9 ms·

A Different Path to Fighting Addiction

63 points by vellum 12y ago

DanBC 12y ago
This is a great article. It doesn't ever mention quantities. In England "binge drinking" can be a surprisingly small amount. Risky drinking can be as little as 2 glasses of wine a day. (One large glass of wine (200 ml) at 13 % would be about 2.5 units - two of those is 5 units. That over 5 days is 25 units). We use a "unit of alcohol" as a public health measure. One unit is 125 ml of drink at 8% ABV (Alcohol by Volume). There's a handy chart at wikipedia here: https://en.wikipedia.org/wiki/File:Units_of_alcohol_chart.svg https://en.wikipedia.org/wiki/File:Units_of_alcohol_chart.sv... Advice about sensible drinking says "no more than 3 to 4 units per day (men) 2 to 3 units per day (women), with some days drink free, and don't save up units to drink at once". But problem drinking is much much larger quantities of alcohol. NICE guidelines say that 15 units per day get assisted withdrawal and 30 units per day (that's 750 ml of 40% vodka every day) is the threshold for medically supervised intervention. The current English guidelines do not strongly recommend total abstinence, especially for people at the milder end of alcoholism. There are a variety of psycho-social interventions that are recommended. http://www.nice.org.uk/Guidance/QS11 http://www.nice.org.uk/Guidance/QS11 http://www.nice.org.uk/guidance/CG115/chapter/1-Guidance http://www.nice.org.uk/guidance/CG115/chapter/1-Guidance
- mason55 12y ago
  That chart seems to be missing one of the more common measures - 355mL @ 4-5% (aka a can or bottle of beer).
  - DanBC 12y ago
    Yes. It was for glasses of wine because at the time public health practitioners in England were worried about people having glasses of wine at work and in the evening. Extending both axises would be useful.
amolsarva 12y ago
Drugs 'train your brain' and we have many techniques for training our brains now that seem to actually work -- now under names like Cognitive Behavioral Therapy and meditation and brain games. This stuff used to go under names like hypnosis or mindreading. It's amazingly underused and it's great to see modernizing approaches to the "command line" to the brain.
hellodevnull 12y ago
As I read these techniques for fighting addiction - "solving emotional and behavioral problems, rather than having abusers forever swear off the substance", "hourlong meetings once a week at which they discuss their goals for moderate drinking, as well as tips, challenges and progress on avoiding triggers" and "motivational interviewing, a goal-oriented form of counseling" I thought it bizarre that they are considered new and an alternative. Perhaps I found them an obvious improvement to the AA model simply because we now have the hindsight to see how ineffective AA is.
- wil421 12y ago
  >to see how ineffective AA is. Please dont speculate on recovery unless you have first hand experience. I know many people who have improved their lives from AA and other meetings of the same type. There are many people with addiction problems who do not trust doctors or religion and a place of like minded people is the only option for them (AA).
  - colanderman 12y ago
    Agreed. (I don't know why you're being downvoted.) I've never been in AA but I am close to someone who has. The primary benefit I see AA provide them is a group of like-minded people who will do fulfilling non-drug-related activities with them. Addiction is as much social as it is physiological. It's very difficult to quit an addiction if you continue to hang out with the same people in the same environment in which you developed your addiction. Replacing that social environment with a new one composed of people who are sworn to avoid those substances and which is filled with fulfilling activities unrelated to your addiction is a superb way to keep from slipping back into old habits.
    - DanBC 12y ago
      > (I don't know why you're being downvoted.) I didn't downvote but I have a knee-jerk reaction to want to downvote people using anecdotal evidence to support medical treatments.
wil421 12y ago
Someone who suffers from "binge drinking" may not be a candidate for AA. I think a lot of people could benefit from programs that catch addiction in the beginning phases. Most addicts dont start out abusing substances heavily from day one, if we had more programs that focused on the early addiction phase then we may be able help many people who are teetering on the edge.
deleted 12y ago
[deleted]
Bangladesh1 12y ago
A great cause...keep it up.
chipgap98 12y ago
The author misses the point of who AA is intended for. Not every person who goes through a period of overindulgent drinking is an alcoholic. Many college students in the US drink like alcoholics and, like the article says, 75% of binge drinkers cut way back when they get more responsibility. AA, in my opinion, is meant for those other 25%. AA is for the people who have a serious job, a family, or other responsibility and don't slow down. There are people who hit rock bottom from drinking and realize they need help. For them the thought of getting back to that rock bottom point can be terrifying. Abstinence only isn't forced upon them, but rather it can be viewed as the only option. This article also doesn't do anything to address drug addiction. I don't think moderating heroin intake is going to be a viable option for people with a heroin problem. There is certainly a large group of people in the world who can benefit from the treatment described here, but I think the article oversteps a great deal by saying this is a more effective addiction treatment than AA.
- deleted 12y ago
  [deleted]
- warfangle 12y ago
  > Eight trials involving 3417 people were included. AA may help patients to accept treatment and keep patients in treatment more than alternative treatments, though the evidence for this is from one small study that combined AA with other interventions and should not be regarded as conclusive. Other studies reported similar retention rates regardless of treatment group. Three studies compared AA combined with other interventions against other treatments and found few differences in the amount of drinks and percentage of drinking days. Severity of addiction and drinking consequence did not seem to be differentially influenced by TSF [Twelve Step Facilitation] versus comparison treatment interventions, and no conclusive differences in treatment drop out rates were reported. Included studies did not allow a conclusive assessment of the effect of TSF in promoting complete abstinence. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005032.pub2/abstract http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005032...
amasad 12y ago
A really new technique for fighting addiction I've been hearing about lately is Ayahuasca. It is a psychedelic brew that originates from the Amazon. I remember watching an episode of Vice (which I can seem to find) following a heroin addict through his Ayahuasca trip to get rid of his addiction and they claimed that it worked and he didn't get back to it.
- HNJohnC 12y ago
  Ibogaine actually what you're thinking of and I have no idea in the world why you are voted down because it's actually been showing great promise under controlled conditions.
- azinman2 12y ago
  I think it's specific to heroine or drugs that chemically work similarly.
SoftwareMaven 12y ago
I wonder how much a nutritionally empty, low fat diet is setting kids up for the anxiety and depression that seems to drive so much alcohol and drug abuse. At a time when major structural changes and growth are happening in the brain, changes and growth that require a lot of fatty acids for creating nerve and other brain cells, kids are getting Fruit Loops and skim milk as their nutrition source.
- yaks_hairbrush 12y ago
  Fruit Loops sound like they wouldn't be too bad. Instead, the Kellogg's product is called Froot Loops. It's a bit fitting: a bastardization of the spelling which underscores the bastardization of nutrition going on with the product.
  - mercer 12y ago
    It might actually be a legal issue too. At least here in Holland there are strict rules as to the naming of product. That's why we call peanut butter 'pindakaas', for example, which means 'peanut cheese'; producers were not allowed to use 'butter' in the name if the product did not contain actual butter.
mckoss 12y ago
The galling thing about AA/NA in the US is that judges often mandate attendance as condition for release of a DUI. The problem being, this violates the defendants 1st amendedment rights by the state forcing a religion on him.
- danesparza 12y ago
  Forgive me, I'm not sure which right you're referring to. The text of the first amendment of the United States of America reads: "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances." AA (in my understanding) doesn't force any religion. The 12 steps (link http://www.aa.org/assets/en_US/smf-121_en.pdf http://www.aa.org/assets/en_US/smf-121_en.pdf) talk about "a power greater than ourselves". There's no reason that couldn't be the judge assigning the sentence, in this case.
  - ambiate 12y ago
    For my pharmacology class, I had to attend multiple AA sessions. From my experience, in two separate regions, AA replaces the addiction with an addiction to social responsibility and moral responsibility (through a deity). In my honest opinion, judges are prescribing religion (or Kohlberg?) as a replacement addiction. My outside observation was cult behaviors with a climbable hierarchy of social power and control.
  - jqm 12y ago
    "Congress shall make no law respecting an establishment of religion.." When you force people into a program that references some idea of God you are doing exactly that..
    - danesparza 12y ago
      I guess I'm nitpicking, but the amendment mentions Congress, not the judicial branch. I suppose you could challenge the judge with a separate case -- I'm pretty certain our legal system would support that. Doing a quick Google search, it appears that at least one court has found mandated AA unconstitutional: http://www.sfgate.com/bayarea/article/Appeals-court-says-requirement-to-attend-AA-2542005.php http://www.sfgate.com/bayarea/article/Appeals-court-says-req...
deleted 12y ago
[deleted]
silentvoice 12y ago
The language of AA and other programs like them have failure as a built-in premise of attendance. Just by insisting on abstinence assumes that failure is the only possible outcome of non-abstinence, however moderated or controlled that non-abstinence is. First and foremost obviously one has to clear themselves of physical addiction, which in most cases should be done with professional medical guidance. Afterwards comes the psychological compulsion to use. For me the best thing was to think rationally about the decision to use, and whether it was going to give me the benefit I sought. In most cases, having a drink doesn't help with the situations in which I wanted it, except for very short-term (hour or two); clearly not a long term solution to problems like anxiety, social awkwardness, depression. I think rational positive thinking like this can be made habitual with practice. Having group support from something like A.A can be beneficial in the early days of this process. The issue with abstinence based programs is that they don't treat the underlying cause of the problem. Their focus is purely on a singular behavior which the problem led to. People in them are terrified of a single drink because it represents failure, but they don't identify what that single drink really means to them psychologically and how to address that problem in a rational way. I know people who have benefited from AA, but their attitudes generally seem to be "don't throw the baby out with the bathwater." They take out the positives and ignore the negatives. There are alternatives to A.A. however, for example SMART: http://www.smartrecovery.org/ http://www.smartrecovery.org/
- paulwithap 12y ago
  The entire point of AA is not to focus on the singular behavior of problem drinking, but instead to produce a complete psychic change. The central theme of the "Big Book" is that simply removing the alcohol from an alcoholic is not enough. The alcoholic must instead completely change their way of living and interacting with others. The program is designed to address the root cause of many specific issues the founders saw to be common among alcoholics. Furthermore, it is highly encouraged to seek outside help (psychiatrists, therapists, etc.) if needed.
  - silentvoice 12y ago
    I've had this discussion before and it usually boils down to someone having a non-traditional view of the 12 steps. I read them at face value: Admitting one has no control over an addiction and relying on a higher power to address it is incompatible with my view of finding the underlying cause. Whether what you say is official canon or not doesn't seem to matter to the reality of how it's managed at the group level. There seems to be for example a very wide variation in how people interpret the "12 steps," particularly amongst atheists or agnostics. I am glad that medical assistance is encouraged at the very least.

63 points by vellum 12y ago

DanBC 12y ago

This is a great article. It doesn't ever mention quantities. In England "binge drinking" can be a surprisingly small amount. Risky drinking can be as little as 2 glasses of wine a day. (One large glass of wine (200 ml) at 13 % would be about 2.5 units - two of those is 5 units. That over 5 days is 25 units). We use a "unit of alcohol" as a public health measure. One unit is 125 ml of drink at 8% ABV (Alcohol by Volume). There's a handy chart at wikipedia here: https://en.wikipedia.org/wiki/File:Units_of_alcohol_chart.svg https://en.wikipedia.org/wiki/File:Units_of_alcohol_chart.sv... Advice about sensible drinking says "no more than 3 to 4 units per day (men) 2 to 3 units per day (women), with some days drink free, and don't save up units to drink at once". But problem drinking is much much larger quantities of alcohol. NICE guidelines say that 15 units per day get assisted withdrawal and 30 units per day (that's 750 ml of 40% vodka every day) is the threshold for medically supervised intervention. The current English guidelines do not strongly recommend total abstinence, especially for people at the milder end of alcoholism. There are a variety of psycho-social interventions that are recommended. http://www.nice.org.uk/Guidance/QS11 http://www.nice.org.uk/Guidance/QS11 http://www.nice.org.uk/guidance/CG115/chapter/1-Guidance http://www.nice.org.uk/guidance/CG115/chapter/1-Guidance

mason55 12y ago
That chart seems to be missing one of the more common measures - 355mL @ 4-5% (aka a can or bottle of beer).
- DanBC 12y ago
  Yes. It was for glasses of wine because at the time public health practitioners in England were worried about people having glasses of wine at work and in the evening. Extending both axises would be useful.

amolsarva 12y ago

Drugs 'train your brain' and we have many techniques for training our brains now that seem to actually work -- now under names like Cognitive Behavioral Therapy and meditation and brain games. This stuff used to go under names like hypnosis or mindreading. It's amazingly underused and it's great to see modernizing approaches to the "command line" to the brain.

hellodevnull 12y ago

As I read these techniques for fighting addiction - "solving emotional and behavioral problems, rather than having abusers forever swear off the substance", "hourlong meetings once a week at which they discuss their goals for moderate drinking, as well as tips, challenges and progress on avoiding triggers" and "motivational interviewing, a goal-oriented form of counseling" I thought it bizarre that they are considered new and an alternative. Perhaps I found them an obvious improvement to the AA model simply because we now have the hindsight to see how ineffective AA is.

wil421 12y ago
>to see how ineffective AA is. Please dont speculate on recovery unless you have first hand experience. I know many people who have improved their lives from AA and other meetings of the same type. There are many people with addiction problems who do not trust doctors or religion and a place of like minded people is the only option for them (AA).
- colanderman 12y ago
  Agreed. (I don't know why you're being downvoted.) I've never been in AA but I am close to someone who has. The primary benefit I see AA provide them is a group of like-minded people who will do fulfilling non-drug-related activities with them. Addiction is as much social as it is physiological. It's very difficult to quit an addiction if you continue to hang out with the same people in the same environment in which you developed your addiction. Replacing that social environment with a new one composed of people who are sworn to avoid those substances and which is filled with fulfilling activities unrelated to your addiction is a superb way to keep from slipping back into old habits.
  - DanBC 12y ago
    > (I don't know why you're being downvoted.) I didn't downvote but I have a knee-jerk reaction to want to downvote people using anecdotal evidence to support medical treatments.

wil421 12y ago

Someone who suffers from "binge drinking" may not be a candidate for AA. I think a lot of people could benefit from programs that catch addiction in the beginning phases. Most addicts dont start out abusing substances heavily from day one, if we had more programs that focused on the early addiction phase then we may be able help many people who are teetering on the edge.

deleted 12y ago

[deleted]

Bangladesh1 12y ago

A great cause...keep it up.

chipgap98 12y ago

The author misses the point of who AA is intended for. Not every person who goes through a period of overindulgent drinking is an alcoholic. Many college students in the US drink like alcoholics and, like the article says, 75% of binge drinkers cut way back when they get more responsibility. AA, in my opinion, is meant for those other 25%. AA is for the people who have a serious job, a family, or other responsibility and don't slow down. There are people who hit rock bottom from drinking and realize they need help. For them the thought of getting back to that rock bottom point can be terrifying. Abstinence only isn't forced upon them, but rather it can be viewed as the only option. This article also doesn't do anything to address drug addiction. I don't think moderating heroin intake is going to be a viable option for people with a heroin problem. There is certainly a large group of people in the world who can benefit from the treatment described here, but I think the article oversteps a great deal by saying this is a more effective addiction treatment than AA.

deleted 12y ago
[deleted]
warfangle 12y ago
> Eight trials involving 3417 people were included. AA may help patients to accept treatment and keep patients in treatment more than alternative treatments, though the evidence for this is from one small study that combined AA with other interventions and should not be regarded as conclusive. Other studies reported similar retention rates regardless of treatment group. Three studies compared AA combined with other interventions against other treatments and found few differences in the amount of drinks and percentage of drinking days. Severity of addiction and drinking consequence did not seem to be differentially influenced by TSF [Twelve Step Facilitation] versus comparison treatment interventions, and no conclusive differences in treatment drop out rates were reported. Included studies did not allow a conclusive assessment of the effect of TSF in promoting complete abstinence. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005032.pub2/abstract http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005032...

amasad 12y ago

A really new technique for fighting addiction I've been hearing about lately is Ayahuasca. It is a psychedelic brew that originates from the Amazon. I remember watching an episode of Vice (which I can seem to find) following a heroin addict through his Ayahuasca trip to get rid of his addiction and they claimed that it worked and he didn't get back to it.

HNJohnC 12y ago
Ibogaine actually what you're thinking of and I have no idea in the world why you are voted down because it's actually been showing great promise under controlled conditions.
azinman2 12y ago
I think it's specific to heroine or drugs that chemically work similarly.

SoftwareMaven 12y ago

I wonder how much a nutritionally empty, low fat diet is setting kids up for the anxiety and depression that seems to drive so much alcohol and drug abuse. At a time when major structural changes and growth are happening in the brain, changes and growth that require a lot of fatty acids for creating nerve and other brain cells, kids are getting Fruit Loops and skim milk as their nutrition source.

yaks_hairbrush 12y ago
Fruit Loops sound like they wouldn't be too bad. Instead, the Kellogg's product is called Froot Loops. It's a bit fitting: a bastardization of the spelling which underscores the bastardization of nutrition going on with the product.
- mercer 12y ago
  It might actually be a legal issue too. At least here in Holland there are strict rules as to the naming of product. That's why we call peanut butter 'pindakaas', for example, which means 'peanut cheese'; producers were not allowed to use 'butter' in the name if the product did not contain actual butter.

mckoss 12y ago

The galling thing about AA/NA in the US is that judges often mandate attendance as condition for release of a DUI. The problem being, this violates the defendants 1st amendedment rights by the state forcing a religion on him.

danesparza 12y ago
Forgive me, I'm not sure which right you're referring to. The text of the first amendment of the United States of America reads: "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances." AA (in my understanding) doesn't force any religion. The 12 steps (link http://www.aa.org/assets/en_US/smf-121_en.pdf http://www.aa.org/assets/en_US/smf-121_en.pdf) talk about "a power greater than ourselves". There's no reason that couldn't be the judge assigning the sentence, in this case.
- ambiate 12y ago
  For my pharmacology class, I had to attend multiple AA sessions. From my experience, in two separate regions, AA replaces the addiction with an addiction to social responsibility and moral responsibility (through a deity). In my honest opinion, judges are prescribing religion (or Kohlberg?) as a replacement addiction. My outside observation was cult behaviors with a climbable hierarchy of social power and control.
- jqm 12y ago
  "Congress shall make no law respecting an establishment of religion.." When you force people into a program that references some idea of God you are doing exactly that..
  - danesparza 12y ago
    I guess I'm nitpicking, but the amendment mentions Congress, not the judicial branch. I suppose you could challenge the judge with a separate case -- I'm pretty certain our legal system would support that. Doing a quick Google search, it appears that at least one court has found mandated AA unconstitutional: http://www.sfgate.com/bayarea/article/Appeals-court-says-requirement-to-attend-AA-2542005.php http://www.sfgate.com/bayarea/article/Appeals-court-says-req...

deleted 12y ago

[deleted]

silentvoice 12y ago

The language of AA and other programs like them have failure as a built-in premise of attendance. Just by insisting on abstinence assumes that failure is the only possible outcome of non-abstinence, however moderated or controlled that non-abstinence is. First and foremost obviously one has to clear themselves of physical addiction, which in most cases should be done with professional medical guidance. Afterwards comes the psychological compulsion to use. For me the best thing was to think rationally about the decision to use, and whether it was going to give me the benefit I sought. In most cases, having a drink doesn't help with the situations in which I wanted it, except for very short-term (hour or two); clearly not a long term solution to problems like anxiety, social awkwardness, depression. I think rational positive thinking like this can be made habitual with practice. Having group support from something like A.A can be beneficial in the early days of this process. The issue with abstinence based programs is that they don't treat the underlying cause of the problem. Their focus is purely on a singular behavior which the problem led to. People in them are terrified of a single drink because it represents failure, but they don't identify what that single drink really means to them psychologically and how to address that problem in a rational way. I know people who have benefited from AA, but their attitudes generally seem to be "don't throw the baby out with the bathwater." They take out the positives and ignore the negatives. There are alternatives to A.A. however, for example SMART: http://www.smartrecovery.org/ http://www.smartrecovery.org/

paulwithap 12y ago
The entire point of AA is not to focus on the singular behavior of problem drinking, but instead to produce a complete psychic change. The central theme of the "Big Book" is that simply removing the alcohol from an alcoholic is not enough. The alcoholic must instead completely change their way of living and interacting with others. The program is designed to address the root cause of many specific issues the founders saw to be common among alcoholics. Furthermore, it is highly encouraged to seek outside help (psychiatrists, therapists, etc.) if needed.
- silentvoice 12y ago
  I've had this discussion before and it usually boils down to someone having a non-traditional view of the 12 steps. I read them at face value: Admitting one has no control over an addiction and relying on a higher power to address it is incompatible with my view of finding the underlying cause. Whether what you say is official canon or not doesn't seem to matter to the reality of how it's managed at the group level. There seems to be for example a very wide variation in how people interpret the "12 steps," particularly amongst atheists or agnostics. I am glad that medical assistance is encouraged at the very least.