way whether the government involved is state or federal.
> nor is it making a law.
It is either (a) enforcing a law that Congress or a state legislature made (which law, if it violates First Amendment religious freedoms, violates the Due Process Clause of the Fourteenth Amendment when a State does it or the applicable clause of the First when the federal government does it) or (b) depriving someone of Constitutional liberty without a basis in law in the first place (which also violates the Due Process Clause of the 14th Amendment when a State does it, and the Due Process Clause of the 5th Amendment if it were a federal court.)
Your understanding is incorrect on two levels; first, AA are religious even if in a somewhat generically deistic way, and not secular in and of themselves, second, the actual AA groups in a particular area to which defendants are permitted to choose are often even more specifically religious than AA-on-its-own, to the point of being affiliated with specific established religious institutions other than AA itself.
So, while it has been a common practice, the tide is turning fairly rapidly against it in the legal system.
First and foremost obviously one has to clear themselves of physical addiction, which in most cases should be done with professional medical guidance. Afterwards comes the psychological compulsion to use. For me the best thing was to think rationally about the decision to use, and whether it was going to give me the benefit I sought. In most cases, having a drink doesn't help with the situations in which I wanted it, except for very short-term (hour or two); clearly not a long term solution to problems like anxiety, social awkwardness, depression. I think rational positive thinking like this can be made habitual with practice. Having group support from something like A.A can be beneficial in the early days of this process.
The issue with abstinence based programs is that they don't treat the underlying cause of the problem. Their focus is purely on a singular behavior which the problem led to. People in them are terrified of a single drink because it represents failure, but they don't identify what that single drink really means to them psychologically and how to address that problem in a rational way.
I know people who have benefited from AA, but their attitudes generally seem to be "don't throw the baby out with the bathwater." They take out the positives and ignore the negatives.
There are alternatives to A.A. however, for example SMART: http://www.smartrecovery.org/
Furthermore, it is highly encouraged to seek outside help (psychiatrists, therapists, etc.) if needed.
Whether what you say is official canon or not doesn't seem to matter to the reality of how it's managed at the group level. There seems to be for example a very wide variation in how people interpret the "12 steps," particularly amongst atheists or agnostics.
I am glad that medical assistance is encouraged at the very least.