The Irrationality of Alcoholics Anonymous

[MachineGhost]

Another faith-based fantasy falls apart due to science. Great revelations here! Here's a few:

The 12 steps are so deeply ingrained in the United States that many people, including doctors and therapists, believe attending meetings, earning one’s sobriety chips, and never taking another sip of alcohol is the only way to get better. Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment. But although few people seem to realize it, there are alternatives, including prescription drugs and therapies that aim to help patients learn to drink in moderation. Unlike Alcoholics Anonymous, these methods are based on modern science and have been proved, in randomized, controlled studies, to work.

...

Nowhere in the field of medicine is treatment less grounded in modern science. A 2012 report by the National Center on Addiction and Substance Abuse at Columbia University compared the current state of addiction medicine to general medicine in the early 1900s, when quacks worked alongside graduates of leading medical schools. The American Medical Association estimates that out of nearly 1 million doctors in the United States, only 582 identify themselves as addiction specialists. (The Columbia report notes that there may be additional doctors who have a subspecialty in addiction.) Most treatment providers carry the credential of addiction counselor or substance-abuse counselor, for which many states require little more than a high-school diploma or a GED. Many counselors are in recovery themselves. The report stated: “The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.”

Alcoholics Anonymous was established in 1935, when knowledge of the brain was in its infancy. It offers a single path to recovery: lifelong abstinence from alcohol. The program instructs members to surrender their ego, accept that they are “powerless” over booze, make amends to those they’ve wronged, and pray.

...

In his recent book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, Lance Dodes, a retired psychiatry professor from Harvard Medical School, looked at Alcoholics Anonymous’s retention rates along with studies on sobriety and rates of active involvement (attending meetings regularly and working the program) among AA members. Based on these data, he put AA’s actual success rate somewhere between 5 and 8 percent. That is just a rough estimate, but it’s the most precise one I’ve been able to find.

...

Sinclair theorized that if you could stop the endorphins from reaching their target, the brain’s opiate receptors, you could gradually weaken the synapses, and the cravings would subside. To test this hypothesis, he administered opioid antagonists—drugs that block opiate receptors—to the specially bred alcohol-loving rats. He found that if the rats took the medication each time they were given alcohol, they gradually drank less and less. He published his findings in peer-reviewed journals beginning in the 1980s.

Subsequent studies found that an opioid antagonist called naltrexone was safe and effective for humans, and Sinclair began working with clinicians in Finland. He suggested prescribing naltrexone for patients to take an hour before drinking. As their cravings subsided, they could then learn to control their consumption. Numerous clinical trials have confirmed that the method is effective, and in 2001 Sinclair published a paper in the journal Alcohol and Alcoholism reporting a 78 percent success rate in helping patients reduce their drinking to about 10 drinks a week. Some stopped drinking entirely.

...

The Finns are famously private, so I had to go early in the morning, before any patients arrived, to meet Jukka Keski-Pukkila, the CEO. He poured coffee and showed me around the clinic, in downtown Helsinki. The most common course of treatment involves six months of cognitive behavioral therapy, a goal-oriented form of therapy, with a clinical psychologist. Treatment typically also includes a physical exam, blood work, and a prescription for naltrexone or nalmefene, a newer opioid antagonist approved in more than two dozen countries. When I asked how much all of this cost, Keski-Pukkila looked uneasy. “Well,” he told me, “it’s 2,000 euros.” That’s about $2,500—a fraction of the cost of inpatient rehab in the United States, which routinely runs in the tens of thousands of dollars for a 28-day stay.

When I told Keski-Pukkila this, his eyes grew wide. “What are they doing for that money?” he asked. I listed some of the treatments offered at top-of-the-line rehab centers: equine therapy, art therapy, mindfulness mazes in the desert. “That doesn’t sound scientific,” he said, perplexed. I didn’t mention that some bare-bones facilities charge as much as $40,000 a month and offer no treatment beyond AA sessions led by minimally qualified counselors.

...

In the United States, doctors generally prescribe naltrexone for daily use and tell patients to avoid alcohol, instead of instructing them to take the drug anytime they plan to drink, as Sinclair would advise. There is disagreement among experts about which approach is better—Sinclair is adamant that American doctors are missing the drug’s full potential—but both seem to work: naltrexone has been found to reduce drinking in more than a dozen clinical trials, including a large-scale one funded by the National Institute on Alcohol Abuse and Alcoholism that was published in JAMA in 2006. The results have been largely overlooked. Less than 1 percent of people treated for alcohol problems in the United States are prescribed naltrexone or any other drug shown to help control drinking.

...

In 1934, just after Prohibition’s repeal, a failed stockbroker named Bill Wilson staggered into a Manhattan hospital. Wilson was known to drink two quarts of whiskey a day, a habit he’d attempted to kick many times. He was given the hallucinogen belladonna, an experimental treatment for addictions, and from his hospital bed he called out to God to loosen alcohol’s grip. He reported seeing a flash of light and feeling a serenity he had never before experienced. He quit booze for good. The next year, he co-founded Alcoholics Anonymous. He based its principles on the beliefs of the evangelical Oxford Group, which taught that people were sinners who, through confession and God’s help, could right their paths.

...

A public-relations specialist and early AA member named Marty Mann worked to disseminate the group’s main tenet: that alcoholics had an illness that rendered them powerless over booze. Their drinking was a disease, in other words, not a moral failing. Paradoxically, the prescription for this medical condition was a set of spiritual steps that required accepting a higher power, taking a “fearless moral inventory,” admitting “the exact nature of our wrongs,” and asking God to remove all character defects.

Full Story: http://www.theatlantic.com/magazine/arc ... us/386255/

[craigr]

All well and good. But you know if someone has a destructive habit that can only be controlled by taking a prescription pill before they engage in the activity, then maybe stopping all forms of that habit outright ain't such a bad idea.

"I find that my heroin use is far more manageable when I speedball some coke at the same time."

[MachineGhost]

i have no problem with abstinence or with pill enhanced self control ( or even with throwing some religion in the mix if it helps you) but i have always found the "accept that they are “powerless” over booze" part of the 12 step system truly cringe worthy, it is just so damn bas-akwards to have a problem with self control and as the first step to address it you must admit you not only have no control but that you never will..

All well and good. But you know if someone has a destructive habit that can only be controlled by taking a prescription pill before they engage in the activity, then maybe stopping all forms of that habit outright ain't such a bad idea.

"I find that my heroin use is far more manageable when I speedball some coke at the same time."

It doesn't "control it". It fixes the brain so they don't crave/want alcohol anymore which abstinence doesn't. I'd say the same process is at play with fat fuck overeaters and other addicts also. Once you don't physiologically need an addictive substance anymore, you can change the habit with nary a thought.

The main point is that a generic prescription pill isn't even the standard of care! Only 1% get that kind of treatment. The other 99% get the bullshitting AA faith in God crap. How well does that work? (rhetorical)

[craigr]

All well and good. But you know if someone has a destructive habit that can only be controlled by taking a prescription pill before they engage in the activity, then maybe stopping all forms of that habit outright ain't such a bad idea.

"I find that my heroin use is far more manageable when I speedball some coke at the same time."

It doesn't "control it". It fixes the brain so they don't crave/want alcohol anymore which abstinence doesn't. I'd say the same process is at play with fat fuck overeaters and other addicts also. Once you don't "need" an addictive something, you can change the habit with nary a thought.

The point is that a generic prescription pill isn't even the standard of care. Less than 1% get that kind of treatment. The other 99% get the bullshitting AA faith in God crap. How well does that work? (rhetorical)

Yeah I understand. Recognizing a weakness and striking it from your life is not a bad thing. If it's AA and pills that's fine with me. Whatever works. I know people who were helped by AA beyond just the drinking aspect so I don't think throwing it out entirely is a great idea though.

[MachineGhost]

Yeah I understand. Recognizing a weakness and striking it from your life is not a bad thing. If it's AA and pills that's fine with me. Whatever works. I know people who were helped by AA beyond just the drinking aspect so I don't think throwing it out entirely is a great idea though.

But is AA meetings alone worth $40K a month? Because that's what they're charging insurance on the high end scale. Where's Penn and Teller when you need them?

Seriously, this is an opportunity ripe for disruption. All someone has to do is open up treatment centers with an eye towards an eventual chain or franchise, by actually using the prescription drugs and you''ll monopolize the market in a flash. It's a no brainer and given the none to minimal qualifications, I'm almost tempted to go and start it tomorrow. Jeeze....

[craigr]

But is AA meetings alone worth $40K a month? Because that's what they're charging insurance on the high end scale.

Could you clarify what this means? Who is charging insurance, and for what?
Do you have a link to support that assertion?

Probably that is for high roller celebrity style rehab. I suspect most people with that kind of money going into rehab have more problems than just alcohol.

I remember watching a celebrity rehab show that had Dennis Rodman on it. The thing is he was the only sane one there. You know your life is bad when you make Dennis Rodman look normal.

[MachineGhost]

Probably that is for high roller celebrity style rehab. I suspect most people with that kind of money going into rehab have more problems than just alcohol.

I remember watching a celebrity rehab show that had Dennis Rodman on it. The thing is he was the only sane one there. You know your life is bad when you make Dennis Rodman look normal.

Commenting on Dennis Rodman's detachment from the rehabilitation process, Pinsky said Rodman was "hyper-focused in some ways, and in others, completely blank", and observed that Rodman didn't comprehend what the other patients were experiencing, or how they perceived him. Pinsky concluded Rodman may have Asperger's syndrome, a diagnosis with which a colleague from UCLA Medical Center concurred.[13]

Source: https://en.wikipedia.org/wiki/Celebrity ... h_Dr._Drew

What as shame so many current and former celebrities/actors have drug problems. Maybe its the price they pay for being objectified?

[MachineGhost]

But is AA meetings alone worth $40K a month? Because that's what they're charging insurance on the high end scale.

Could you clarify what this means? Who is charging insurance, and for what?
Do you have a link to support that assertion?

Read the article!

[curlew]

From another article on the same subject....

Contrary to popular belief, most people recover from their addictions without any treatment — professional or self-help — regardless of whether the drug involved is alcohol, crack, methamphetamine, heroin, or cigarettes. One of the largest studies of recovery ever conducted found that, of those who had qualified for a diagnosis of alcoholism in the past year, only 25 percent still met the criteria for the disorder a year later. Despite this 75 percent recovery rate, only a quarter had gotten any type of help, including AA, and as many were now drinking in a low-risk manner as were abstinent.

https://psmag.com/after-75-years-of-alc ... .svu09264i

[Pointedstick]

Yeah I understand. Recognizing a weakness and striking it from your life is not a bad thing. If it's AA and pills that's fine with me. Whatever works. I know people who were helped by AA beyond just the drinking aspect so I don't think throwing it out entirely is a great idea though.

That's really the key. It has to come from you. The technical and organizational details of how you do it are just window dressing. I recently gave up online porn, news, and video games entirely and this has caused incredible changes in my life. I wrote a bit about it here: http://hommelscitadel.com/surrogate-activities

[curlew]

That's really the key. It has to come from you. The technical and organizational details of how you do it are just window dressing. I recently gave up online porn, news, and video games entirely and this has caused incredible changes in my life. I wrote a bit about it here: http://hommelscitadel.com/surrogate-activities

I recently read a book written by a woman addicted to drugs and she described how another ex-addict who was in AA took her by the hand and knelt down and asked God to release her from her addiction. She described a powerful and palpable response to that prayer and it was the last time she ever took drugs, although it didn't turn her towards any kind of religion.

So did a "higher power", really perform a miracle and release her from her addiction - or was she so desperate to change her life that she just needed some kind of catalyst to do it and this emotional experience was it? My own belief tends toward the latter but I guess it doesn't matter as long as it worked.

[Pointedstick]

That's really the key. It has to come from you. The technical and organizational details of how you do it are just window dressing. I recently gave up online porn, news, and video games entirely and this has caused incredible changes in my life. I wrote a bit about it here: http://hommelscitadel.com/surrogate-activities

I recently read a book written by a woman addicted to drugs and she described how another ex-addict who was in AA took her by the hand and knelt down and asked God to release her from her addiction. She described a powerful and palpable response to that prayer and it was the last time she ever took drugs, although it didn't turn her towards any kind of religion.

So did a "higher power", really perform a miracle and release her from her addiction - or was she so desperate to change her life that she just needed some kind of catalyst to do it and this emotional experience was it? My own belief tends toward the latter but I guess it doesn't matter as long as it worked.

Exactly. I would tend to agree, but who cares as long as it worked?

[Xan]

Yeah I understand. Recognizing a weakness and striking it from your life is not a bad thing. If it's AA and pills that's fine with me. Whatever works. I know people who were helped by AA beyond just the drinking aspect so I don't think throwing it out entirely is a great idea though.

That's really the key. It has to come from you. The technical and organizational details of how you do it are just window dressing. I recently gave up online porn, news, and video games entirely and this has caused incredible changes in my life. I wrote a bit about it here: http://hommelscitadel.com/surrogate-activities

I'm glad we made the cut! Your blog post reminds me of the pilot episode of Star Trek, "The Cage", from 1964. An advanced race got so smart that they'd figured out how to simulate anything perfectly (and they had enormous brains/skulls too) but they ended up spending all their time in simulations and their civilization went to pot.

[MachineGhost]

That's really the key. It has to come from you. The technical and organizational details of how you do it are just window dressing. I recently gave up online porn, news, and video games entirely and this has caused incredible changes in my life. I wrote a bit about it here: http://hommelscitadel.com/surrogate-activities

I think this is an interesting commentary about Millennials. They're addicted to the mediastream. I'm actually surprised you would be caught up in that stuff, so that is pretty telling also.

The only problem I see is ... meatspace isn't necessarily as gratifying or as dopamine-inducing in an immediate or relaxing sense. Density induces stress. Dealing with increasingly idiotic people induces stress (which I'm sure is a result of mediastream addictions so its a self-reinforcing cycle I see no hope of ever ending). Boredom, patience, tolerance and other things like that that may be beyond the purview of Millennials because they grew up without learning to suffer and deal with those virtures in the first place. If you give your 3-4 year old a smart phone, tablet, kids PC, etc. you likely have doomed them to be mediastream addicts for life.

[Pointedstick]

That's really the key. It has to come from you. The technical and organizational details of how you do it are just window dressing. I recently gave up online porn, news, and video games entirely and this has caused incredible changes in my life. I wrote a bit about it here: http://hommelscitadel.com/surrogate-activities

I think this is an interesting commentary about Millennials. They're addicted to the mediastream. I'm actually surprised you would be caught up in that stuff, so that is pretty telling also.

The only problem I see is ... meatspace isn't necessarily as gratifying or as dopamine-inducing in an immediate or relaxing sense. Density induces stress. Dealing with increasingly idiotic people induces stress (which I'm sure is a result of mediastream addictions so its a self-reinforcing cycle I see no hope of ever ending). Boredom, patience, tolerance and other things like that that may be beyond the purview of Millennials because they grew up without learning to suffer and deal with those virtures in the first place. If you give your 3-4 year old a smart phone, tablet, kids PC, etc. you likely have doomed them to be mediastream addicts for life.

"Addicted to the media stream" is right. But I had plenty of hurt and suffering as a kid. I didn't watch TV or use a computer until I was 6, and the computer was arcane and challenging to use. I only really got "into" media at around age 9. We didn't have an internet connection until I was like 12 and I never had a private internet connection until I went to college. The real world is just fine. It's really not any of that; it's that modern media is designed by professionals to be psychologically addictive, and we let it into our lives without even realizing how much of it we're doing. A lot of retirees spend more time in front of a screen than millennials do. We actually have more free time than ever before, but we truly don't know what to do with it, so we fill it with these digital banalities instead of doing all the things we tell ourselves we'd do "if only I had more free time." Bullshit, you have plenty of time, you just spend it all watching sports or reading the news or masturbating to porn or liking selfies or playing video games or browsing Reddit… or gyroscopicinvesting.com!