6 ms·

Fun fact: The current standard within the US is AA/NA. AA and NA are not only wholly unscientific, being invented of whole cloth by a layperson in the early 2

Fun fact: The current standard within the US is AA/NA. AA and NA are not only wholly unscientific, being invented of whole cloth by a layperson in the early 20th century (for context, lobotomy was a totally accepted psychological treatment for decades after 1935). There was no science whatsoever involved in AA, and indeed Alcoholics Anonymous actively resists any data collection about the efficacy of its techniques whatsoever. It's main advantages from a US perspective are a) it's free. The costs are borne mostly in the form of churches providing basements and meeting rooms. and b) it's super churchy. We love churchy stuff around here. So basically we kicked addiction under the rug for the entire 20th century in favor of religious hokum that refuses any objective evaluation of its efficacy, or changing its methods. I should say, for the record, that there's a lot of people that have been helped by AA and NA, and there's indisputably good work being done there. But it's not perfect and categorically refuses to get better, and its longevity is IMHO more a result of our collective refusal to take the problem of addiction seriously in the US than anything else.

rajacombinator 9y ago
Got any better suggestions? Genuinely interested, not sarcasm. (Mostly.)
- milkytron 9y ago
  I've seen a lot of headlines about studies of psychedelic drugs and compounds having a positive impact on addicts. There are a ton of articles out there, most seem like clickbait, but there are studies that have been done such as this one [1] which say that LSD has had a positive impact on alcohol abuse. I'm not saying this is the cure, but I do think further studies could prove beneficial. Edit: Added pdf of paper [2]. [1] http://journals.sagepub.com/doi/abs/10.1177/0269881112439253 http://journals.sagepub.com/doi/abs/10.1177/0269881112439253 [2] https://www.ntnu.edu/documents/139226/8932977/JOP439253.pdf https://www.ntnu.edu/documents/139226/8932977/JOP439253.pdf
- curun1r 9y ago
  Not the poster you're replying to, but I'd say mindfulness and meditation. Learning to look inward can be an incredibly powerful tool for dealing with issues like substance abuse.
  - rajacombinator 9y ago
    I think those things have a lot of value but quite a challenge for the kind of person who struggles with addiction to make the leap to having the kind of mindset that would benefit from them.
- erikpukinskis 9y ago
  The OP suggested CRAFT and methadone are proven approaches. You could read the whole article it's informative and not that long.
  - rajacombinator 9y ago
    Will do, thanks.
- warcher 9y ago
  It's happening, it's just happening slowly. Point of fact, addiction is a disease and must be treated like a disease. This is pretty mainstream and not really all that controversial. The issue we're working through, glacially, is that in the US healthcare is for-profit and junkies are not profitable. So we just.... throw those people in the garbage. I think that's both immoral and economically wasteful. I know former junkies. Personally. And they're not garbage-- they have value and if you can get them well, they want to live a productive life. The plain fact of the matter is that there's no business case for treating these folks-- the government is going to do it or nobody is going to do it. And the status quo is "Fuck it, send them to church. I'm not paying for a bunch of crackheads to get clean. They need to find jesus." Which is another way of saying "Let them eat thoughts and prayers."
  - rajacombinator 9y ago
    While I appreciate the "US healthcare sux!!" sentiment, that's a pretty naive viewpoint that underestimates the difficulty of the situation imo. Are there other non "for profit" healthcare countries that have substantially better results in this area?
kirse 9y ago
actively resists any data collection What an overly dramatic way to restate that these orgs are anonymous. collective refusal to take the problem of addiction seriously Incorrect. The church, particularly Jesus, does take it seriously. Addictive and destructive behavior patterns are called sin, but because this "progressive" society continues to water down right vs. wrong and tread down a path of moral relativism (that's just like your opinion, man!), it has reaped exactly what it has sown - a lukewarm and ineffectual stance towards active repentance from sin, including the desire to help others in that process. What have you personally been doing to take things more seriously?
- krastanov 9y ago
  My understanding is that Jesus suggested helping sinners stop being sinners, not shaming them for being sinners. And "progressive" society is all about that - helping those that have failed. Evaluating the performance of our current approach is very much "taking it seriously". This is what the OP is suggesting.
  - newsmania 9y ago
    I don't think he's advocating shaming people with problems. I think he's just pointing out that the way our culture acts like obvious sin is hunky dory is a real problem.
  - deleted 9y ago
    [deleted]
- newsmania 9y ago
  Thanks, glad to see someone stand up for Jesus on HN. People act like religion is stupid here, but you make a great point to the contrary. If everything truly is relative and all that matters is what you want, why is opioid addiction a problem if that's what you want? There is good and there is evil. The attempt to deny it, as you correctly say, causes huge problems. Like how we tell school children that they are no more than evolved animals, then wonder about why they go shooting people then take their own life.
ThrustVectoring 9y ago
The only way to fairly evaluate a program is on the difference between it and a control intervention of some sort. Like, you can't just claim that the best students must have had the best teachers. A fair chunk of data supports the claim that people have gotten sober while in AA, which is significantly different than the claim that AA helps people. Unless you've got comparisons with control groups, "good work being done there" is disputable.
- warcher 9y ago
  AA is all volunteer, run by people who are doing their level best to help with a monstrously difficult problem, with demonstrable success. I do think they got some things right. I don't think their work is finished, and they do need to examine their methods and the efficacy of the same.
  - ThrustVectoring 9y ago
    Oh, I completely agree. I don't think AA is run by bad people or anything - my disagreement is with the level of institutional support given to AA. Decisions come with opportunity costs, and the cold logic of prioritization means that sometimes the best thing to do is to give less money to "people who are doing their level best to help with a monstrously difficult problem, with demonstrable success".
aaron695 9y ago
>refuses any objective evaluation of its efficacy, or changing its methods. The reason AA works is it refuses to change. It refuses to follow fads. It makes it imperfect but also makes it very resistant to politics. > actively resists any data collection about the efficacy of its techniques whatsoever. Because it's Anonymous. This is part of what it is. Sucks, but that's what it is. It's an important part. > it's super churchy. True, it's full of atheists though, I'd be interested to see if it has more atheists than the general population. But true it does use a cult model for positive change. > There was no science whatsoever involved in AA But there is solid science that backs AA. Even if it was started without a scientific underlying idea. People love to bag out AA, but as your last line says it is working for some people, studies back this. In a future utopia where healthcare is free and drug abuse is treated appropriately there might be better but we can't toss out one of the best treatments while we wait. The article is about family (Nar-Anon) and opioids (NA) so my comment is all a bit OT. But let's take CRAFT from the article, without the culty bit of Al-Anon/Nar-Anon, which CRAFT removes, can it be self sustainable across the world? If not, then is it really a better cure.
- warcher 9y ago
  > Because it's Anonymous. This is part of what it is. Sucks, but that's what it is. It's an important part. Dude, there is no reason you can't collect medical data responsibly and with respect to privacy. Cmon man. We do a whole lot of this, all over the place. They can, they just won't. > But there is solid science that backs AA. Even if it was started without a scientific underlying idea. > People love to bag out AA, but as your last line says it is working for some people, studies back this. It would be untrue and unfair to say that there's nothing to AA. It's been successful, but how successful? Compared to what? IMHO, the greatest aspect of its success is its ability to let people off the hook. This is just a way for politicians to throw some 'thoughts and prayers' at a hard problem and call it good. It's not good. It's not all bad, but you start digging into the social science research and there's a lot of progress that's been made since the 30's that AA just won't touch. AA isn't working for a whole lot of people. But it's cheap and it doesn't trigger certain populations within our democratic society, so it's gone on and on. I think we're running out of road here, but... well, we'll have to see.

rajacombinator 9y ago

Got any better suggestions? Genuinely interested, not sarcasm. (Mostly.)

milkytron 9y ago
I've seen a lot of headlines about studies of psychedelic drugs and compounds having a positive impact on addicts. There are a ton of articles out there, most seem like clickbait, but there are studies that have been done such as this one [1] which say that LSD has had a positive impact on alcohol abuse. I'm not saying this is the cure, but I do think further studies could prove beneficial. Edit: Added pdf of paper [2]. [1] http://journals.sagepub.com/doi/abs/10.1177/0269881112439253 http://journals.sagepub.com/doi/abs/10.1177/0269881112439253 [2] https://www.ntnu.edu/documents/139226/8932977/JOP439253.pdf https://www.ntnu.edu/documents/139226/8932977/JOP439253.pdf
curun1r 9y ago
Not the poster you're replying to, but I'd say mindfulness and meditation. Learning to look inward can be an incredibly powerful tool for dealing with issues like substance abuse.
- rajacombinator 9y ago
  I think those things have a lot of value but quite a challenge for the kind of person who struggles with addiction to make the leap to having the kind of mindset that would benefit from them.
erikpukinskis 9y ago
The OP suggested CRAFT and methadone are proven approaches. You could read the whole article it's informative and not that long.
- rajacombinator 9y ago
  Will do, thanks.
warcher 9y ago
It's happening, it's just happening slowly. Point of fact, addiction is a disease and must be treated like a disease. This is pretty mainstream and not really all that controversial. The issue we're working through, glacially, is that in the US healthcare is for-profit and junkies are not profitable. So we just.... throw those people in the garbage. I think that's both immoral and economically wasteful. I know former junkies. Personally. And they're not garbage-- they have value and if you can get them well, they want to live a productive life. The plain fact of the matter is that there's no business case for treating these folks-- the government is going to do it or nobody is going to do it. And the status quo is "Fuck it, send them to church. I'm not paying for a bunch of crackheads to get clean. They need to find jesus." Which is another way of saying "Let them eat thoughts and prayers."
- rajacombinator 9y ago
  While I appreciate the "US healthcare sux!!" sentiment, that's a pretty naive viewpoint that underestimates the difficulty of the situation imo. Are there other non "for profit" healthcare countries that have substantially better results in this area?

kirse 9y ago

actively resists any data collection What an overly dramatic way to restate that these orgs are anonymous. collective refusal to take the problem of addiction seriously Incorrect. The church, particularly Jesus, does take it seriously. Addictive and destructive behavior patterns are called sin, but because this "progressive" society continues to water down right vs. wrong and tread down a path of moral relativism (that's just like your opinion, man!), it has reaped exactly what it has sown - a lukewarm and ineffectual stance towards active repentance from sin, including the desire to help others in that process. What have you personally been doing to take things more seriously?

krastanov 9y ago
My understanding is that Jesus suggested helping sinners stop being sinners, not shaming them for being sinners. And "progressive" society is all about that - helping those that have failed. Evaluating the performance of our current approach is very much "taking it seriously". This is what the OP is suggesting.
- newsmania 9y ago
  I don't think he's advocating shaming people with problems. I think he's just pointing out that the way our culture acts like obvious sin is hunky dory is a real problem.
- deleted 9y ago
  [deleted]
newsmania 9y ago
Thanks, glad to see someone stand up for Jesus on HN. People act like religion is stupid here, but you make a great point to the contrary. If everything truly is relative and all that matters is what you want, why is opioid addiction a problem if that's what you want? There is good and there is evil. The attempt to deny it, as you correctly say, causes huge problems. Like how we tell school children that they are no more than evolved animals, then wonder about why they go shooting people then take their own life.

ThrustVectoring 9y ago

The only way to fairly evaluate a program is on the difference between it and a control intervention of some sort. Like, you can't just claim that the best students must have had the best teachers. A fair chunk of data supports the claim that people have gotten sober while in AA, which is significantly different than the claim that AA helps people. Unless you've got comparisons with control groups, "good work being done there" is disputable.

warcher 9y ago
AA is all volunteer, run by people who are doing their level best to help with a monstrously difficult problem, with demonstrable success. I do think they got some things right. I don't think their work is finished, and they do need to examine their methods and the efficacy of the same.
- ThrustVectoring 9y ago
  Oh, I completely agree. I don't think AA is run by bad people or anything - my disagreement is with the level of institutional support given to AA. Decisions come with opportunity costs, and the cold logic of prioritization means that sometimes the best thing to do is to give less money to "people who are doing their level best to help with a monstrously difficult problem, with demonstrable success".

aaron695 9y ago

>refuses any objective evaluation of its efficacy, or changing its methods. The reason AA works is it refuses to change. It refuses to follow fads. It makes it imperfect but also makes it very resistant to politics. > actively resists any data collection about the efficacy of its techniques whatsoever. Because it's Anonymous. This is part of what it is. Sucks, but that's what it is. It's an important part. > it's super churchy. True, it's full of atheists though, I'd be interested to see if it has more atheists than the general population. But true it does use a cult model for positive change. > There was no science whatsoever involved in AA But there is solid science that backs AA. Even if it was started without a scientific underlying idea. People love to bag out AA, but as your last line says it is working for some people, studies back this. In a future utopia where healthcare is free and drug abuse is treated appropriately there might be better but we can't toss out one of the best treatments while we wait. The article is about family (Nar-Anon) and opioids (NA) so my comment is all a bit OT. But let's take CRAFT from the article, without the culty bit of Al-Anon/Nar-Anon, which CRAFT removes, can it be self sustainable across the world? If not, then is it really a better cure.

warcher 9y ago
> Because it's Anonymous. This is part of what it is. Sucks, but that's what it is. It's an important part. Dude, there is no reason you can't collect medical data responsibly and with respect to privacy. Cmon man. We do a whole lot of this, all over the place. They can, they just won't. > But there is solid science that backs AA. Even if it was started without a scientific underlying idea. > People love to bag out AA, but as your last line says it is working for some people, studies back this. It would be untrue and unfair to say that there's nothing to AA. It's been successful, but how successful? Compared to what? IMHO, the greatest aspect of its success is its ability to let people off the hook. This is just a way for politicians to throw some 'thoughts and prayers' at a hard problem and call it good. It's not good. It's not all bad, but you start digging into the social science research and there's a lot of progress that's been made since the 30's that AA just won't touch. AA isn't working for a whole lot of people. But it's cheap and it doesn't trigger certain populations within our democratic society, so it's gone on and on. I think we're running out of road here, but... well, we'll have to see.