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Sobriety startups shaking up the 12-step model (abc.net.au)
136 points by mathgenius on Jan 4, 2019 | hide | past | favorite | 191 comments

After years and years of struggling with alcoholism and AA, I got sober with naltrexone using the "Sinclair Method". I followed the treatment plan for a few weeks and at the end quitting drinking was easy and obvious. That was just over ten years ago and I haven't had a drink or gone to any meetings since.

I'm only one person and I'm fully aware that the plural of anecdote isn't data. However, the experience was so drama, and more importantly self-loathing, free and so effective, that I can't help but feel bitter towards the proponents of AA who insist on it being a monopoly... especially those in positions of power in the criminal justice or public health systems because from my perspective it's a malicious and vindictive stance.

From your short message, it seems our experience with alcohol is similar. I've been struggling with my level of alcohol consumption, about 7-8 months ago I read an article on the Atlantic[1] that detailed the effectiveness of naltrexone.

I've included it as others might find it helpful.

[1] - https://www.theatlantic.com/magazine/archive/2015/04/the-irr...

These are useful references for Naltrexone.

Roy Eskapa, the Cure for Alcoholism [book] https://www.benbellabooks.com/shop/the-cure-for-alcoholism-s...

One Little Pill [documentary film] https://www.onelittlepillmovie.com/

These wikipedia pages are also helpful:



Naltrexone/nalmefene works with 85% of the population, while 15% do not respond because of genetic disposition.

Of the 85% who do respond, 75% are successful in what they are attempting.

Proponents advise you to take it for the rest of your life. Naltrexone is not costly. This is your decision.

Using the Sinclair method you only take naltrexone when you drink (well just prior to drinking). Not at all times. It's not expensive and it works so so well. In Finland it is the first line treatment option for alcoholism and it's wildly successful.

I quit taking it when I quit drinking. I literally never finished the second box of tablets.

What you are referring to are those who for whatever reason wish to continue drinking in moderation.

>However, the experience was so drama, and more importantly self-loathing, free and so effective,

I remember reading a while ago that this is the main problem with 12 step programs. Not that they don't work (they often do), but the manner in which failure is viewed. With typical medical and therapy treatments, if one treatment (psychological or chemical) is not working, the attitude of the doctor is to consider other treatments. The claim was that with the 12 step program, if it doesn't work for a person, the person is the problem. The notion that the 12 step program isn't for everyone is usually absent.

> The notion that the 12 step program isn't for everyone is usually absent

I lament the notion that the 12-step program is the be-all end-all for curing all addictions for everybody everywhere. It is not. It should stop being sold as such. Yes, it is helpful for many; it is also not helpful for many others.

Naltrexone is an amazing medication!

Two things to note about it though.

One, it’s not a quick fix. It works by inhibiting the pleasure response of alcohol. Therefore, it takes a very long time (a few months) for the brain to become re-conditioned and not associate alcohol with pleasure. During this time, one will continue to drink, but the desire to drink should gradually wane.

Two, it has a very short half-life. Therefore, it’s very easy for the brain to trick itself into not taking it. I have seen many people ‘accidently’ forget to take it before drinking. And, since the goal is to re-train thr brain, this really defeats the purpose.

Anyway, I recommend it to all of my friends. Unfortunately, it’s not well-known, so I only discovered it after doing my own research. And, then, I had to seek out doctors that even knew about it.

> ... I can't help but feel bitter towards the proponents of AA who insist on it being a monopoly... especially those in positions of power in the criminal justice or public health systems ....

Not an alcoholic, but I had extended discussions with a number of AA members some years ago. And I found that many of them also felt pretty negatively about the involvement of the justice system with AA. What happens (they said) is that people are forced to attend AA meetings as part of sentencing, but these people generally are not interested in recovery. The result is a lot of wasted time and the diversion of resources away from people who could be helped.

Agreed. AA has a tradition of "attraction rather than promotion" but AA cannot control what those outside of AA do.

Does this only work for alcoholism, or does naltrexone work for any compulsive behaviour?

Naltrexone is an opioid antagonist, meaning that it blocks your opioid receptors and basically prevents opioids from having an effect. Naltrexone and naloxone (another opioid antagonist) are used in treating opiate addictions.

Not an expert, but my understanding is that these receptors (and naturally occurring opioids) play a role in the reward pathways in the brain, so it's possible that naltrexone and other opioid antagonists could be effective for other types of addiction or compulsive behaviors.

Apprently its an opioid receptor antagonist and its mechanism of action for treating alcoholism isn't well understood. Since it modulates the reward system of the brain it could potentially be useful for any addictive behavior, however there's probably a reason it doesn't seem to be prescribed outside of alcoholism or opioid addiction.

I believe I read that Dr. Sinclair was thinking Naltrexone could also be used to help with any sort of addiction such as smoking or overeating. I don't think there is any clinical research to support this though in the same way there is research supporting its effectiveness with alcoholism.

Link? Curious!

I believe it was in Eskepa's "The Cure for Alcoholism"

Commonly used to treat opiate dependence, often a combo of buprenorphine + naltrexone

What margin of error did you have with the sinclair method, like if you were off an hour or two with taking the naltrexone would that matter? Also - did you have any withdrawal symptoms?

Anyone know if there is something similar to quit smoking? Tried to quit cold turkey 20 times at least, usually can’t get past the first day.

Vaping did it for me. For some reason that I ignore, you can then, as a second step, quit vaping very easily (at least for me, it was much easier than quitting cigarettes). There have been some studies about this, it’s been speculated that it’s because of the different way you absorb nicotine when vaping, as opposed to smoking. (Sorry I’m unable to find a link now but I will try later when I get home). I am now 2 years off the stinkies, and about 9 months off vaping.

10 years ago I quit smoking. I don't recommend doing it this way, but I started chewing tobacco. I didn't like it, didn't care for the taste, but for some reason, it let me break the mental habits of having a cigarette every so often, and the hand movements, etc.

About a year later, I was planning on having Lasik eye surgery. They recommended no nicotine/caffeine for 24 hours prior and 7 days after. I gave caffeine up for the next year, and never picked up nicotine again.

There is probably a few reasons why you smoke. Just remember, you probably like all of them. Start to figure out how to remove and replace them. And keep trying to quit. At some point it will work.

I probably tried to quit 200 times cold turkey, 2 or 3 times with medication, and maybe a dozen times with patches.

Nicotine chemical dependence is gone in 48-72 hours. Take a 3 day vacation without access and you'll be done.

You can probably justify first class tickets to and from Singapore with the money you'll save to ensure you won't have access.

Juul has helped a few friends quit smoking, but some still use the juul. Nicotine salts in their juice make it feel stronger than cigarettes, so its easier to switch than standard nicotine-base juices.

I've known several people in my life who went from being 2-pack a day smokers to, well, vapors on a low nicotine dose. Juul is sort of an overpriced unit and really they're trying to run a subscription model on their dumb pods - but in general vaping can help in smoking cessation (though not necessarily nicotine addiction!)

Wellbutrin (bupropion hcl) is FDA approved as a smoking-cessation aid.

I took it for a year or so (though not for smoking cessation), if you have any questions I'd be happy to answer them! Email in profile.

I had the same problem and then quit with the first round of chemo treatment for Hodgkin's Disease, and certainly not because I had an epiphany.

It must have been one, or a combination of the many drugs against nausea, vertigo etc. I strongly suspect that the mild euphoria caused by the Corticosteroids played an important role.

I’ve had success with nicotine patches. For me it worked best to very slowly ween myself down to lower doses over a period of several weeks. Been cigarette free for almost 5 years now (after smoking for 17 years).

Ibogaine is extremely efficacious, but it's quite intense.

First congrats on finding something that works for you and making it stick!

From that perspective, I can see why you would not like folks that insist on AA being a monopoly, but I'm curious about that position. I've seen a lot of people that hate AA and a lot of people that think it saved their lives, but I've never seen anyone say that AA must be the only way to sobriety. What's the angle?

I can't speak from first hand experience or actual knowledge, but I've seen several articles over the years about AA being the only US court approved treatment, leaving some people with the choice of accepting only AA or jail. Atheists in particular have commented on this, but also people that take issues with certain other AA stances (such as "you will forever be an alcoholic").

I have no idea if this was federal, state, or local courts.

> "you will forever be an alcoholic"

That doesn't seem like an unjustified statement to me. I'm not an alcoholic, but I am a food addict and the experience of losing half my body weight and keeping it off for years has only reinforced, to me, the idea that I will always be a food addict.

Many agree with you. I've not encountered an addiction myself, (yet, at least, knock on wood), so I have no stance one way or another, but I've read accounts where many people have experiences similar to yours, and yet there are others that (claim to, at least) encounter it like an illness. They were sick, got treated, and now are not sick. Perhaps the Sinclair method that others discuss does that, breaking the longing for the alcohol, perhaps not.

From where I sit, if you're in a place where you are no longer suffering and others are no longer suffering, you get to define how you relate to the problem you had. Having your only option be a group that insists you must be a victim when you don't agree feels wrong. Now, do we have real people in that situation - not a perma-alcoholic but somehow being forced to join AA or go to jail?. I don't know.

>you will forever be an alcoholic

I believe that this is the current medical understand of alcoholism as well.

You may have encountered these people casually in passing but not read anything from AA proponents. Basically every AA proponent I’ve ever read from tows the party line that it is the only viable treatment. Many of them disparage and suppress alternatives like the Sinclair method.

This is completely contrary to anything officially published by Alcoholics Anonymous. Possibly "proponents" have their own opinions but AA itself specifically states in its that it does not have a monopoly on recovery from alcoholism.


That's one example. It is also in the main text.

AA's "Big Book" says "Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of be­ing honest with themselves."[1] In other words, "it works if you work it". They may not say that AA is the only way to sobriety, but why would you need anything else?

[1] https://www.aa.org/assets/en_US/en_bigbook_chapt5.pdf

Wow! Beautiful results. Count me in :)

Can you detail this more?

You really naltrexone when you drink, and only when you drink. They also advise drinking somewhat frequently at the start so your brain can quickly break the connection between alcohol and having a really good time. Once it is broken you do need to continue using naltrexone every time you want a drink or over time you will go back to being addicted. But it is generic and not expensive to get.

Where did you get it generic and cheaply from? My primary won't prescribe it.

See the book:


There is a chapter in this book "for the physician."

If you have brought this to your physician, and you are still refused, get a new physician. Request all your records, and depart.

GoodRX will let you price compare. Most sources are under $2 per pill.

You can either get a new doctor or buy from India.

I’m confused. When I googled Naltrexone, it warns: “Alcohol: Avoid. Very serious interactions can occur”. So are you supposed to take it hours before drinking or something else?

> When I googled Naltrexone, it warns: “Alcohol: Avoid. Very serious interactions can occur”.

The whole point of using Naltrexone to treat alcohol abuse is to use the adverse reactions to foster aversion to counteract the desire to drink.

It is Definitely safe to take with alcohol. Not sure where your seeing that it's not.

> It is Definitely safe to take with alcohol. Not sure where your seeing that it's not.

“It is for some people less unsafe, in a very specific treatment model, with alcohol than continuing untreated alcohol dependence is” would be more accurate.

Wouldn't you consider beating an addiction to actually being able to take one or two drinks and leaving it at there?

In other words, if you're constantly counting the days without a drink and struggle with yourself to not drink, are you really "cured" from the addiction?

Every person i've ever met that's quit an addiction has never thought of themselves as cured. They may not partake in they're substance of choice any more but they've all still called themselves addicts and think about their substances still.

As far as the counting the days thing I think I agree with you on that. A couple years ago a friend of mine was struggling to quit their drug addiction. For almost a year they would count the days or weeks between the times they 'fucked up' as my friend called it. In the end after some pretty bad things happening and a few times almost losing their life. My friend got serious about it and they've been over a year now clean. The thing is this time my friend hasn't been counting the days or thinking about how long it's been. They've just been getting on trying to rebuild their life and avoiding the people and things that used to be part their addiction and I think it's made a big difference.

The term “lifestyle change” has been abused and overused, but what you’ve described is a true perfect example of the difference between something like a diet, and true lifestyle change. An alcoholic who sits in his old local drinking soda water and counting the days he’s been clean hasn’t changed the factors that led him to drink, his habits, and everything other than just not drinking. Your friend decided, not just that he should stop drinking, but that he wants to, and wants to change his life accordingly.

The problem with addition is that there’s often an “upper level” cognitive process that wants to stop, doesn’t enjoy the fallout of addition, but that exists with the “lower level” processes of enjoying the drugs and disliking withdrawal, boredom, finding new friends and ways of living. You can only really change and stay changed when you unite both of those urges and work hard to change beyond just quitting x. AA does that in a way that seems to work for some, as religion has always been capable of restricting people’s lives. Of course people who don’t believe in that framework don’t actually need it, but they do need something comprehensively geared to changing their overall lifestyle.

I think the idea of a group setting for support is smart, the idea that the group has to be fanatically religion is not.

It's not a struggle to not drink (other than potential social impacts).

The problem is that once you start you have a set of well-worn reward pathways in your brain that want more of it.

A true cure would need to look at neuroplastic, genetic, and environmental factors that lead to an addiction response. But what's the point when you can just not drink, which is unhealthy anyway.

>Wouldn't you consider beating an addiction to actually being able to take one or two drinks and leaving it at there?


>In other words, if you're constantly counting the days without a drink and struggle with yourself to not drink, are you really "cured" from the addiction?

This is an entirely different statement from your first point and a mischaracterization of recovery.

Truly curing it would mean that. But you've still beaten the addiction if you can stay away, and beating the addiction is by far the important part for your health.

Hey all HNers that might be wanting to stop drinking, or have trouble staying sober even though you try!

The community in https://reddit.com/r/stopdrinking is amazing and keeps me and many others on a sober path.

I've soon been sober for a year, and I was on a very destructive path. Would never have kept at it without that sub.

Here's how it helped me:

1. In the beginning I was hurting and feeling really isolated - posting semi-regular helped me vent and people with more sobriety under their belt gave support directly.

2. When I've been to occasions (weddings, birthday parties) that include drinking, I've been able to jump into the chat and find instant support telling me to not have the first drink.

3. There's a daily check-in where you post to pledge today's sobriety. In the beginning I pledged each day.

4. I have a badge by my name that keeps track of each day I've been sober. Having to reset that to zero is more motivating than you might believe at first.

5. I now comment on other users posts, trying to keep their mood up and push them to not drink by giving them support.

Also, the community and mods are superb, kind people.

It only hit me in the past few months how ingrained alcohol/drinking culture is in adult lives. It’s absolutely everywhere (ads, sports events, festivals, workplace, nightlife, social events). It’s actually crazy how lightly we treat this addictive, toxic substance that we joke about despite how many people it kills every year and harms directly and indirectly. At some point I was unknowingly drinking 4-5 times a week and thinking that was normal or OK. I’ve mostly just stopped and will only allow myself 1-2 drinks every few months on a vacation or social event with friends.

The unfortunate thing is how much people actually buy into it. I remember once in university, I was at a national entrepreneurship conference for student entrepreneurs. One night, there was a party at a club type of venue. I was sitting with a pretty female friend from my university when she asked me to get her water. So I went and got her a bottle of water. This jerk from another university walks up to us and incredulously asks me, "You got her water??? Here??? You got her water??? What's wrong with you???"

Nerdy, socially awkward me at the time couldn't think of a comeback and I felt embarrassed that I didn't get her a beer or cocktail. But I was also really annoyed, like logically, why am I the embarrassed one here? Today's me would have a lot more confidence and some witty comebacks. :)

But... part of me wonders... how much did that guy really believe what he was saying, and how much was that guy also just a scared kid inside trying to act cool and fit in due to the imagery he's been bombarded with?

> how much did that guy...and how much was that guy...

Neither. It's a common joke used when people get water when there's a bar close by. Nothing more, nothing less. It doesn't have to be believed, and one does not have to be a "scared kid inside" to say it. I think you just read way too much into it, perhaps since it was your first encounter with said joke.

I can get that, but if true, the fact that this joke is considered funny and acceptable makes parent's point about the imagery bombardment and how culturally ingrained drinking is:

>> It’s actually crazy how lightly we treat this addictive, toxic substance that we joke about despite how many people it kills every year and harms directly and indirectly.

As a personal aside, I find jokes that put down others to be distasteful. You don't need to denigrate to be funny. Unless the target is in on the joke. Laughing at oneself is OK. Laughing at others when the target is not laughing is not OK.

It's a common joke because drinking water at a bar is seen as wimpy or uncool. Put another way, the only way the joke works is if we all agree that there's something wrong with drinking water instead of alcohol. I agree with PakG1's reading.

Indeed, I've experienced this joke many times while drinking water at bars/alcohol events and I just laugh it off. On the inside I think about how much better I'm going to feel than everyone else the next day.

Depends on the quantity I guess, but... why is drinking 4-5 times a week not ok? Something like a glass of wine or a small beer should be fine, right? In some countries (e.g. France) it's a wide-spread habit to drink a glass of wine at lunch, and it doesn't seem to harm public health.

You're right when you say that the quantity is important.

The UK talks about "units" of alcohol. One unit is 10ml of pure alcohol. Drinks in the UK are labled with their Alcohol by Volume (ABV) percentage. To work out how many units are in a drink you multiply the serving size in litres by the ABV number. Current UK guidelines are no alcohol at all if you're pregnant, and less than 14 units a week with some days alcohol free and don't save up the units for a binge.

In the past wine used to be weaker and serving sizes were smaller. One unit of wine is one glass at 125ml at 8%. In the UK by law everywhere selling glass by the wine has to offer a 125ml serving. That doesn't have to be a prominent offer though, it could be a footnote to the menu. UK serving sizes tend to be 175ml (for a small) or 250ml (for a large). This means there's huge variation in the quantity that people drink when they describe "5 glasses a week".

Five glasses * 125ml * 8%ABV is 5 units.

Five glasses * 175ml * 12.5%ABV is 11 units.

Five glasses * 250ml *12.5%ABV is 15.5 units.

15 units a week isn't hugely worrying, but it's a big difference. I guess we'd want people drinking 15 units a week to unwind after work to take up some exercise or mindfulness instead.

There's some cultural variation too. When a middle class couple in the UK talk about "a glass of wine" that could mean "half a bottle", and "a few times a week" could mean "most days". I used to work in a factory and people spoke about "going for a beer" after work, and that never meant one beer, it meant a drinking session where two or three beers are drunk.

I watched this documentary on alcohol unit measurements in the UK...


Kinda slow - so recommend watching on 1.5x speed or so.

> Five glasses x 250ml x 12.5%ABV is 15.5 units.

I’ve always found it easier to visualize drink quantities relative to a standard bottle, 750ml for most wine and spirits.

So that 250ml serving is 1/3 of a bottle per glass.

Yep - its pretty commonly accepted that a bottle of wine is ~3 glasses.

No it's not? A typical bottle should be about 5 glasses + or - one depending on how you pour.

This. I pour 5-6 glasses of wine from a bottle, and I don't feel that they're "small" in any way. Putting a third of a bottle at once in the glass is far too much - at that quantity, swirling the wine becomes nearly impossible. And anyway, holding a wine glass should be effortless, you should be able to talk & do mild gestures with the glass in your hand.

250ml isn't some unusual serving size. It's a standard "large" when eating out in the UK.





etc etc.

And these large glasses are used in many homes. I have no problem believing that people are drinking glasses of wine this big, mostly because I see them do it.

New findings show there’s no such thing as a “safe amount of alcohol” https://www.npr.org/2018/08/24/641618937/no-amount-of-alcoho...

Eh, so what. To a certain extent everything enjoyable about life is harmful to your health. Ice cream, pizza, cigars, staring at screens while sitting for hours at a time, playing sports..

Well, the increased risks from 1 glass of wine per day is abysmal. Even 2 glasses of wine.

That link (which keeps being posted in HN) a case study in terrible, absurd statistics. There's some other study recently touted that booze (and coffee) keeps old people alive longer. I have no idea if it's any more sound, but it's obvious that alcohol isn't that bad in moderation based on simple demographics.

Yes, but that's not important takeaway. What's important is that with better, recent methodology, we're discovering that the "moderate drinking is beneficial" effect vanishes.

One study, one time.

Also, studies find driving a car to be dangerous. Same with leaving your house.


"The findings reveal that the widespread perception of the French as a healthy nation is rapidly becoming outdated."

> "We're not proponents of complete abstinence. There probably is an amount of drinking that's OK," LoConte told NPR in June. "But from a cancer-prevention standpoint, drinking the least amount of alcohol possible would be the best strategy."

I always found defending your drinking with the "a glass of wine a day is good for your heart" study a bit lame. But advocating abstinence because no level of alcohol is safe is very narrow minded as well.

Saying something is ok in moderation always defines moderation relative to the harm. This study puts moderation very low ~1-2 glasses of wine a month. Studies focused on different forms of harm have different thresholds, but you get all forms of harm not just what a specific study looks at.

Saying I accept the harm for this benefit is fine, but pretending it does not exist is irrational.

Do you have the study? Not some newspaper articles. It feels very unlikely to me that they were able to prove harm from 3 glasses a month, I'd like to read that.

[edit] In the article cited in NPR, https://www.thelancet.com/action/showPdf?pii=S0140-6736%2818... , which makes the claim "zero consumption minimises risk", you can see that ischemic heart disease & diabetes risks actually go down for 1 glass a day, while cancer & tuberculosis go slightly up. Their own chart of "relative weighted risk from all attributable causes" is flat-line for the first 1 glass/day. And that's from the paper that's cited to say "no level of alcohol consumption is safe!"

We are looking at different studies. This is the meta analysis I am referring to:

“Every category of drinking was associated with an increased risk of cancer.”


PS: The study included what it called light drinking as a cancer risk. I am less generous with terminology.

Look at the "light drinking"[] result in figure 2 - most whiskers cross the 1.0 line when it's not downright in the left-hand side! (e.g. lung cancer relative risk - if you trust that result, it means light drinking _improves_ your lung cancer prospects). They flat out state that lymphoma risk is inversely correlated with drinking. AND it's only about cancer - no word about other diseases (e.g. ischemic heart disease, where there are studies showing light wine drinking improve your odds).

Overall, your meta-study hardly proves that "any quantity of alcohol is bad for your health"; quite the contrary in fact, I'd say.

[] 1 glass of wine a day according to their definition.

You are ignoring what the paper actually says.

Each cancer type is independently analyzed independently. 1 wine a day measurably increases overal cancer risks as stated by the authors. Rather than assuming you have a better understanding after a quick analysis you may want to rethink your analysis.

Hint the base rate for each cancer is not equivalent.

> 1 wine a day measurably increases overal cancer risks as stated by the authors.

Where? I just re-read it and didn't see this conclusion.

(And even if they did - it's just cancer. What if we include heart diseases, too?)

Beyond the original statement. “Every category of drinking was associated with an increased risk of cancer.”

“In the present study, alcohol drinking was associated withcancer of the oral cavity and pharynx, oesophagus (SCC) andfemale breast even at low doses. These results represent an updateand corroboration of previously published findings on the linkbetween light alcohol drinking and cancer (Bagnardi et al, 2013).Given the high proportion of light drinkers in the population andthe high incidence of these tumours, especially breast cancer(Ferlay et al, 2010), even small increases in cancer risk might be of great public health relevance. Approximately 5000 deaths from oraland pharyngeal cancer, 24 000 from oesophageal SCC and 5000 from breast cancer were attributable to light drinking in 2004worldwide (Bagnardi et al, 2013).

Yes, some cancers where negatively associated with drinking, but the net effect was negative over the range of cancers studied.

As to light drinking and heart disease, that link is under some question as to the relative gain from drinking vs associated lifestyle factors. Short term controlled studies suggest some benifit, but it’s less clear for younger drinkers and people with good cardiovascular heath.

At a guess, the benifit of moderate drinking might win somewhere between 40 and 70 depending on specific risk factors.

Ignoring the harm of the alternatives is also irrational. If you remove the wine you replace the calories with something else, and that will have its own risk numbers. Some studies sort of average that in but an average isn't nearly as good as numbers for specific items. You can't reasonably extrapolate total risk from one or two diseases either.

Dealing with tiny risk factors is very difficult, and it's easy to make the wrong conclusions. See also the vast majority of reporting on whether x food is good or bad for you.

I guess it depends what you define as "not ok". I mean, why is smoking 4-5 times a week not ok? Why is shooting up heroin 4-5 times a week not ok?

In the end, we're simply willfully poisoning ourselves. For some reason we, as a society, have decided that it's OK to poison ourselves with certain substances (caffeine, cigarette smoke) but not others (heroin, methamphetamines). We've made this socially acceptable. So if by "ok" you mean socially acceptable, thensure, it's ok.

I don't know enough about smoking or heroin to know whether they produce actual damage to your health, if done in small enough dosages. I guess 5 cigarettes per week (one per day) might not be that bad? But maybe I'm wrong. Anyway, smoking bothers others too (unlike drinking), and heroin is much more addictive (I suspect 5 doses a week would definitely end up hurting you).

By "not ok" I mean "actually harmful to your health". I don't buy the argument that "there is no safe dosage of alcohol", I've seen the claim but not actual evidence. AFAIK the liver is perfectly able to deal with small quantities of alcohol.

Specialists are making that claim: the dangers start at the first glass. It's not a conspiracy theory. Google a bit and you can find a few decent studies.

I'd also add that alcohol definitely bothers people, maybe not just you.

I did google, all I found were journalists making that claim, and no convincing data. See e.g. my comment here: https://news.ycombinator.com/item?id=18824502 - about one of the papers that's cited here to make this claim.

> caffeine

There's little evidence that drinking coffee or tea is bad for you overall. In contrast, anything beyond very moderate alcohol consumption is almost certainly bad for you.

Good point, caffeine was not a good example. Cigarettes (or smoking in general, whatever it is) and alcohol are really the primary "legal poisons" we allow, I guess. At least in most of the world. With alcohol actually almost encouraged in most parts.

> The available evidence suggests that the main legitimate concern regarding caffeine and energy drink use is the potential negative impact on sleep but that, otherwise, there is no cause for concern regarding caffeine use in the general population.


Ingesting too large amounts of caffeine is almost certainly bad for you. It's a stimulant that increases your blood pressure and heart rate. You don't want to overdo that. It's also diuretic, if you substitute water for coffee (which some people do) it can actually lead to dehydration.

But yes, I agree to your larger point that coffee is less dangerous than alcohol.

>It's a stimulant that increases your blood pressure and heart rate.

Does it do that to a significant extent to regular users, though? I thought the stimulant effects mostly went away once you build up a tolerance.

Similarly, there is little diuretic effect for regular coffee drinkers:


Interesting, I didn't know that.

As to stimulation effect for regular users... I guess it might depend, but for me, I do notice when I drink too much coffee. And I am a "regular user" - I'd say I drink around 4 espresso a day (which is not a problem, but if say I bump that up to 10, I definitely feel it)

The same would be said for those who drink regularly over years. More is required for the same effects which introduces more risk.

Of course too much of anything is bad. People also die from drinking too much water. But the reality is that billions of people a day use caffeine and there are not widespread problems.

Isn’t that duretic problem a myth? The water in coffee more than compensates for it. It is actually funny to see atricles about the coffee. One week it’s how it is bad for you, another week how it’s good. There is a song by one old Lithuanian band “Doctors”, basically lamenting how this and that is bad for you, acorrding to doctors. And it has the line “but if you think about it, the most harmul thing is the living itself”.

Same thing. I wouldn't say I ever had a problem with alcohol, but even 1-2 drinks here or there do not line up with my life goals. I realized that even a single drink makes me feel not quite 100% the next day, and this effect has only increased as I've gotten older.

I do like beer and wine so I will have one on occasion. I found it makes them actually taste better, as I savor it now.

Some other side benefits is that it saves a TON of money, and I consume less calories. Alcohol is expensive, particularly in a bar or restaurant. Less calories is obvious.

It used to be much more ingrained. Factory or construction workers used to drink during work, and if those old movies are to believe men would pour themselves drinks all the times.

These days it is mostly acceptable to decline alcohol.

It's interesting that you cite factory or construction workers. I'm a first-generation college graduate, who grew up around skilled (and unskilled) labor. I've never heard of this being prevalent, even from old-timers discussing how things used to be way back when. Quitting time is one thing... but the last environment on earth in which you'd want to drink alcohol is around power tools or heavy machinery!

My own first thought was "Mad Men"'s portrayal of privileged office workers in the mid-20th century.

Of course, my second thought was my own office in the present day. Has this culture ever really gone away? I work for a tech startup, and there's a fully-stocked beer fridge and cocktail bar setup at all times. They're one of the first things that recruiters show off when I go on interviews to other similar companies.

Every single company event, or small group outing, basically revolves around alcohol. I'm not a teetotaler, but I am a parent in my 40's who has kinda lost interest in drinking, and I'm starting to feel alienated by that part of the industry's culture. I don't want to feel like I have accept the beer you're offering me in order to fit in with a team, or give up my evening with my family to go watch you stand in a circle and get shit-faced in front of your co-workers.

This is 2019, in our own industry.

> Has this culture ever really gone away?

It's possible I'm being naive as to what my coworkers are up to, but the "Man Men", 3 martini lunch culture has certainly gone away.

It's fair to complain that a company's social events revolve around alcohol, but, explicitly, when people talk about "company culture" and "good fit", internal company norms around alcohol are a huge part of it. There are workplaces that are basically a continuation of college frat houses, down to the levels of sexual harassment that make Uber look hospitable. There are also workplaces where everyone goes leaves at 5pm on the dot to get home to be with their partner/kids, and the Christmas party is a potluck with very limited amounts of wine.

Pick your poison. The recruiter is there to, well, recruit you, and they can't know how a given candidate feels about alcohol consumption, so if they too-gleefully show off their bar - push back! Ask how much people actually drink - there's a difference between between zero and one beer after work with coworkers (I just drink a la croix/talking rain while my coworker who does drink, drinks a beer), vs drinking liquor to excess.

I can't find the sources now, but based on what what I have been told the workers at the Danish beer producer Carlsberg were, per union agreement, to be paid a certain number of beers (4?) per day, up until the 1990ish.

Before there were any special taxes on liquer in Denmark, it wasn't uncommon to buy a bottle before work, and finish it through the day (this would be just after the Victorian age, so those workers probably needed) and of course the Gin Wagons in the UK are legendary for a reason.

Same here, my company has a keg on tap and they love showing it off. I've had one beer in the two years I've worked there. Just not that interested in alcohol.

I concur. I used to work in a plastic factory in the 70's and at lunchtime there was a fair stream of machine operators who's make a beeline for the pub opposite. Pint or two of beer and a pie was the standard lunch.

It used to be acceptable and widespread to drink at lunch in white collar jobs, too.

A buddy of mine's dad was an on the floor stock trader in the 70s/80s, and he joked that he made all his money taking advantage of the drunk people after lunch. Whether or not that part is true, he was serious when he said it was common for people to 2-3-4 martinis at lunch. He didn't drink, and still doesn't.

Out of curiosity, do you drink? My experience as someone who doesn't drink is that people at best tend to react with confusion when I tell that that I don't drink (and not due to religious beliefs, a medical condition, or something similar). I think I'd agree that not drinking is considered socially acceptable, but I definitely feel that most people still consider complete abstention from alcohol at least abnormal.

While I'm guessing you probably know, for those outside of the UK - The story of one of Scotland's national drinks, Irn-Bru, is somewhat related.


Unfortunately the sugar tax, a tax on sugar-laded drinks, has resulted in them changing the recipe and now it's disgusting tasting.

As someone who doesn't drink alcohol (and never has), this can often be a bit overwhelming. People tend to be very surprised when I tell them that I don't drink and are very confused when I'm unable to provide a reason like religious beliefs, a medical condition, or family history of alcoholism. From my perspective, it's pretty strange that I need a reason not to besides not wanting to; nobody seems to expect that I have a reason beyond that for any other form of entertainment activity, but consuming alcohol seems so ingrained in culture that people assume that anyone able to does so.

I hate to ever say this, but alcohol is actually a selfish thing to consume. If you are drinking water and I'm drinking a beer, we are having a conversation, in a way, I'm telling you your not interesting enough because I need a kick from alcohol.

Alcohol is a funky beast, for sure.

> how ingrained alcohol/drinking culture is in adult lives

I agree.

About a month ago I went to a social event where we would be doing XYZ. We finished our task and trundled for lunch; "when is the bar going to be open" was a common lament. All I wanted was to buy and eat pizza; which I did, but others were so very happy when the bartender showed up.

And this was lunch time. "Noon", for example. Martinis were wanted. I just wanted pizza.

It all worked out. But it was worth mentioning.

If you consider addiction as a psychological and physical dependence on a chemical what healthcare professional would design a program like AA? Seven of the 12 steps involve God. It also reinforces the 'moral failure' stigma attached to the person. You drink too much for a reason, not because you are a bad person. It's likely due to genetic and environmental factors. ohh and you can die from withdrawal (unlike most other addictions).





There are any number of persistent myths attached to the popular conception of 12 step programs.

I am in no way an expert on AA, but I have researched various addiction treatment methods fairly extensively and am close to people who work professionally in recovery programs.

The idea that AA reinforces the "moral failing" aspect of addiction seems contrary to everything I've ever read, heard, or seen in regards to AA.

There may be a sense in which what you wrote is true, depending on defining very hard to define words such as "moral" ... I say that to apply the principle of charity to your comment as liberally as possible.

My problem with you writing what you wrote is that it could discourage someone from seeking help. AA is free and nearly ubiquitous. It is decentralized and the implementation varies considerably from group to group. People can relatively easily find meetings and just walk in. Whether or not it is the best fit for any given addict, it is often the first step someone takes on a very difficult road.

I don't think it in any way serves the common good to make discouraging comments about it. Especially if they are potentially misleading, which IMO yours is.

> The idea that AA reinforces the "moral failing" aspect of addiction seems contrary to everything I've ever read, heard, or seen in regards to AA.

The entire insistence on the belief in a higher power, along with insistence that one is "powerless over your addiction" is intrinsically talking about a moral failing, and more specifically adherence to a christian-worldview where all from birth are morally failed.

They are offering a solution, in the form of rewiring your entire worldview (and deeply held beliefs) to the idea that you are powerless, there's an all powerful deity, and all good things are because of said deity. Step 4 is literally "Made a searching and fearless moral inventory of ourselves." [1] It may be effective for some, and some may have issues or resistance to such a thing.

Having a conversation about the methodologies is impossible without potentially discouraging someone from seeking help - but we should not hide the negatives, or else there'll be no way to actually get to better solutions. My feeling is that religion and giving up to a higher power can work for some people, but for others it can be a betrayal of their deeply held principles and values - my fear is that places like AA in an effort to evangelize their own principles and values take people who are rock bottom and offer up theirs as a solution rather than something that might work well for the person.

1: https://12step.org/the-12-steps/

The entire insistence on the belief in a higher power, along with insistence that one is "powerless over your addiction" is intrinsically talking about a moral failing, and more specifically adherence to a christian-worldview where all from birth are morally failed.

Does belief in a higher power constitute being morally failed? Is it even specifically Judeo-Christian?

Being "powerless over your addiction" has more to do with setting aside rationalizations and not mistaking temporary breaks for having control.

AA undeniably has a Christian flavor -- it was developed and elaborated by Christian people -- but that doesn't mean it's about Christianity.

AA absolutely is about Christianity, it is an offshoot of Christianity and a Christian organization.

The emphasis on public self-flagellation and self-humiliation via drunkalogs and self labeling as “alcoholics” aka sinners, the insistence on the nonsensical idea of “personal powerlessness,” the dogmatic suggesting of a book (the AA big book) written by Christian religious freaks as if it’s the Bible...

AA quite literally IS Christianity. It’s just that they use the generic label “God” rather than the more specific label of “Jesus Christ.”

It’s not like they allow polytheism, lol. They are specifically a monotheistic group religion, based on the idea of a singular MALE “higher power.” AA is Christianity. Saying otherwise reveals you either don’t know much about AA, or you don’t know much about Christianity. They are functionally the same.

I think you should check the link I posted if you want to say it doesn’t mean it’s about Christianity.

> You drink too much for a reason

I don't think that's right. More than anywhere else, it seems like on HN there's an idea of the infallibility of human rationality. Would anyone in their right mind a) shoot dirty dope filtered through a cigarette butt, b) gamble themselves into debt with the mafia, c) overeat to the point they can't leave the house, d) play videogames compulsively for days on end, etc?

A reason doesn't mean from a rational perspective. A reason someone wouldn't go in an elevator might be an irrational fear of heights. A few reasons someone might continue drinking even though its slowly destroying their lives and relationships:

* Undealt with trauma/abuse

* Lack of skills to express themselves emotionally, and experience that it is a "socially acceptable outlet" (for a while)

* Depression and lack of self worth (sometimes brought on by excess drinking, in a cycle/loop)

* Neurochemical or biological imbalance - note that the rates of ASD spectrum or bipolar alcoholism is much higher than neurotypical, for example

* Cultural enforcement of drinking (frequently being around people with other of these issues)

* Others

Or most frequently

* Multiple of above

I think that was the point of OP's comment, since you cut the rest of the statement

> You drink too much for a reason, not because you're a bad person.

the reason here being predisposition, environmental factors, genetics, and/or current illness

So those factors listed essentially encompass your personality and dictate why a person does any action.

In that case, how do we hold anyone personally responsible for anything considering that the reason a person does any action is a result of their genetics and the environment they grow in?

Not criticizing, just wondering how others reconcile this.

My dad drank heavily while he was in the army. He swore off alcohol when I was seven, but I never saw him drink to alcoholic levels.

I think he drank to suppress the nightmares from serving in the front lines of two wars. I think he began tapering off when he left the army when I was three. I think he did so with no conscious plan. He just didn't need as much alcohol to push away his personal demons so he could sleep and he probably just naturally reduced it over time without really thinking about it.

I've got a serious medical condition. I used to take a lot of prescription medication. I've gotten off all the drugs. It's really normal for me to stop doing X slowly over time and not really notice it until later. It's common for me to only really notice a change precisely because I talk a lot about my medical stuff with my adult sons, so we periodically go over "Oh, yeah, you used to do X, Y and Z and you don't anymore."

I also spoke once with someone who had a lot of shame surrounding a DUI on their record. One of the stories they told me: They had surgery for something and when the doctors opened them up, they found one of the organs necrotic. This was unexpected and they expressed surprise that this individual was still alive. They removed the organ in the process of doing this other surgery. The individual quit drinking after that, but still saw themselves as a bad person and an alcoholic rather than someone who was managing a terrible and life threatening medical condition with alcohol until surgery happened to resolve it.

I'm convinced that this type of thing is much more common than is generally recognized.

> In that case, how do we hold anyone personally responsible for anything considering that the reason a person does any action is a result of their genetics and the environment they grow in?

Every society struggles with this - how to stop people from acting in ways that are anti-social? Nobody has a universal solution, because universal solutions can't and don't exist - but thats why we have judges and justice systems.

Accountability is different than responsibility. Is it the fault of a pedophile that the psychological reason for their desires came through no fault of their own? No, but they are still held accountable for acting upon such desires, as its clearly an assault on the victim. Its a bit like arguing causality - it can go in a loop and you can never come out. The line most societies draw is when one person negatively effects another (assault, fraud, etc), or has a high likelihood to negatively effect another (driving dangerously, some would say drug use).

Note that being an alcoholic itself isn't illegal. Its a legal drug, you can have as much as you want as an adult in a free society. All the illegalities come in when your alcoholism negatively effects others.

Human being is fundamentally weak. The worst and mostly uncontrollable factor leading to addiction is not having a friend when you really need someone. It's not someone's fault. If person is assole and that's why can't befriend anyone, maybe it's because that person was traumatized by cruelty or ignorance in the past. We are weak and can't handle our lives alone at all.

I would like to know if there is anybody on Hacker News who does anything "in irrationality" as you describe.

Over work? Over program? Over game similar to your "d)"? Over technology -- e.g. databases and search at work whilst Drones & Arduino at home?

When is any of this "addiction"? What if you replaced "Arduino" with "Alcohol"? What if you looked at "databases" and asked "is this interfering with my normal life"?

The AA steps were constructed in a culturally-Christian environment, for people who are also culturally-Christian, even if they’re atheists. (I.e., they are people who were taught Christian messages and then maybe rejected them, and who also have a mostly-Christian community around them.) Thus, they have to be read through this lens.

Basically, if you want to “translate” the AA steps for the modern era where things aren’t so culturally-Christian, try replacing “God” with “a Church congregation-community”, where a “Church” is any social technology designed for taking a group of average people and trying to extract the best, most empathetic/humanist/“moral” group behavior out of them.

When AA says to rely on the “power of God” which is “strong” while your own willpower is “weak”, what they’re really saying, stripping away the culturally-Christian assumptions, is to rely on the social technology of a Church-like organization to amplify and backstop your willpower in various ways.

• Most Church-like organizations, regardless of religion, have a membership that strive to practice moderation in things like drinking, so switching your “community” to be that of the Church-like organization means switching your friends (maybe people who love to go out and get drunk?) for people who don’t. (This is a similar idea to why some people say prisoners are better off paroled: the last people you want prisoners around are other prisoners. You want them around good role-models, not bad ones, if you want them rehabilitated.)

• Most Church-like organizations provide access to a confidant and therapist (in Christian churches, that’d be the priest.) If you bond with this confidant-and-therapist figure, you’ll feel less bad about temporary failures, because you’ll have someone to tell who will help you get back on the horse, rather than shunning you for your failure.

• In most Church-like organizations, if you don’t attend the regular community meetings, the community members will get worried about you and check up on you. This will help prevent you from degenerating further after falling off the wagon.

AA is already a bridge between two worlds; although it is constructed under a culturally-Christian lens, it assumes that its attendeees are not necessarily members of any Church-like organization. So one of the goals of AA group meetings is to be a Church-like organization, for people who don’t attend Church. It pushes you “back” toward the Christian Church because it knows it can’t help you forever and wants you to find a more permanent Church-like organization to help you. This is similar to how psychiatrists encourage people who are stable on a maintenance dose of some drug to stop seeing them, by instead getting a family doctor (if they don’t already have one) and getting the family doctor to perscribe the maintenance dose of the drug.

I think that, while AA could be rephrased to not be culturally-Christian, it’d be very hard to replace its insistence on accepting some kind of religious Church-like organization into your life... because there really just aren’t that many non-religious Church-like organizations. If there were, maybe there’d be fewer alcoholics.

> It pushes you “back” toward the Christian Church because it knows it can’t help you forever

AA very specifically does not push you off on some other organization for support, and very specifically does not see or bill itself as being unable to provide lifetime support.

It's designed as “you come, you stay, you evangelize”, not “you come, you get some value, you go back to some other support system”.

The AA steps were constructed in a culturally-Christian environment

I've read the origin story. It was constructed by a group of people who had been terrible, hard core alcoholics for decades who had failed all efforts to get off the alcohol and were still drinking even though it was literally killing them. "Giving it up to God" helped these folks get sober when nothing else had.

Now, we call every college kid who goes on a bender an alcoholic, blame every personal problem they have on the alcohol and refer them to AA. Reality: Most people naturally drink less over time without any intervention whatsoever. Generally speaking, young people drink a lot more than old people, and not because all young people go to AA and get "cured."

One guy explained it thusly: "When I was young, it felt great to get drunk. I had fun for hours and then the hangover wasn't too bad. Now, I get a short term pleasant feeling, followed by a terrible hangover. It's just not fun like it used to be. It's simply not worth it anymore."

How do you feel and what do you think about Lilith Starr's opinion and experience that a religion at-least partially focused on self responsibility was more helpful on achieving sobriety than AA?

It seems plausible that the complex set of control systems that govern our survival became intimately intertwined with various alkaloids over a few million years, "outsourcing" production of raw building blocks to plants. One example is the way in which sulforaphane from broccoli (via glucosinolate glucoraphanin) reduces symptoms of autism in the presence of myrosinase (present in mustard). [^1]

Specifically, on the topic of addiction: "Ibogaine-treated rodents exhibit attenuated opioid withdrawal symptoms, and diminished self-administration of a variety of drugs of abuse, including opioids, cocaine, nicotine and alcohol. Anecdotal evidence suggests that ibogaine is also anti-addictive in humans." [^2]

Meta-analysis of randomized controlled trials show that a single dose of LSD had a beneficial effect on alcohol misuse (OR, 1.95, 95% CI, p=0.0003). [^3]

As we get better at modelling our own bodies, hopefully we can start to selectively replace or suppress some of our out-dated control systems to reduce suffering and increase efficiency while retaining our survivability.


- [^1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672987/ - [^2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382526/ - [^3]: https://www.ncbi.nlm.nih.gov/pubmed/22406913

"Reduces the symptoms of autism" isn't what you'd naively think it is. Autism symptoms are often more accurately described as "the sorts of things autistic people do while distressed." In other words, I suspect that the main effect is stress reduction of some sort, rather than autism reduction.

I want to see data driven novel approaches to addiction management. The 12-step model has dismal success rates [0]. Virtually all of the novel programs and facilities either do not report a success rate or their reported rate is highly suspicious. There are some exceptions [1]. The global addiction market is $4 billion and growing [2]. Any company working in the addiction space should keep accurate records of their success rate and push to improve that rate, because beating AA/NA's success rate at scale would be worth a large portion of the addiction market.

[0] http://articles.latimes.com/2011/mar/03/news/la-heb-sheen-aa... [1] https://www.drugabuse.gov/publications/principles-drug-addic... [2] https://www.transparencymarketresearch.com/addiction-treatme...

Very few studies have proper control groups.


> In conclusion, as best I can tell – and it is not very well, because the studies that could really prove anything robustly haven’t been done – most alcoholics get better on their own. All treatments for alcoholism, including Alcoholics Anonymous, psychotherapy, and just a few minutes with a doctor explaining why she thinks you need to quit, increase this already-high chance of recovery a small but nonzero amount. Furthermore, they are equally effective after only a tiny dose: your first couple of meetings, your first therapy session.

> most alcoholics get better on their own.

These statements and studies show how little the average person, even a doctor, understands about alcoholics. Anyone who's attended an AA meeting or worked with alcoholics can easily tell you what's so crazy about these types of studies:

AA is full of people who, by definition, cannot quit on their own. Other than some court-ordered cases, every single person in AA has already tried and failed to quit on their own. It's a nonsense comparison.

You are comparing a group of people who have never tried quitting before, with those who have already spent years failing to quit on their own. Of course the first group does better! The second group is filled with more serious conditions. If they were able to quit on their own they would have never tried AA.

> Any company working in the addiction space should keep accurate records of their success rate and push to improve that rate

Collecting metrics on lack of relapse from alcoholics and drug addicts seems like a tough task, since once a person becomes an addict (as defined by the DSM-V), this is a population that is often either less than truthful about the severity of their addiction problem, measures their consumption falsely, or will self-report as being sober when they actually are not.

Let's not throw the baby out with the bathwater. New programs are not competing against the actual success rates of 12-step variants, but their highly propagandized perceived success rates.

Judges and prosecutors aren't reading published, peer-reviewed science when deciding what to do with an addict that has committed a crime. They are listening to people who tell them "12-step programs just work, so send addicts to my 12-step program, instead of to prison!" And these people are claiming that, because the shipping and handling of convicted criminals is a big business, and they want to get at some of that money.

The programs from the article seem to be targeting non-criminal addicts that simply want to stop using without also having to prove it to their probation/parole officer. By that approach, even if they have a 100% relapse rate, they still might be more effective in terms of cost per month saved by abstinence or reduction in use. If someone has a $X/month drug habit, and pays $Y one time from their own pocket on a program that gets them to kick it completely for N months, before relapsing to $Z/month, they still got to spend part of the money they saved from not burning up their whole paycheck, on something other than drugs or drug treatment, and they might still be able to repeat the program before backsliding all the way. That's a different market from the guy caught stealing televisions to pay for meth, who has no money or earning potential left, but the state might still be willing to pay any price less than what it would cost for full imprisonment, to anyone that can manage to keep that one guy from causing more trouble.

While those people are burning up their brains and spare time on para-religious, pseudo-scientific procedures, they might also be holding down a regular job and not stealing stuff. That's a success, in that they are not actually wasting away in prison limbo or out actively tearing down society. That's the standard of success that the 12-step program has to meet. It isn't managing the addiction, but managing the addict. It's not part of the addiction market, but part of the criminal justice market.

That's a somewhat cynical and skeptical view of the system, from someone who hasn't been in it. From the outside, the 12-step program more closely resembles a cult than a valid psychiatric therapy. If your addiction hasn't cost you your job, your savings, and your friends, that 12-step program is probably not for you. And the rehab center designed around capturing some of the not-going-to-prison money is not for you. The online seminar that tries to teach you to recognize how much is enough, and to stop somewhere before getting there, might be.

It's very likely that it's just another package of woo-woo bullcrap that worked for one person, anecdotally, but it is still a valid tactic to try the cheaper options first, on a cost/perceived-utility basis.

> Judges and prosecutors aren't reading published, peer-reviewed science when deciding what to do with an addict that has committed a crime. They are listening to people who tell them "12-step programs just work, so send addicts to my 12-step program, instead of to prison!"

No, they are largely listening to and applying the laws of their state which set standards for such diversion. The problem is legislatures aren't looking at evidence, either.

> From the outside, the 12-step program more closely resembles a cult than a valid psychiatric therapy.

AA is actually one of the examples given detailed consideration in one of the seminal works on cults, Marc Galanter’s Cults: Faith, Healing, and Coercion.

For something supposedly so good on it's own, religion really does try it's best to target vulnerable people. Naive children, desperate people, people who have lost someone, people sick with addiction (referencing the submitting to the higher power step).

Whatever helps during trying times I guess. It just seems to me if religion was so great on its own, it would be approached in a calm rational manner targeted at mature adults with no driving force behind it.

Alternatively, religion is trying to help those that need it the most. The set of people who need help the most also tend to be the most vulnerable.

Religion is just something that lays the groundwork for individuals' ideology. Looking back on elementary school I now realize that a large part of it served basically the same function and learning reading/writing/math was a parallel objective.

I'm quite salty over how I went to public school and they skipped everything that was politically inconvenient. I switched states in high school and I realized that "social studies" in my old state was basically "history" in my new state sans whatever could lead to people questioning the ideology/narrative of the ruling party (effectively single party state). My girlfriend went to religious grade school and they did the same thing. Evolution was inconvenient so they just skipped it and covered more chemistry/geology/space stuff in science.

When you teach a kid (or any vulnerable person) the same things over and over again there becomes a point where it tends to stick with them even when they later learn it's wrong.

My own sense is that the religions of the world are mostly in agreement about the following things:

* renunciation of self

* acceptance of the world / reality, including suffering

* love of mankind

* love of the gift of life

Religion as an institution, however, is something different than the "message" contained within the sacred texts or traditions of religions (lower-case r).

Some religion attracts fanatics, those who believe "We are right and everyone else is wrong." Within that statement there is a marked absence of acceptance, love of mankind, love of life.

There is also spiritual pride, which is more subtle. In Christ's parable of the pharisee and the publican, we see the publican, who prays in all humility for God's mercy, and the pharisee, who thanks God that he is better than the publican. And many Christians reading that parable will think, "and thank God I'm not like the pharisee"!

>For something supposedly so good on it's own, religion really does try it's best to target vulnerable people.

As does medicine, if you think about it.

As a person of Christian faith willing to share my faith, I'm not sure I "target" vulnerable people. I don't discriminate for who receives my sharing. I'm spoiled to live in a society and social circle that doesn't have a lot of suffering. Even when people pass away, those still living are often rational and emotionally mature enough to understand that their grief is temporary, and that they can move on with life after grieving. We should support them in the manner that they'd find most helpful, and it's not complicated. In fact, if me sharing at that moment would cause them to seethe with hate, I probably should back off; they should be able to feel love from me, not hate, and if they feel hate, I'm doing it wrong.

Correspondingly, I'd need to go out of my way to share with vulnerable people, like to a homeless shelter or an orphanage or the like, as I don't run into many vulnerable people in everyday life. I am sure you would have no issue with my volunteering and donations. You'd only have issue with my sharing my thoughts to these vulnerable people. But again, I'm not targeting them, and I'm not discriminating towards them. I say the same things to people who are mature, successful, and solid. My faith just happens to power my actions, and my actions hopefully reflect my faith. As written in James ch2 v18: "But someone will say, “You have faith; I have deeds.” Show me your faith without deeds, and I will show you my faith by my deeds."

If I run into a vulnerable person and my sharing helps them, that's great. That's happened before. If I run into a nonvulnerable person and my sharing helps them, that's also great. That's also happened before. If either of them want to reject me, I feel sad about it, but I imagine it's similar to how a nutritionist feels sad when someone refuses to eat healthy food. If they reject me or my sharing, not much I can do about that, and everyone makes their own decisions. If they don't agree with my decisions, well, despite believing in the Judeo-Christian God, I am not God to make them think the way I want them to think.

I am not sure how to live out my faith and volunteer without sharing what drives my actions. You may find that in poor taste because you do not agree with my faith. But it is not sensible to do some action and at the same time reject or suppress the reason why I perform that action. I posit that it's simply a coincidence that my faith delivers a message that can appeal to vulnerable people. You find it to be malicious and disingenuous. I find it to be logical, as this is what Jesus' sermon on the mount was all about. Blessed are the poor, the weak, the meek, etc.

I'll concede that there are people of faith who seem to care about getting the message out while forgetting what the message actually means. I'm sorry those people exist. But I hope you'll be willing to consider it's not supposed to be like that. The above quoted James ch2 v18 is what it's supposed to look like.

Well said. Thanks for taking the time to post a thoughtful reply.

Religion has nothing to do with the higher power step. That's just meant to assert that there are things beyond one's control, even if your chosen higher power is just your conscience. In fact, 12 step programs are completely agnostic on their own (there are some who try to make it about a religious deity, but that's rare).

AA SPEAKER: Your "higher power" can be anything. It doesn't have to be God. RON HOWARD VOICE-OVER: It's God

Ok, now what if I were to tell you that the idea that "things are beyond one's control" can also be a toxic ideology that pushing people into a forced helplessness position?

That's a pretty broad brush to paint all of religion with.

There are plenty of rational arguments for Christianity for those willing to do due diligence:


Do you have an example of those types of arguments? The linked article doesn't actually go into any of then and just referenced books I couldn't find. I'm very curious about this subject because in high school I took theology classes and the monks taught about the logical arguments but the arguments were always a little lackluster (the teacher's knew this going into it). The teacher's point during that section was that it would always require faith.

Sorry, the link wasn't that good in hindsight. Was trying to respond between meetings.

Here is a better jumping off point :


If you want a very in depth treatment, then:


Peruse the short arguments section on Peter Kreeft's website:


I've just read one (http://www.peterkreeft.com/topics/design.htm) and it was less than convincing. In fact, I feel like it's a less-crude version of Mac's argument (https://www.youtube.com/watch?v=Zgk8UdV7GQ0).

I don't know much about Mac, but I'm sure he was inspired by others, as was Kreeft. There's a lot more besides the one you read, e.g.


I've read the Handbook of Christian Apologetics by Kreeft and it tries to make these philosophical topics more accessible to the average reader. There are numerous speakers and writers out there, and you may prefer one of them. For example, Tim Keller is quite different and you can hear him here:


I've enjoyed reading Dallas Willard:


> There are plenty of rational arguments for Christianity

No there aren't. Faith, by its very definition, is irrational.

Faith is not by definition irrational, any more than hope is irrational. It's not provable, but that's different from irrational.

But the thing is: acting rational in every situation requires a lot of mental effort, knowledge, intelligence. Not everyone is capable of this, in fact it is quite rare (because probably you need IQ > 130).

Now, the workaround for people who fail to act rationally on their own was to give them a set of heuristics that they could follow to achieve the same effect without too much thinking, a.k.a. religion.

Of course some religions advocate totally irrational things, like human sacrifices or jihad, but some evolved to the point that following their teachings is a net gain for the society.

The subject matter of faith may be irrational, but faith-based communities have benefits that ratheists miss out on.

All communities have benefits that those they exclude and other miss out on.

But I'm not joining a communist cell just for the comradeship.

Doesn't look like you've provided any in that link?

Yah, sorry about that. I responded above with a better link.

I would consider myself to be an expert of sorts on AA. I was a member for over 20 years, attended at least 4000 meetings, have read everything ever published by AA World Services (and even held private study groups with folks to discuss these books). I served at every level except national.

I left AA when I became a christian 15 years ago. (Yes, I started AA young, as a teenager.)

All that is background for these strongly held opinions:

1. AA is decidedly not christian. If anything, it is a mere cult with some christian trappings and actually some occult underpinnings. No one ever heard the gospel at an AA meeting. It's not synonymous with christianity.

2. AA's recovery rate is abysmal, and actually less successful than just doing nothing about addiction. There is lots of room for providing much more effective help for people with addictions.

3. The practice of forcing people to attend AA meetings under court order should be stopped entirely.

I know that most here are likely not christian and some are openly hostile. That's a completely different discussion than helping addicts to recover.

A good resource for the many failings of AA can be found at the Orange Papers site. It seems the original site is down, but I believe someone has mirrored it elsewhere. Lots of info on the strange origins of AA there.

The christian part is a barrier for atheists and agnostics that would otherwise be OK with participating in Alcoholics Anonymous.


There are secular AA meetings... heck I just went to one tonight. For those that want AA without the religious aspects


I'm not sure why, it may be a regional thing but I attend meetings in support for someone else and there are plenty of people who do not believe in God and state as such. I believe the third step even agrees, though I may be misinterpreting it: "Made a decision to turn our will and our lives over to the care of God as we understood Him."

The "as we understood Him", while most likely still referring to God, is what is used to mean whatever works for you even if it isn't God but something you can believe in as much to help you, which then opens the door for substituting God in the later steps for your version (or not) of him.

My personal opinion is that I find the program a bit cultish and don't agree that telling people they are helpless is the right way to help them, but that's my opinion and I respect that the program works for some people.

> I find the program a bit cultish

I have shared in meetings that I sometimes think AA/NA is a cult. Everyone understood. And over time I've come to see the importance of the word "Anonymous", which is found in the name (obviously) but also in the traditions, and means exactly this: that everyone is equal within the group. There is no "great leader", nobody that is "right", nobody that is "wrong". It is about sharing one's experience -- the things one has done, the actions one has taken -- which speak for themselves.

> and don't agree that telling people they are helpless is the right way to help them

The actual word is "powerless", not "helpless". And this powerlessness describes:

- the addict's inability to stop despite earnest and sincere desire.

- the inability, once clean for a short time, to keep from returning to drug use

Before I started attending 12-step, I had read the Bible, Marcus Aurelius, Tao Te Ching, various self-help books, The Power of Now, How to Win Friends and Influence People, and on and on and on. I had within me all the beliefs and understanding needed to live in a good way, in accordance with my principles. In short, to live with dignity. And yet I could not live according to my own principles. This wasn't just about drug use...it was about being patient, kind, tolerant, loving, helpful. I think that's the root of the powerlessness talked about in AA/NA. What I've found is that, with the belief in a higher power, I'm able to go to bed with a sense of dignity most days.

Powerlessness is the idea that an addict can't just do a little and stop on their own will. Anyone who can stop (like my wife who drinks half a glass of wine) isn't an addict. Being powerless over addiction isn't helpless. The help is right there in the meeting.

I get what you're saying about feeling cult-like. Is it maybe it feels like there are cliques in the room? If so, I imagine if your friend asks to talk to or hang out with those people, they'll more likely than not be open to it. A lot of members don't run right up and hug new people because we don't want to freak them out.

Speaking as an individual here, not on behalf of NA...

As an openly Atheist member of Narcotics Anonymous, with 23 years clean time, I'm here to say Christianity as a barrier to recovery is a matter of personal choice. Yes, I'm an Atheist with a higher power, it's my [G]roup [O]f [D]rug addicts. I kibitz with them about how to stop using, losing the desire to use and finding a new way to live. The Third Tradition of any 12-Step Fellowship clearly says there is only one requirement for membership. In the case of NA, that requirement is a desire to stop using. AA states a desire to stop drinking. They literally cannot kick you out for choosing a secular life. In my experience, anything beyond a brief mention of someone's faith or Atheism is frowned upon, because every addict's choice of a higher power or lack thereof is their own to make.

The principles of the 12-Steps, though adapted from Christian (or Muslim, Hindu, Jewish or you name it, even select Atheist) teachings, they really don't have anything to do with religion at all. They have a lot to do with being human. They are guides that teach people about being honest (particularly with themselves and about their addiction), having an open mind, willingness to change, willingness to amend the wrongs they have committed in the past, being accountable going forward, and participating in selfless service to others inside and outside NA. This is not about virtue; it's about how, for addicts, the opposite of these is a recipe for active addiction.

The thing about addiction is, the ego is a strong force that perpetuates cycles of arrogance and self-righteousness (among potentially many other issues). Using religion as a barrier to recovery is nothing more than an excuse to resume using. And it is certainly not the only addict-contrived excuse to get loaded. There's too many to count; and I have known dozens of people who are now dead as a result of that type of excuse and the using that followed.

The turning point for any addict is coming to terms with the trauma that created the pain they are trying to cover up. That's why honesty is so important; once that pain is out in the open, it can be dealt with and healing can occur. But that's not a simple problem to solve. The route to such clarity varies widely from one addict to another. The 12 Steps create an environment to facilitate revealing such core issues but certain issues may escape detection. Some people will require therapeutic or legal intervention (we call it "Outside Help for Outside Issues") to get "there". Some never get there and white-knuckle it to stay clean. Or kill themselves with something other than drugs.

12-Step programs like NA are NOT highly successful. I think it's about 1 in 10 that make it. Probably even less. Our stats are probably skewed by attendance coerced by the justice system; who knows, there is no science to collecting surveillance in an anonymous program. We even make efforts to let the justice system know that we are not taking attendance or verifying identities of attendees; our 12 Traditions make us resistant to such observation. This isn't the program for people who require those kinds of stats.

What I can say, when I look at the people I got clean with, the people who we hung tight together with and were committed to staying clean no matter what, nearly all of them are still clean. Many of them without relapse (including myself). And so are the serious members who were here when I arrived. Those who told me it was OK if I didn't believe in God, that I just had to be open to the idea that maybe my decision-making skills were prone to creating problems rather than solutions.

NA makes no claims of any performance. It's just a thing some people found that works for those who work it. Those being the members who don't use in-between or at meetings, come on a regular basis, work steps and serve others. Anyone else isn't actually working this program, they're doing something else. We don't insist we're the only way to recovery. We humbly accept this program comes with no guarantees. If other methods work for others, awesome! Go to what works for you, and hopefully that doesn't include a dependency on doctor-prescribed dope.

While I'm certain AA might not work for everyone, in cases where there's some sort of emotional trauma or personality disorder involved, it's probably the way to go.

The religious aspects some people get so self-righteous about I think aren't really as much about religion or god, as they are about the feeling of belonging to something greater and faith in intrinsic good of the world. I assume this is not something everyone lacks, but for those who do, this seemingly religious language is one way to communicate it. Also when people propose ibogaine or LSD, I'd guess the aim of those therapies is a very similar form of healing and effective in similar cases as AA would be, but requiring less commitment from the patient. If you are a psychologically healthy individual and don't perceive the world around you as hostile, then this kind of healing isn't necessary and other options might be far more suitable (or you'll most likely just stop drinking by yourself).

I also think it's a shame people are forced to go to these meetings by the judical system, because I think the system was never intended as such and it probably completely defeats its purpose.

I don't know why. One of the founders of AA was atheist. He just realized that acting like a bigger entity exist helped him, so he started using it as a tool.

This does not mean that he really believed that.

I had seen several atheist and agnostics go to AA without any problems. When you have a serious problem like this that makes you loose your wife, your kids, your job, you try anything that could get you out.

When you are desperate you try anything, anything, including visiting shamans.

From my point of view the people that have problems with AA will be the hyper rational people that could not test something without knowing why they are doing that.

The problem is that when you are under the influence of drugs, your mind is not really free to think, but is strongly biased(cognition bias), so what looks from inside like common sense is not objectively. You can rationalize anything.

What the AA method does is you accepting that the solution is outside you, accepting external influence without judging. This is a necessary step, at least while the influence is very strong.

You’re incorrect, neither founder of AA was an atheist, they were both hardcore Christians.

There's an extremely instructive lesson for programmers in the success and persistence of Alcoholics Anonymous. It's still around because:

* It's free * It's decentralized * It works

Is it the absolute best and most efficient method for treating addiction? Maybe not, but unless you have another method that works, which also does 1 and 2, it probably won't become as pervasive and long-lasting as AA.

How does this apply to programmers? Look at every dumb project that ever tried to "disrupt" email. That's a field littered with dead bodies. Email survives. Why? See above.

The AA 12-step program was so strange when I accompanied my friend to one

I had no idea it was so religious

I found this to be a bug, not a feature

It is interesting to see other methods being tried instead of masquarading the 12-step programs longevity as absolute validation

"The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry" https://smile.amazon.com/dp/B00FIMWI1O/

> An exposé of Alcoholics Anonymous, 12-step programs, and the rehab industry—and how a failed addiction-treatment model came to dominate America.

> AA has become so infused in our society that it is practically synonymous with addiction recovery. Yet the evidence shows that AA has only a 5–10 percent success rate—hardly better than no treatment at all. Despite this, doctors, employers, and judges regularly refer addicted people to treatment programs and rehab facilities based on the 12-step model.

> In The Sober Truth, acclaimed addiction specialist Dr. Lance Dodes exposes the deeply flawed science that the 12-step industry has used to support its programs. Dr. Dodes analyzes dozens of studies to reveal a startling pattern of errors, misjudgments, and biases. He also pores over the research to highlight the best peer-reviewed studies available and discovers that they reach a grim consensus on the program’s overall success.

> But The Sober Truth is more than a book about addiction. It is also a book about science and how and why AA and rehab became so popular, despite the discouraging data. Dr. Dodes explores the entire story of AA’s rise, from its origins in early fundamentalist religious and mystical beliefs to its present-day place of privilege in politics and media.

> The Sober Truth includes true stories from Dr. Dodes’s thirty-five years of clinical practice, as well as firsthand accounts submitted by addicts through an open invitation on the Psychology Today website. These stories vividly reveal the experience of walking the steps and attending some of the nation’s most famous rehabilitation centers.

> The Sober Truth builds a powerful response to the monopoly of the 12-step program and explodes the myth that these programs offer an acceptable or universal solution to the deeply personal problem of addiction. This book offers new and actionable information for addicts, their families, and medical providers, and lays out better ways to understand addiction for those seeking a more effective and compassionate approach to this treatable problem. […]

If a 12 steps program works or has worked for you, that's wonderful.

People who want to change so that they can handle their life without the trouble are welcome to attend.

There are many types of therapy. In art therapy alone, what've we got here: music, dance, writing, film, drawing, writing about problems and lists of solutions for each and for all of them (maybe only for yourself and then for others), etc.





- create a list of things that are reinforcing the [un]desired behaviors

- create a plan for doing something different with/about identified triggers (problems)

(I just thought of this and decided to share)

Healing the underlying PTSD (and high blood pressure and very complex anxiety partly resulting from having adapted counterproductive coping strategies and defense mechanisms) is the objective of a number of randomized controlled clinical trials.

Developing evidence-based treatment programs requires randomization and controls. https://en.wikipedia.org/wiki/Evidence-based_medicine

An evidence-based parenting book I read recently (Kazdin) strongly emphasised ABC for understanding behavior: Antecdents, Behaviors, and Consequences

It also emphasized that far more effective than punishment is reinforcing the positive opposite.

What do you plan to do with your time that has positive ROI (return on investment) for yourself, your family and friends, and/or your community?

People who abuse substances are attempting to escape their reality because they feel powerless to change it. Educating people how to change their life is the cure.

That or changing society so people aren't powerless to fix their own destiny.

Until that happens the chemical people are addicted to is irrelevant. They can use any number of drugs to include sugar in a way that is detrimental to their health and will do so.

This is overly simplistic. People may start to abuse substances because of a feeling of powerlessness, depression or some other form of unhappiness, but once addicted, a person's life can improve and the use will continue until the psychological connections are broken and rewired.

Having been addicted I find complicating things to add to the issue.

Simplest method to fix it is to address the underlying issues starting with the biggest first.

As a note. You cannot fix this for other people they have to want to fix it and change.

Ok, but how can I quit drinking Coca-Cola?

Tried like 10+ times now. It's not even Coke, it's sugar. Just such a powerful grip. Always relapse when a stressful time comes. Feels just the same as alcohol or cigarettes to me, but I don't feel justified in saying it's a real problem on the same level. I feel like it is though.

Anyone else?

Most people with substance abuse problems “grow out of it” with no outside help at all.


Just from personal experience partying with lots of drugs and drinking in the rave scene when I was in my 20s and djing and promoting, the vast vast majority of people just got tired of it one day and quit — or it interferes with their jobs or their families and they did the right thing and stopped eventually.

12 steps’s entire thing about how once you’re an addict you’re going to be one for the rest of your life is just wrong.

These articles are silly, and don't understand alcoholism. They give a few examples of successful ways that people have quit on their own, and since lots of people did it that way, then it must be more effective than treatment.

They miss the blindingly obvious point that every single person in treatment has already tried and failed those "self-help" ways. Treatment is a final, desperate, step for alcoholics, once all those self treatment methods have failed. You can't compare the two, and the first treatment has already failed for the second group.

It's like saying Tylenol is a more effective treatment than going to the hospital, because more people get better that way. Of course they do - because they have a less serious problem.

But 12 step is barely better than doing nothing at all, even in this groups.

My issue is I'm extremely productive on weed.

I hate alcohol, but weed makes my life, and everyone elses lives better(I run a consumer website).

During my month off weed, I pretty much only wanted to relax and play video games.

It seems to benefit, which makes it addicting.

If you genuinely don't have negative consequences, a repetitive behavior isn't really considered an addiction. Otherwise drinking water would be an addiction. Or any hobby.

Sobriety startup, that's a great idea! Fixing problems, and using the fast speed of startup culture. I'm not sure if they can fix it, but it seems like unique idea.

The headline is misleading, it barely references 12-steps, basically clickbait.

What more would you like it to mention? I just read the article and it was about startups that are introducing newer and cheaper options for people who may have used the 12 step program, exactly what the headline insinuates.

Maybe it was changed since you commented?

> about startups that are introducing newer and cheaper options for people who may have used the 12 step program

Just want to chime in here and say 12-Step Programs are free of charge. They pass the basket to pay for coffee and rent, but nobody is required to contribute.

Treatment Centers are not 12-Step Programs unto themselves. In fact, they engage a lot of methods that are contrary to 12-Step Programs.

12 steps has a 10% success rate.

Naltrexone or nalmafene have a 75% success rate.

Why are we even having this conversation?

This is the COMBINE study:


Thus, the results of the COMBINE study demonstrated that a pharmacotherapy, like naltrexone, when given with medical counseling that emphasizes taking medications as prescribed, can yield clinically significant outcomes (reduced drinking/increased abstinence) that are either as compelling, and under some conditions, more compelling than those observed with specialty behavioral therapy. One important implication of the COMBINE results is that naltrexone with MM can be delivered in healthcare settings where traditional specialty treatment is unavailable.

The foremost pronent of naltrexone (or nalmafene where it is not available) is Claudia Christian:


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