3 ms·

> The 12-step view is that there isn’t a “once and done” cure. If I were to use an analogy it’s more like having lifelong diabetes. You gotta keep taking that i

> The 12-step view is that there isn’t a “once and done” cure. If I were to use an analogy it’s more like having lifelong diabetes. You gotta keep taking that insulin. It’s the continuity that forestalls the disease/ keeps you in remission. This is actually one of the things that many psychologists are dubious about. It's entirely possible that self-labeling as an alcoholic forever makes it harder, not easier, for some people to remain abstinent. To the extent that it keeps you vigilant and involved in a supportive community, it can be good. But it could also make it harder to get back on the wagon if you have a single drink if you think you're "an alcoholic", and not "a sober person who made a mistake". Due to the anonymous and heterogeneous nature of AA, good data and studies of its efficacy are very hard to come by, so we have little idea if it's actually better than non-AA or pharmaceutical alternatives.

phs318u 4y ago
Identifying as an alcoholic or gambling addict or drug addict etc, is no different than saying "I'm a diabetic". It's the label of a chronic disease. Applying that label to self is about acceptance of that as a fact of life that you can then work with. If you've ever been unfortunate enough to see e.g. a diabetic who did not accept the reality of their illness - it's not pretty. Acceptance is the price of vigilance. I also believe you've misunderstood how we view ourselves (and each other) when we fall of the wagon/bust/slip. I'm not a "sober person who made a mistake". I'm an addict who made a mistake. Most of us in 12-step programs have tried psychology (and counselling and hypnotherapy and...) before the despair was enough that we'd admit defeat and join *A. Admittedly, there's a cohort of people mandated to turn up. It should surprise no one that this cohort sees very high rates of recidivism. But I'd suspect the same to be the case for people mandated to attend psychotherapy. If you don't want to change, nothing can make you. Pharmaceuticals are interesting. I believe that LSD has been trialled to help those with substance addictions but I'm not sure of the state of research regarding behavioural addictions. Fundamentally though, the evidence is pretty clear that there's a neurological basis to most addictions including the behavioural ones. e.g. check the research of Mira Fauth-Buhler. https://www.researchgate.net/profile/Mira-Fauth-Buehler https://www.researchgate.net/profile/Mira-Fauth-Buehler
- specproc 4y ago
  People can choose to identify as they wish, and I'm not for one second diminishing that identification. But problematic drinking is very different to diabetes, it's also highly varied in its expression and not as deterministic as the label suggests. I totally understand why it's a helpful framing for some people, but it really isn't for others.
  - vorpalhex 4y ago
    To extend this, there have been programs that have attempted to fix the problems of alcohol addiction but not require patients to remain sober. The core concept being that there is an underlying cause to the alcohol problem and the alcoholism is an expression of that problem, not itself a root. Thus once the root cause is fixed, the alcohol is no longer a trigger. Another form allows participants to drink but uses a medicine which induces unpleasant effects from alcohol. Thus participants self train an avoidance pattern and break the positive feedback loop. These should not be seen as contrary to the AA abstinance approach. For some people that appears to be the most effective means. For many other people, AA is not. I suspect as we advance our understanding we'll come to find distinct subdiagnoses in alcoholism and alcohol abuse that suggest different treatment strategies. Right now our understanding feels very rudimentary.
    - Eisenstein 4y ago
      > Another form allows participants to drink but uses a medicine which induces unpleasant effects from alcohol. Actually, the successful medical method doesn't introduce unpleasant effects, but removes the pleasant ones and introduces 'extinction'. The medication is naltraxone. Look up 'Sinclair method'.
      - vorpalhex 4y ago
        > To avoid strong side effects such as nausea and vomiting, practitioners typically wait until after the alcohol detox process before administering naltrexone. If you take one or two drinks, yeah it will just be not good. If you binge, you be puking your guts out.

phs318u 4y ago

Identifying as an alcoholic or gambling addict or drug addict etc, is no different than saying "I'm a diabetic". It's the label of a chronic disease. Applying that label to self is about acceptance of that as a fact of life that you can then work with. If you've ever been unfortunate enough to see e.g. a diabetic who did not accept the reality of their illness - it's not pretty. Acceptance is the price of vigilance. I also believe you've misunderstood how we view ourselves (and each other) when we fall of the wagon/bust/slip. I'm not a "sober person who made a mistake". I'm an addict who made a mistake. Most of us in 12-step programs have tried psychology (and counselling and hypnotherapy and...) before the despair was enough that we'd admit defeat and join *A. Admittedly, there's a cohort of people mandated to turn up. It should surprise no one that this cohort sees very high rates of recidivism. But I'd suspect the same to be the case for people mandated to attend psychotherapy. If you don't want to change, nothing can make you. Pharmaceuticals are interesting. I believe that LSD has been trialled to help those with substance addictions but I'm not sure of the state of research regarding behavioural addictions. Fundamentally though, the evidence is pretty clear that there's a neurological basis to most addictions including the behavioural ones. e.g. check the research of Mira Fauth-Buhler. https://www.researchgate.net/profile/Mira-Fauth-Buehler https://www.researchgate.net/profile/Mira-Fauth-Buehler

specproc 4y ago
People can choose to identify as they wish, and I'm not for one second diminishing that identification. But problematic drinking is very different to diabetes, it's also highly varied in its expression and not as deterministic as the label suggests. I totally understand why it's a helpful framing for some people, but it really isn't for others.
- vorpalhex 4y ago
  To extend this, there have been programs that have attempted to fix the problems of alcohol addiction but not require patients to remain sober. The core concept being that there is an underlying cause to the alcohol problem and the alcoholism is an expression of that problem, not itself a root. Thus once the root cause is fixed, the alcohol is no longer a trigger. Another form allows participants to drink but uses a medicine which induces unpleasant effects from alcohol. Thus participants self train an avoidance pattern and break the positive feedback loop. These should not be seen as contrary to the AA abstinance approach. For some people that appears to be the most effective means. For many other people, AA is not. I suspect as we advance our understanding we'll come to find distinct subdiagnoses in alcoholism and alcohol abuse that suggest different treatment strategies. Right now our understanding feels very rudimentary.
  - Eisenstein 4y ago
    > Another form allows participants to drink but uses a medicine which induces unpleasant effects from alcohol. Actually, the successful medical method doesn't introduce unpleasant effects, but removes the pleasant ones and introduces 'extinction'. The medication is naltraxone. Look up 'Sinclair method'.
    - vorpalhex 4y ago
      > To avoid strong side effects such as nausea and vomiting, practitioners typically wait until after the alcohol detox process before administering naltrexone. If you take one or two drinks, yeah it will just be not good. If you binge, you be puking your guts out.