6 ms·

There is absolutely no sense in which antabuse "cures alcoholism", I really can't think of a worse way to put that. All it does is cause a violent physical reac

There is absolutely no sense in which antabuse "cures alcoholism", I really can't think of a worse way to put that. All it does is cause a violent physical reaction when alcohol is consumed. Alcoholism is an umbrella term for 2 co-occurring disorders, one physical and one mental. On the physical side, alcohol produces an allergy which manifests as an intense physical craving for more alcohol - craving in the sense of a physiological need, which the alcoholic experiences on equal footing as a need for food, water or oxygen. The mental side of things (often referred to in AA as a spiritual ailment) is a sort of compulsive disorder in which the alcoholic becomes absolutely obsessed with proving to himself and others that he can "drink normally". The obsession is why the first drink is taken and the allergy is why it will never be enough. Now, the allergy is relieved immediately by removing the allergen, say by going to rehab or drying out at home, but as anyone who has spent any time at all around one of us knows, this purely physical "sobriety" is usually short lived if the mental obsession is left untreated. The proposition of antabuse is basically identical. Everyone I've ever known who took antabuse simply stopped X days ahead of a relapse. It is completely useless. As for whether or not it alleviates anxiety in rodents, I will leave that to the people who are studying it.

bee_rider 5y ago
Is there any medically backed information on the idea that alcoholism is an allergic reaction to alcohol? I mean -- it doesn't seem like a great analogy, but I don't generally have an uncontrollable desire to overindulge in cat dander and pollen, personally.
- gitfan86 5y ago
  No. Allergic reactions are the immune system responding to a substance in a hypersensitive way[1]. There is however a genetic component to how people respond to alcohol. Some people after having 1 drink have a strong desire to continue drinking to blackout levels. Others are more likely to feel sick or sleepy after 2 drinks and have a desire to stop. It isn't an immune system reaction, but it is a reaction. The AA community generally considers this a disease that has no cure. Once an alcoholic you are permanently an alcoholic. So that is why you'll see people pushing the idea that it is similar to an allergy. They are correct that genetic differences exist, but in the real world, many people have substance abuse problems due to stress or anxiety or childhood trauma. Meaning the biological components are far less of an issue than the psychological and mental health component in most cases of substance abuse. A well documented point of evidence of this is heroin use in Vietnam [2] [1] https://en.wikipedia.org/wiki/Type_I_hypersensitivity https://en.wikipedia.org/wiki/Type_I_hypersensitivity [2] https://jamanetwork.com/journals/jamapsychiatry/article-abstract/490667 https://jamanetwork.com/journals/jamapsychiatry/article-abst...
  - giraffe_lady 5y ago
    I can't speak for all of AA obviously but I've been heavily involved in it for decades now. This is definitely one of those "all models are wrong but some models are useful" situations with the allergy thing. Most individuals either find that model sufficiently useful that they don't need to expand it. Or, they're more or less fully aware of the gaps but still find that model useful. Or they don't find it useful and quietly use another model personally. All kinds of approaches in there. If we're talking about 'the real world' then "It is never safe for you to begin drinking again, in any context" is a highly conservative and risk-averse approach, but it has been valuable for so many, and the consequences of relapse can be so high. AA is full of people who "went back out there" after 2, 5, 10+ years of sobriety because they thought they could reintroduce it into their lives and were wrong. Also many stories of people who did and just straight died in the relapse. Often our support networks can't handle another round, plus kindling is a real thing. AA is where I first heard about van der Kolk's research, which demonstrates very convincingly that in some very real ways there's not a meaningful difference between "biological" and "psychological" components of trauma or addiction. The AA framework has some incredible faults don't get me wrong. But above all those people are intensely, almost pathologically sometimes focused on "the real world." You'll hear some weird shit coming out of there sometimes because of that, but it doesn't mean they're not aware of the contradictions, or unwilling to apply more "scientific" models. Just, they have a system that works for a lot of people so they keep it going.
    - photochemsyn 5y ago
      Are you saying that AA promotes discredited scientific claims because of a belief among their members that such claims have utility in helping their members quit drinking and stay off alcohol? Why even have the quasi-scientific patina then? Just go back to purely religious-era thinking, things like 'You'll burn in hell for all eternity if you don't get off the booze right now". The problem with groups like AA is that they seem incapable of revising their dogmatic beliefs when presented with new evidence. What if opiate addiction and alcohol addiction are not 'lifelong diseases' at all, but simply treatable conditions? Would AA revise its claims if presented with such evidence?
- xanaxagoras 5y ago
  It's an adverse, life threatening physical reaction that reliably occurs in a small subset of the population when a specific chemical is ingested. I'm not an immunologist and my understanding of alcohol allergy comes 100% from AA and the work done by 2 doctors in the 1930s. I expect the science has changed considerably since then but if the term "allergy" has evolved to no longer include this case, I believe that the evolution left behind something of critical importance to millions of people and replaced it with nothing. The term itself is less important than the understanding it conveys both to the afflicted and a judgemental public. The alcoholic craving is not similar to desire, there is no agency involved, and you can't think or will your way out of it. I have extensive personal experience with basically every other treatment modality for alcoholism that modern medicine has to offer and the allergy/obsession framework is the reason I am alive. It's not just me. The rooms of AA are filled with people who have tried everything else and been failed by it; nobody wants to wind up in AA. At any rate, if it's not an allergy anymore, it's something else in it's own category that is indistinguishable from an allergy to laymen.
  - bee_rider 5y ago
    I'm a layman but I think it is pretty well known that allergies typically come from an immune system over-reaction. I'm not saying AA should be tossed out (it has helped people I care about), it just seems weird to stick to using a pretty well understood word wrong. This is not a grand philosophical statement, just a matter of not using intentionally confusing lingo. If there's anyone out there who actually thinks it is an allergy, they should understand that current research into treating allergies won't help them, that specialists who treat allergies are the wrong ones to go to, etc etc. Surely there's a better word for a physiologically based tendency toward addictions.
neuroma 5y ago
Loved your comment. Also I'm impulsively here to query the use of Physical vs Mental components of alcohol abuse. I personally find it difficult to separate the two domains. I understand one is referring to detoxification and the other to habbit and belief. Both those are simultaneously physical and mental, and benefit from support within both those frames. Mind brain dichotomy is not very useful IMO. Happy to be shown counter examples.
taneq 5y ago
Allergy? Are you sure that’s the right word?
- abcc8 5y ago
  Use of the term allergy often indicates that the individual is sharing from an AA-based viewpoint, as allergy and other antiquated terms are central to the descriptive dogma of the groups.

bee_rider 5y ago

Is there any medically backed information on the idea that alcoholism is an allergic reaction to alcohol? I mean -- it doesn't seem like a great analogy, but I don't generally have an uncontrollable desire to overindulge in cat dander and pollen, personally.

gitfan86 5y ago
No. Allergic reactions are the immune system responding to a substance in a hypersensitive way[1]. There is however a genetic component to how people respond to alcohol. Some people after having 1 drink have a strong desire to continue drinking to blackout levels. Others are more likely to feel sick or sleepy after 2 drinks and have a desire to stop. It isn't an immune system reaction, but it is a reaction. The AA community generally considers this a disease that has no cure. Once an alcoholic you are permanently an alcoholic. So that is why you'll see people pushing the idea that it is similar to an allergy. They are correct that genetic differences exist, but in the real world, many people have substance abuse problems due to stress or anxiety or childhood trauma. Meaning the biological components are far less of an issue than the psychological and mental health component in most cases of substance abuse. A well documented point of evidence of this is heroin use in Vietnam [2] [1] https://en.wikipedia.org/wiki/Type_I_hypersensitivity https://en.wikipedia.org/wiki/Type_I_hypersensitivity [2] https://jamanetwork.com/journals/jamapsychiatry/article-abstract/490667 https://jamanetwork.com/journals/jamapsychiatry/article-abst...
- giraffe_lady 5y ago
  I can't speak for all of AA obviously but I've been heavily involved in it for decades now. This is definitely one of those "all models are wrong but some models are useful" situations with the allergy thing. Most individuals either find that model sufficiently useful that they don't need to expand it. Or, they're more or less fully aware of the gaps but still find that model useful. Or they don't find it useful and quietly use another model personally. All kinds of approaches in there. If we're talking about 'the real world' then "It is never safe for you to begin drinking again, in any context" is a highly conservative and risk-averse approach, but it has been valuable for so many, and the consequences of relapse can be so high. AA is full of people who "went back out there" after 2, 5, 10+ years of sobriety because they thought they could reintroduce it into their lives and were wrong. Also many stories of people who did and just straight died in the relapse. Often our support networks can't handle another round, plus kindling is a real thing. AA is where I first heard about van der Kolk's research, which demonstrates very convincingly that in some very real ways there's not a meaningful difference between "biological" and "psychological" components of trauma or addiction. The AA framework has some incredible faults don't get me wrong. But above all those people are intensely, almost pathologically sometimes focused on "the real world." You'll hear some weird shit coming out of there sometimes because of that, but it doesn't mean they're not aware of the contradictions, or unwilling to apply more "scientific" models. Just, they have a system that works for a lot of people so they keep it going.
  - photochemsyn 5y ago
    Are you saying that AA promotes discredited scientific claims because of a belief among their members that such claims have utility in helping their members quit drinking and stay off alcohol? Why even have the quasi-scientific patina then? Just go back to purely religious-era thinking, things like 'You'll burn in hell for all eternity if you don't get off the booze right now". The problem with groups like AA is that they seem incapable of revising their dogmatic beliefs when presented with new evidence. What if opiate addiction and alcohol addiction are not 'lifelong diseases' at all, but simply treatable conditions? Would AA revise its claims if presented with such evidence?
xanaxagoras 5y ago
It's an adverse, life threatening physical reaction that reliably occurs in a small subset of the population when a specific chemical is ingested. I'm not an immunologist and my understanding of alcohol allergy comes 100% from AA and the work done by 2 doctors in the 1930s. I expect the science has changed considerably since then but if the term "allergy" has evolved to no longer include this case, I believe that the evolution left behind something of critical importance to millions of people and replaced it with nothing. The term itself is less important than the understanding it conveys both to the afflicted and a judgemental public. The alcoholic craving is not similar to desire, there is no agency involved, and you can't think or will your way out of it. I have extensive personal experience with basically every other treatment modality for alcoholism that modern medicine has to offer and the allergy/obsession framework is the reason I am alive. It's not just me. The rooms of AA are filled with people who have tried everything else and been failed by it; nobody wants to wind up in AA. At any rate, if it's not an allergy anymore, it's something else in it's own category that is indistinguishable from an allergy to laymen.
- bee_rider 5y ago
  I'm a layman but I think it is pretty well known that allergies typically come from an immune system over-reaction. I'm not saying AA should be tossed out (it has helped people I care about), it just seems weird to stick to using a pretty well understood word wrong. This is not a grand philosophical statement, just a matter of not using intentionally confusing lingo. If there's anyone out there who actually thinks it is an allergy, they should understand that current research into treating allergies won't help them, that specialists who treat allergies are the wrong ones to go to, etc etc. Surely there's a better word for a physiologically based tendency toward addictions.

neuroma 5y ago

Loved your comment. Also I'm impulsively here to query the use of Physical vs Mental components of alcohol abuse. I personally find it difficult to separate the two domains. I understand one is referring to detoxification and the other to habbit and belief. Both those are simultaneously physical and mental, and benefit from support within both those frames. Mind brain dichotomy is not very useful IMO. Happy to be shown counter examples.

taneq 5y ago

Allergy? Are you sure that’s the right word?

abcc8 5y ago
Use of the term allergy often indicates that the individual is sharing from an AA-based viewpoint, as allergy and other antiquated terms are central to the descriptive dogma of the groups.