
A Different Path to Fighting Addiction - vellum
http://www.nytimes.com/2014/07/06/nyregion/a-different-path-to-fighting-addiction.html
======
silentvoice
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
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
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.

~~~
randomflavor
The idea of a higher power is simply faith that life is good. many addicts
have an auto response to everything in life as being shit, and this warps
perception. Most non faith based people actually are quite faith based in that
they believe things will work out well when they put their energy into it.
That is faith. Many addicts do not have that innate understanding. The 12
steps is just a set of skills to obtain that world view.

~~~
voxic11
Sorry what? Have you read the 12 steps? The explictly refer to "God" and
explain "his" role in "remove[ing] all these defects of character." How is
that at all ambiguous?

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chipgap98
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.

~~~
warfangle
> 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...](http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005032.pub2/abstract)

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hellodevnull
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
>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
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
> (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.

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DanBC
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.sv...](https://en.wikipedia.org/wiki/File:Units_of_alcohol_chart.svg)

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
That chart seems to be missing one of the more common measures - 355mL @ 4-5%
(aka a can or bottle of beer).

~~~
DanBC
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.

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SoftwareMaven
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
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
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.

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amolsarva
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.

------
amasad
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
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.

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wil421
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.

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mckoss
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
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.

~~~
jqm
"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..

~~~
Stronico
I think the alternative to AA meetings is usually jail time - so it probably
is to some degree voluntary.

~~~
dragonwriter
> I think the alternative to AA meetings is usually jail time - so it probably
> is to some degree voluntary.

"Do this or go to jail" is pretty much the definition of something which is --
legally speaking -- compulsory, not voluntary.

Its voluntary in the trivial sense that a conscious choice is involved, but
not voluntary in the legal sense (or the substantive sense of a free choice
made without threat of force.)

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Bangladesh1
A great cause...keep it up.

