Althouse: Addicts have a choice.

March 24, 2010

Addicts have a choice.

Right?

93 comments:

Anonymous said...: Alcoholism. The disease you get from empty bottles.; 3/24/10, 8:23 AM
TosaGuy said...: In today's new health care world, we need to impose a tax on the addicts to cover the increased cost of their health care.; 3/24/10, 8:27 AM
TosaGuy said...: Some liberals may think it would be cruel to tax addicts, but many of you should be able to rationalize doing so by simply dreaming of taxing Rush Limbaugh.; 3/24/10, 8:30 AM
Robert Cook said...: I have a close friend who has fallen into an abyss of alcoholism in the last couple of years, and it's a terrible and pitiful thing to see and experience. She's lost just about everything as a result of her addiction. However, I still have hope that at some point she will decide that she wants to regain her life badly enough to make the choice to pursue sobriety, and will stick to it, hard as it will be. Many addicts have made this recovery and more are doing so every day.

So, yes, addicts do have a choice.; 3/24/10, 8:35 AM
bagoh20 said...: I've been arguing this with my addict friends for years. It's not just the professionals who cling to the disease idea. Like most self-described victims, addicts cling to that idea like a race card holder.

Good post John. I was caught by this:

"But having good intentions behind your account of reality hardly ensures that your account will be accurate."

I'm pretty sure John is a liberal and that piece of wisdom explains the problem with that addiction as well.; 3/24/10, 8:35 AM
Hoosier Daddy said...: Some liberals may think it would be cruel to tax addicts, but many of you should be able to rationalize doing so by simply dreaming of taxing Rush Limbaugh.

Am I the only one that differentiates between someone who gets hooked on prescription drugs as a result of a dibilitating disease or chronic pain and a meth or coke addict? Getting high to escape reality as opposed to getting high to make the pain go away I find to be two different things.

But that's just the logic in me.; 3/24/10, 8:38 AM
bagoh20 said...: I've known and buried many addicted friends. I do believe it is a choice, but the problem I see is that the addict simply loses the ability to appreciate the benefits of sobriety fully and consistently enough to make the right choice. The drug always looks like the better pick sooner or later and back on the ride they go. That and the natural bent of some people to just never say: "That's enough, I'm satisfied."; 3/24/10, 8:40 AM
Skyler said...: Old but nonetheless welcome news.
O
I wonder why one shrink is called a "Harvard psychiatrist" and the other simply a "psychiatrist" as though being from Harvard makes someone so superior. There are plenty of smart people from other schools. I tire of this pro-Harvard bigotry.; 3/24/10, 8:52 AM
Anonymous said...: In today's new health care world, we need to impose a tax on the addicts to cover the increased cost of their health care.

Are we going to charge extra to sex addicts, too? I think we should.; 3/24/10, 8:56 AM
Hoosier Daddy said...: "Harvard psychiatrist" and the other simply a "psychiatrist" as though being from Harvard makes someone so superior.

Louis Winthorpe III: He was wearing my Harvard tie. Can you believe it? My Harvard tie. Like oh, sure he went to Harvard.

Trading Places, 1983; 3/24/10, 8:57 AM
Anonymous said...: I've long been bemused by how easily impressed people are by brain scans. That every state of mind is paired with something going on physically in the brain was known in principle long before anyone was able to capture pretty pictures of it. Excellent post, JAC.; 3/24/10, 8:58 AM
Michael said...: I stopped drinking 20 years ago because I am/was addicted to alcohol. I doubt seriously that alcoholism is a "disease" but I do not doubt that if you quit drinking the desire to drink will go away. Give a monkey a number of drinks every day and the monkey will become addicted to alcohol. Not because he didn't get enough bananas when a baby and not because he had a bad home life but because he drank too much alcohol with too much regularity. Our therapeutic culture has transformed a fairly simple solution (quit drinking) into a very complicated solution(quite drinking after you find out why you drink). I commend to all Theodore Dalrymple's book "Romancing Opiates: Pharmacological Lies and the Addiction Bureaucracy" which supports the view that the industry built around "recovery" is very invested in the notion that addictions to drugs and alcohol are nearly impossible to overcome without the help of therapy, medical supervision, etc. The point about addiction to pain killers versus "recreational drugs" is well taken. If the underlying physical pain has gone, however, continuing to take pain killers would be in my opinion a clear choice.; 3/24/10, 9:05 AM
Greg Hlatky said...: I wonder why one shrink is called a "Harvard psychiatrist" and the other simply a "psychiatrist" as though being from Harvard makes someone so superior.

People from Harvard always let you know they're from Harvard.; 3/24/10, 9:06 AM
kjbe said...: Getting high to escape reality as opposed to getting high to make the pain go away I find to be two different things.

That’s really only the difference between psychic pain and physical pain. Both are very real.

I had a brother-in-law who was caught up in addiction and died because of it. I know he tried to break away from it, tried to make a different choice, but in the end, couldn’t. I also have friends who have made the choice and been able to make recovery work. Recognizing and putting weight in consequences is the key.

To paint it as all-or-nothing choice vs. disease I think is incorrect. From my own experiences, I’d contend that there are elements of both.; 3/24/10, 9:08 AM
themightypuck said...: How does this philosophical pearl affect the practice of medicine? Is it to simply say that addiction can't be treated by doctors? I don't know the numbers and given the way the State picks winners in the addiction game (like AA) it seems conceivable that it is all a scam. Still, I'd like to see some more evidence.; 3/24/10, 9:12 AM
The Drill SGT said...: People from Harvard always let you know they're from Harvard.

early and often in my experience; 3/24/10, 9:17 AM
Scott said...: This comment has been removed by the author.; 3/24/10, 9:20 AM
mesquito said...: I have no doubt that I'm hard-wired to be an alcoholic. However, I don't get any sort of pass on being a destructive, obnoxious asshole for 15 years.; 3/24/10, 9:22 AM
themightypuck said...: @Hoosier Daddy,

Aren't you really just using morality to underpin the cold hard calculus of who is really worth saving? The fact of the matter is that people who become addicted because they have unbearable lives don't really have much incentive to get better, whereas people whose addictions have made their lives terrible are probably worth saving and are far more likely to make the effort to save themselves.; 3/24/10, 9:26 AM
Scott said...: This comment has been removed by the author.; 3/24/10, 9:28 AM
Michael said...: K*thy: You wrote about your brother-in-law: "I had a brother-in-law who was caught up in addiction and died because of it. I know he tried to break away from it, tried to make a different choice, but in the end, couldn’t" As hard as it is to say, the man "wouldn't" or "didn't" give up alcohol, not that he "couldn't." My personal experience with the problem and direct knowledge of hundreds of people with addiction tells me that we do indeed have a choice, the addict knows he has that choice and the addict makes the choice in favor of the drug. He knows it is going to kill him but he does it anyway. He perceives the other choice as too hard or he has been told it is too hard or the people around him provide him with substance in the form of pity that makes the romance of addiction more attractive than the boring, the sober.; 3/24/10, 9:30 AM
Scott said...: "It's easy to keep believing in a dogma if you don't look at any of the evidence that goes against it."

So true. But sometimes reality catches up. Like the bumper sticker says, "My karma ran over my dogma."

The interesting anecdote John relates about incentivizing good behavior in Vietnam vets is old news. Today, most big companies require successful job applicants to undergo a pre-employment drug screening. That must be very effective in suppressing overall drug use in the USA (although I've never seen a study on that phenomenon).

In addiction, the fuzzy philosophy looks like this:

a. Addiction is characterized by people making choices that a person with "self control" would not make.

b. The tendency to be an addict is influenced by a neurological component.

c. Therefore, altering the neurology of an addict will cause them to make the choices that someone with "self control" would make.

I would argue that the self-control-influenced choice is not about using drugs. It's a choice about whether or not to be an addict.

"Being an addict" is a state of identity that is chosen of free will. If one becomes aware of one's addiction and chooses to shed that identity, then choosing to not pick up the bottle or the joint or the cigarette becomes more attractive.

Altering the neurology of the addict may be one way to change the attraction of addict identity, but it's not the only way, and it may have unintended consequences. People who can identify with the culture of the 12 Step programs (which can be difficult to do) generally do stop using.

===

(arrgh, I can't type today); 3/24/10, 9:33 AM
John Althouse Cohen said...: I wonder why one shrink is called a "Harvard psychiatrist" and the other simply a "psychiatrist" as though being from Harvard makes someone so superior. There are plenty of smart people from other schools. I tire of this pro-Harvard bigotry.

There's no Harvard psychiatrist. Heyman is a Harvard psychologist. In the context of the review, the fact that he's a psychologist rather than a psychiatrist or neuroscientist is very significant. As a psychiatrist, the reviewer might be more attuned than Heyman to brain chemistry -- and in fact, the review mildly criticizes Heyman for this in the fourth-to-last-paragraph.

I was more specific about Heyman because as the author of the book being reviewed, his credentials are more important than those of Satel, the reviewer. I considered being parallel and referring to Satel as "an American Enterprise Institute psychiatrist," but I thought this would be too wordy and less informative than "Harvard psychologist."; 3/24/10, 9:38 AM
Hoosier Daddy said...: Aren't you really just using morality to underpin the cold hard calculus of who is really worth saving?

Maybe I haven't had enough coffee yet but I honestly have no idea what you're saying.

My point is that I differentiate between someone who got hooked on Vicadin because of chronic pain and someone who spent their 20s smoking pot, doing shrooms and following the Grateful Dead. It's not an issue of who is worth saving but not all addicts are equal in my eyes.; 3/24/10, 9:38 AM
David said...: I learned about alcoholism up close and personal through by beloved but alcoholic second wife.

The argument about whether it's a disease is all semantics. If it's a disease, it's a treatable disease. The treatment is to stop drinking. There are lots of ways the treatment can fail, but unlike in other diseases, the treatment is ultimately in the hands of the patient.

RIP Sally.; 3/24/10, 9:42 AM
Chennaul said...: Well ya coulda just dropped Haaaavaaard.

But, there's hope for you yet kid, because even though you "believe" in redistribution after much brooding on the subject you've decided to "tip" according to performance.

Imagine that.

Your own personal capitalism.; 3/24/10, 9:47 AM
Scott said...: David, I'm so sorry for your loss.

My partner died of AIDS in 1994; but since his death, his father and two of his brothers had their deaths hastened by alcohol addiction. (It's hard to stay sober on the rez.)

HIV and alcohol have taken so many of the people I have loved. Sometimes I feel like I've survived a war.; 3/24/10, 9:50 AM
Phil 314 said...: We tend to have dichotomous and/or moralistic viewpoints of behavioral conditions. By dichotomous I mean either "Its a disease; I'm powerless. I need treatment." versus "Its a choice. Choose wisely."

Clearly biochemistry is involved in behavior. That doesn't eliminate choice and volition. At a minimum I need to choose to take my medicine (i.e. naltrexone)

My clinical experience tells me that some folks have a much harder time overcoming their ?biochemistry. And some folks would rather be high.

A little personal anecdote. When I worked on the reservation we had many alcoholics. Sometimes an individual would plead powerlessness because he/she had a "disease". My standard response was to point out that diabetes (also prevalent on that reservation) is also a disease and that doesn't mean the diabetic doesn't have to take his meds and follow a diet.; 3/24/10, 9:56 AM
Scott said...: c3, that's a disingenuous bifrucation. :)

You are powerless over your diabetes. You can choose to eat properly, monitor your blood sugar, and take your medications.

You are powerless over alcohol. You can choose not to pick up the first drink, and to get mutual support from other alcoholics in not drinking.

Last trip to San Francisco, I saw a panhandling bum (er, homeless person, sorry for being judgmental) on the street holding a sign, "I ADMIT IT, I'M AN ALCOHOLIC, GIVE ME MONEY TO DRINK!" And I was tempted to do so! I love honesty.; 3/24/10, 10:06 AM
themightypuck said...: @Hoosier Daddy,

I'm short on coffee as well so I'll just concede that if you didn't understand me it was probably me. It seemed like a good idea at the time.; 3/24/10, 10:06 AM
Kirby Olson said...: British doctor Theodore Dalrymple claims in his books that it's like a case of flu, and lasts about as long, to get off of heroin.

One of the funny things to think about though is -- we now have gay rights parades. How long will it be until we have heroin users' parades! Addicts pride marches.

Maybe it's something to be proud of, really, but our consciousness just hasn't been raised as of yet?

Perhaps addiction is a choice we should all consider when we're thinking about the optimum lifestyle. Now that the state is going to expand healthcare to be more like the British system, this will mean that heroin is now free, too, right?; 3/24/10, 10:12 AM
Scott said...: "One of the funny things to think about though is -- we now have gay rights parades. How long will it be until we have heroin users' parades! Addicts pride marches."

The whole Alcoholics Anonymous - 12 Step culture would frown on such parades. Anonymity is considered not only a practical necessity to preserve the effectiveness of the program, but also a spiritual component that leads one to a "genuine humility". (Program heads, see the "long form" of the 12th Tradition in the appendix of the 12x12.); 3/24/10, 10:18 AM
Dust Bunny Queen said...: In today's new health care world, we need to impose a tax on the addicts to cover the increased cost of their health care.

Can't.

It would be considered a pre-existing condition.

We can't charge extra for people who smoke themselves into illness, eat themselves into obesity and self infliced diabetes, heart condidtions, neuropathy or drink themselves into liver failure.

We can't charge extra for ANYTHING. The concept of insurance as covering a risk that you pay premiums that are proportional to the level of the risk is DEAD as a doorknob.

We are ALL equal now Comrades.

Well....except for those at the top of the Politburo and official members of the Party/aka Union Members..... who are exempt from Obamacare.; 3/24/10, 10:20 AM
traditionalguy said...: Welcome to the Nanny State. A basic under-pinning of settled science is being propagated so that only deniers are the spokes people for truth. The hateful effect of a nanny state is the denial of moral choice by a "man's" free will. The messsage to be put into science speak is that there are no more men, only collections of cells walking. That is also a DEATH SENTENCE. Beware of pretend scientists bearing gifts that are killers.; 3/24/10, 10:20 AM
themightypuck said...: I've gotten off heroin and pain meds and it was never a problem. The hardest drug for me to quit was crystal meth but I got off that as well. The most painful drug for me to quit was xanax which I had taken daily for 8 years as prescribed by a doctor for a legitimate health reason. That was hell for 3 days and dysfunction for 3 months. The only drug I have been unable to quit is alcohol and for the most part I don't abuse it (although I bet I'd live longer if it were illegal).; 3/24/10, 10:20 AM
caseym54 said...: Define "addict."

AA defines "alcoholic" as one who has lost control over alcohol. They suggest that, first, a person with an alcohol problem attempt to regain control. The AA solution presumes that self-control is unlikely, and it is not at all based upon choice, will-power or self-knowledge, all of which concepts are more of a hindrance to the AA solution than a help.; 3/24/10, 10:20 AM
Joe said...: I hate to agree with Rob't Cook, but yeah addicts have a choice...part of Recovery is realizing that I DID have a choice, where previously I didn't see the choice....much less choose wisely.

My choices is/was to drink or not, snort or not, date the obsessive-compulsive or not, a host of things...when you're in the world of AA/NA/ACA you often don’t realize you had choices. AFTER you get into Recovery you begin to see you do and did...they may not be palatable choices, or easy choices, but I do and did have them

Sometimes they are to not numb myself with drugs or shopping or gambling or guilt and actually confront the painful things in my life. And sometimes that choice is so difficult I'd rather drink or smoke or shop or be a self-destructive, guilt-wracked person...but sooner or later the choice(s) will re-occur and I'll have the chance to choose CORRECTLY this time.; 3/24/10, 10:25 AM
Skyler said...: Puck wrote: (although I bet I'd live longer if it were illegal).

There has been no evidence I can see that either during Prohibition or now with drugs that making them illegal stops the addicts from getting them. All prohibition does is make crime more likely for them to get their illegal fix. I've not even seen any evidence that it even slows anyone down.; 3/24/10, 10:32 AM
TosaGuy said...: "Can't.

It would be considered a pre-existing condition."

Sorry, DBQ, they can because health care policy is now a political issue, not a medical one. All it takes is a vote by Congress to render addiction a non-prexisting condition. They could even tax different rates for different drugs. Liberals may wish to tax Oxy at confiscatory rate because they perceive it as a rich person's drug, while give those addicted to weed a subsidy. I am exaggerating a bit, but its to make a point that such decisions can be made whenever Congress feels like it.

The same thing could happen with fat people or those who smoke or those who engage in high-risk sports. The guy who pays the bills gets to make the rules.

My initial point was dripping with sarcasm, but every single issue like this is now open to exploitation and will be decided in the political arena as much as it will be the medical one.; 3/24/10, 10:33 AM
jamboree said...: It's a choice although just like overeating it becomes a harder choice as you go down the spiral.

It's one thing choosing to not enjoy more food because you want to look hot. It's another if you will have to make that choice over and over - possibly for years if you are obese - to enjoy the same outcome.

If you've tried everything to make whatever in your life better and nothing is working you might try say champagne and get the immediate relief. It's a choice. If you keep making the drugs/alcohol choice over and over, the results of the non-escapist, productive choices will be so far out on the horizon that you won't be able to see them making it feel completely pointless.

Less of a choice then from your perspective.

But do I think they are compelled by anything but momentum? No.; 3/24/10, 10:33 AM
themightypuck said...: @JAC Sounds like you were thinking that the probative value of links to the AEI would be substantially outweighed by the danger of unfair prejudice.; 3/24/10, 10:37 AM
Scott said...: Oy.

@themightypuck: What tools did you find useful in ending your relationship with these chemicals? Do tell.

@caseym54:

AA as an institution and a movement does not define alcoholism. Some speculation is thrown around in the literature (a physical disease combined with a mental obsession, etc.) but none is considered to be a definition. The first tradition of AA is, "The only requirement for membership is a desire to stop drinking." That alone is the common bond. There is no definition of alcoholism there, or in any of the twelve traditions, or twelve steps, or twelve concepts for world service..

Your statement...

"The AA solution presumes that self-control is unlikely, and it is not at all based upon choice, will-power or self-knowledge, all of which concepts are more of a hindrance to the AA solution than a help."

...is not entirely true. Any member of AA will tell you that to stay sober, you have to choose not to pick up the first drink; that in fact you do have choices, and that you have a better chance of making the right choices generally if you work the program. But it is true, AAs will generally tell you that using raw willpower alone is like "trying to pull yourself up with your own bootstraps."; 3/24/10, 10:37 AM
themightypuck said...: @Skyler. I'll admit to being a bit glib. Still, I really liked opiates and I bet if I could get them at the corner store I'd probably use them more often (no guarantee I'd get hooked). Right now, I know I can find junk somewhere in downtown LA but there isn't a snowball in hells chance I'll go down there to buy it.; 3/24/10, 10:41 AM
AllenS said...: I'm neither a psychiatrist nor a psychologist. I have made some clinical observations over the years. A lot of people like to get fucked up.; 3/24/10, 10:41 AM
Scott said...: On self knowledge: Steps 4 through 9 are all about gaining awareness of the dynamic of one's active alcoholism; and about moving beyond it. If that isn't self knowledge, then what is?; 3/24/10, 10:42 AM
Scott said...: generally :); 3/24/10, 10:44 AM
themightypuck said...: @ Scott, For getting off opiates the tools were having shit I needed to get done. I never had a chance to go too far down into the bunny hole. For speed it was tougher because you can really be functional on that if you don't go overboard. Wellbutrin helped me bridge the gap. Xanax was really hard. I basically lay in bed for a week in the fetal position listening to books "on tape". Alcohol I have no solution for. The conventional wisdom is that submission to a higher power and relentless confrontation of the sources of your addiction will help.; 3/24/10, 10:45 AM
Scott said...: Damn, themightypuck, you're awesome! Major-league self awareness, and I'm saying that without being glib. Live long and prosper!; 3/24/10, 10:49 AM
kjbe said...: Michael, I also had a desire quit and chose to make moves in that direction. I know how hard that is. Being on the other side of my choice, I can see that there is a choice. When I was in the middle of the addiction, I wasn’t able to see that I had an option. As my gas ran out, I began to question whether I would or could make that choice. From that, I’d say that whether you’re deep in it or on the outside makes the difference in if you see a choice.

True enough - he wouldn’t give up alcohol. I know that he tried, but in the end, I see that his fear eventually killed him. I’ll always wonder if he gave up and just thought he couldn’t.; 3/24/10, 10:56 AM
Joan said...: British doctor Theodore Dalrymple claims in his books that it's like a case of flu, and lasts about as long, to get off of heroin.

I know a young man, currently finishing a jail term, who is a heroin addict. He has been through "rehab" countless times. He has always relapsed, although before his last (worst) relapse, he stayed straight for well over a year, because his son was born and he wanted to be there for him. Eventually, though, his son wasn't a strong enough motivator to keep him clean.

The "rehab" referenced above is a very short-term thing. In that sense, Dalrymple's statement matches current medical practice: it doesn't take that long to clear the drug from your system. This guy's problem is much deeper than the physical dependence aspect, and it does have to do with his neurology.

Your ability to deal with addiction -- and adult life in general -- is greatly determined by your experiences during adolescence. Brain development during this time occurs at about the same rate as it does during the few years after birth -- just tremendous growth in the connections being formed, and the speed at which we're able to retrieve information and make decisions. Decision making ability develops last of all. That's why current secondary teaching education now stresses explicitly teaching junior high and high school students responsibility, learning strategies and organizational skills.

If you don't learn how to make good decisions as an adolescent, it will be harder (but not impossible) to make good decisions as an adult. If you start smoking pot at 13 and spend your teen years stoned, as the young man I know did, your brain development will literally be stunted. In many ways this guy still thinks like a kid because he never learned how to think like an adult. He tuned out at exactly the wrong time.

None of that removes the idea of agency from his behavior, though. It just means that it's harder for him to discern what he should he do, because his brain isn't wire to think that way.; 3/24/10, 10:58 AM
themightypuck said...: @Scott,

Thanks, but I doubt I am that self aware. It is really easy for a person to fool oneself about such things and way easier to fool others. I think this is why most 12-step programs require a kind of blind submission. One caveat: I've never been in a 12 step program but I have read the blue book.; 3/24/10, 10:58 AM
Unknown said...: My old man was a drunk. From the time I was born until just a few years before he died.

Though it's not anything original, it's still true: until you've hit what you see as rock bottom (and you have to see it that way), you won't quit. Once you do, then you'll quit.

So, yes, you have a choice, but you have to stop lying to yourself - and there's always at least one lie.

themightypuck said...

@Hoosier Daddy,

Aren't you really just using morality to underpin the cold hard calculus of who is really worth saving? The fact of the matter is that people who become addicted because they have unbearable lives don't really have much incentive to get better, whereas people whose addictions have made their lives terrible are probably worth saving and are far more likely to make the effort to save themselves

My bolding. The first part is the lie and the second is the reality. Addiction will make any addict's life Hell and they all have an excuse. The issue is that somebody somewhere went through the same ordeal and didn't get addicted, so you have that choice. Once addicted, something has to come along to make them stop lying to themselves. For some, it never comes.

And, yes, after a half century of how it's cool to get high and how we must understand the addicted, I can't wait to see how the death panels handle this one.

Truth in advertising: for about ten years I was on Zoloft and Xanax (both prescribed) for severe depression. I decided to get off them because I had gotten some perspective and wanted to tackle my problems rationally. I've since been told Xanax is addictive. I do remember some withdrawl, but I didn't have that much trouble. Make of it what you will.; 3/24/10, 11:17 AM
Joe said...: 12-step programs have an extremely high failure rate, approaching 90%. On the flip side, the success rate for people doing it on their own is in excess of 80%.

One thing that has struck me watching various rehab programs on TV is how cult-like they are.

Cults don't work by causing genuine self-motivated change, but a phony change in behavior in order to appease the leader or someone else. (And they can cause huge guilt when a person tries to reconcile their natural behaviors with the artificial ones pushed on them by the leaders [to an extent I've been there with the religion of my birth.])

I've also been struck that for the vast majority of the subject on these shows, it's blindingly obvious that the addiction is a symptom and that many (most?) of the subjects suffer from depression.

Thus, changing the behavior has nothing whatsoever do to with actually helping the person. Worse, having the subject change simply to appease the show's charismatic star is simply substituting one high for another. Relapse is inevitable once the cult environment is removed and/or the subject fails to respond to the social stimuli.; 3/24/10, 11:23 AM
Phil 314 said...: c3, that's a disingenuous bifrucation. :)

Scott;
You lost me. I think we're saying the same thing. Its both biology and choice.

another anecdote. Had a patient who was a poly-substance abuse. He succeeded in getting off the meth and the opiates. He just couldn't kick his smoking habit. He thought that was the hardest; 3/24/10, 11:31 AM
Scott said...: "12-step programs have an extremely high failure rate, approaching 90%. On the flip side, the success rate for people doing it on their own is in excess of 80%."

This is the internet. Numbers are easy to throw out. If you can't link your presumed statistics to the source documents, then your words are just so much blah-blah.

AA is not a treatment program.

Here is what AA calls its Preamble. It's AA's declaration of what it is:

"Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership; we are self-supporting through our own contributions. A.A. is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy; neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety."

If a person who goes to AA stays sober three years, is it a success? If they get drunk in the fourth year, is AA a failure? That's what makes statistics regarding recidivism so bogus. People in AA go to meetings because they find it useful. Those who don't, don't go.

If you're afraid of AA, please stay away. If you want to try it, go ahead. If you like it, stay as long as you want. If you want to leave, go ahead, nobody is going to run after you or send you a bill. If you don't think it works, cool, try something else.

As for AA being a cult: If it is, then it has to be the cheapest, most benign cult around. If you don't think so, then try Scientology. Or the Catholic Church. Or Islam.; 3/24/10, 11:45 AM
Scott said...: @c3: Yeah, I agree, we're on the same page.; 3/24/10, 11:46 AM
Joe said...: Scott, I clearly said that 12-step programs use cult-like techniques. Moreover, I've heard these statistics for over thirty years and there are several well done studies to back it up.

Even that aside, I'm sure we would agree that forcing someone into a treatment program of any type isn't going to be very successful. On the other hand, a person who really wants to change will likely be successful in any program, even one that is self-directed.; 3/24/10, 11:52 AM
Kirby Olson said...: Food addictions are probably similar. People shove their faces full to get a feeling of contentment, one which of course can never come from food.

Michelle Obama ought to team up with drug addiction counselors to get the lard off, the needles out of the eyeballs, and the show on the road.; 3/24/10, 11:56 AM
Joe said...: (One Who Used(s) 12 Step Work)
Joe has "studies" that show 90% of AA-type work fails...well I have seen studies that show AA-type programs at least as successful as Group or Individual Therapy.

My thinking on his stat's are as follows, the 80% number is for folks who wanted to quit drinking, or smoking or just decided Pot wasn't for them. IF, you're not an addict, quitting is not a struggle....

As to the 90% number, IF true, I'd submit that is the result from this population being ADDICTS, not just casual users. If you're an Alcoholic, or Dependent on Pot, or Shopping, or a Drug Addict, to be distinguished from someone who has tied one on, or got high, or likes to shop....IF you can't just have ONE DRINK, then yes, you will have a high failure rate.

Because quitting is tough....It's easier to stay in the pit than climb out, or at least it seems that way. And all the folks around you want you to STAY in that Pit.

Quitting alcohol, drugs, Pot, shopping, or gambling means changing your life, pretty much top to bottom, changing friends, alienating family, and confronting some things about yourself that most of us would rather not confront.

So, it is not surprising that there is a high failure rate in 12 Step Work...just like quitting smoking is easy. I did it three times.

Bottom-Line: Joe may or may not be right with his numbers, and they may not mean as much as he thinks they do.; 3/24/10, 12:12 PM
Joe said...: As to 12 Step work being "cult-like." I'd say it's more like a CHURCH...it's very Catholic if you ask me.

I'd say Catholicism is cult-like or Islam...I mean they want you at their place of worship/indoctrination pretty much all the time. They constantly hit you up for money, use guilt, and have a Party-Line on a host of issues.

And this is from someone who's Catholic AND been in 12 Step work...I see a lot of similarities, so if AA is a cult so is my church...or neither is, which is my bet.

Never understood why people have a case of the @rse with 12 Step work. It's not for everyone, but then neither is macramé or Veganism. If it isn't your cup of tea, I say just leave it well enough alone. In my 12 Step group we didn't care if you stayed or went, only that you got help and got better....we were just one way of doing so, and freely acknowledged it.; 3/24/10, 12:18 PM
Julie said...: @HoosierDaddy:

I think it's because to you physical pain and psychological pain are different. I infer that to you one is real and the other is not, and so one is a more or less acceptable reason to use drugs and then allow yourself to become addicted to them (because at some point, for most of the people addicted to pain killers or other meds, the physical pain has gone away but they still use the drugs. It might be a different case for people with chronic pain, although I'm really skeptical about this alleged epidemic of chronic pain). Addicts are not college-aged pseudohippies smoking pot and following the Grateful Dead; almost none of them are addicts in any sense of the word. And certainly not all addicts, of either variety, use drugs initially out of a need to relieve any kind of pain. Some of them just do it for fun, I guess. But a constant and persistent desire to escape reality, physically and/or mentally, often does speak to some kind of pain, whether physical or mental, and to me they are equally real. In some cases I have personally seen, I would argue that mental pain was more debilitating than physical pain.

That does not mean that I believe that addiction is not a choice. I think it is. I just don't think there is any moral difference between someone who allows themselves to become addicted to pain meds and those who allow themselves to become addicted to alcohol or meth or coke.; 3/24/10, 12:33 PM
Penny said...: It seems implausible to me that there isn't a pharmaceutical company out there that couldn't come up with drug "x" that would make you feel "high" for "y" period of time, without becoming physically addicted, or having serious health consequences.

But it wouldn't be "right" to make such a drug. Would it?; 3/24/10, 12:42 PM
Joan said...: I'd say Catholicism is cult-like or Islam...I mean they want you at their place of worship/indoctrination pretty much all the time. They constantly hit you up for money, use guilt, and have a Party-Line on a host of issues.

Joe, unfortunately you sound like a too-typical poorly catechized Catholic. You don't know what you're talking about.

You are obligated to attend Mass on Sundays -- that's an hour a week -- plus the occasional holy day of obligation, and there are scarcely half a dozen of those scattered throughout the year. You are always welcome to attend Mass or simply be present to the Lord, but there is no requirement to do so. Additionally, you are only required to take Communion during Easter time, so if you choose, you can simply receive reconciliation and Communion all within the same week and be done with your yearly obligation. Many Catholics do.

As for "constantly hit[ting] you up for money," no Catholic church has membership fees or dues the way some other religious organizations do. Anyone, Catholic or not, can walk into a Catholic church and participate in the rite (although only those in a state of grace and in communion with the Church's beliefs may take the Eucharist). Sure, we pass the plate, and we collect money for various charitable works supported by the parish and the local St. Vincent de Paul Society, and a host of other worthy causes. There is no requirement that you donate to these organizations. If you have children you wish to have educated by the church and you cannot afford to pay for their religious education, the fees will be waived.

As to having a "Party Line": yes, we have our dogma. But the faith also requires you to form your own conscience, not be an unthinking mindless robot. Unlike a cult, there are no "hidden mysteries" in the Church -- all of our mysteries are out there in the open, and we talk about them all the time: virgin birth, God made man, Jesus risen from the dead, redemption. These are lively topics of discussion.

God - and we - know that the Church has done some horrible, horrible things over its history. The Church is made up of men, after all. But please don't trash the religion by lumping it in with the likes of cults and Islam, which ignore natural law and despise freedom.; 3/24/10, 12:47 PM
Joe said...: Let me repeat myself one more time "cult-like techniques".

A major feature of a cult is that it tears you down and makes you dependent on the group; your sense of self becomes linked to the cult and mostly to the cult's leader.

Some religions do this, though all have the potential to do this since religions and cults depend on the same psychology. One important distinction is that cults insist and depend on this, while religions allow a person to be a casual member. Thus, all religions are not cults, but all religions can become cult-like (and can cause individual leaders to create sub-cults within the religion. Some Catholic orders definitely fall into this category.)

At one point in my life I took the religion of my birth very seriously. Leaving it in my thirties proved easier than I expected, but looking back, I'm astonished, chagrined and embarrassed at how much of my free will I turned over to others (and, mind you, this is a religion that preaches that free will is one of the most important things around.)

Another interesting thing cults and religions can do is to simply redirect an obsession from one thing to another. So an alcoholic may join a religion and become a devoted volunteer. Yes, that's good, but what happens if their faith slips or the leader they put their trust in betrays them in some, perhaps even otherwise benign, way?

(Now we get into the philosophical territory of whether people in general really can change that much at a deep level or whether much of our changes are merely redirecting our impulses and desires.

Regardless, I do think it could be shown that people who change to the extent they can out of deep self-motivation are more likely to stick with that change than people who change in order to please others. I think it could also be shown that for some people, it really doesn't matter WHY they changed their behaviors, the change sticks.); 3/24/10, 12:59 PM
pst314 said...: "...I commend to all Theodore Dalrymple's book 'Romancing Opiates: Pharmacological Lies and the Addiction Bureaucracy'..."

I second that. Just finished reading it a few days ago. Excellent book. Dalrymple's book is based on his many years of experience treating addicts.; 3/24/10, 1:08 PM
Joe said...: Yeah Joan...whatever.

I'm perfectly happy being Catholic. I'm a convert. But please lay off...I find I could be at the parish pretty 3 or more nights a week, mayhap more, Scouts, RCIA, Bible Study, Dave Ramsey, Knights of Columbus, Church Fair planning, Prep, and on and on....

We have a position on health Care, Illegal Immigration, Womyn in Priesthood, Womyn in the Deaconate, pornography, War, Poverty, again on and on...

There's the first collection, the second collection, the Bishops' Annual Appeal, our Capital Campaign, Flowers for Easter, a chance to play poker, a chance to play casino games, a chance on the 50-50 Raffle...and on and on.

Bottom-line: LIGHTEN UP FRANCIS. It was a joke, but if you want to get all Prissy about it, yeah, the Church wants you there pretty much as a part-time job, wants you to conform to a whole raft of positions that are "Catholic" and hits you up for cash multiple times a week.

All of which I don't mind, but I don't deny them either.; 3/24/10, 1:21 PM
Scott said...: "I've heard these statistics for over thirty years and there are several well done studies to back it up."

But then, as Mr Althouse Cohen noted,

"It's easy to keep believing in a dogma if you don't look at any of the evidence that goes against it."

So until someone can actually link to one of these studies "proving" that 12 Step programs are not efficacious, then I'll just assume that it's garden variety bullshit. This is the internet. You can do that.

In any case, talking about efficacy and AA in the same breath is sort of stupid. AA isn't treatment. The people who go to meetings find them useful. The people who don't probably don't.

One of my pet peeves, though, is when courts send people convicted of DUIs to go to a certain number of AA meetings. Although some people do get sober under these circumstances, there are a lot who don't, and who end up resenting being sent there. This is understandable. AA is for people who have a desire to stop drinking. If there is no such desire, then there is no reason to go.

wv: retab :); 3/24/10, 1:24 PM
Joan said...: Bottom-line: LIGHTEN UP FRANCIS. It was a joke.

No, it wasn't, as evidenced by the fact that you responded the way you did. All that stuff you listed? Doesn't contradict a word I wrote. Yes, your parish church asks for your participation, both in time and money. But you can't deny that if you don't participate in any of that, they'll still welcome you whenever you decide to show up, however infrequently that may be.

That is not cult-like.

You want to slag on the church, that's your right -- but I don't have to let it go uncontested.; 3/24/10, 1:31 PM
Joan said...: Joe -- I mean, c'mon -- look at my profile picture. It's there for a reason.; 3/24/10, 1:33 PM
Joe said...: That is not cult-like.

And had you read my post closely you would have discovered that was my VERY POINT, thank you.

I was pointing out that IF, AA was a cult or cult-like, then how much more so my parish or mosque...the for the reasons I enumerated. I concluded by stating that I believed that NEITHER was cult-like….so LIGHTEN UP FRANCIS.

I can point out the foibles of being Catholic and NOT be anti-Catholic….just like I can point out that my life partner snores and doesn’t like doing the dishes. That doesn’t mean I want a new life partner, merely that I am cognizant that my life partner is not perfect, far from it. Parenthetically, let me state that I am even further from perfect than my life partner and that truly I have “married up” to the extent it is possible to do so in this life. So too, my parish…I derive IMMENSE joy from it, but I still notice when my parish “snores, burps, or farts.” Now if a discussion of the “cult-like” nature of my parish disturbs you, please move on….because we are simply going to have to agree to disagree on this issue.

My view of the Church is the view of TS Eliot in his THE HIPPOPOTAMUS…as I read it, Eliot acknowledges the foibles of the Church and the person, mired in the swamp, but does not deny their Divinity and Salvation, for all that.; 3/24/10, 1:42 PM
Greg Hlatky said...: God - and we - know that the Church has done some horrible, horrible things over its history.

It is said that the Church truly is a divine organization: how else could it have survived 2000 years under such incompetent management?; 3/24/10, 1:49 PM
Michael said...: As I said earlier I stopped drinking twenty years ago. I used AA extensively in the first couple of years to get me through the early days but haven't been in years. The percentages being thrown around are, of course, meaningless. I would guess that there are many people who have successfully used AA to stop drinking and then have gone on with their lives free of alcohol and AA. The guys active in AA have to conclude, for their own reasons, that people that leave AA do so to resume their drinking lives. Thus the wacky statistics.

If one thinks of AA as a cult then I would avoid it. There is clearly a lot of nonsense spouted in AA but it is a club that is full of losers and drunks so what would you expect? In general if you are just sober you might question whether something you have heard is BS or the truth. Generally you should go with your instincts and accept it as what it probably is, BS. But the overriding theme is "don't drink." If you carve out all the other stuff, all the stuff you don't like but adhere to this one principal you will succeed at ending your dependence on alcohol. And after a year or so, it will probably never cross your mind to have a drink.

Finally, AA proves without a doubt that the stresses of an investment banker, housewife, plumber, biker, petty thief, insurance salesman and house painter are identical.; 3/24/10, 1:53 PM
Joe said...: God - and we - know that the Church has done some horrible, horrible things over its history.

And how much more so the "State." Torquemada NEVER killed as many, either in absolute or proportional terms, than did Yezhov, Yagoda, Beria, Himmler, Pol Pot or Mao...Last century over 100 million folks killed as "undesirables" by the "State", makes the "intolerance" of the religious pale into insignificance, doesn't it?; 3/24/10, 1:54 PM
Joan said...: I can point out the foibles of being Catholic and NOT be anti-Catholic

I think what we have here is a tone issue. I read your posts with a dismissive tone, you're insisting they're light-hearted, just noting the "foibles" of a dearly loved organization.

My problem is that there's a lot of Catholic bashing around, and I am conditioned to read anti-Catholic statements, however kindly they may intended, in a negative tone. I apologize for over-reacting to you, personally, but I still believe that what I wrote has a lot of value for other readers who may come to your posts from a perspective similar to mine. Were you and I having this conversation face-to-face, I can assure you I wouldn't have given you the lecture.

I ask you to please think carefully before making such comparisons in the future. There are a lot of people out there who do think that the RCC is a cult, and giving them any fodder whatsoever is unfortunate.

FWIW, I don't believe AA is cult either, but I have no experience with the organization. People in any group can be unduly swayed by a charismatic leader, and if corruption is revealed later, devastation results. I submit that's much less likely to happen in the RCC, where the focus is - rightly - on Jesus Christ, and not on any earthly leader.; 3/24/10, 1:55 PM
Joe said...: Finally, AA proves without a doubt that the stresses of an investment banker, housewife, plumber, biker, petty thief, insurance salesman and house painter are identical.
Oh yeah...it's why I liked Rush Limbaugh's problems. People making hundreds of millions of dollars can be addicts...they all aren't on Skid Row, and just because you're "functional" doesn't mean you're NOT an addict.; 3/24/10, 1:57 PM
Joe said...: And Joe talks about AA as cult-like and one of the things he points out is cults have charismatic leaders...AA has NO leaders, charismatic or otherwise. Groups, at least the ones I attended, have no leaders...they have "old timers" but no leaders. To the extent that there was leadership; it was by example and 'suasion. Each person took it in turn to lead meetings, and the decisions of the group were based on CONSENSUS, we all agreed or not...the very antithesis of a "cult."

Sorry, I kept hearing "Dennis the Peasant" in my head as I wrote that...."We're an Anarcho-Syndicalist Collective"......; 3/24/10, 2:02 PM
Joe said...: Any way I've talked too much...you all have fun.; 3/24/10, 2:02 PM
Scott said...: @Michael:

"Finally, AA proves without a doubt that the stresses of an investment banker, housewife, plumber, biker, petty thief, insurance salesman and house painter are identical."

It's like church was back in the day when just about everybody went to church. You learned that you had a kinship with people in your neighborhood who were different from you.; 3/24/10, 2:03 PM
Alex said...: A lot of people like to get fucked up.

I think this might be the real secret to it all. I know why I drink, it's to get a buzz.; 3/24/10, 2:51 PM
Alex said...: And how much more so the "State." Torquemada NEVER killed as many, either in absolute or proportional terms, than did Yezhov, Yagoda, Beria, Himmler, Pol Pot or Mao...Last century over 100 million folks killed as "undesirables" by the "State", makes the "intolerance" of the religious pale into insignificance, doesn't it?

Except back in the middle ages, the Church was the state so you just proved the other guy's point.; 3/24/10, 3:09 PM
Joe said...: Except back in the middle ages, the Church was the state so you just proved the other guy's point.

Reading for understanding is NOT your forte is it....

Torquemada NEVER got 100 million folks, or the same percentage of populace that those 100 million represent.

So, NO, I did NOT make the other guy's point. But please don’t hesitate to contribute when the Spirit so moves you.; 3/24/10, 3:22 PM
Joe said...: Joe (the other Joe) will you please read what I fucking wrote. This just pisses me off. I DID NOT say AA was a cult. I said 12-step programs use "cult-like techniques". That phrase is important.

Step three of AA, specifically, is "3 - Made a decision to turn our will and our lives over to the care of God as we understood Him."

Surrendering your will to someone else is one of the defining factors of a cult. The word like, modifies that (surely you understand the concept of simile. If someone takes a car to a mechanic and says "my engine makes a sound like that of a dog barking" the mechanic wouldn't say, "are you saying your engine is a dog?"); 3/24/10, 3:41 PM
Penny said...: "But then, as Mr Althouse Cohen noted,

"It's easy to keep believing in a dogma if you don't look at any of the evidence that goes against it.""

It's also easy to "frame a problem" to come up with the answer you want, AND the answer that society can accept.; 3/24/10, 3:52 PM
Joe said...: Step three of AA, specifically, is "3 - Made a decision to turn our will and our lives over to the care of God as we understood Him."

Surrendering your will to someone else is one of the defining factors of a cult.

I would not consider turning my will and my life over to God, or some other Higher Power as You/We/I choose to understand it/Him/Her is actually turning one's will over to SOMEONE. Certainly not in the same sense that the people of Jonestown turned their will and their lives over to Jim Jones or the Davidians turned their will and their lives over to Koresh.

So NO, AA really isn't "cult-like" is it...or if it IS, then EVERY church, synagogue and mosque is also a "cult-like" following.

Sorry your "evidence" is pretty weak so far...By your definition the RC Church, and the United States Marine Corps are also "cult-like"...when pretty much anything is "cult-like" the term loses precision and utility.; 3/24/10, 4:08 PM
Alex said...: Joe - from the standpoint of militant atheists ANY religion/church is a cult.; 3/24/10, 4:10 PM
Joe said...: Joe - from the standpoint of militant atheists ANY religion/church is a cult.

as could be said of militant atheists......and still your term lacks precision and seems to fail in its understanding of AA, as well. It's not jsut AA or churches, but also sports teams, military units and militant atheist organizations or the NAACP or Operation PUSh that now could be considered "cult-like." Agian when anything can be cult-like what value is the term?; 3/24/10, 4:15 PM
Michael said...: Joe: Why don't you just go have a drink and relax?; 3/24/10, 4:21 PM
kjbe said...: Joe at 4:08, I'd agree. I think the phrase "as we understood Him" covers this. It's up to each of us to define for ourselves. There is no singular God, here.; 3/24/10, 4:24 PM
Joe said...: Joe: Why don't you just go have a drink and relax?, mayhap I can...mayhap I can't go to the track...or just smoke a little marijuana..who knows.

But if someone's going to use "cult-like" they're going to have to do a better job than the other Joe did.; 3/24/10, 4:29 PM
bagoh20 said...: "If you start smoking pot at 13 and spend your teen years stoned, as the young man I know did, your brain development will literally be stunted."

I'm screwed.; 3/24/10, 5:44 PM
Eric said...: Sure, addicts have a choice. Even if you're the most easily addicted person on the face of the earth you don't need to take that first dose of whatever it is.

I'm the kind of person who can sit down in front of the television with a two pound bag of Doritos and eat the entire thing without even realizing it.

But knowing that, when people offered me various drugs in college I turned them down.; 3/24/10, 6:24 PM
Joan said...: bagoh20: I'm screwed.

Depends. If you were stoned but managed to finish high school, go to college, or get and hang onto a job, you'll probably be fine.

If you got high every day, flunked out of high school, never held a job a day in your life, got sent to juvie and then prison for various petty offenses, moved up to H from pot, and turned to drug dealing to support your habit... you've screwed yourself.

By which I mean, you've made it a lot harder to play it straight, because you don't know the rules, or, more importantly, the thought patterns behind the rules. You can still learn them, but it's going to take a lot of work, and you're going to have put in years before knowing what's good and what's bad, what's right and what's wrong, are things you really don't have to think about, because you just know.

For you, I'm hopeful. I love your screen name. It is - bag o' H2O, isn't it? That's what we all are, bags of water...

wv: being (deep! LOL); 3/24/10, 6:30 PM
Jaz said...: Without attending a drug alcohol treatment program under the care of medical professionals, you cannot hope to achieve complete recovery.; 3/25/10, 9:43 AM