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You know what'€™s great?  The Affordable Care Act covers treatment for addiction:

The ACA includes substance use disorders as one of the ten elements of essential health benefits. This means that all health insurance sold on Health Insurance Exchanges or provided by Medicaid to certain newly eligible adults starting in 2014 must include services for substance use disorders.
You know what'€™s bad?  Current substance abuse treatment fails most of the people it is supposed to help.  That's people, as in real human beings with addiction, not just statistics, unfortunates that can'€™t or won'€™t "get it", self-centered defectives who refuse to do the work; but people.

I read a book yesterday, it is "€œSober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry", by Dr. Lance Dodes and Zachary Dodes.  Dr. Lance Dodes has an impressive background, he retired as assistant clinical professor of psychiatry at Harvard Medical School, to name just one.  He is not a light-weight.
The Sober Truth goes into great detail in its discussion of various scientific studies on the effectiveness of current addiction treatment (nearly all 12-step based) and the sad truth revealed in the least biased of these is that there are many people that are failed by this system, yet the system is so self-perpetuating that it is virtually immune to new ideas.  AA is used as an example of how 12-step does not work for everyone in the quote below (keep in mind that it is recommended that an addicted person attend a 12-step group for the rest of their lives in order to maintain sobriety):

Even though AA does not conduct scientific studies on its success rates, a number of clinicians have tried to audit the figures.  The National Longitudinal Alcohol Epidemiologic Survey, a 1992 review by the US Census Bureau and National Institute on Alcohol Abuse and Alcoholism (NIAAA), included a survey of AA members.  It found that only 31 percent of them were still attending after one year.  AA itself has published a comparable figure in a set of comments on its own thirteen-year internal survey, stating that only 26 percent of people who attend AA stay for longer than one year.  A third study found that after eighteen months, between 14 and 18 percent of people still attended AA.
In examining the rehab industry this book discusses what lots money can buy; beautiful scenery, reiki treatments, equine therapy, AA/NA meetings, and group discussion, to name some.  But one particular point, quoted below, stood out to me and I believe it applies to everything from the opulent treatment centers catering to the rich, to the dreary, publicly funded centers attached to homeless shelters:  
Many staff members at rehabilitation centers have extremely limited training.  Although every program boasts the presence of psychologists and psychiatrists in a consulting capacity, many of those who provide direct treatment are qualified mainly by being €œin recovery€.  This is not a terribly difficult credential to attain:  Hazelden'€™s own group setting website invites visitors to €œbecome and addiction counselor in as little as one year. Training to be a clinical social worker, psychologist, or psychiatrist, by contrast, requires from three to eight years, and to be an excellent therapist takes years beyond the end of formal training.
Can this really be the best way to approach addiction treatment?  Train people up in a year to treat others with a major problem?  Consider someone a specialist because they have suffered the same problem they are treating?  If addiction treatment ever goes beyond the 12-step system, which was developed from a religious movement called The Oxford Group in 1938, there are going to be a lot of people with job security problems.  I believe this is one of the reasons that new ideas are rarely implemented.  Someone trained in a year is also a lot cheaper to pay than a person who studied years and had to pass various tests in order to get a license.

Then there is the religious issue, many courts in our country have declared the 12-step model to be a religion and said that it isn'€™t even constitutional to require people to attend (as many courts do for drug and alcohol offenses).  But even beyond that, all the God talk in 12-step can cause someone who is an atheist or one who has been badly damaged by Religion in some way to turn around and walk right back out of the only option that is readily available.  That'€™s nowhere in the ballpark of fair.

So far as what does work in the treatment of addicted people; Dr. Dodes opinion is that addicts respond better to psychotherapy that gets down to the deeper issues that trigger each individual person's addiction.  Whether one agrees with his assessment of what causes addiction (he feels it is a sense of helplessness in most cases) or not, it is very hard to dismiss the fact that a lot of money is being spent on ineffective treatments (for most people anyway) in this country with a lot of people suffering as a result.

I a€™m sure to many people this book is an outrage since even in its title it attacks the '12-step system that has saved millions and millions and€......and who is this very uneducated 'get the red out' person that would even read a book like this and diary about it?  

In the fall of 1992 I was in the process of drinking myself to death.  I went to detox, treatment, and long term treatment.  I have been sober in a 12-step program for 21 years and still attend a group.  I have had a sponsor, done the steps, done the service; so I must be a dry drunk!!!!!!  I guess that depends on each individual€™s assessment of whether there is such a thing (I don't believe there is).  I don'€™t drink and I was helped by being given a community that did not hate me at a time that I needed it.  I was also given a culture, the 12-step culture, which most of my fellows within it will defend against any perceived slight.  Am I grateful? Yes, that was the only help available to me, but I was offered it, and I needed a way out of a terrible place in my life, I needed support, and I needed social interactions.  But it took many, many years for me to realize and admit that I needed more.  I suffered from anxiety and depression as a child, before I ever tasted alcohol; that did not go away when I put down the bottle.  I was very scared I would lose my standing in €œthe fellowship€ if I addressed that problem through medication, or by even speaking up about it.  12-step isn'€™t cut out to deal with mental health issues, nor should it be.  But a lack of holistic or comprehensive treatment let my life-long mental health issue fall through the cracks when I sought help.  I should have had the courage to address it sooner, but I didn'€™t.  Not every person suffering from addiction has this sort of a €œduel diagnosis€ issue.  But some do, and in the current immovable system all kinds of issues can be neglected by the current one size fits all approach.  

I had a friend that I was in that long-term treatment center with who was simply a lovely woman, she never had a harsh word to say about anyone, she was NOT selfish, self-centered, resentful, angry, or any other commonly held assumption regarding people with addiction.  She prospered in sobriety for a while, but she told me one time she just never felt that 12-step was really a good fit for her and she was not comfortable with it.  She began drinking again after 5 years, went €œin and out€™ of the rooms, as we say, for a number of years afterward not €œgetting it, but trying again and again€.  Then she didn'€™t turn up one day at the local recovery club, she was found hanging by the neck in her apartment later that afternoon.  She'€™s one of many I have seen die from not €œgetting it€.  With the advent of more availability (supposedly) of treatment for addiction via the ACA I hope more people will be helped.  But I've come to the conclusion that there needs to be more than one "it"€ that our society will find acceptable to get€.  I'€™m tired of hearing that others died so that I might live.  I'm tired of the death.  

I recommend this book to anyone with any interest in addiction, and I don't think I a€™m an ingrate or traitor for that.  I am of the opinion that when it comes to information, more is much better than less.

Originally posted to get the red out on Wed Mar 26, 2014 at 07:25 AM PDT.

Also republished by Community Spotlight.

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Comment Preferences

  •  More Bad News (12+ / 0-)

    When my aunt was diagnosed with cancer she was told that the treatment they prescribed "may not work". In fact it didn't, but for many it has proven to be a life saver.

    •  They are always searching (11+ / 0-)

      for new and better cancer treatments.  It is not a stagnant field, thankfully.

      Manufacturing outrage; the only manufacturing jobs Republicans won't outsource.

      by get the red out on Wed Mar 26, 2014 at 08:04:44 AM PDT

      [ Parent ]

      •  ACA technically covers rehab, with a big BUT (2+ / 0-)
        Recommended by:
        Galtisalie, bewild

        Insurance companies still only pay out for addictions to alcohol and benzodiazepines–i.e. Pharmaceuticals.

        My best friend has a terrible meth addiction. When I heard the ACA mandates rehab coverage I was elated. I called multiple rehab facilities inquiring about what insurance policies they accept.

        They all told me the same thing: Yes we take insurance, but the company will ONLY cover alcohol and benzos. If you have a problem with meth, heroin, cocaine etc they will not pay. The rehab center has to find something else wrong with you and plead your case to Blue Cross, Cigna, whoever.

        If you're an alcoholic or a pill popper, Oh you poor thing, we understand.

        If you're addicted to hard drugs, Go fuck yourself.

        •  I don't think that's true (0+ / 0-)

          I think he was misinformed.  Meth is considered a huge health hazard, and it's hard to fine a meth addict who isn't also alcoholic.  Opiate addiction is usually for prescription opiates.  

          That is nothing I have ever heard, and it makes no sense.  Insurance companies try to cover the cheapest option first, more likely to cover intensive outpatient, then in patient, more likely to cover two weeks then four, so cases must be made individually to extend treatment.

          You don't need detox for meth, there aren't withdrawals, but there are for alcohol and serious ones for Xanax, those can kill you. Maybe he or she was inquiring about detox services?

          •  So the rehabs and insurance co's were lying to me? (0+ / 0-)

            They specifically said insurance won't pay for meth, heroin or cocaine, just benzodiazepines and alcohol. I was inquiring about inpatient, non 12 step rehab. Outpatient hasn't worked; he needs to be under constant supervision in a safe environment.

            •  name them (0+ / 0-)

              I'll call them up and find out what they're up to.   It sounds all wrong, on the phone they told you no?   And they separated out drugs, this not that?

              My best guess is you were asking for detox only, because rehabs aren't non-12 steps, there is no such thing, they aren't 12-steps but they're never against the 12 steps, and they use the 12-steps in the education part.  Most programs have that film, My Name is Bill W.

              Any evidence based program will include learning about 12-steps, and will recommend going to meetings, but none will force anyone to attend meetings or follow any relapse prevention program, just, if you want the best success rate, you'll refrain from inventing a wheel and use evidence.  There are atheist 12-step meetings.  

              If some program makes their treatment up, whatever it may be, it won't be evidence based, it's been accumulating, there's a lot now.

              To me this is like climate change deniers, it really is science, and many if not most programs really are evidence based and they'll tell you if you ask.  And if you don't like the 12 steps, there are other similar support groups, that go by other names.  

              As we say, denial's not just a river in Egypt?

              •  Coverage (0+ / 0-)
                The Essential Health Benefits framework, unfortunately, does impose some limits on the extent of addiction coverage, Heller said. Defining benchmark plans for each state, that list of 10 benefits requires only "a bare minimum" of addiction treatment coverage, leaving out medication like methadone, Heller said. Expanding benchmark plans to include such medication treatment will require further advocacy, Heller said.
                •  it'll be standard of care (0+ / 0-)

                  and methadone is controversial.  That's because it delays sobriety, and withdrawal from methadone is more dangerous than from opiates, and it lasts longer, and it's painful.  Junkies  may sell methadone on the street and buy cheaper heroin.  I am not in favor of methadone maintenance, but there isn't a consensus, and because there isn't a consensus, it isn't standard of care.  

                  It's usually the least first, so someone would try in an intensive outpatient program before being referred to a rehab, and the insurance would prefer paying for two weeks, rather than four, and it'll only be with later studies, if they show longer mean fewer relapses and thus cheaper in the long run, that they'll make it the standard.

                  it mostly depends on home support, it's a good idea to be in a program at least a month, it's a time that doesn't feel that great, and so being with peers and getting support while learning makes it easier.  I think the studies are showing the one month, with aftercare, meetings and an SLE if the home situation isn't supportive, is showing the best outcomes, but that also makes sense, people are motivated if they do all that.

    •  abstinence (1+ / 0-)
      Recommended by:
      Lonely Texan

      prevents pregnancy, too! many many pregnancies have been avoided that way.

  •  There are no figures published (10+ / 0-)

    by any rehab for the success rates. I believe they would if they worked worth a damn.

    Ibogaine works. But of course it's illegal in the United States. Especially effective on opiate addictions. No withdrawals, no cravings after one night-long treatment. Lesser and varying degrees of success for alcohol, meth and cocaine. Not at all for benzodiazepines.

    A miracle for opiate addicts, though. And totally illegal. You have to go to Mexico or Canada.

    •  In the book (8+ / 0-)

      He said that treatment centers rarely published any success rates.  He found an old one for Hazeldon, but it wasn't too good, and even then they had fudged by not discussing people who basically refused to be contacted by them for the survey.

      Manufacturing outrage; the only manufacturing jobs Republicans won't outsource.

      by get the red out on Wed Mar 26, 2014 at 08:01:34 AM PDT

      [ Parent ]

    •  I've read some, (4+ / 0-)
      Recommended by:
      Piren, mythatsme, jessical, spacecadet1

      put out by such treatment centers.  One springs to mind: they did not judge success by studying the actual behavior of their patients, post-release; they judged success by having counselors rate their own patients' long-term prospects based on how 'spiritual' they were.  Garbage, but it got published in a peer-reviewed journal.  

      Even with that insane methodology, they could not claim to hit the 50% mark.

      190 milliseconds....

      by Kingsmeg on Wed Mar 26, 2014 at 12:02:25 PM PDT

      [ Parent ]

      •  it's usually one year of sobriety (3+ / 0-)
        Recommended by:
        annecros, marykk, sydneyluv

        post treatment and staying in contact with the program so they know. Many programs have graduations, a year or more after the end.  Programs offer aftercare, and some have SLE's available.  The programs reach out, but if they can't find the previous client, it counts as failure.

        But when you work in addiction, there are always some who went through a previous program and learned a lot, but not quite enough, or didn't follow the program, or really didn't believe they had a disease and only had to break a habit.  But they learned enough to bring them back after a relapse.

        But there is no industry standard to measure success.

        I once interviewed a guy who'd been sober 7 years and relapsed after a head cold, when he took Nyquil.  he was no longer attending meetings, and he got the craving for alcohol that is common after exposure, but didn't speak about it so no one could ask him if he'd been exposed, and he wasn't then able to relate it to the Nyquil, so he got the idea that it was curiosity, and he'd have to 'satisfy' his curiosity to get the idea out of his mind. Within two months his use was higher than it had ever been, and he went back into a program.

        Success?  Measured by one year, yes, but a relapse can happen after exposure 50 years later, 75.  But he returned to treatment, so success?  

    •  That isn't true . . . (6+ / 0-)

      There is no evidence that AA works, because people aren't selected to do it randomly and there aren't any trials. But there is tons of evidence that other modalities work, and work well. This include Motivational Interviewing and other forms of counseling; and opioid replacement therapy (methadone and suboxone). This diary is quite misleading because it conflates 12 step with substance abuse treatment, which is not the same thing at all.

      I think this diary does a disservice, really.

      •  However, there are folks for whom it works. (3+ / 0-)
        Recommended by:
        wasatch, jan4insight, OIL GUY

        And every day, week, month, year that someone doesn't drink is a day they don't drink.

        If you think you're too small to be effective, you've never been in the dark with a mosquito.

        by marykk on Wed Mar 26, 2014 at 05:07:27 PM PDT

        [ Parent ]

        •  what I heard years ago (5+ / 0-)

          was that maybe 1 in10 stay sober, but that 10% is still more successful than anything else that's been tried. I have no citations to back that up. Since AA/NA/etc. are anonymous programs that don't keep records, the best one can do is speculate. Have seen a lot of turnover, have attended a lot of funerals.

          That's the thing. This is a very difficult disease to treat, relapse is high, and most people won't get better. There isn't some better idea out there  being ignored that will have a significantly higher success rate. Most addicts stay addicted, no matter what they try.

          It's worked for me for about 23 years. I didn't see how it could, but I was desperate, so I had to make it work. (and I'm still agnostic, simply didn't allow that to be a barrier, and it wasn't).

          Anecdotally, it seems like there are quite a few dual diagnosis people who need additional help from professionals. I needed a LOT of help. AA, counseling, medication, I needed it all.

          People in recovery are not doctors, and some are ignorant about categories of drugs (I knew one idiot who talked a guy into stopping his lithium, what a disaster that was). But many are in the same boat I am, and others are supportive of our getting the help we need.

           I just didn't let the people who didn't know what they were talking about stop me from doing what I needed to do for myself, and I don't feel a need to tell everyone in the room about it.

          Also, not everyone in AA is trustworthy. People walk in pretty sick, after all, and like everywhere else in the world, there's a mix of people, some helpful and wonderful, and some... kinda toxic.

          A couple of my long-time friends from recovery, even thought they are slightly phobic about any kind of pill or at least skeptical, can tell when I go off meds, they can see the difference, and they tell me to get back on. Those are people I can trust, but not everyone is, again, as is the case in any group of people.

          I landed in treatment first, and it was 12-step based, but they also got me to set up counseling with a professional and appointments with a psychiatrist. So perhaps the problem is lack of an industry standard for treatment centers making sure that this happens for those who need it?

          •  Keep in mind (2+ / 0-)
            Recommended by:
            ladybug53, marykk

            that there are people who go to AA without going to a treatment center (thus not a question of insurance at all), and some of them stay sober. It's not clear to me that they have more or less success than those who enter AA via an inpatient program, no idea. Again, success rate for the whole group of people trying to get clean is low, but success rate for an addict getting clean is low not going to AA is well. That's the sad fact. Research continues.....

      •  and they don't allow (1+ / 0-)
        Recommended by:

        data collection.

      •  AA isn't a treatment program (2+ / 0-)
        Recommended by:
        OIL GUY, anna shane

        it's a support group.  No different than any other support group.  A support group is only for the people who want to attend and who benefit from talking to others who have been through the same experience.  Not everybody does.  

        Ask the people who attend the meetings if they think it works.

    •  Ibogaine works? (2+ / 0-)
      Recommended by:
      Gottlieb, jan4insight

      It's a powerful hallucinogen, OK, and...

      One of the first noticeable effects of large-dose ibogaine ingestion is ataxia, a difficulty in coordinating muscle motion which makes standing and walking difficult without assistance. Xerostomia (dry mouth), nausea, and vomiting may follow. These symptoms may be long in duration, ranging from 4 to 24 hours in some cases. Ibogaine is sometimes administered by enema to help the subject avoid vomiting up the dose. Psychiatric medications are strongly contraindicated in ibogaine therapy due to adverse interactions. Some studies also suggest the possibility of adverse interaction with heart conditions.
      Sounds lovely!

      There are some animal-model studies that look interesting on rats physically addicted to opiates, cocaine and alcohol, but getting past physical addiction is just the bare beginning of recovery.

      I see claims on some pro-ibogaine sites that the drug permanently alters the brain's neural chemistry. Really? If true, worrysome.

    •  Ibogaine works (3+ / 0-)

      I actually know someone who did the Ibogaine therapy. It made a difference for this person. Of course other factors helped as well. A lot of the other treatments people are pushing didn't work either and I was astonished, and appalled, at how expensive and how much of an outright scam the other treatments were (there's a drug that is commonly used in treating addiction and is being pushed but my brain refuses to remember it's name right now).

      If actual research could be funded for Ibogaine, it could be combined with other therapies.

      There is a larger issue here though: while as some people note above, there are conventional medical treatments for diseases like cancer or high blood pressure that may not work for everyone. Of course, there are issues here as well about the priorities of funding for the drug companies and the pressure to market.

      On the other hand, I think that people severely underestimate how much outright quackery and abuse goes into conventional mental health treatment. It is a quandary: on the one hand, some people will really benefit from mental health treatment-if they are diagnosed correctly, treated correctly, etc.

      Yet the reality is that for the most part people are being treated in a field and with tools that are subjective and slippery in an authoritarian environment. But the psychological profession markets itself as an objective science with the same level of certainty and medical authority as a diagnosis of diabetes.

  •  I heard an interview with the author on NPR (5+ / 0-)

    just yesterday. Fascinating stuff.

    Pope Francis: the Thumb of Christ in the eyes of the Pharisees.

    by commonmass on Wed Mar 26, 2014 at 08:04:21 AM PDT

  •  Thanks for an important and personal diary. (5+ / 0-)

    The most important way to protect the environment is not to have more than one child.

    by nextstep on Wed Mar 26, 2014 at 08:15:54 AM PDT

  •  actually, you're wrong (6+ / 0-)

    some of the problem is the end point data, and some is not getting it.  Not all treatment facilities are the same, sadly some use 'the gut' to choose how to work with addicts.  

    but, some programs are evidence based.  That's now behavior mod, it's education about the disease and relapse prevention, and it's discovery, challenging all those 'good reasons,' and location - which one's are triggers and must be avoided in the earlier stages of recovery, and it accepts that relapse is part of recovery.


    Because addiction is a disease but most people, addicts included, think it has to do with psychological problems or with will power problems. Neither is true.  It's often only with a relapse that the individual sufferer gets off his or her own back and gets it, and then does a program and follows a relapse prevention program that includes life-long support groups, usually aa or na, but anything where there are others with the disease, to commiserate and share, and to remind yourself that it is life long, and to guard sobriety.

    It's the only disease that makes you healthier, if you learn how to stay sober. Red wine reduces heart attacks but increases cancer. Exercise is better at reducing heart attacks than red wine, and you're less likely to stumble if you're exercising sober.

    Individual counseling makes addictions worse.  Uncovering past trauma is useless in treating addiction, and thus contraindicated. There are no underlying psychological causes for acne, or height, or eyesight, and there are no underlying psychological  'causes' for addictions.  Screwed up people may be sober.  Non-screwed up people may be addicts.

    It's a progressive disease, as the body always (wrongly) demands more, slow or fast it happens, and over time it gets worse.  For some that takes a very long time, and for some it happens very fast.  It's genetic.  

    It's now very well studied, and there are evidence based programs, and the best ones are effective, but not necessarily the first time.  

    It's counter-intutitive, it seems like you should be in charge of what you put in your mouth and swallow.  That's why the first step in AA is admit powerlessness.  

    •  This book offers another view (6+ / 0-)
      Recommended by:
      mslat27, Piren, CS in AZ, MPociask, bsmechanic, hmi

      It is worth a read.  He offers evidence for many of his points.  The majority of treatment options are still 12-step based.

      I'm not the researcher, I just found the book quite informative.

      Manufacturing outrage; the only manufacturing jobs Republicans won't outsource.

      by get the red out on Wed Mar 26, 2014 at 09:46:06 AM PDT

      [ Parent ]

    •  Trauma (4+ / 0-)
      Recommended by:
      Kingsmeg, Piren, bsmechanic, Lonely Texan

      He didn't discuss "uncovering trauma" as a part of his psychological approach.  He discussed helplessness as a trigger.  I personally don't believe that would cover all cases of addiction, but that's just me.  I am sure it covers some.

      There is quite a lot of debate on whether addiction is a "disease" or a behavior problem.  This book presents a case for the assumption of it being a disease to be mistaken.

      Manufacturing outrage; the only manufacturing jobs Republicans won't outsource.

      by get the red out on Wed Mar 26, 2014 at 09:50:26 AM PDT

      [ Parent ]

      •  there is no more debate (8+ / 0-)

        and the idea that it is psychological has caused much harm and allowed blame and self-blame.  

        When the research was behavior driven, that idea was in vogue. Once the research was in biology and chemistry, it changed everything.  

        There are lots of ways to make it hard for people with addictions to seek treatment that works, and not get sidelined by some new theory.   There was once harm control, and if it were psychological you'd think that would have been a good treatment for some, but the woman who developed and sold that as treatment died in a one-car accident after 'controlled drinking' didn't stop her from a binge.  

        There is no psychological treatment that works.  That's all the research and it's also my experience, I've worked in this field 40 years. We are now only evidence based.  
        Now we really know what we're doing, and the success rates show it.  The idea of relapse is part of recovery is related to the sufferer finally 'recognizing' they have a disease and not a problem with self-control.  There isn't a special treatment for a special addict who want's to have the special variety and get that treatment.   The first impediment in seeking treatment is having to give up the idea that you're special and that your addiction is different, more poetic, or trauma based, or whatever, that's why individual treatment has never worked for establishing sobriety and why AA worked before we knew why.  

        •  Wonderful! NO MORE DEBATE (5+ / 1-)
          Recommended by:
          Piren, buddabelly, bsmechanic, Catesby, Lonely Texan
          Hidden by:

          Everyone who doesn't get 12 step can die and we can wash our hands of them because we know all that there is to know.

          So glad you cleared that up!

          Manufacturing outrage; the only manufacturing jobs Republicans won't outsource.

          by get the red out on Wed Mar 26, 2014 at 12:40:25 PM PDT

          [ Parent ]

        •  "Now we really know what we're doing" (6+ / 0-)

          "and the success rates show it"


          •  you can find your own (1+ / 0-)
            Recommended by:

            there are hundreds of links.  Want me to give a link for chemotherapy?  This is sooooo known. Medical schools now have addiction as a speciality, ten so far, more coming.  This isn't a debate.

            •  sorry, your job to substantiate such a comment (6+ / 0-)

              not ours...

              You claim a good success rate, link it because the biggest collection of quacks I've ever seen congregate in "Recovery"....and I've never seen even a 20% legit success rate let alone anything that could be called good, verified of course, not woo from the councilors pov...

              Vaya con Dios Don Alejo
              I want to die a slave to principles. Not to men.
              Emiliano Zapata

              by buddabelly on Wed Mar 26, 2014 at 01:37:38 PM PDT

              [ Parent ]

              •  no it isn't (0+ / 0-)

                get a textbook. Go on line and google.  

                •  you have been here as long as I and as that's (3+ / 0-)
                  Recommended by:
                  ebrann, Lonely Texan, get the red out

                  the case, you well know that any statement of fact is yours to verify, with links...

                  Thus it has always been, thus shall it always be.

                  Extraordinary claims require extraordinary evidence and you refuse to provide any.

                  One link to many studies by another commenter shows at the 12 step study, no benefit at all could be quantified...none...

                  So link it or it it doesn't exist....

                  Vaya con Dios Don Alejo
                  I want to die a slave to principles. Not to men.
                  Emiliano Zapata

                  by buddabelly on Wed Mar 26, 2014 at 06:00:25 PM PDT

                  [ Parent ]

                  •  how about climate change (0+ / 0-)

                    are we to give our evidence on climate change to deniers?

                    I am not making a controversial point.  It's that standard now, so standard I can say, any textbook?  

                    •  Big difference. (1+ / 0-)
                      Recommended by:
                      Lonely Texan

                      97% of all scientists believe in climate change.

                      But as far as addiction? You won't find a substantial link anywhere, that says anywhere near half of all doctors think that alcoholism is even a disease. Yet you claim that this knowledge is decisive on a level of... 97%. Hence... end of debate?

                      Were those doctors biased? It doesn't appear that way:

                      It is significant that a survey of doctors attending an annual conference of the International Doctors in Alcoholics Anonymous (IDAA) found that 80% of its members believed that alcoholism is simply bad behavior - - not a disease.

                      Gods can do anything. They fear nothing: they are gods. There is one rule, one Seal of Solomon that can confound a god, and to which all gods pay service, to the letter: when belief in a god dies, the god dies. -- Harlan Ellison

                      by bsmechanic on Thu Mar 27, 2014 at 06:53:16 PM PDT

                      [ Parent ]

                      •  only doctors who (0+ / 0-)

                        specialize in addiction?  That is very sad that doctors are so out of touch, once Charlie Rose had addiction scientists on his show, I presume to educate.  There were four or six of them, in a round table discussion.  That was about four years ago.

                        those ideas are not just wrong, they are harmful. That means that someone with a treatable disease might forgo treatment and instead think they're just behaving badly.  Or their family might disown them, and blame them.

                        This is very sad information, seems like any fool can weigh in on someone's else's problem.  Doctors aren't any smarter out of their specialty than anyone else, but you'd think they'd at least know enough to say they don't know enough.

            •  Chevalier Mal Fet asked you for a link (6+ / 0-)

              to back up your anecdotal statement:

              Now we really know what we're doing, and the success rates show it.
              To source such information with a link is common practice at Daily Kos, a reality-based community. You posted this statement as fact, without backing it up. It is not anybody else's job to "find the links themselves."

              Gods can do anything. They fear nothing: they are gods. There is one rule, one Seal of Solomon that can confound a god, and to which all gods pay service, to the letter: when belief in a god dies, the god dies. -- Harlan Ellison

              by bsmechanic on Wed Mar 26, 2014 at 01:41:25 PM PDT

              [ Parent ]

      •  I tend to think it has elements of both (0+ / 0-)

        which is another reason that it's a tough nut to crack. There are many facets to it.

        •  we used to think that (0+ / 0-)

          no more, medical researchers have proved otherwise. For every personality or history, there will be a counterpart who is a normal drinker.

          Twins reared apart have high correlations to addiction.  Addiction runs in families.  Sometimes it's grandparent to grandchild and neither parent has it.  There are now 1000's of studies. It's a big public health problem.

    •  Asdf (3+ / 0-)
      individual counseling makes addictions worse
      Strikes me as a highly irresponsible comment.

      There are many talk therapies, not all based in focus on the past. People with addictive behaviors should not be discouraged from having a one on one with a TRAINED professional. And many people have co-morbidities.

      •  Personally, individual counseling (2+ / 0-)
        Recommended by:
        ScienceMom, Lonely Texan

        May well have saved my life after many years SOBER, and without a relapse; since I was having thoughts of suicide almost daily some years ago.

        Manufacturing outrage; the only manufacturing jobs Republicans won't outsource.

        by get the red out on Thu Mar 27, 2014 at 05:44:41 AM PDT

        [ Parent ]

        •  psychotherapy is fine for psychological problems (0+ / 0-)

          and just because someone no longer drinks doesn't means they might not benefit from therapy for life's problems, or for diagnoses that do improve with therapy. Sadly, even in this area cognitive behavioral is showing superior results over insight oriented therapy.  Some studies have shown that insight oriented therapy can worsen depression, for example.

          But if you go into individual counseling to 'cure' an addiction, studies show the addictions usually worsen.  Alcoholics don't need more help finding fake underlying reasons for drinking, they need to stop drinking.

  •  You touch on the role of the state (7+ / 0-)

    but should also consider it's perverse incentives.  Rehab is an industry, that lobbies to receive favorable treatment from the government.  On the local level, this means contracts to participate in mandatory treatment programs, which incentive-ize filling the chairs in these programs to maximize grant funding.  This set-up, unsurprisingly, leads to what I suspect to be deep corruption throughout this industry, exemplified by my experience.

    I pled out to a first offense DUI for the minimum sentence in NJ two years ago.  I was literally pulled over for driving too slowly on a five minute ride from the bar to my house, hours after my last drink, but early in the morning.  It was a mistake in judgement in my part, but the Court recognized the circumstances and gave me the lowest possible sentence.

    However, the Intoxicated Driving Program and it's rehab vendors and the state decided I was an alcohol abuser.  No matter what the facts said and that I had to attend the extended 16 week program (and pay them for the privilege).

    In order to do so, they lied to the Court/DMV about multiple failures in role obligations, multiple hazardous uses of alcohol, multiple legal problems due to alcohol in a one year period (the DSM criteria), despite having zero evidence of the same.  They stated on one page of an evaluation that I was willing to cooperate with level 1 treatment (and thus qualified for the program) and on the next page that I was refusing to comply (and thus subject to license re-suspension indefinitely, more fines and possible jail time).

    I reported these clear and present facts to first the County Intoxicated Driving Resource Center then to the statewide Intoxicated Driving Program.  The response was to bring the force of the state attorney general's office to compel me through coercion into treatment they knew I did not need for a condition they knew I did not suffer from.  I reported the behavior of the fraudulent counselor to both her superiors at Jersey City Medical Center (where the fraud occurred) and to the state board for Addictions Counselors.  Neither have taken action to date.

    My license was re-suspended indefinitely, and they kept pushing the original sentencing Judge to throw me in jail, fine me further, etc....   This harassment - which included the OAG denying me due process through NJ's administrative courts, included me having to fend off 2 driving while suspended tickets to support myself, numerous letter writing and court appearances  - lasted all in all 12 months, before the Judge finally challenged the Parties harassing me to show cause at which point they folded like a cheap suitcase and retroactively rescinded the punishment.

    To date, no action has been taken against any of these people because, duh, the Christie Administration (which receives lots of support from this industry) and because attorneys (neither personal injury or civil rights or the NJCLU) will not take on cases against the state/counties for this offense.

    I got through this because I have a lot of self-respect, and experience in legal matters and was able and willing to fight.  I can't imagine what percentage of individuals are railroaded into fraudulent therapy on the taxpayer's dime in NJ and elsewhere given my experience.  I can't help but to wonder how this may skew statistics on the numbers of drug and alcohol addicts by state or nationwide and how people with real problems are crowded out so that these scam artists can meet their grant quotas.

    Unlike the OP I now begin from the place of assuming that addictions therapy and it's programs and counselors are total frauds unless proven otherwise.  For these reasons I would never suggest such treatment for my friends who do have problems, rather referring them to traditional therapy.  For these reasons I can not support any "mental health" response to mass shooting tragedies due to my knowledge that such programs will likely become as counterproductive and abusive as the current programs I have experience with.

    Thank you for this diary and sorry for my rant.  It's in my mind a significant public health/criminal justice and corruption issue that does not get addressed nearly enough.

    •  You were charged without a Breathalyzer? (1+ / 0-)
      Recommended by:
      I was literally pulled over for driving too slowly on a five minute ride from the bar to my house, hours after my last drink, but early in the morning.
      Or you tested over legal limit, but you're of the opinion you were OK?

      Somehow I don't think you were as innocent as you make it sound.

      •  Did not say I was innocent (3+ / 0-)
        Recommended by:
        get the red out, Kingsmeg, CS in AZ

        I made a mistake in judgment and my BAC was over the legal limit.  I took responsibility for my crime and pled guilty.  That said, the police report cited that the "pc" for pulling me over was driving too slowly, and the arresting officers stated I did not appear intoxicated.  The arresting officer did follow me out of the bar essentially which is why I got pulled over and the breathalyzer.

        Being intoxicated in one instance is not evidence of alcohol abuse (as defined by DSM or NJ statute 10:162).  With respect to the IDP/IDRC referral to treatment as such, both their assessment and referral were completely fraudulent.

        •  the only thing that shows addiction (1+ / 0-)
          Recommended by:

          is not learning from mistakes. If you drink and drive again, then drinking is a little too important to you. Normal drinkers learn after one consequence.  

          •  That's actually incorrect to the point of asinine. (5+ / 0-)

            From both the statutory and clinical point of view.  Making the same mistake twice is not very smart, but does not prove that one is an addicted to a substance.

            If I was arrested for DUI once in 1985 and once in 2005 and have never been witnessed consuming alcohol on any other occasion, that would make me an addict in your book under that criteria.

            Think before you type.  

            Also, please stop derailing the actual subject of this thread by playing the morality police on me.  

            •  if you are facing a prison sentence (0+ / 0-)

              for a third, or just ten grand and no driver's license for two years, what is the rational choice? Is having a drink worth that risk?  You can kid yourself if you like, but if the answer is yes?????

              Now there are alcoholics who keep drinking and avoid driving, but that one doesn't always work.  Once you're drunk you may find many reasons to drive.

              Want a number?  

              •  LOL whut? (1+ / 0-)
                Recommended by:

                If I have two drinks in my lifetime, 20 years apart and on both those occasions get a DUI, and otherwise do not drink at any other point in my life, I am an addict according to your definition based on your rehab industry experience.

                Is this assertion, which you made above, true or false?

                •  is that what happened? (0+ / 0-)

                  I did not diagnose you but I have to say that would be quite an amazing coincidence, like getting pregnant twice? It isn't that easy to get a DUI, drunk drivers usually don't get more than one every few years.  Often it's only when they hit something, or pulled over to take a nap, or a cop watched them leaving the bar and followed.

                  •  Tons of women (0+ / 0-)

                    get pregnant twice.

                    •  after sex only twice? (0+ / 0-)

                      two lifetime drinks = two DUI's is farfetched.

                      •  I repeat myself, again (0+ / 0-)

                        This is a hypothetical to YOUR POINT.

                        You said

                        the only thing that shows addiction is not learning from mistakes. If you drink and drive again, then drinking is a little too important to you. Normal drinkers learn after one consequence.
                        I provided an example of a person who may make the mistake of drinking and driving twice on the only two far separated occasions that hypothetical person imbibed alcohol and asked you to confirm that was enough information to diagnose that hypothetical person as an addict.

                        Please proceed.

                        •  it's not diagnosed as a dependence (0+ / 0-)

                          unless you've tried to stop and could not, or if you've gotten into problems from drinking and didn't stop.  You could be a huge lush but if it hasn't caused any life problems or health problems or legal problems and you haven't ever tried to stop, who knows, you only find out when you try and can't.

                          Normal drinkers aren't attracted to drinking, so they would never choose the 'pleasure' of drinks over the peace of mind of not DUI, never.  If they are aware of the likelihood that there will be another DUI if they keep drinking, and they still elect to drink, then alcohol is too important.  Would you give up soda crackers if you got a soda cracker ticket and didn't want the next one?

                          It is possible to have a judgement problem that isn't necessarily dependence, especially with younger people, to think it's a one off and won't happen again, but then they'd never drink enough again to be over the limit, because normal drinkers rarely do drink enough for that, maybe at a celebration, and then they'd feel drunk, it would be so unusual, and so would know they were impaired. So the second DUI is diagnostic, ten grand and suspended license. And the third is jail.

                          People who know they like drinking, it's great for them so they think, may chose to not drive after drinking to avoid a second DUI, but drinking takes a standard deviation off the old IQ, so it impairs judgement and gets in the way of not driving after drinking. Show up in some drunk driver's ed program and hear the stories.  

                          And some people can and do stop without help, they just fight it and they don't go to meetings and they never learn the biology or the sobriety skills, or they didn't have the disease and it was just time to stop.  Many people drink too much in college, or after high school and before responsibilities, and stop when they get married, or get a job, or slow down so much that it's as good as stopping (but if so by definition they don't have the disease. And if they have it and stopped and they'll never drink again, great, but if they go back, some will end up in a rehab, or in jail. It's a progressive disease.)  

                          One example is always BS and you know that, maybe that is true for her, or maybe she'll end up drinking more one of these days, one hopes not, but that does not refute the science, any more than a cold day refutes global warming.  You can always find individuals who don't fit the expected outcomes, but it's  a dangerous test, and destructive and if you're trying to defend your own repeated DUI's by calling into question the sobriety of others, that isn't nice.

                          This isn't a game for people with the disease, it's life or death.

                          •  Thank you for admitting your initial comment (0+ / 0-)

                            was incorrect.  In fact logically it would follow that someone who drinks rarely and isn't even near an addict is more likely to not know their limits and get a DUI than an alcoholic.

                            That is why addictions counselors in Intoxicated Driving Program participate in this scam I believe.  You have a population of say 40-60 people in the first offender "class" post conviction.  Likely, at most, 1 or 2, 5 on the outside of these people actually have issues with alcohol as opposed to having made isolated judgement mistakes like I did.  

                            Of course the ineffective programs you champion can't survive on grant funding for only 1 or 2 people, so they set an artificial quota - say at 45-60% of the class to refer as alcohol abusers regardless of any clinical support for that.

                            I will also dispute this idea:

                            It is possible to have a judgement problem that isn't necessarily dependence, especially with younger people, to think it's a one off and won't happen again, but then they'd never drink enough again to be over the limit, because normal drinkers rarely do drink enough for that
                            This might have been true when BAC for DUI was .1, but since it's been lowered to .08 basically anyone who goes to the bar and does anything more than sniff a thimble of an alcoholic beverage is leaving that bar over the limit.  Almost anyone who leaves their house the next day after drinking is also over the limit.

                            The police knowing this, set up shop outside bars to simply "trap" anyone leaving to fill their quotas, the mandatory minimum delivers them to the intoxicated driving program, the IDP counselors simply pick a requisite number of alcohol abusers to invent to satisfy their quotas.

                            FYI, I am all for both taking a strong and rational legal stand against drunk driving, getting people effective help if they need it, and the use of BAC as an evidential factor (but not a sentencing factor).

                            Having gone through the system myself, having been abused and harassed unrelentingly by it's participants and observed it keenly it is clear that currently these intervention programs (in NJ at least) are broken, corrupt and can in no way guarantee the public that the purpose of the laws they supported are being fulfilled.

                    •  Obviously, according to Anna (2+ / 0-)
                      Recommended by:
                      Lonely Texan, bsmechanic

                      This woman is a nymphomaniac.

    •  Definitely a greed element (9+ / 0-)

      There is a huge money grubbing element to addiction treatment.  That is a part of why even the richest of treatment centers employee unqualified people as counselors.

      This industry, I believe, also thrives on "repeat business".

      Manufacturing outrage; the only manufacturing jobs Republicans won't outsource.

      by get the red out on Wed Mar 26, 2014 at 09:53:46 AM PDT

      [ Parent ]

      •  excuse me? (2+ / 0-)
        Recommended by:
        sydneyluv, ruellia

        There is no shortage of addicts, and sadly there never will be, that's like saying that surgeons leave in a little cancer so they'll get repeat business.  Addiction counselors aren't raking in the bucks, and programs struggle to stay afloat with the changes in  law that are frequent. Private insurance tries to get away with the least treatment.  Counties and cites cut addiction treatment money first, when there budget shortfall. The sequester took a bite out of it. Well run rehabs with good success rates go under.  

        This is not a cash cow.

        •  based on your definition of "addict" (5+ / 0-)

          in your prior response to me, it seems there is no shortage of frauds in the counseling business inventing addicts.

          individual counselors may not rake in the bucks, but both private corporate rehabs and not-for-profits are perversely incented to fill seats and bill hours to get that grant money, and their employees follow that line, like the two corrupt counselors I encountered during my experience.

          Counselor 1:  "Your urine test is negative, no positive, no negative, no positive.  A single positive test is the criteria for counseling (no it isn't), the law requires a urine test (no it doesn't).

          Counselor 2:  "You are an alcohol abuser because you drank one kind of alcohol on one occasion and another kind of alcohol on another occasion"

          "You have multiple legal problems with alcohol in a single 12 month period"  (NOPE, contradicts the public record and reality.

          Me to various bodies of counselors who are supposed to hold other counselors accountable:  "Look at this clear documented evidence of fraud"

          Counselor Committee who enforces standards in the industry "Whatever".

          Scam artists all.

          •  oh right (0+ / 0-)

            keep on drinking, we're all frauds anyway. I can't tell you how many times I've heard that one.

            •  Every addictions counselor I have encountered (4+ / 0-)

              so far is a fraud.  I like the implication that I am an alcoholic from you as well.  I am not, never was, and when challenged to stand behind that assertion with a factual basis for their diagnoses, 3 licensed counselors,  2 social workers supervising the program and a deputy attorney general backed down and reversed themselves.

              I called them liars in open court and they had no response.  I proved everything they said wrong with documented facts and they had no response.  Why, because they were frauds.

              And you have made several comments now implying I am an alcoholic.  Based on what evidence?  That the facts prove that those counselors were scam artists, and presumably, based on your behavior in this thread, you're one too.

              There's a reason you hear that a lot.  Grass is green.  The sky is blue.

              •  hey, I admitted I like Turkey 101 here and I was (2+ / 0-)
                Recommended by:
                spacecadet1, MKinTN

                labeled an alcoholic....I guess cause only alcoholics like their Bourbon strong and neat.......

                Of course, the fact that I go through about 2 bottles a year if that much....well that has nothing to do with it...I must be an alcoholic.....

                Vaya con Dios Don Alejo
                I want to die a slave to principles. Not to men.
                Emiliano Zapata

                by buddabelly on Wed Mar 26, 2014 at 02:27:39 PM PDT

                [ Parent ]

                •  Not like it's a pleasant experience (3+ / 0-)
                  Recommended by:
                  buddabelly, spacecadet1, MKinTN

                  But if anyone wants to test my propositions, it's easy.  Go into any addictions counseling center (for or non profit), and say you need to be evaluated.

                  Pretty much anything you say after that will make you an addict.

                  I smoked pot once in high school - ADDICT.
                  I had too many drinks at my sister's wedding and barfed, but otherwise drink one glass of wine a month - ADDICT.
                  I watched New Jack City - ADDICT.
                  I have a package for you to sign for - ADDICT.

                  •  BS (1+ / 0-)
                    Recommended by:

                    there are actual standards.  No one is diagnosed addicted until they've tried to stop and could not, or if they have to stop, for their marriage or their legal case or their child custody case, or their liver, and could not.  It's always voluntary from the program's point of view. If  someone has never tired to stop and has had no problems from drinking, then we don't care, we don't treat anyone who thinks they're fine.

                    You seem quite adamant for someone who's only had two drinks in your life?

                    •  I did not say I had two drinks in my life (1+ / 0-)
                      Recommended by:
                      Lonely Texan

                      But I am 100% living proof that you are wrong.  I was diagnosed as an alcoholic despite not meeting any one of the DSM criteria, all of which were falsely cited, and all of which were objectively provable (Role Obligations, Hazardous Use, especially Legal Problems).  To reach this diagnosis the counselor in question made intentional misrepresentations.  

                      Despite documented factual citations (only one legal problem in my life, was getting a professional designation, a promotion and a raise while supposedly failing my role obligations) I made to support my position, despite soliciting letters from family, friends and co-workers counteracting the diagnoses.  2 counselors, and 2 social workers, an entire committee of Addictions Counselors, etc... would not give me the time of day, decided to continue persecuting me instead maliciously and at the end of the day could not cobble together any evidence that I was an alcohol abuser, factual, circumstantial or otherwise and at the end of day folded when the Judge challenged all of them to defend the diagnoses.

                      So you are wrong.  It happened in my case, another IDP counselor who I met on a social level advised me that such treatment was SOP in this industry, I trust his word since he also believes in the treatments you do.

                      Your own, completely empty defense of your field and attempt to impugn me rather than address the issues I raised is all the more ammunition for me to paint your whole industry as a bunch of pseudo-scientific scam artists.

                      You have no evidence based treatment and to the extent anyone leaves your programs better than they came in, it is pure coincidence and not the result of anything an addictions counselor does.

                      •  name the program (0+ / 0-)

                        was it evidence based?  Not all programs are the same. Some programs use 'the gut' rather than the evidence.  

                        •  The Intoxicated Driving program of NJ (1+ / 0-)
                          Recommended by:

                          First in the County of my arrest - Sussex, run by a licensed social worker - Cindy Armstrong and addictions counselor (not identified), both of who willingly participated in this fraud.

                          Two licensed counselors (Pascale Augustin for Jersey City Medical Center and Christina Sgaramella for Capital Care center) for private contracted affiliates, both of who willingly participated in this fraud.

                          The director of the state program (Andrea Connor), I believe a licensed addictions counselor herself, who willingly participated in this fraud.

                          Each of these individuals and organizations fraudulently fabricated, perpetuated and defended assessments made based on factual misrepresentations that I was an alcohol abuser.  All basically violated "evidence based" standards to do so.

                          All when challenged, could not defend their finding in Court while their attorneys (Michael Garofalo and DAG John Regina) executed a legal strategy of denying me due process through the Office of Administrative Law and attempting to coerce the Court through their knowingly false statements to punish me further for blowing the whistle.

                          A committee of addictions counselors tasked with enforcing the law and licensing standards in NJ has been presented with clear factual evidence from the public record itself that this fraud has occurred and has done nothing.

                          I was never in a treatment program, I was referred to Level One Outpatient Treatment which I refused to participate in.

                          Again, you don't have "evidence based treatment" in your field, because you can not provide statistical support to back up an assertion that these programs on any consistent level help all, most, or even many of the participants.  The most you can say is that an anecdotal number of people do improve their behavior with alcohol, but I don't really see evidence that even those results are compared to a "placebo" or "control" group.

                          "evidence based" is a weasel word in this regard to imply "scientific", what evidence addictions counselors base their methods on is extremely weak to the point of insubstantial.

                          This failure to support the effectiveness of treatment, plus the fact that in my experience I encountered at least 8-10 addictions professionals, all of whom either lied on the public record, committed fraud, helped cover up the fraud or ignored the fraud despite their responsibility to address it - tells me all I need to know about your industry.

                          Your own obfuscations, attacks on me and empty rhetoric with little or no solid support is just more icing on the cake for me.

    •  Sorry that happened to you... (0+ / 0-)

      You needed a much better lawyer. I know a couple (Oregon, not NJ), both recovering alcoholics and active AAers with 10+ years sober. :-)

  •  I understand that higher paid and better (3+ / 0-)
    Recommended by:
    sneakers563, sydneyluv, ruellia

    trained professionals are what are needed at many organizations that purport to help addicts which would probably yield in a higher success rate. However, I find it ironic that AA which doesn't pay anyone works and can have a 31% success rate of folks attending for at least a year. I'd like to see the success rate of a 12-step program alongside the success rate of a formal medical organization that treats addiction, and if you cited it, I couldn't find it. I also feel that 30% after a year is a LOT of lives that are saved. Now I realize that the participation goes down from there, but I still can't help but believe that the FREE 12-step program is there for those who need it in their darkest hour. How many clinics will be there for these people who need to talk to someone at any hour of the night, or just hear other people talk and be with other supporters who understand your problem. A sponsor is there 24/7 365 days a year and no money can buy that kind of support.

    •  AA does not have (4+ / 0-)

      a 31% success rate.  Not even close.  And 'attending aa' does not equal 'sober'.

      190 milliseconds....

      by Kingsmeg on Wed Mar 26, 2014 at 12:08:17 PM PDT

      [ Parent ]

      •  AA does not collect data (3+ / 0-)
        Recommended by:
        annecros, chrisa1, jan4insight

        But for those who stay sober and attend, it's 100 percent. In any group there will be some who relapsed and are lying to their peers, but they usually stop going. And their AA peers usually contact them and do interventions and help them find a rehab. Lots of people in rehab were referred by their AA peers.  It's a process.  The longer you stick, the greater your chance.  

        •  Your killing me Anna (4+ / 0-)
          Recommended by:
          atana, Catesby, get the red out, MKinTN

          For those alcoholics who stop drinking the success rate is 100%.


          •  yeah (0+ / 0-)

            AA doesn't keep data?  What else are you struggling with?

            •  Let me go slow for you (2+ / 0-)
              Recommended by:
              ebrann, get the red out

              I understand you are in Addictions Counseling and this may be difficult to comprehend.  (Anyone better at math then me - please feel free to fix this)

              There are 140 people in AA or any other 12 step faith based program today

              40 of them are there not because they are alcoholics but because they had a dui, or some other infraction and a fraudulent counselor sent them there.  Let's not count them.

              That leaves 100 people who are actually alcoholics, and for the sake of argument lets say these 100 are there voluntarily and want to stop being alcoholics.

              Of those 100 people, lets say 25 get sober and stay sober forever, never touching a drink again.

              That could be construed as a 25% success rate (to be nice, or a 75% failure rate).

              Except, to actually be scientifically rigorous (I know this concept is alien in the addiction counseling sca...industry), you need a control group.

              So, lets take another 100 people who are actually alcoholics, and for the sake of argument lets say these 100 all want to stop being alcoholics, but rather than go to AA or a 12 step program, they all decide to shrug their shoulders and decide not to drink no more.

              Let's say this has a lesser success rate than AA/12 Step.  Let's say that only 10% of this second group of 100 get sober and stay sober forever.

              Finally let's take a third group of 100 alcoholics who don't have any opinion on whether they want to or no longer want to be alcoholics and do jack shit to affect it either way.  Of this group 3% somehow randomly manage to stop being alcoholics.  They pour their passions into magic the gathering, or illicit sex or something weird like family or civic participation and stop drinking.

              The actual success rate of AA/12 Step is not 25% it's 25% less the 3% who would just stop being alcoholics naturally, or 22%.

              Of any method of treating alcoholism it's 25% less 10% who could basically use their willpower to affect change in their lives, or 15%.

              Science makes accurate predictions about the future.  AA/12 Step would have to demonstrate at minimum in my hypothetical above a 70% success rate among it's own members to make the point that by attending AA/12 step there is more than a 50-50 probability the program might help you more than staring at the wall and humming, unrelenting masturbation, or doing jack-shit.

              Until then, the addictions counseling communities very citation of science or studies is about as fraudulent as Ken Ham and his Creation Museum.

              •  AA is not a first line treatment (0+ / 0-)

                there are people who get sober in AA but those who go through a rehab may be referred to and generally are referred to  AA or some other weekly support group that goes on forever, with fellow addicts, as part of a relapse prevention program.  Among other parts. They're individual in that not everyone has the same support from home. And some are in more risk of dying and may need more protection.  It's the same disease but not everyone comes at the same stage and it isn't manifested exactly the same for each person.  

                Some treatments were found to be harmful.  One of them won. Hands down. Not all programs use the evidence based treatments, but in time insurance will only pay for those treatments.

                •  Your proposition is that treatment programs work (1+ / 0-)
                  Recommended by:
                  Lonely Texan

                  in that they have a high success rate, even 100%!

                  Prove it.

                  Show me a study which defines a pool of alcohol abusers, even by secondary characteristics such as you lay out above (home support, etc...) which proves any one program has a success rate over 60%

                  Hell prove it works sometimes, 30%

                  Prove it works as well as doing nothing, 5%

                  Until then stop using the words "evidence based", those words don't mean what you think they mean.

                  •  no it isn't (0+ / 0-)

                    I said that the evidence based rehabs are defined as having highest rates of success, as measured by independent researchers, like universities, or by insurance companies, I didn't say the rate of success, they vary from program to program, and the measurements aren't standard.  

                    When they do a study it's between this type and that type, but they don't always measure the same thing.  it's always stated like, 'as measured by six months of sobriety post treatment,' or by 'improvement in liver functioning,' or whatever they may chose as a desirable outcome.  

                    Evidence meaning they did better than the other ones they were compared with. I said individual psychotherapy is now contra-indicated based on those studies.  Actually, all of them. That's what's wild, whatever the measure, cognitive behavioral works best and insight oriented is worst.  

                    I said all evidence based rehabs recommend life-long support groups, and as AA is free and everywhere and is great, AA is never ruled out.

                    •  This is an asinine definition of success (0+ / 0-)

                      that is customized to make your field feel justified in sucking down the money of taxpayers and suckers.

                      Again, are these programs provably better than doing nothing?  

                      - "Statistically, "evidence based" rehabs are one way to help" - Can this statement be supported?

                      Are these programs provably better than other kinds of programs - individual therapy, joining Scientology whatever?

                      -  "- "Statistically, "evidence based" rehabs are the best choice among all other options to get help" - Can this statement be supported? (you seem to be saying this but not backing it up)

                      Finally, what actual success rate do these programs have that justify public/taxpayer support as opposed to seeking/designing alternatives.

                      -  "- "Statistically, "evidence based" rehabs help at least _% of people beat addiction - Can this statement be completed and supported?

                      Your above comment is more obfuscation - there is no evidence behind your evidence based programs that you have been able to produce anywhere in this thread that these programs satisfy any of the above criteria from low to high.

                      The Intoxicated Driving Resource Centers of NJ which feed into the IDP issue annual reports per county:

                      IDP Reports

                      You can review by state or county  You will see a lot of "activity" based reporting none of which to my mind is credible given my experience.  However you'll note a paltry amount of actual "results" or "evidence" based reporting.

                      The IDP exists to address alcohol and drug abusers, to prevent DUI recidivism - the program's actual purpose as designed by lawmakers and supported by taxpayers.  You can't even find the word recidivism in any of these reports.  There is no indication how many people referred or not referred to treatment based on evaluation committed second DUIs.  I.e. one of the most critical facts to support this program.

                      It's not there because I bet it's not favorable given how this program is run and the general lack of ethics of the addictions counseling community in NJ (and I suspect elsewhere).  I bet they miss alcoholics all the time who go on to cause bodily injury, death or property damage to themselves or others.  I bet they have little to no evidence that those who went through the program have any better or worse results in terms of recidivism than those who haven't.  I remember in my own class a girl who blew a BAC (.39) that could kill an elephant did not get referred to the program though I with a .095 did

                      All they can tell you is how many people went through the program, which indicates that beyond all reason 45-60% of DUI's are clinical substance abusers.  That figure is absolutely absurd.  At most I'd say 25% would seem to be a legit number and even that's a stretch.

                      •  here's one for you (0+ / 0-)


                        It's part of Charlie Rose's brain series, but there are others, those that compare identical twins reared separately, and those that showed only biological family history but nothing from the effect of parenting.  

                        the outcome studies don't always use the same outcome measures, they compare one treatment with another treatment or treatments to see which works best.

                        There are addiction journals, it's a real field of study. Right now ten medical schools offer addiction as a speciality.  Most of the research now is biological, there have been many studies over many years that contribute to the 'best practices' that you seem not to have encountered and sincerely believe don't exist.  

                        In many states it's possible to earn an AA degree in addiction studies, which should tell you there must be some, or what would be studied?  The textbooks are updated, but they all lead to the same place, which is clearly amazing, that one treatment would be so much more effective than any other, whatever the chosen outcome, and however much individual junkies might want to know better.  

                        It is very common for junkies to 'defend' their 'lover,' heroin, cocaine, opiates, designer crap, whatever.  And how special these junkies are, so special as to take them into the grave.  But, even in hard-nut cases, programs refer to those defensive know-it-alls as the dinosaurs, with actual sobriety comes new experience and leads to new knowledge.  It can't be faked, the body heals, inflammation is reduced, memories improve, people feel less cranky when they're not regularly ingesting or injecting some poison, go figure.  

                        And it's sad so many just assume the field hasn't changed over the last ten years, with the hard data finally in and the programs adjusting if they want to be approved for insurance payments.   And on a place like this, to be making a case for death seems sad.  

                        I feel sorry for you, but you seem to have a mission, and if someone is stupid enough to believe you and avoid treatment and then happens to die or even take someone with them, can't be helped.

                        Good luck.  

                        •  You are the one arguing with me (1+ / 0-)
                          Recommended by:

                          Not Charlie Rose's panel.  I have laid out various scenarios of statistics that could demonstrate success and efficacy of the methods you defend.  You have not in many, many responses cited one statistic in support of your position.


                          the outcome studies don't always use the same outcome measures, they compare one treatment with another treatment or treatments to see which works best.
                          The outcome is presumably that one who suffers from addiction, no longer suffers from addiction or is at least able to manage/resist their addiction for some substantial period of time directly due to that treatment to such an extent it is superior to other treatments or placebo time and time again.  Outcome studies that don't use consistent measurements are not actually measuring outcomes.  They are anecdotal fairytales about giant legendary shifting goalposts.
                          There are addiction journals, it's a real field of study. Right now ten medical schools offer addiction as a speciality.  Most of the research now is biological, there have been many studies over many years that contribute to the 'best practices' that you seem not to have encountered and sincerely believe don't exist.  

                          In many states it's possible to earn an AA degree in addiction studies, which should tell you there must be some, or what would be studied?  The textbooks are updated, but they all lead to the same place, which is clearly amazing, that one treatment would be so much more effective than any other, whatever the chosen outcome, and

                          Ten medical schools out of slightly less than 200 nationwide is less than 6%.  Not a strong support for your point  Again you obfuscate the science behind the factors influencing addiction, with the efficacy of the programs you are defending.  There is some emerging hard science behind the former, but no credible science behind the latter.

                          Again, you make unsupported statements about treatment being effective.  I have asked you to provide direct statistical figures to that effect.  You have none to support that statement.

                          and however much individual junkies might want to know better.  

                          It is very common for junkies to 'defend' their 'lover,' heroin, cocaine, opiates, designer crap, whatever.  And how special these junkies are, so special as to take them into the grave.  But, even in hard-nut cases, programs refer to those defensive know-it-alls as the dinosaurs, with actual sobriety comes new experience and leads to new knowledge.  It can't be faked, the body heals, inflammation is reduced, memories improve, people feel less cranky when they're not regularly ingesting or injecting some poison, go figure.  

                          I wonder if in your mind this line of commentary is subtle.  It's not, you are again accusing anyone who questions the total lack of factual and evidential support you have brought to the table as junkies, myself obviously included.  You have made this implication over and over again.

                          You are representing this field on this forum.  You accuse anyone questioning it's validity of being a junkie or an alcoholic.  If that's not a statement on your quality as a professional and as a person and that of your industry, I don't know what else is.  One thing that always shines through with addictions counselors is their total resentment for the standards of science, their clients and the public understanding.  It's sad, pathetic and weak and nothing else in your rhetoric really shines a light on the state of your profession than these continued immature insinuations.

                          A junkie or an addict is a real person with a real problem.  The fact that you imply and outright accuse anyone who disagrees with your religion must be one is again, just really revealing about who you are as a person and a professional.  What evidence do you have right now, clinical addictions professional, that I am a junkie or an addict as you have repeatedly insinuated?

                          And it's sad so many just assume the field hasn't changed over the last ten years, with the hard data finally in and the programs adjusting if they want to be approved for insurance payments.   And on a place like this, to be making a case for death seems sad.  

                          I feel sorry for you, but you seem to have a mission, and if someone is stupid enough to believe you and avoid treatment and then happens to die or even take someone with them, can't be helped.

                          My mission here was to support the original poster and discuss the fraud of the addictions counseling industry.  I appreciate your help in this matter.

                          You have produced no evidence that seeking counseling through so called professionals such as yourself actually results in any tangible or demonstrable benefit to people who do suffer from addiction.  There is no hard data that you have pointed to given multiple opportunities and framings, even with my helping you to do so.  

                          Not only can you not prove with any rigorous scientific measurement that your profession has any actual demonstrated track record of helping people than the alternatives, you can't even prove it's better than doing nothing.

    •  there is little or no difference in (2+ / 0-)
      Recommended by:
      ruellia, Lying eyes

      outcome between addiction specialists who are often in recovery and PhD's and MD's.  The need for higher degrees is more for licensing and supervision, than for the treatments.

      They are pretty standard now, the trick is to believe in them and follow the book, not your 'gut,' and to be kind.  It's hard enough to get sober without crabby counselors.  Addicts themselves plenty, don't need extra judgement from their doctors.  

      The treatment is now well established, there are steps and there are milestones.  And they work.  That's what's really great, they work.

    •  I agree - there's really no way to judge the 31% (2+ / 0-)
      Recommended by:
      atana, wasatch

      number, or the 18% number without comparing it to a control group. 18% could be a wild success or a dismal failure - there's really no way to know unless you know what the alternatives are.

      To believe that markets determine value is to believe that milk comes from plastic bottles. Bromley (1985)

      by sneakers563 on Wed Mar 26, 2014 at 01:47:04 PM PDT

      [ Parent ]

  •  One of the facts AA emphasizes is that (11+ / 0-)

    success is dependent on the individual.  I'm a bi-polar alcoholic, my success chances are somewhere under nil, yet I've been continuously clean and sober for 38 years, in AA.  That bi-polar diagnosis, extant for 47 years, went bye-bye when I was finally effectively treated for PTSD.  If you want higher success rates, change the underlying assumptions about both mental illness and addiction.  98% of addicts have a history of sexual, physical and/or emotional abuse.  Most of us were tragically young when we were abused and our lives went off the rails as a result.  AA kept me alive until I found a healer.  I keep going to meetings because that's where the people are who need the help.

    I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

    by I love OCD on Wed Mar 26, 2014 at 10:14:27 AM PDT

    •  it's easier now (5+ / 0-)

      when you got sober it was very much up in the air. Now we know it's biological and inherited, and we can predict fairly accurately (some individual differences of course) how long the urges will last and how fast the brain heals, and what works for relapse prevention.  It's the same with bi-polar, addiction isn't connected to bi-polar, that's just a coincidence.  You treat one condition one way and the other another way.

      people at risk for relapse pretty much have home situations that aren't supportive of sobriety.  Like homelessness, or 'normal' drinkers who won't stop even though they claim it's not a big deal and think the addict is making excuses. It's hard to follow a relapse prevention program in such circumstances.

  •  I don't know if it's fair (7+ / 0-)

    I have not read the book, but not sure I agree with the the basic premise that AA is a fraud. Too many people I know who started their journeys through 12-step programs are living healthy happy lives, a far cry from where they started. Susan G Koman can be categorized as a big fat fraud - putting a dollar in a jar to cover coffee at a group support meeting that may or may not be the tool that saves your life doesn't even come close.
    My feeling is that nobody - be it an insurance provider or politician or physician or a man on the street - should be the judge of any path to sobriety, no matter how rocky or religious or spiritual or not spiritual or holistic or day counting...not for anyone else to decide.
    So, I agree that the ACA needs to cover a broad range of treatment, but not at the cost of dismissing 12-Steps, which may be a lifeline for just one person.

    •  that's a destructive idea (2+ / 0-)
      Recommended by:
      annecros, ruellia

      the fact is that addiction kills, and dismissing a treatment that is working isn't nice

      AA was the only treatment for many years, and it worked, because of the 12 steps. The first is to admit powerlessness, and that's just as good as what we know now, that it's a disease.  The longer you stay sober the easier it gets, over time, not each minute.  And when you've been sober long enough, no desires to use. And if you use just a little, it's back to square one.  

      Some people who don't want to get sober have a personal stake in claiming the treatments don't work, or that AA isn't a viable treatment.  I think it's very wrong.  Why not tell someone with cancer to avoid chemotherapy? But then I have known people who've relapsed and died.  

    •  but ACA (1+ / 0-)
      Recommended by:

      will only cover what works. They are following insurance companies who stopped paying for ineffective addiction treatment as soon as the outcomes studies showed the big disparity, maybe six or seven years ago.  The data is now in. ACA won't pay for 'curing the gay,' and they won't pay for special treatment for special addicts. If someone wants a new treatment to be covered, they'd best show that it works better than behavior mod and good luck with that.  It's not inside out anymore, it's outside in.

      In in psychotherapy, insurance companies may pay only for treatments that have been shown to work for a specific condition.  ACA isn't inventing standard of care, but standard of care is standard for a reason.  

      •  Right (4+ / 0-)
        Recommended by:
        annecros, anna shane, jan4insight, ruellia

        Have a close friend who failed 60 days in, but popped back into AA and has been sober for 10 he counted as a failure or a success? Because he's both.

        •  that's how it is (1+ / 0-)
          Recommended by:

          It's really not what anyone thinks at first. Everyone starts off thinking it's about self control or will power but after a relapse (or many, but for your friend it was only one) the suffer gets it, it's hard and awful but it gets better, and there are quick physical improvements, better sleep is one of the first ones, and more energy, and clearer thinking, easier time with concentration, there are cool benefits,  and if you stay sober long enough, it's great, no urges, don't care, healthier, smarter.

          That's great, thank you, I love to hear those stories.

          The program would count it as a failure unless the patient kept in touch and told his story.  But it's obviously a great success.

          the trick is to never get exposed again. No sips of champagne at some daughter's wedding, or the urges come right back.

  •  Religion is at the core of American thinking about (5+ / 0-)

    alcohol and drugs -- specifically, Protestant and especially Calvinist thinking. That is why the area is not evidence-based.

    American Presidents: 43 men, 0 women. Ready for Hillary

    by atana on Wed Mar 26, 2014 at 12:40:36 PM PDT

    •  yeah it's moral (1+ / 0-)
      Recommended by:

      people want to judge illness as moral failure.  That's why AA was a life-line back in the day, and that's why these ideas that equate addiction with mental disorders, which are coincidental, or personalty disorders, harm people who want help.  

      And why we owe a debt to the biological researchers, even if they were looking for a profit.  Were it not for that research, those ideas would be hard to dispute, it seems so rational. It's counter-intutitive to view it as outside anyone's control.  

      It is now evidence based, totally, those bad days are over, thankfully.  


  •  I thought the disease vs.behavior stuff was (5+ / 0-)

    settled a long time ago. There was substantial evidence of genetic association 23 years ago when I got sober. Now they think they've located the gene, or one of them. Psychotherapy doesn't work in treating physical ills and these two authors can't come up with any hard numbers to bolster their anecdotal evidence. Lengthy inpatient treatment in combination withAA or cognitive behavioral therapy to learn coping skills is the most effective and the most expensive. Yes, most of AA is learning and sharing coping skills.  I agree that it's outdated and sometimes not appropriate for women--AA urges you to take responsibility and most women I know will willingly take responsibility for everything, including the weather. However, it still works and I think to a more significant degree than stats can show. I know a number of people with long term sobriety who no longer attend meetings regularly.

    "Is there any cause in nature that makes these hard hearts?" King Lear, Act III, Scene 6.

    by kkkkate on Wed Mar 26, 2014 at 12:56:27 PM PDT

    •  you'd think (3+ / 0-)
      Recommended by:
      chrisa1, ruellia, kkkkate

      but it wasn't totally settled until the biological researchers found drugs that block receptors and eliminate urges.  Even obesity is now (finally) in the disease category.  Probably won't stop people from judging fat people, any more than it has stopped them from judging addicts.

      Yep, it's cognitive behavioral (behavior mod on the old days) that won, and insight oriented treatments that lost, and lost big.  

      But it's not so expensive anymore.  There are short-term models, 28 days is often sufficient, and follow ups in aftercare and 12-step meetings, and there are more SLE's provided by the rehabs and they don't cost more than living on your own, probably less.

      What has changed the game is that we've gotten rid of all those old special people who had their reasons.  

      I do feel sad that the lady the writer mentions didn't find an AA where she felt comfortable, and couldn't regain her sobriety after relapse.   It's hard to start all over again.  But if she'd been in AA, she would have had a lot of support and people to laugh with and to talk to at 3:00 am.  Hardly any are totally religious, the higher power part isn't related to belief in god, and there are always non-belivers who attend meetings, and often the majority.

      •  all I can speak to regarding (2+ / 0-)
        Recommended by:
        buddabelly, ruellia

        treatment programs is that, in the 3 month program I attended (12 step based) I saw a bit more than 100 people cycle through. Of those, there were less than 10 who weren't repeating an inpatient program and for many this was their 4th, 5th, or even more trip through one. The meetings I attended after completing the in patient program mostly had people with many years of sobriety or a year or less with nearly nothing in between.

        anecdotal evidence, but my experience lines up with studies showing that less than 18% of AA members are still sober after 2 years.

        •  there are not outcome studies (2+ / 0-)
          Recommended by:
          ruellia, kkkkate

          for AA, they don't conduct them and they don't allow data collection.

          It's how you measure success, most everyone relapses at least once before they get it.  There are people who go into programs because of family pressure, or ultimatums, or legal problems who have no intention of staying sober.  So first you have to separate those who want to be sober from those who do not. Motivation is the first assessment, and the first goal then is to develop motivation.  

          the reason this stuff makes me crazy when people weigh in is that junkies use it as an excuse to not bother, and if they just get some sobriety they just may come to see how cool it is and then they'll remember and just maybe get motivation.

          People shop AA, the meetings aren't all the same, so returning to one meeting isn't necessarily returning to some other one.  

          I see people die, this isn't a joke.  We are really good at this now, and addicts should know that. So when they're ready, hit bottom, they'll know that there is treatment.

          •  as I said (2+ / 0-)
            Recommended by:
            get the red out, Lonely Texan

            my experience is anecdotal.  I've also seen numerous deaths. But until AA joins the reality based world - that is, being willing to put its methods up for a true examination your anecdotes are no more reliable than mine.

            •  Alcoholics Anonymous will be there when (1+ / 0-)
              Recommended by:
              anna shane

              you desperately need it. You seem to think they're concealing something--they're not.They don't keep the kind of records you desire to be included in your version of reality. And all the methods are freely available for your examination in the Twelve steps and Traditions and accompanying literature.

              "Is there any cause in nature that makes these hard hearts?" King Lear, Act III, Scene 6.

              by kkkkate on Thu Mar 27, 2014 at 12:18:54 AM PDT

              [ Parent ]

              •  I'm quite familiar with AA, thank you (2+ / 0-)
                Recommended by:
                get the red out, Lonely Texan

                attended meetings for nearly a year, but it wasn't what got me sober. Cognitive therapy did the trick.

                When I tried to explain to some people I'd met through AA that I'd used a method outside of AA every single one said that I must not have been an real alcoholic or I that was a 'dry drunk' because only AA has the cure.

                •  not all AA groups are the same (1+ / 0-)
                  Recommended by:

                  you must keep looking. If there is one person you can relate to, ask them what other meetings they attend.  It's not usual for AA people to make judgements or to hype only AA, but some groups develop their own culture.  My own experience is that alcoholics are often referred to rehab from their AA group, when they fell.  One way to find out about rehabs is to attend AA and ask for people's recommendations based on their own experiences.

                  If you're new to a town, visit the library and ask the librarian. And go to as many meeting as you can find, so you can pick the ones where you feel most comfortable. Where your peers may be in your age range, or where they like to do fun sober things, like sober softball games.

        •  Hospital or treatment-affiliated meetings tend (0+ / 0-)

          to have that mix of old timers and newbies because people go back to their communities after treatment. The trick is to find a home meeting that suits your needs. I have found, and I know some men who have found same sex groups to be helpful and almost liberating. Or, for younger people there are often meetings at local colleges. Sometimes there's no way to tell the mixture of people without attending. And there can be surprises. I know an Anglo lawyer who found a home in a group composed primarily of Mexican-American farm workers.

          "Is there any cause in nature that makes these hard hearts?" King Lear, Act III, Scene 6.

          by kkkkate on Thu Mar 27, 2014 at 12:07:27 AM PDT

          [ Parent ]

  •  That's really the downfall of healthcare in (2+ / 0-)
    Recommended by:
    MPociask, get the red out

    this country - a whole lot of stuff is paid for that "doesn't work"

    I had the impression that ACA was supposed to work on changing that, but either it's going to be a long hard slog towards that objective, or the provision was entirely gutted at some point.

  •  my sister is a bi-polar alcoholic (4+ / 0-)

    though she certainly won't embrace that title.  Drinks only wine, and says she only drinks on weekends.
    But both her dui stops were on weekdays.
    She claims both were the result of her other personality taking over...
    recent widow after 40+ years is certainly not helping.
    She's an artist who feels her meds inhibits her work, so self medicates.

    No easy answers would be ok, but even the hard answers are really questionable...

    seems like there's a real need for dopamine research.

    •  I'm Curious If You Have A Feeling That You Could (1+ / 0-)
      Recommended by:

      do something to help your sister or have to leave it up to her to decide it's a problem that she feels needs treatment?

      The reason I ask is I have a friend who recently spent 9 months in jail for doing stupid stuff while under the influence.  He didn't have alcohol while in jail.  I was hoping that he would be able to decide with a extended clear head that he might need treatment.  Well he got out and we were able to visit for three days while he was sober which I hadn't seen him in  that state in over 10 years.  That lasted three days and then he's back on the bottle.   I guess he's not ready or doesn't know how to get involved in support or doesn't see it as a problem.  Maybe he doesn't have the capacity to know he needs treatment.  I often ask myself why do I care and why do often feel a need to impose my opinions.   I find myself stepping away.

      "I think that gay marriage is something that should be between a man and a woman.” - Arnold Schwarzenegger 2003

      by kerplunk on Wed Mar 26, 2014 at 03:03:55 PM PDT

      [ Parent ]

      •  everybody has a bottom (1+ / 0-)
        Recommended by:
        Lying eyes

        sadly, for some it's death.  

      •  her cases are pending, the lawyer is telling her (0+ / 0-)

        not to drive
        and if possible get into a treatment program of some sort to make the judge more acceptable to a fine rather then jail

        so, first, get her insurance to cover the treatments
        next, get her into a shrink who can treat the bi-polar with a scalpel rather then a sludgehammer

        make sure she's got transportation, so the driving isn't necessary.  

        then, we can talk about treating the wine problem

        that is the list so far.

        •  lots of times (0+ / 0-)

          people go in treatment to show the judge they're serious, and even when they start out not that motivated, they get motivation in the program, from their peers and from counselors in recovery.  Jail is sometimes the only thing that saved someone's life, if it's the bottom.

  •  well I am here to say that as someone who is (9+ / 0-)

    disabled, and living with chronic back/knee pain and who has a dependency on pain meds, through no fault of my own, other than the fact these narcotic meds are very addicting, I am going into treatment in about 3 weeks to get off addicting pain meds, and on non-addicting pain meds, and for me, failure is NOT an option!

    •  that's hard (2+ / 0-)
      Recommended by:
      ruellia, Alexandra Lynch

      and your group actually has the highest success rate, not that that helps or will make it easy, just that once you're off, you are very unlikely to try some to 'see.'  

      The worst is that the opiates can mask recovery from pain, but the best is you may find the pain isn't as bad as you fear.

      But it's also true that some people need pain meds, and the fact that many get addicted or misuse them makes doctors worry, and they may hurry to get the patient off meds.  Dependency in your case is measured, it's physical dependency, you'll have withdrawal symptoms that they will treat so it won't be that bad, but I would not rush to say you have a problem, more you were given a problem and now you have to solve it.

  •  GTRO, I'm confused... (5+ / 0-)

    You say:

    In the fall of 1992 I was in the process of drinking myself to death.  I went to detox, treatment, and long term treatment.  I have been sober in a 12-step program for 21 years and still attend a group.  I have had a sponsor, done the steps, done the service; so I must be a dry drunk!!!!!!
    Everything you're describing is the OPPOSITE of a dry drunk, at least the way I'm used to hearing it discussed.  Just wondered what I'm missing.

    Also, I love this juxtaposition:

    Dr. Lance Dodes has an impressive background, he retired as assistant clinical professor of psychiatry at Harvard Medical School...
    and this:
    Dr. Dodes opinion is that addicts respond better to psychotherapy that gets down to the deeper issues that trigger each individual person's addiction.
    Gee, what a surprise! :-) Not to minimize the importance of mental health care. Many successful AAers seek outside help for mental health issues.

    In my 3 years of AA and 1000+ meetings, I have never, ever,  heard anything but support for folks that are using talk therapy or medication for their mental heath. Just the opposite.

    Thanks for the diary, it's interesting.

    •  Just reading this book (2+ / 0-)
      Recommended by:
      bsmechanic, Lonely Texan

      I was just implying that since I have been "in the program" for a while that reading this book would say to some people in the fellowship in my area that I was getting ready to buy out the liquor store, or at least having a lot of "stinkin' thinkin'".  But since facing my demons other than alcohol, I've kind of become an alternative information junkie.  I just don't do lockstep very well.

      I actually have heard many people in the fellowship in my area speak outright against mental health medications, or imply that taking them was a cop-out on working a "good" program.  I attended a meeting when I was a couple of years sober that was in a hospital and the psych ward of that hospital stopped allowing their patients to attend because of an old-timer expressing this opinion.  She used to say if someone was on anti-depressants they couldn't hurt bad enough to work the steps properly. And yes, this is the exact opposite of AA's official opinion as stated in its literature.

      Manufacturing outrage; the only manufacturing jobs Republicans won't outsource.

      by get the red out on Thu Mar 27, 2014 at 06:16:17 AM PDT

      [ Parent ]

      •  Thanks, I understand. (1+ / 0-)
        Recommended by:
        get the red out

        Yes, there are intolerant assholes both in and out of AA . The situation you describe (intolerance of prescribed anti-depressants, mood levelers, or anti-psychotics) is pretty much evil. I've heard it described before, and here again by you. Sigh.

        If that happened in a meeting I was in, I hope I would have it together enough to talk to the newcomer after the meeting, and then remind the asshole that we're there to make newcomers feel welcome, not chase them away... Thanks.

      •  Heh. Totally by coincidence, I just read this... (2+ / 0-)
        Recommended by:
        wavpeac, get the red out

        I've been reading "As Bill Sees It" when I'm on break sometimes lately.

        Our Companions

        Today, the vast majority of us welcome any new light that can be thrown on the alcoholic's mysterious and baffling malady.  We welcome new and valuable knowledge whether it issues from a test tube, from a psychiatrist's couch, or from revealing social studies. We are glad of any kind of education that accurately informs the public and changes its age-old attitude toward the drunk.

        More and more we regard all who labor in the total field of alcoholism as our companions on a march from darkness into light. We see that we can accomplish together what we could never accomplish in separation and in rivalry.

        GRAPEFINE, MARCH 1958

        Now, "some people" (including some long-time AAers) think that Bill W. was a dangerous person who never worked a serious program; I've heard a couple people talk along those lines in my short time.

        On reflection (and since this is Daily Kos) perhaps it's simply that some people crave absolute certainty and rigidity in their lives, no grey areas allowed. Even right-wing Republicans need to get sober, so it's a good thing we don't discuss politics in AA meetings!

        •  I think it's more identity than "politics" (2+ / 0-)
          Recommended by:
          JayBat, Chitown Kev

          There's a whole lot of fear of new ideas hidden behind anger and scoffing, IMO.  I think people, all people no matter whether they suffer from addiction or anything else, have difficulty dealing with the idea of their identity being tested.  If something else becomes as mainstream as 12-step; that might be perceived as an identity threat to some people in anonymous fellowships.  Just my opinion.

          Manufacturing outrage; the only manufacturing jobs Republicans won't outsource.

          by get the red out on Thu Mar 27, 2014 at 10:46:18 AM PDT

          [ Parent ]

  •  Psychotherapy is a load of Bullshit (0+ / 0-)

    I won't take seriously anyone advocating for it. There's no standardization, it's all interpretive, there's no consistent outcomes. It threw off the entire diary for me.

    by DAISHI on Wed Mar 26, 2014 at 04:20:20 PM PDT

  •  I attended lots of 12-Step meetings (3+ / 0-)

    back in the 80s when I was in my 20s. I have several issues with that model. One is, as you say, people are unfairly blamed for "not working the steps right" when 12-step doesn't work for them. Another problem I have with 12-step, looking back, is it wasn't the right model for me, and was way over-sold in those times, perhaps still is today. I grew up in a dysfunctional family. Other than having physical needs met, I virtually have had to raise myself. I had, and have, issues from that. But that's not addiction. The two are not the same, or even comparable. 12-step is not "one-size-fits-all," and, yet, it's promoted that way, most likely for reasons you mention.

    One of my most serious issues with 12-step is that it "therapizes" issues that are actually political. For example, with depressing regularity, when I was attending lots of 12-step meetings I can remember hearing stories from women who were being mistreated by men in intimate relationships. What in the world was that about??? Why was it an issue for a treatment model that  actively dissuaded people from an examination of political matters as "trying to save the world" when you were supposed to be "working on yourself"??? This is just one example.

    In short, 12-step often doesn't "work," and critical reasons for that include its mis-application.

    It's here they got the range/ and the machinery for change/ and it's here they got the spiritual thirst. --Leonard Cohen

    by karmsy on Wed Mar 26, 2014 at 05:53:09 PM PDT

  •  Suboxone and (1+ / 0-)
    Recommended by:
    get the red out

    some family or friends that love you.

  •  I am a proponent of 12 step programs... (0+ / 0-)

    Having cleaned up through AA, I can absolutely recommend them. In regards to the medication question, I can say that I was never given any shit for needing prozac or anti-depressants. That said, I have heard from others that some groups can be, or were in the past, a bit judgmental (I think this is maybe an old school vs new school thing). My own advice would be to seek out a group that specializes in dual-diagnosis (substance abuse and mental health) if you can, or at the very least a group that might have some people dealing with similar issues that will be tolerant and supportive. AA/NA has the added benefit of being quite cheap (self-funded through member contributions).

    In terms of in-patient centers, I would think they'd be best utilized by people who have difficulty getting even a day or two of sobriety or who would suffer from severe physical and/or mental withdrawal. Unfortunately, it seems to be a field ripe with scams. I would suggest you check with your county health department for scientific, responsible programs. Watch out for Narcanon. They're a front-group for Scientology, it's very expensive, and they peddle pseudo-science (dangerous sauna treatments and heavy niacin supplementation), and are zealously opposed to any psychiatry at all. Honestly, the idea that people are trying to profit off the suffering of others with recovery programs makes me sick to my damn stomach.

    Whatever you do, don't be afraid to ask questions, find a group or program you're comfortable with, and if at all possible, work with your MD.

    •  anti-depressants don't cause dependency (0+ / 0-)

      and they're pretty safe, and I no of know program that would disallow any psychiatric med. Used to, but no more. (need I say why?)

      The field isn't ripe with scams, if you ask about the treatment philosophy, meaning what ACA covers wouldn't likely be any scam.

      If a program says there have a 'cure,' it's a scam. If they say it won't be hard, same thing. If it's guaranteed to work, big scam.

      •  If anti-depressants don't cause (0+ / 0-)

        Dependency, then what is discontinuation syndrome? It is physical withdrawal. These drugs change your brain chemistry.

        For some people, psych meds can and do help, but to call it "pretty safe" when you can have a stroke or otherwise be too sick to function if you discontinue, for whatever reason, say, losing your health insurance?

        I think they are very dangerous from personal experience, especially as they are prescribed in the US, with minimal contact with doctors, maybe 20 minutes a month, when the type and dosage and combinations must be so fine tuned and they are so expensive as to be unsustainable for many people.

        •  there is no street value (1+ / 0-)
          Recommended by:
          get the red out

          some can be dangerous when getting off, depending on which ones, but you can't buy them on the street or sell them, and since you have to get them from doctors, presumably the doctor will wean you off.  They're not harmful when used as directed and no one abuses them, in the way of taking too many, or hoarding and taking them all at once, which could be lethal but not recreational.  

          I am not disputing your experience, there are lots of them and like any medicine, they can be prescribed improperly.  One has to assume that the doctor is competent.  

          There are medicines that rehabs generally, or at least used to generally, ask residents to discontinue, mainly benzodiazepines like Xanax and stimulants like Ritalin and both can be abused, both have street value, both can lead to dependency.  While that doesn't happen anymore as a rule, it was never the case with antidepressants, they were allowed because they have no recreational value and they don't lead to dependency - in that limited way they're safe.

          Now it's case by case, and in consultation with the prescribing physician.

  •  It's not an either/or (0+ / 0-)

    It's unfortunate he trashes AA.  

    There is no one size fits all in addiction treatment.  Sometimes people need to try different types or a combination of types in order to get and stay sober.  And it doesn't happen over night.

  •  Tipped and recced (1+ / 0-)
    Recommended by:
    get the red out

    As a long-time member of a 12 Step Program, I always think that the more info, the better.

  •  Lots of misinformation here. (1+ / 0-)
    Recommended by:
    anna shane

    Here is a list of research on Dialectical Behavior Therapy and substance abuse. Research needs to continue. Some conflicts. But there is plenty to suggest that it can be effective. can be an atheist in 12 step program. It's an absolute misunderstanding of the program to say it's "faith based". All you have to do is believe in something bigger than can be "truth" or "love" or "scientific methodology". This helps an alcoholic get out of the rigid emotion mind centered thinking that occurs per MRI proof while intoxicated chronically. It's a way to get outside your head to look for answers. I work with lots of atheist alcoholics in 12 step.

    There is also a new treatment related to EMDR for trauma called :feeling state addiction protocols. It has not been researched empirically yet but it is promising. We are seeing significant changes in use. We are on the process of design research and outcomes studies for our practice.

    Bottom line is that therapists are collecting outcomes more than ever before. This serves to improve outcomes. This practice will continue. The idea that treatment is not effective is not accurate. Go Google the subject, go to some A A meetings...try working the steps...before you dismiss it. Do your own research and you will find that some treatments are highly effective and one size does not fit all.

    We don't know everything we need to know but we know more than ever today about addiction and more will be revealed. My husband is 8 years sober and I have the pleasure of helping many sober people! They do exist and all of them credit something.

  •  Some years back, there were clinics who treated (1+ / 0-)
    Recommended by:
    anna shane

    drug addiction by anesthetizing the patient throughout withdrawal. This was said to be a quick and painless way to break addiction. The method was severely criticized by the rehab establishment. I wonder what ever happened to that type of treatment.

    •  there was a weight loss one (0+ / 0-)

      that induced sleep for one week.  

      When the goal was to detox, that could have been a detox idea, but detox is now managed medically, usually Librium  - used to always be like 3 to 5 days in a hospital, but now they do it outpatient.  My guess is that that one proved dangerous, not just unnecessary.

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