5 ms·

I’m unsure of the situation in other countries but getting adequate treatment for substance use disorder in the U.S. is terribly difficult (nearly impossible fo

I’m unsure of the situation in other countries but getting adequate treatment for substance use disorder in the U.S. is terribly difficult (nearly impossible for some) and faith-based 12 step programs such as AA/NA dominate the landscape and effectively replace mental healthcare in many situations. The poor utilize 12-steps because it’s free social support which is great, but for-profits do the same thing (because it’s very cheap to just implement 12 step thinking) and rehab patients are often handed a “big book” (AA/NA’s main text) well before they get a psych evaluation, if they get one at all In short, substance use disorder is treated as a primary condition here, there’s a massive high-profit industry built around it and specifically treating it using faith-based 12 step methodology so a lot of mentally ill people who use drugs never receive proper treatment

zamnos 4y ago
Thankfully times are starting to change, with places like http://boulder.care http://boulder.care prescribing Subutex as an easier rung to reach while climbing the ladder on addressing opiate use disorder (OUD).
- MavisBacon 4y ago
  yeah Bicycle and Ophelia are a few other U.S. suboxone telehealth startups that seem to be doing good work as well (if anyone is interested, it's worth checking each of these out as their coverage varies in terms of which states, last I checked)
sirsinsalot 4y ago
Those places, let's not forget, deliver care often with a motive of indoctrination in to religion. It really is taking advantage of people who are vulnerable. Sickening that that's what is on offer in a "developed" nation. That's not even getting to the fact that the leading cause of death in children and teenagers is guns[1] I can't really understand it. [1]: https://eu.statesman.com/story/news/politics/politifact/2022/06/07/fact-check-firearms-leading-cause-death-children/7529783001/ https://eu.statesman.com/story/news/politics/politifact/2022...
- giardini 4y ago
  sirsinsalot says <">That's not even getting to the fact that the leading cause of death in children and teenagers is guns[1] I can't really understand it. [1]: https://eu.statesman.com/story/news/politics/politifact/2022 https://eu.statesman.com/story/news/politics/politifact/2022..."< No surprise, because the URL contradicts what you say. If omitting certain age ranges is your idea of the truth, please say so up front.
  - sirsinsalot 4y ago
    > Rockefeller and Johns Hopkins researchers said that when analyzing the leading causes of death among "children," infants are typically not included because of certain fatal conditions unique to children under a year old. Yes OK, excluding those under a year old. So guns are the leading cause of death in America for those between 1 and 18 years old. Is that OK now? Defensible now? Did that undermine my entire point? Or are you nit picking to detract from the toxic state of the country?
- comfypotato 4y ago
  This is blatantly false. It’s stated very plainly in the traditions spoken every meeting that the 12-based programs don’t align with any sect denomination or religion. The programs are faith based and widely supported by medical professionals. Plenty of folks have problems with anything being faith based, but unfortunately there aren’t better alternatives for alcoholics and addicts.
  - sirsinsalot 4y ago
    [flagged]
    - comfypotato 4y ago
      This is offensive and a blatant violation of the HN rules. 12-step programs are definitively unrelated to any religion and well respected by the professional medical community. Various religious institutions around the world host the meetings altruistically, and it has no influence on the fundamental content and purpose of the 12-step programs.
slfnflctd 4y ago
Bingo. I remember telling my mother in the 90s that my 'substance abuse' was a symptom, not the problem itself. I was self medicating. No one wanted to hear it. In the time since, it often feels like we've gotten worse at recognizing this. Meanwhile, proper treatment for mental health issues continues to be difficult to find (many if not the majority of so-called professionals are anything but), as well as increasingly expensive and inconvenient. To say nothing of how much of psychiatry has devolved into pinning you to a DSM category and throwing drugs at you in as short of a session as possible-- "come back in 2 months and we'll just as quickly throw some different drugs at you if those aren't working"... rinse and repeat ad infinitum. Anyone struggling to get through each day is not going to be well served by this. We need at least 10x more therapists willing to spend time with patients and address their many intertwined issues, using logical, rational, evidence based methods. Right now, I don't see how we even start to get there from here. 12 step can be a lifeline for people at the end of their rope who have no other options, but it also inevitably fails anyone who doesn't buy into the narrative about a higher power. [I would argue it fails even those who do, as it teaches powerlessness.] Some may benefit from such an extreme approach, but it is deeply, deeply flawed. The main strength it does have is connecting you with other people and being very accessible. But we can & should do better.
- MavisBacon 4y ago
  >12 step can be a lifeline for people at the end of their rope who have no other options, but it also inevitably fails anyone who doesn't buy into the narrative about a higher power. [I would argue it fails even those who do, as it teaches powerlessness.] Some may benefit from such an extreme approach, but it is deeply, deeply flawed. The main strength it does have is connecting you with other people and being very accessible. But we can & should do better. oh indeed. I found myself in the rooms of AA/NA at the age of 19, still very foolish in my youth, confused, pretty desperate. Even in that state I had such a hard time buying into just the first few steps. it all seemed so utterly nonsensical to me and I realized believing in god was a prerequisite I could never meet. for those unfamiliar with the 12 steps of alcoholic anonymous this is how they begin... 1. We admitted we were powerless over alcohol—that our lives had become unmanageable. 2. Came to believe that a Power greater than ourselves could restore us to sanity. 3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
comfypotato 4y ago
This comment implies that faith-based 12-step programs aren’t proper treatment, and that is false. Any medical professional will tell you that there’s no alternative that produces better results. The problem is abysmal: both faith-based and non-faith-based approaches perform poorly, but 12-step programs are the industry standard because they are the best we have. Personally I think the non-faith-based centers only exist as a result of severe religious trauma. I’ve met plenty of 12-step alcoholics who make jokes about how bad things like SMART recovery are. It’s a trope on recovery meme sites.

zamnos 4y ago

Thankfully times are starting to change, with places like http://boulder.care http://boulder.care prescribing Subutex as an easier rung to reach while climbing the ladder on addressing opiate use disorder (OUD).

MavisBacon 4y ago
yeah Bicycle and Ophelia are a few other U.S. suboxone telehealth startups that seem to be doing good work as well (if anyone is interested, it's worth checking each of these out as their coverage varies in terms of which states, last I checked)

sirsinsalot 4y ago

Those places, let's not forget, deliver care often with a motive of indoctrination in to religion. It really is taking advantage of people who are vulnerable. Sickening that that's what is on offer in a "developed" nation. That's not even getting to the fact that the leading cause of death in children and teenagers is guns[1] I can't really understand it. [1]: https://eu.statesman.com/story/news/politics/politifact/2022/06/07/fact-check-firearms-leading-cause-death-children/7529783001/ https://eu.statesman.com/story/news/politics/politifact/2022...

giardini 4y ago
sirsinsalot says <">That's not even getting to the fact that the leading cause of death in children and teenagers is guns[1] I can't really understand it. [1]: https://eu.statesman.com/story/news/politics/politifact/2022 https://eu.statesman.com/story/news/politics/politifact/2022..."< No surprise, because the URL contradicts what you say. If omitting certain age ranges is your idea of the truth, please say so up front.
- sirsinsalot 4y ago
  > Rockefeller and Johns Hopkins researchers said that when analyzing the leading causes of death among "children," infants are typically not included because of certain fatal conditions unique to children under a year old. Yes OK, excluding those under a year old. So guns are the leading cause of death in America for those between 1 and 18 years old. Is that OK now? Defensible now? Did that undermine my entire point? Or are you nit picking to detract from the toxic state of the country?
comfypotato 4y ago
This is blatantly false. It’s stated very plainly in the traditions spoken every meeting that the 12-based programs don’t align with any sect denomination or religion. The programs are faith based and widely supported by medical professionals. Plenty of folks have problems with anything being faith based, but unfortunately there aren’t better alternatives for alcoholics and addicts.
- sirsinsalot 4y ago
  [flagged]
  - comfypotato 4y ago
    This is offensive and a blatant violation of the HN rules. 12-step programs are definitively unrelated to any religion and well respected by the professional medical community. Various religious institutions around the world host the meetings altruistically, and it has no influence on the fundamental content and purpose of the 12-step programs.

slfnflctd 4y ago

Bingo. I remember telling my mother in the 90s that my 'substance abuse' was a symptom, not the problem itself. I was self medicating. No one wanted to hear it. In the time since, it often feels like we've gotten worse at recognizing this. Meanwhile, proper treatment for mental health issues continues to be difficult to find (many if not the majority of so-called professionals are anything but), as well as increasingly expensive and inconvenient. To say nothing of how much of psychiatry has devolved into pinning you to a DSM category and throwing drugs at you in as short of a session as possible-- "come back in 2 months and we'll just as quickly throw some different drugs at you if those aren't working"... rinse and repeat ad infinitum. Anyone struggling to get through each day is not going to be well served by this. We need at least 10x more therapists willing to spend time with patients and address their many intertwined issues, using logical, rational, evidence based methods. Right now, I don't see how we even start to get there from here. 12 step can be a lifeline for people at the end of their rope who have no other options, but it also inevitably fails anyone who doesn't buy into the narrative about a higher power. [I would argue it fails even those who do, as it teaches powerlessness.] Some may benefit from such an extreme approach, but it is deeply, deeply flawed. The main strength it does have is connecting you with other people and being very accessible. But we can & should do better.

MavisBacon 4y ago
>12 step can be a lifeline for people at the end of their rope who have no other options, but it also inevitably fails anyone who doesn't buy into the narrative about a higher power. [I would argue it fails even those who do, as it teaches powerlessness.] Some may benefit from such an extreme approach, but it is deeply, deeply flawed. The main strength it does have is connecting you with other people and being very accessible. But we can & should do better. oh indeed. I found myself in the rooms of AA/NA at the age of 19, still very foolish in my youth, confused, pretty desperate. Even in that state I had such a hard time buying into just the first few steps. it all seemed so utterly nonsensical to me and I realized believing in god was a prerequisite I could never meet. for those unfamiliar with the 12 steps of alcoholic anonymous this is how they begin... 1. We admitted we were powerless over alcohol—that our lives had become unmanageable. 2. Came to believe that a Power greater than ourselves could restore us to sanity. 3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

comfypotato 4y ago

This comment implies that faith-based 12-step programs aren’t proper treatment, and that is false. Any medical professional will tell you that there’s no alternative that produces better results. The problem is abysmal: both faith-based and non-faith-based approaches perform poorly, but 12-step programs are the industry standard because they are the best we have. Personally I think the non-faith-based centers only exist as a result of severe religious trauma. I’ve met plenty of 12-step alcoholics who make jokes about how bad things like SMART recovery are. It’s a trope on recovery meme sites.