42 ms·

Sobriety startups shaking up the 12-step model

136 points by mathgenius 8y ago

whiddershins 8y ago
The headline is misleading, it barely references 12-steps, basically clickbait.
- markatkinson 8y ago
  What more would you like it to mention? I just read the article and it was about startups that are introducing newer and cheaper options for people who may have used the 12 step program, exactly what the headline insinuates. Maybe it was changed since you commented?
  - chasil 8y ago
    12 steps has a 10% success rate. Naltrexone or nalmafene have a 75% success rate. Why are we even having this conversation?
    - chasil 8y ago
      This is the COMBINE study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945872/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945872/ Thus, the results of the COMBINE study demonstrated that a pharmacotherapy, like naltrexone, when given with medical counseling that emphasizes taking medications as prescribed, can yield clinically significant outcomes (reduced drinking/increased abstinence) that are either as compelling, and under some conditions, more compelling than those observed with specialty behavioral therapy. One important implication of the COMBINE results is that naltrexone with MM can be delivered in healthcare settings where traditional specialty treatment is unavailable.
      - chasil 8y ago
        The foremost pronent of naltrexone (or nalmafene where it is not available) is Claudia Christian: https://www.youtube.com/watch?v=6EghiY_s2ts https://www.youtube.com/watch?v=6EghiY_s2ts
  - Throwaway12step 8y ago
    > about startups that are introducing newer and cheaper options for people who may have used the 12 step program Just want to chime in here and say 12-Step Programs are free of charge. They pass the basket to pay for coffee and rent, but nobody is required to contribute. Treatment Centers are not 12-Step Programs unto themselves. In fact, they engage a lot of methods that are contrary to 12-Step Programs.
max76 8y ago
I want to see data driven novel approaches to addiction management. The 12-step model has dismal success rates [0]. Virtually all of the novel programs and facilities either do not report a success rate or their reported rate is highly suspicious. There are some exceptions [1]. The global addiction market is $4 billion and growing [2]. Any company working in the addiction space should keep accurate records of their success rate and push to improve that rate, because beating AA/NA's success rate at scale would be worth a large portion of the addiction market. [0] http://articles.latimes.com/2011/mar/03/news/la-heb-sheen-aa-20110302 http://articles.latimes.com/2011/mar/03/news/la-heb-sheen-aa... [1] https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment https://www.drugabuse.gov/publications/principles-drug-addic... [2] https://www.transparencymarketresearch.com/addiction-treatment-market.html https://www.transparencymarketresearch.com/addiction-treatme...
- Scaevolus 8y ago
  Very few studies have proper control groups. https://slatestarcodex.com/2014/10/26/alcoholics-anonymous-much-more-than-you-wanted-to-know/ https://slatestarcodex.com/2014/10/26/alcoholics-anonymous-m... > In conclusion, as best I can tell – and it is not very well, because the studies that could really prove anything robustly haven’t been done – most alcoholics get better on their own. All treatments for alcoholism, including Alcoholics Anonymous, psychotherapy, and just a few minutes with a doctor explaining why she thinks you need to quit, increase this already-high chance of recovery a small but nonzero amount. Furthermore, they are equally effective after only a tiny dose: your first couple of meetings, your first therapy session.
  - turingcompeteme 8y ago
    > most alcoholics get better on their own. These statements and studies show how little the average person, even a doctor, understands about alcoholics. Anyone who's attended an AA meeting or worked with alcoholics can easily tell you what's so crazy about these types of studies: AA is full of people who, by definition, cannot quit on their own. Other than some court-ordered cases, every single person in AA has already tried and failed to quit on their own. It's a nonsense comparison. You are comparing a group of people who have never tried quitting before, with those who have already spent years failing to quit on their own. Of course the first group does better! The second group is filled with more serious conditions. If they were able to quit on their own they would have never tried AA.
walrus01 8y ago
The christian part is a barrier for atheists and agnostics that would otherwise be OK with participating in Alcoholics Anonymous. https://en.wikipedia.org/wiki/History_of_Alcoholics_Anonymous https://en.wikipedia.org/wiki/History_of_Alcoholics_Anonymou...
- bsagdiyev 8y ago
  I'm not sure why, it may be a regional thing but I attend meetings in support for someone else and there are plenty of people who do not believe in God and state as such. I believe the third step even agrees, though I may be misinterpreting it: "Made a decision to turn our will and our lives over to the care of God as we understood Him." The "as we understood Him", while most likely still referring to God, is what is used to mean whatever works for you even if it isn't God but something you can believe in as much to help you, which then opens the door for substituting God in the later steps for your version (or not) of him. My personal opinion is that I find the program a bit cultish and don't agree that telling people they are helpless is the right way to help them, but that's my opinion and I respect that the program works for some people.
  - Throwaway12step 8y ago
    Powerlessness is the idea that an addict can't just do a little and stop on their own will. Anyone who can stop (like my wife who drinks half a glass of wine) isn't an addict. Being powerless over addiction isn't helpless. The help is right there in the meeting. I get what you're saying about feeling cult-like. Is it maybe it feels like there are cliques in the room? If so, I imagine if your friend asks to talk to or hang out with those people, they'll more likely than not be open to it. A lot of members don't run right up and hug new people because we don't want to freak them out.
  - coleifer 8y ago
    > I find the program a bit cultish I have shared in meetings that I sometimes think AA/NA is a cult. Everyone understood. And over time I've come to see the importance of the word "Anonymous", which is found in the name (obviously) but also in the traditions, and means exactly this: that everyone is equal within the group. There is no "great leader", nobody that is "right", nobody that is "wrong". It is about sharing one's experience -- the things one has done, the actions one has taken -- which speak for themselves. > and don't agree that telling people they are helpless is the right way to help them The actual word is "powerless", not "helpless". And this powerlessness describes: - the addict's inability to stop despite earnest and sincere desire. - the inability, once clean for a short time, to keep from returning to drug use Before I started attending 12-step, I had read the Bible, Marcus Aurelius, Tao Te Ching, various self-help books, The Power of Now, How to Win Friends and Influence People, and on and on and on. I had within me all the beliefs and understanding needed to live in a good way, in accordance with my principles. In short, to live with dignity. And yet I could not live according to my own principles. This wasn't just about drug use...it was about being patient, kind, tolerant, loving, helpful. I think that's the root of the powerlessness talked about in AA/NA. What I've found is that, with the belief in a higher power, I'm able to go to bed with a sense of dignity most days.
Quequau 8y ago
After years and years of struggling with alcoholism and AA, I got sober with naltrexone using the "Sinclair Method". I followed the treatment plan for a few weeks and at the end quitting drinking was easy and obvious. That was just over ten years ago and I haven't had a drink or gone to any meetings since. I'm only one person and I'm fully aware that the plural of anecdote isn't data. However, the experience was so drama, and more importantly self-loathing, free and so effective, that I can't help but feel bitter towards the proponents of AA who insist on it being a monopoly... especially those in positions of power in the criminal justice or public health systems because from my perspective it's a malicious and vindictive stance.
- chasil 8y ago
  Naltrexone/nalmefene works with 85% of the population, while 15% do not respond because of genetic disposition. Of the 85% who do respond, 75% are successful in what they are attempting. Proponents advise you to take it for the rest of your life. Naltrexone is not costly. This is your decision.
  - sedatk 8y ago
    or you know, don’t take medical advice from random people on the internet.
  - Quequau 8y ago
    I quit taking it when I quit drinking. I literally never finished the second box of tablets. What you are referring to are those who for whatever reason wish to continue drinking in moderation.
  - mdhen 8y ago
    Using the Sinclair method you only take naltrexone when you drink (well just prior to drinking). Not at all times. It's not expensive and it works so so well. In Finland it is the first line treatment option for alcoholism and it's wildly successful.
- jcims 8y ago
  First congrats on finding something that works for you and making it stick! From that perspective, I can see why you would not like folks that insist on AA being a monopoly, but I'm curious about that position. I've seen a lot of people that hate AA and a lot of people that think it saved their lives, but I've never seen anyone say that AA must be the only way to sobriety. What's the angle?
pgt 8y ago
It seems plausible that the complex set of control systems that govern our survival became intimately intertwined with various alkaloids over a few million years, "outsourcing" production of raw building blocks to plants. One example is the way in which sulforaphane from broccoli (via glucosinolate glucoraphanin) reduces symptoms of autism in the presence of myrosinase (present in mustard). [^1] Specifically, on the topic of addiction: "Ibogaine-treated rodents exhibit attenuated opioid withdrawal symptoms, and diminished self-administration of a variety of drugs of abuse, including opioids, cocaine, nicotine and alcohol. Anecdotal evidence suggests that ibogaine is also anti-addictive in humans." [^2] Meta-analysis of randomized controlled trials show that a single dose of LSD had a beneficial effect on alcohol misuse (OR, 1.95, 95% CI, p=0.0003). [^3] As we get better at modelling our own bodies, hopefully we can start to selectively replace or suppress some of our out-dated control systems to reduce suffering and increase efficiency while retaining our survivability. Citations: - [^1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672987/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672987/ - [^2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382526/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382526/ - [^3]: https://www.ncbi.nlm.nih.gov/pubmed/22406913 https://www.ncbi.nlm.nih.gov/pubmed/22406913
- ThrustVectoring 8y ago
  "Reduces the symptoms of autism" isn't what you'd naively think it is. Autism symptoms are often more accurately described as "the sorts of things autistic people do while distressed." In other words, I suspect that the main effect is stress reduction of some sort, rather than autism reduction.
aaron695 8y ago
Lol you are going to trust your LIFE to a "sobriety start-ups" The pure fact it's a start-up should tip you off there's going to be no evidence it works. Good luck with that. The whole article is junk. All treatments have huge failure rates, above 90%, including Naltrexone and AA and rehab and shrinks etc Chose / keep looking until you find the one that works for you. The whole X doesn't work is bullshit, none "work" well, it's a complicated topic.
randomacct3847 8y ago
It only hit me in the past few months how ingrained alcohol/drinking culture is in adult lives. It’s absolutely everywhere (ads, sports events, festivals, workplace, nightlife, social events). It’s actually crazy how lightly we treat this addictive, toxic substance that we joke about despite how many people it kills every year and harms directly and indirectly. At some point I was unknowingly drinking 4-5 times a week and thinking that was normal or OK. I’ve mostly just stopped and will only allow myself 1-2 drinks every few months on a vacation or social event with friends.
- virgilp 8y ago
  Depends on the quantity I guess, but... why is drinking 4-5 times a week not ok? Something like a glass of wine or a small beer should be fine, right? In some countries (e.g. France) it's a wide-spread habit to drink a glass of wine at lunch, and it doesn't seem to harm public health.
  - tonyedgecombe 8y ago
    https://www.theguardian.com/world/2003/oct/27/worlddispatch.france https://www.theguardian.com/world/2003/oct/27/worlddispatch.... "The findings reveal that the widespread perception of the French as a healthy nation is rapidly becoming outdated."
    - dnate 8y ago
      > "We're not proponents of complete abstinence. There probably is an amount of drinking that's OK," LoConte told NPR in June. "But from a cancer-prevention standpoint, drinking the least amount of alcohol possible would be the best strategy." I always found defending your drinking with the "a glass of wine a day is good for your heart" study a bit lame. But advocating abstinence because no level of alcohol is safe is very narrow minded as well.
      - Retric 8y ago
        Saying something is ok in moderation always defines moderation relative to the harm. This study puts moderation very low ~1-2 glasses of wine a month. Studies focused on different forms of harm have different thresholds, but you get all forms of harm not just what a specific study looks at. Saying I accept the harm for this benefit is fine, but pretending it does not exist is irrational.
bunkydoo 8y ago
This is very interesting, but it's important to realize that it has only been since the late 1950's that alcoholism has been treated as a disease. It started with a program called PAR at the post office that evolved into EAP (Employee Assistance Program) available at most major employers today. Prior to the 20th century it was generally safer to consume an alcoholic beverage than otherwise because, well, alcohol kills bacteria. But modern advertising has transformed Alcohol and Pornography into something truly mutated from their initial purposes. I'm sorry, but tech industry workers are mostly to blame for this - downvote me all you want, but I drink all I want as long as it doesn't involve getting behind a wheel of a car or being around children. I've been through the Silicon Valley "Microdosing" culture and I used marijuana pretty heavily most of my childhood & adult life. I can confidently say drinking, no matter the amount is generally a better bet societally with self-driving cars on their way soon. Example: I was camping in the great north and drinking water straight out of the lake, I could have bought a kit to try and sanitize the water with chemicals - but shots of Everclear grain alcohol got the job done.
sobernowadays 8y ago
Hey all HNers that might be wanting to stop drinking, or have trouble staying sober even though you try! The community in https://reddit.com/r/stopdrinking https://reddit.com/r/stopdrinking is amazing and keeps me and many others on a sober path. I've soon been sober for a year, and I was on a very destructive path. Would never have kept at it without that sub. Here's how it helped me: 1. In the beginning I was hurting and feeling really isolated - posting semi-regular helped me vent and people with more sobriety under their belt gave support directly. 2. When I've been to occasions (weddings, birthday parties) that include drinking, I've been able to jump into the chat and find instant support telling me to not have the first drink. 3. There's a daily check-in where you post to pledge today's sobriety. In the beginning I pledged each day. 4. I have a badge by my name that keeps track of each day I've been sober. Having to reset that to zero is more motivating than you might believe at first. 5. I now comment on other users posts, trying to keep their mood up and push them to not drink by giving them support. Also, the community and mods are superb, kind people.
empath75 8y ago
Most people with substance abuse problems “grow out of it” with no outside help at all. https://www.google.com/amp/s/www.psychologytoday.com/us/articles/200405/the-surprising-truth-about-addiction-0%3famp https://www.google.com/amp/s/www.psychologytoday.com/us/arti... Just from personal experience partying with lots of drugs and drinking in the rave scene when I was in my 20s and djing and promoting, the vast vast majority of people just got tired of it one day and quit — or it interferes with their jobs or their families and they did the right thing and stopped eventually. 12 steps’s entire thing about how once you’re an addict you’re going to be one for the rest of your life is just wrong.
- robertAngst 8y ago
  My issue is I'm extremely productive on weed. I hate alcohol, but weed makes my life, and everyone elses lives better(I run a consumer website). During my month off weed, I pretty much only wanted to relax and play video games. It seems to benefit, which makes it addicting.
  - empath75 8y ago
    If you genuinely don't have negative consequences, a repetitive behavior isn't really considered an addiction. Otherwise drinking water would be an addiction. Or any hobby.
- turingcompeteme 8y ago
  These articles are silly, and don't understand alcoholism. They give a few examples of successful ways that people have quit on their own, and since lots of people did it that way, then it must be more effective than treatment. They miss the blindingly obvious point that every single person in treatment has already tried and failed those "self-help" ways. Treatment is a final, desperate, step for alcoholics, once all those self treatment methods have failed. You can't compare the two, and the first treatment has already failed for the second group. It's like saying Tylenol is a more effective treatment than going to the hospital, because more people get better that way. Of course they do - because they have a less serious problem.
thelasthuman 8y ago
For something supposedly so good on it's own, religion really does try it's best to target vulnerable people. Naive children, desperate people, people who have lost someone, people sick with addiction (referencing the submitting to the higher power step). Whatever helps during trying times I guess. It just seems to me if religion was so great on its own, it would be approached in a calm rational manner targeted at mature adults with no driving force behind it.
- rsyring 8y ago
  That's a pretty broad brush to paint all of religion with. There are plenty of rational arguments for Christianity for those willing to do due diligence: https://www.thegospelcoalition.org/article/countering-a-distortion-christianity-as-intellectual-suicide/ https://www.thegospelcoalition.org/article/countering-a-dist...
  - rafamct 8y ago
    Doesn't look like you've provided any in that link?
    - rsyring 8y ago
      Yah, sorry about that. I responded above with a better link.
  - tdb7893 8y ago
    Do you have an example of those types of arguments? The linked article doesn't actually go into any of then and just referenced books I couldn't find. I'm very curious about this subject because in high school I took theology classes and the monks taught about the logical arguments but the arguments were always a little lackluster (the teacher's knew this going into it). The teacher's point during that section was that it would always require faith.
    - stephenhuey 8y ago
      Peruse the short arguments section on Peter Kreeft's website: http://www.peterkreeft.com/featured-writing.htm http://www.peterkreeft.com/featured-writing.htm
mgamache 8y ago
If you consider addiction as a psychological and physical dependence on a chemical what healthcare professional would design a program like AA? Seven of the 12 steps involve God. It also reinforces the 'moral failure' stigma attached to the person. You drink too much for a reason, not because you are a bad person. It's likely due to genetic and environmental factors. ohh and you can die from withdrawal (unlike most other addictions). https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2008.02203.x https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.... https://www.aa.org/assets/en_US/smf-121_en.pdf https://www.aa.org/assets/en_US/smf-121_en.pdf https://www.theatlantic.com/health/archive/2014/03/the-surprising-failures-of-12-steps/284616/ https://www.theatlantic.com/health/archive/2014/03/the-surpr... https://www.inspiremalibu.com/blog/alcohol-addiction/7-things-you-might-not-know-about-delirium-tremens/ https://www.inspiremalibu.com/blog/alcohol-addiction/7-thing...
- derefr 8y ago
  The AA steps were constructed in a culturally-Christian environment, for people who are also culturally-Christian, even if they’re atheists. (I.e., they are people who were taught Christian messages and then maybe rejected them, and who also have a mostly-Christian community around them.) Thus, they have to be read through this lens. Basically, if you want to “translate” the AA steps for the modern era where things aren’t so culturally-Christian, try replacing “God” with “a Church congregation-community”, where a “Church” is any social technology designed for taking a group of average people and trying to extract the best, most empathetic/humanist/“moral” group behavior out of them. When AA says to rely on the “power of God” which is “strong” while your own willpower is “weak”, what they’re really saying, stripping away the culturally-Christian assumptions, is to rely on the social technology of a Church-like organization to amplify and backstop your willpower in various ways. • Most Church-like organizations, regardless of religion, have a membership that strive to practice moderation in things like drinking, so switching your “community” to be that of the Church-like organization means switching your friends (maybe people who love to go out and get drunk?) for people who don’t. (This is a similar idea to why some people say prisoners are better off paroled: the last people you want prisoners around are other prisoners. You want them around good role-models, not bad ones, if you want them rehabilitated.) • Most Church-like organizations provide access to a confidant and therapist (in Christian churches, that’d be the priest.) If you bond with this confidant-and-therapist figure, you’ll feel less bad about temporary failures, because you’ll have someone to tell who will help you get back on the horse, rather than shunning you for your failure. • In most Church-like organizations, if you don’t attend the regular community meetings, the community members will get worried about you and check up on you. This will help prevent you from degenerating further after falling off the wagon. AA is already a bridge between two worlds; although it is constructed under a culturally-Christian lens, it assumes that its attendeees are not necessarily members of any Church-like organization. So one of the goals of AA group meetings is to be a Church-like organization, for people who don’t attend Church. It pushes you “back” toward the Christian Church because it knows it can’t help you forever and wants you to find a more permanent Church-like organization to help you. This is similar to how psychiatrists encourage people who are stable on a maintenance dose of some drug to stop seeing them, by instead getting a family doctor (if they don’t already have one) and getting the family doctor to perscribe the maintenance dose of the drug. I think that, while AA could be rephrased to not be culturally-Christian, it’d be very hard to replace its insistence on accepting some kind of religious Church-like organization into your life... because there really just aren’t that many non-religious Church-like organizations. If there were, maybe there’d be fewer alcoholics.
b0bby_tabl3s 8y ago
"Nyquil IS the 13th step. I'm high as a kite, and my teethe are green...MERRY FCKN CHRISTMAS!" - Denis Lery
geggam 8y ago
People who abuse substances are attempting to escape their reality because they feel powerless to change it. Educating people how to change their life is the cure. That or changing society so people aren't powerless to fix their own destiny. Until that happens the chemical people are addicted to is irrelevant. They can use any number of drugs to include sugar in a way that is detrimental to their health and will do so.
- normal_man 8y ago
  This is overly simplistic. People may start to abuse substances because of a feeling of powerlessness, depression or some other form of unhappiness, but once addicted, a person's life can improve and the use will continue until the psychological connections are broken and rewired.
  - geggam 8y ago
    Having been addicted I find complicating things to add to the issue. Simplest method to fix it is to address the underlying issues starting with the biggest first. As a note. You cannot fix this for other people they have to want to fix it and change.
vertline3 8y ago
Sobriety startup, that's a great idea! Fixing problems, and using the fast speed of startup culture. I'm not sure if they can fix it, but it seems like unique idea.
GoodJokes 8y ago
Yes! Capitalism will solve addiction! Not to sound like a broken record, but in what hell world are we so desperate for profit that we seek something like this?
beatpanda 8y ago
There's an extremely instructive lesson for programmers in the success and persistence of Alcoholics Anonymous. It's still around because: * It's free * It's decentralized * It works Is it the absolute best and most efficient method for treating addiction? Maybe not, but unless you have another method that works, which also does 1 and 2, it probably won't become as pervasive and long-lasting as AA. How does this apply to programmers? Look at every dumb project that ever tried to "disrupt" email. That's a field littered with dead bodies. Email survives. Why? See above.
gammateam 8y ago
The AA 12-step program was so strange when I accompanied my friend to one I had no idea it was so religious I found this to be a bug, not a feature It is interesting to see other methods being tried instead of masquarading the 12-step programs longevity as absolute validation
sverige 8y ago
I would consider myself to be an expert of sorts on AA. I was a member for over 20 years, attended at least 4000 meetings, have read everything ever published by AA World Services (and even held private study groups with folks to discuss these books). I served at every level except national. I left AA when I became a christian 15 years ago. (Yes, I started AA young, as a teenager.) All that is background for these strongly held opinions: 1. AA is decidedly not christian. If anything, it is a mere cult with some christian trappings and actually some occult underpinnings. No one ever heard the gospel at an AA meeting. It's not synonymous with christianity. 2. AA's recovery rate is abysmal, and actually less successful than just doing nothing about addiction. There is lots of room for providing much more effective help for people with addictions. 3. The practice of forcing people to attend AA meetings under court order should be stopped entirely. I know that most here are likely not christian and some are openly hostile. That's a completely different discussion than helping addicts to recover. A good resource for the many failings of AA can be found at the Orange Papers site. It seems the original site is down, but I believe someone has mirrored it elsewhere. Lots of info on the strange origins of AA there.
TheSoberTruth 8y ago
"The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry" https://smile.amazon.com/dp/B00FIMWI1O/ https://smile.amazon.com/dp/B00FIMWI1O/ > An exposé of Alcoholics Anonymous, 12-step programs, and the rehab industry—and how a failed addiction-treatment model came to dominate America. > AA has become so infused in our society that it is practically synonymous with addiction recovery. Yet the evidence shows that AA has only a 5–10 percent success rate—hardly better than no treatment at all. Despite this, doctors, employers, and judges regularly refer addicted people to treatment programs and rehab facilities based on the 12-step model. > In The Sober Truth, acclaimed addiction specialist Dr. Lance Dodes exposes the deeply flawed science that the 12-step industry has used to support its programs. Dr. Dodes analyzes dozens of studies to reveal a startling pattern of errors, misjudgments, and biases. He also pores over the research to highlight the best peer-reviewed studies available and discovers that they reach a grim consensus on the program’s overall success. > But The Sober Truth is more than a book about addiction. It is also a book about science and how and why AA and rehab became so popular, despite the discouraging data. Dr. Dodes explores the entire story of AA’s rise, from its origins in early fundamentalist religious and mystical beliefs to its present-day place of privilege in politics and media. > The Sober Truth includes true stories from Dr. Dodes’s thirty-five years of clinical practice, as well as firsthand accounts submitted by addicts through an open invitation on the Psychology Today website. These stories vividly reveal the experience of walking the steps and attending some of the nation’s most famous rehabilitation centers. > The Sober Truth builds a powerful response to the monopoly of the 12-step program and explodes the myth that these programs offer an acceptable or universal solution to the deeply personal problem of addiction. This book offers new and actionable information for addicts, their families, and medical providers, and lays out better ways to understand addiction for those seeking a more effective and compassionate approach to this treatable problem. […]
- TheSoberTruth 8y ago
  If a 12 steps program works or has worked for you, that's wonderful. People who want to change so that they can handle their life without the trouble are welcome to attend. There are many types of therapy. In art therapy alone, what've we got here: music, dance, writing, film, drawing, writing about problems and lists of solutions for each and for all of them (maybe only for yourself and then for others), etc. Problem: Solutions: - - - create a list of things that are reinforcing the [un]desired behaviors - create a plan for doing something different with/about identified triggers (problems) (I just thought of this and decided to share) Healing the underlying PTSD (and high blood pressure and very complex anxiety partly resulting from having adapted counterproductive coping strategies and defense mechanisms) is the objective of a number of randomized controlled clinical trials. Developing evidence-based treatment programs requires randomization and controls. https://en.wikipedia.org/wiki/Evidence-based_medicine https://en.wikipedia.org/wiki/Evidence-based_medicine
james_s_tayler 8y ago
Ok, but how can I quit drinking Coca-Cola? Tried like 10+ times now. It's not even Coke, it's sugar. Just such a powerful grip. Always relapse when a stressful time comes. Feels just the same as alcohol or cigarettes to me, but I don't feel justified in saying it's a real problem on the same level. I feel like it is though. Anyone else?

136 points by mathgenius 8y ago

whiddershins 8y ago

The headline is misleading, it barely references 12-steps, basically clickbait.

markatkinson 8y ago
What more would you like it to mention? I just read the article and it was about startups that are introducing newer and cheaper options for people who may have used the 12 step program, exactly what the headline insinuates. Maybe it was changed since you commented?
- chasil 8y ago
  12 steps has a 10% success rate. Naltrexone or nalmafene have a 75% success rate. Why are we even having this conversation?
  - chasil 8y ago
    This is the COMBINE study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945872/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945872/ Thus, the results of the COMBINE study demonstrated that a pharmacotherapy, like naltrexone, when given with medical counseling that emphasizes taking medications as prescribed, can yield clinically significant outcomes (reduced drinking/increased abstinence) that are either as compelling, and under some conditions, more compelling than those observed with specialty behavioral therapy. One important implication of the COMBINE results is that naltrexone with MM can be delivered in healthcare settings where traditional specialty treatment is unavailable.
    - chasil 8y ago
      The foremost pronent of naltrexone (or nalmafene where it is not available) is Claudia Christian: https://www.youtube.com/watch?v=6EghiY_s2ts https://www.youtube.com/watch?v=6EghiY_s2ts
- Throwaway12step 8y ago
  > about startups that are introducing newer and cheaper options for people who may have used the 12 step program Just want to chime in here and say 12-Step Programs are free of charge. They pass the basket to pay for coffee and rent, but nobody is required to contribute. Treatment Centers are not 12-Step Programs unto themselves. In fact, they engage a lot of methods that are contrary to 12-Step Programs.

max76 8y ago

I want to see data driven novel approaches to addiction management. The 12-step model has dismal success rates [0]. Virtually all of the novel programs and facilities either do not report a success rate or their reported rate is highly suspicious. There are some exceptions [1]. The global addiction market is $4 billion and growing [2]. Any company working in the addiction space should keep accurate records of their success rate and push to improve that rate, because beating AA/NA's success rate at scale would be worth a large portion of the addiction market. [0] http://articles.latimes.com/2011/mar/03/news/la-heb-sheen-aa-20110302 http://articles.latimes.com/2011/mar/03/news/la-heb-sheen-aa... [1] https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment https://www.drugabuse.gov/publications/principles-drug-addic... [2] https://www.transparencymarketresearch.com/addiction-treatment-market.html https://www.transparencymarketresearch.com/addiction-treatme...

Scaevolus 8y ago
Very few studies have proper control groups. https://slatestarcodex.com/2014/10/26/alcoholics-anonymous-much-more-than-you-wanted-to-know/ https://slatestarcodex.com/2014/10/26/alcoholics-anonymous-m... > In conclusion, as best I can tell – and it is not very well, because the studies that could really prove anything robustly haven’t been done – most alcoholics get better on their own. All treatments for alcoholism, including Alcoholics Anonymous, psychotherapy, and just a few minutes with a doctor explaining why she thinks you need to quit, increase this already-high chance of recovery a small but nonzero amount. Furthermore, they are equally effective after only a tiny dose: your first couple of meetings, your first therapy session.
- turingcompeteme 8y ago
  > most alcoholics get better on their own. These statements and studies show how little the average person, even a doctor, understands about alcoholics. Anyone who's attended an AA meeting or worked with alcoholics can easily tell you what's so crazy about these types of studies: AA is full of people who, by definition, cannot quit on their own. Other than some court-ordered cases, every single person in AA has already tried and failed to quit on their own. It's a nonsense comparison. You are comparing a group of people who have never tried quitting before, with those who have already spent years failing to quit on their own. Of course the first group does better! The second group is filled with more serious conditions. If they were able to quit on their own they would have never tried AA.

walrus01 8y ago

The christian part is a barrier for atheists and agnostics that would otherwise be OK with participating in Alcoholics Anonymous. https://en.wikipedia.org/wiki/History_of_Alcoholics_Anonymous https://en.wikipedia.org/wiki/History_of_Alcoholics_Anonymou...

bsagdiyev 8y ago
I'm not sure why, it may be a regional thing but I attend meetings in support for someone else and there are plenty of people who do not believe in God and state as such. I believe the third step even agrees, though I may be misinterpreting it: "Made a decision to turn our will and our lives over to the care of God as we understood Him." The "as we understood Him", while most likely still referring to God, is what is used to mean whatever works for you even if it isn't God but something you can believe in as much to help you, which then opens the door for substituting God in the later steps for your version (or not) of him. My personal opinion is that I find the program a bit cultish and don't agree that telling people they are helpless is the right way to help them, but that's my opinion and I respect that the program works for some people.
- Throwaway12step 8y ago
  Powerlessness is the idea that an addict can't just do a little and stop on their own will. Anyone who can stop (like my wife who drinks half a glass of wine) isn't an addict. Being powerless over addiction isn't helpless. The help is right there in the meeting. I get what you're saying about feeling cult-like. Is it maybe it feels like there are cliques in the room? If so, I imagine if your friend asks to talk to or hang out with those people, they'll more likely than not be open to it. A lot of members don't run right up and hug new people because we don't want to freak them out.
- coleifer 8y ago
  > I find the program a bit cultish I have shared in meetings that I sometimes think AA/NA is a cult. Everyone understood. And over time I've come to see the importance of the word "Anonymous", which is found in the name (obviously) but also in the traditions, and means exactly this: that everyone is equal within the group. There is no "great leader", nobody that is "right", nobody that is "wrong". It is about sharing one's experience -- the things one has done, the actions one has taken -- which speak for themselves. > and don't agree that telling people they are helpless is the right way to help them The actual word is "powerless", not "helpless". And this powerlessness describes: - the addict's inability to stop despite earnest and sincere desire. - the inability, once clean for a short time, to keep from returning to drug use Before I started attending 12-step, I had read the Bible, Marcus Aurelius, Tao Te Ching, various self-help books, The Power of Now, How to Win Friends and Influence People, and on and on and on. I had within me all the beliefs and understanding needed to live in a good way, in accordance with my principles. In short, to live with dignity. And yet I could not live according to my own principles. This wasn't just about drug use...it was about being patient, kind, tolerant, loving, helpful. I think that's the root of the powerlessness talked about in AA/NA. What I've found is that, with the belief in a higher power, I'm able to go to bed with a sense of dignity most days.

Quequau 8y ago

After years and years of struggling with alcoholism and AA, I got sober with naltrexone using the "Sinclair Method". I followed the treatment plan for a few weeks and at the end quitting drinking was easy and obvious. That was just over ten years ago and I haven't had a drink or gone to any meetings since. I'm only one person and I'm fully aware that the plural of anecdote isn't data. However, the experience was so drama, and more importantly self-loathing, free and so effective, that I can't help but feel bitter towards the proponents of AA who insist on it being a monopoly... especially those in positions of power in the criminal justice or public health systems because from my perspective it's a malicious and vindictive stance.

chasil 8y ago
Naltrexone/nalmefene works with 85% of the population, while 15% do not respond because of genetic disposition. Of the 85% who do respond, 75% are successful in what they are attempting. Proponents advise you to take it for the rest of your life. Naltrexone is not costly. This is your decision.
- sedatk 8y ago
  or you know, don’t take medical advice from random people on the internet.
- Quequau 8y ago
  I quit taking it when I quit drinking. I literally never finished the second box of tablets. What you are referring to are those who for whatever reason wish to continue drinking in moderation.
- mdhen 8y ago
  Using the Sinclair method you only take naltrexone when you drink (well just prior to drinking). Not at all times. It's not expensive and it works so so well. In Finland it is the first line treatment option for alcoholism and it's wildly successful.
jcims 8y ago
First congrats on finding something that works for you and making it stick! From that perspective, I can see why you would not like folks that insist on AA being a monopoly, but I'm curious about that position. I've seen a lot of people that hate AA and a lot of people that think it saved their lives, but I've never seen anyone say that AA must be the only way to sobriety. What's the angle?

pgt 8y ago

It seems plausible that the complex set of control systems that govern our survival became intimately intertwined with various alkaloids over a few million years, "outsourcing" production of raw building blocks to plants. One example is the way in which sulforaphane from broccoli (via glucosinolate glucoraphanin) reduces symptoms of autism in the presence of myrosinase (present in mustard). [^1] Specifically, on the topic of addiction: "Ibogaine-treated rodents exhibit attenuated opioid withdrawal symptoms, and diminished self-administration of a variety of drugs of abuse, including opioids, cocaine, nicotine and alcohol. Anecdotal evidence suggests that ibogaine is also anti-addictive in humans." [^2] Meta-analysis of randomized controlled trials show that a single dose of LSD had a beneficial effect on alcohol misuse (OR, 1.95, 95% CI, p=0.0003). [^3] As we get better at modelling our own bodies, hopefully we can start to selectively replace or suppress some of our out-dated control systems to reduce suffering and increase efficiency while retaining our survivability. Citations: - [^1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672987/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672987/ - [^2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382526/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382526/ - [^3]: https://www.ncbi.nlm.nih.gov/pubmed/22406913 https://www.ncbi.nlm.nih.gov/pubmed/22406913

ThrustVectoring 8y ago
"Reduces the symptoms of autism" isn't what you'd naively think it is. Autism symptoms are often more accurately described as "the sorts of things autistic people do while distressed." In other words, I suspect that the main effect is stress reduction of some sort, rather than autism reduction.

aaron695 8y ago

Lol you are going to trust your LIFE to a "sobriety start-ups" The pure fact it's a start-up should tip you off there's going to be no evidence it works. Good luck with that. The whole article is junk. All treatments have huge failure rates, above 90%, including Naltrexone and AA and rehab and shrinks etc Chose / keep looking until you find the one that works for you. The whole X doesn't work is bullshit, none "work" well, it's a complicated topic.

randomacct3847 8y ago

It only hit me in the past few months how ingrained alcohol/drinking culture is in adult lives. It’s absolutely everywhere (ads, sports events, festivals, workplace, nightlife, social events). It’s actually crazy how lightly we treat this addictive, toxic substance that we joke about despite how many people it kills every year and harms directly and indirectly. At some point I was unknowingly drinking 4-5 times a week and thinking that was normal or OK. I’ve mostly just stopped and will only allow myself 1-2 drinks every few months on a vacation or social event with friends.

virgilp 8y ago
Depends on the quantity I guess, but... why is drinking 4-5 times a week not ok? Something like a glass of wine or a small beer should be fine, right? In some countries (e.g. France) it's a wide-spread habit to drink a glass of wine at lunch, and it doesn't seem to harm public health.
- tonyedgecombe 8y ago
  https://www.theguardian.com/world/2003/oct/27/worlddispatch.france https://www.theguardian.com/world/2003/oct/27/worlddispatch.... "The findings reveal that the widespread perception of the French as a healthy nation is rapidly becoming outdated."
  - dnate 8y ago
    > "We're not proponents of complete abstinence. There probably is an amount of drinking that's OK," LoConte told NPR in June. "But from a cancer-prevention standpoint, drinking the least amount of alcohol possible would be the best strategy." I always found defending your drinking with the "a glass of wine a day is good for your heart" study a bit lame. But advocating abstinence because no level of alcohol is safe is very narrow minded as well.
    - Retric 8y ago
      Saying something is ok in moderation always defines moderation relative to the harm. This study puts moderation very low ~1-2 glasses of wine a month. Studies focused on different forms of harm have different thresholds, but you get all forms of harm not just what a specific study looks at. Saying I accept the harm for this benefit is fine, but pretending it does not exist is irrational.

bunkydoo 8y ago

This is very interesting, but it's important to realize that it has only been since the late 1950's that alcoholism has been treated as a disease. It started with a program called PAR at the post office that evolved into EAP (Employee Assistance Program) available at most major employers today. Prior to the 20th century it was generally safer to consume an alcoholic beverage than otherwise because, well, alcohol kills bacteria. But modern advertising has transformed Alcohol and Pornography into something truly mutated from their initial purposes. I'm sorry, but tech industry workers are mostly to blame for this - downvote me all you want, but I drink all I want as long as it doesn't involve getting behind a wheel of a car or being around children. I've been through the Silicon Valley "Microdosing" culture and I used marijuana pretty heavily most of my childhood & adult life. I can confidently say drinking, no matter the amount is generally a better bet societally with self-driving cars on their way soon. Example: I was camping in the great north and drinking water straight out of the lake, I could have bought a kit to try and sanitize the water with chemicals - but shots of Everclear grain alcohol got the job done.

sobernowadays 8y ago

Hey all HNers that might be wanting to stop drinking, or have trouble staying sober even though you try! The community in https://reddit.com/r/stopdrinking https://reddit.com/r/stopdrinking is amazing and keeps me and many others on a sober path. I've soon been sober for a year, and I was on a very destructive path. Would never have kept at it without that sub. Here's how it helped me: 1. In the beginning I was hurting and feeling really isolated - posting semi-regular helped me vent and people with more sobriety under their belt gave support directly. 2. When I've been to occasions (weddings, birthday parties) that include drinking, I've been able to jump into the chat and find instant support telling me to not have the first drink. 3. There's a daily check-in where you post to pledge today's sobriety. In the beginning I pledged each day. 4. I have a badge by my name that keeps track of each day I've been sober. Having to reset that to zero is more motivating than you might believe at first. 5. I now comment on other users posts, trying to keep their mood up and push them to not drink by giving them support. Also, the community and mods are superb, kind people.

empath75 8y ago

Most people with substance abuse problems “grow out of it” with no outside help at all. https://www.google.com/amp/s/www.psychologytoday.com/us/articles/200405/the-surprising-truth-about-addiction-0%3famp https://www.google.com/amp/s/www.psychologytoday.com/us/arti... Just from personal experience partying with lots of drugs and drinking in the rave scene when I was in my 20s and djing and promoting, the vast vast majority of people just got tired of it one day and quit — or it interferes with their jobs or their families and they did the right thing and stopped eventually. 12 steps’s entire thing about how once you’re an addict you’re going to be one for the rest of your life is just wrong.

robertAngst 8y ago
My issue is I'm extremely productive on weed. I hate alcohol, but weed makes my life, and everyone elses lives better(I run a consumer website). During my month off weed, I pretty much only wanted to relax and play video games. It seems to benefit, which makes it addicting.
- empath75 8y ago
  If you genuinely don't have negative consequences, a repetitive behavior isn't really considered an addiction. Otherwise drinking water would be an addiction. Or any hobby.
turingcompeteme 8y ago
These articles are silly, and don't understand alcoholism. They give a few examples of successful ways that people have quit on their own, and since lots of people did it that way, then it must be more effective than treatment. They miss the blindingly obvious point that every single person in treatment has already tried and failed those "self-help" ways. Treatment is a final, desperate, step for alcoholics, once all those self treatment methods have failed. You can't compare the two, and the first treatment has already failed for the second group. It's like saying Tylenol is a more effective treatment than going to the hospital, because more people get better that way. Of course they do - because they have a less serious problem.

thelasthuman 8y ago

For something supposedly so good on it's own, religion really does try it's best to target vulnerable people. Naive children, desperate people, people who have lost someone, people sick with addiction (referencing the submitting to the higher power step). Whatever helps during trying times I guess. It just seems to me if religion was so great on its own, it would be approached in a calm rational manner targeted at mature adults with no driving force behind it.

rsyring 8y ago
That's a pretty broad brush to paint all of religion with. There are plenty of rational arguments for Christianity for those willing to do due diligence: https://www.thegospelcoalition.org/article/countering-a-distortion-christianity-as-intellectual-suicide/ https://www.thegospelcoalition.org/article/countering-a-dist...
- rafamct 8y ago
  Doesn't look like you've provided any in that link?
  - rsyring 8y ago
    Yah, sorry about that. I responded above with a better link.
- tdb7893 8y ago
  Do you have an example of those types of arguments? The linked article doesn't actually go into any of then and just referenced books I couldn't find. I'm very curious about this subject because in high school I took theology classes and the monks taught about the logical arguments but the arguments were always a little lackluster (the teacher's knew this going into it). The teacher's point during that section was that it would always require faith.
  - stephenhuey 8y ago
    Peruse the short arguments section on Peter Kreeft's website: http://www.peterkreeft.com/featured-writing.htm http://www.peterkreeft.com/featured-writing.htm

mgamache 8y ago

If you consider addiction as a psychological and physical dependence on a chemical what healthcare professional would design a program like AA? Seven of the 12 steps involve God. It also reinforces the 'moral failure' stigma attached to the person. You drink too much for a reason, not because you are a bad person. It's likely due to genetic and environmental factors. ohh and you can die from withdrawal (unlike most other addictions). https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2008.02203.x https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.... https://www.aa.org/assets/en_US/smf-121_en.pdf https://www.aa.org/assets/en_US/smf-121_en.pdf https://www.theatlantic.com/health/archive/2014/03/the-surprising-failures-of-12-steps/284616/ https://www.theatlantic.com/health/archive/2014/03/the-surpr... https://www.inspiremalibu.com/blog/alcohol-addiction/7-things-you-might-not-know-about-delirium-tremens/ https://www.inspiremalibu.com/blog/alcohol-addiction/7-thing...

derefr 8y ago
The AA steps were constructed in a culturally-Christian environment, for people who are also culturally-Christian, even if they’re atheists. (I.e., they are people who were taught Christian messages and then maybe rejected them, and who also have a mostly-Christian community around them.) Thus, they have to be read through this lens. Basically, if you want to “translate” the AA steps for the modern era where things aren’t so culturally-Christian, try replacing “God” with “a Church congregation-community”, where a “Church” is any social technology designed for taking a group of average people and trying to extract the best, most empathetic/humanist/“moral” group behavior out of them. When AA says to rely on the “power of God” which is “strong” while your own willpower is “weak”, what they’re really saying, stripping away the culturally-Christian assumptions, is to rely on the social technology of a Church-like organization to amplify and backstop your willpower in various ways. • Most Church-like organizations, regardless of religion, have a membership that strive to practice moderation in things like drinking, so switching your “community” to be that of the Church-like organization means switching your friends (maybe people who love to go out and get drunk?) for people who don’t. (This is a similar idea to why some people say prisoners are better off paroled: the last people you want prisoners around are other prisoners. You want them around good role-models, not bad ones, if you want them rehabilitated.) • Most Church-like organizations provide access to a confidant and therapist (in Christian churches, that’d be the priest.) If you bond with this confidant-and-therapist figure, you’ll feel less bad about temporary failures, because you’ll have someone to tell who will help you get back on the horse, rather than shunning you for your failure. • In most Church-like organizations, if you don’t attend the regular community meetings, the community members will get worried about you and check up on you. This will help prevent you from degenerating further after falling off the wagon. AA is already a bridge between two worlds; although it is constructed under a culturally-Christian lens, it assumes that its attendeees are not necessarily members of any Church-like organization. So one of the goals of AA group meetings is to be a Church-like organization, for people who don’t attend Church. It pushes you “back” toward the Christian Church because it knows it can’t help you forever and wants you to find a more permanent Church-like organization to help you. This is similar to how psychiatrists encourage people who are stable on a maintenance dose of some drug to stop seeing them, by instead getting a family doctor (if they don’t already have one) and getting the family doctor to perscribe the maintenance dose of the drug. I think that, while AA could be rephrased to not be culturally-Christian, it’d be very hard to replace its insistence on accepting some kind of religious Church-like organization into your life... because there really just aren’t that many non-religious Church-like organizations. If there were, maybe there’d be fewer alcoholics.

b0bby_tabl3s 8y ago

"Nyquil IS the 13th step. I'm high as a kite, and my teethe are green...MERRY FCKN CHRISTMAS!" - Denis Lery

geggam 8y ago

People who abuse substances are attempting to escape their reality because they feel powerless to change it. Educating people how to change their life is the cure. That or changing society so people aren't powerless to fix their own destiny. Until that happens the chemical people are addicted to is irrelevant. They can use any number of drugs to include sugar in a way that is detrimental to their health and will do so.

normal_man 8y ago
This is overly simplistic. People may start to abuse substances because of a feeling of powerlessness, depression or some other form of unhappiness, but once addicted, a person's life can improve and the use will continue until the psychological connections are broken and rewired.
- geggam 8y ago
  Having been addicted I find complicating things to add to the issue. Simplest method to fix it is to address the underlying issues starting with the biggest first. As a note. You cannot fix this for other people they have to want to fix it and change.

vertline3 8y ago

Sobriety startup, that's a great idea! Fixing problems, and using the fast speed of startup culture. I'm not sure if they can fix it, but it seems like unique idea.

GoodJokes 8y ago

Yes! Capitalism will solve addiction! Not to sound like a broken record, but in what hell world are we so desperate for profit that we seek something like this?

beatpanda 8y ago

There's an extremely instructive lesson for programmers in the success and persistence of Alcoholics Anonymous. It's still around because: * It's free * It's decentralized * It works Is it the absolute best and most efficient method for treating addiction? Maybe not, but unless you have another method that works, which also does 1 and 2, it probably won't become as pervasive and long-lasting as AA. How does this apply to programmers? Look at every dumb project that ever tried to "disrupt" email. That's a field littered with dead bodies. Email survives. Why? See above.

gammateam 8y ago

The AA 12-step program was so strange when I accompanied my friend to one I had no idea it was so religious I found this to be a bug, not a feature It is interesting to see other methods being tried instead of masquarading the 12-step programs longevity as absolute validation

sverige 8y ago

I would consider myself to be an expert of sorts on AA. I was a member for over 20 years, attended at least 4000 meetings, have read everything ever published by AA World Services (and even held private study groups with folks to discuss these books). I served at every level except national. I left AA when I became a christian 15 years ago. (Yes, I started AA young, as a teenager.) All that is background for these strongly held opinions: 1. AA is decidedly not christian. If anything, it is a mere cult with some christian trappings and actually some occult underpinnings. No one ever heard the gospel at an AA meeting. It's not synonymous with christianity. 2. AA's recovery rate is abysmal, and actually less successful than just doing nothing about addiction. There is lots of room for providing much more effective help for people with addictions. 3. The practice of forcing people to attend AA meetings under court order should be stopped entirely. I know that most here are likely not christian and some are openly hostile. That's a completely different discussion than helping addicts to recover. A good resource for the many failings of AA can be found at the Orange Papers site. It seems the original site is down, but I believe someone has mirrored it elsewhere. Lots of info on the strange origins of AA there.

TheSoberTruth 8y ago

"The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry" https://smile.amazon.com/dp/B00FIMWI1O/ https://smile.amazon.com/dp/B00FIMWI1O/ > An exposé of Alcoholics Anonymous, 12-step programs, and the rehab industry—and how a failed addiction-treatment model came to dominate America. > AA has become so infused in our society that it is practically synonymous with addiction recovery. Yet the evidence shows that AA has only a 5–10 percent success rate—hardly better than no treatment at all. Despite this, doctors, employers, and judges regularly refer addicted people to treatment programs and rehab facilities based on the 12-step model. > In The Sober Truth, acclaimed addiction specialist Dr. Lance Dodes exposes the deeply flawed science that the 12-step industry has used to support its programs. Dr. Dodes analyzes dozens of studies to reveal a startling pattern of errors, misjudgments, and biases. He also pores over the research to highlight the best peer-reviewed studies available and discovers that they reach a grim consensus on the program’s overall success. > But The Sober Truth is more than a book about addiction. It is also a book about science and how and why AA and rehab became so popular, despite the discouraging data. Dr. Dodes explores the entire story of AA’s rise, from its origins in early fundamentalist religious and mystical beliefs to its present-day place of privilege in politics and media. > The Sober Truth includes true stories from Dr. Dodes’s thirty-five years of clinical practice, as well as firsthand accounts submitted by addicts through an open invitation on the Psychology Today website. These stories vividly reveal the experience of walking the steps and attending some of the nation’s most famous rehabilitation centers. > The Sober Truth builds a powerful response to the monopoly of the 12-step program and explodes the myth that these programs offer an acceptable or universal solution to the deeply personal problem of addiction. This book offers new and actionable information for addicts, their families, and medical providers, and lays out better ways to understand addiction for those seeking a more effective and compassionate approach to this treatable problem. […]

TheSoberTruth 8y ago
If a 12 steps program works or has worked for you, that's wonderful. People who want to change so that they can handle their life without the trouble are welcome to attend. There are many types of therapy. In art therapy alone, what've we got here: music, dance, writing, film, drawing, writing about problems and lists of solutions for each and for all of them (maybe only for yourself and then for others), etc. Problem: Solutions: - - - create a list of things that are reinforcing the [un]desired behaviors - create a plan for doing something different with/about identified triggers (problems) (I just thought of this and decided to share) Healing the underlying PTSD (and high blood pressure and very complex anxiety partly resulting from having adapted counterproductive coping strategies and defense mechanisms) is the objective of a number of randomized controlled clinical trials. Developing evidence-based treatment programs requires randomization and controls. https://en.wikipedia.org/wiki/Evidence-based_medicine https://en.wikipedia.org/wiki/Evidence-based_medicine

james_s_tayler 8y ago

Ok, but how can I quit drinking Coca-Cola? Tried like 10+ times now. It's not even Coke, it's sugar. Just such a powerful grip. Always relapse when a stressful time comes. Feels just the same as alcohol or cigarettes to me, but I don't feel justified in saying it's a real problem on the same level. I feel like it is though. Anyone else?