The majority of people that overcome alcohol dependene do so without any treatment

[Legerity]

Just some interesting information that I recently came across. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the majority of people who overcome alcohol dependence do so without any treatment. And alcohol dependence or alcohol abuse actually do have criteria for diagnosis in the DSM, whereas "alcoholism" is ambiguous and can be used to mean different things to different people. The details can be found at http://www.spectrum.niaaa.nih.gov/features/alcoholism.aspx. Overall, the point is that the majority of people who overcome alcohol dependence do so ON THEIR OWN, and half of these people that do so on their own are now able to moderate their consumption.

I think this brings up a lot of questions related to the nature of substance use in general, be it alcohol or anything else.

The fact that the majority of people quit on their own, and half of them do not abstain but actually moderate their drinking, goes completely against what we are being told about addiction, at least in the majority of rehabs. The majority will not permit even the idea of moderation, and instead tell us that we require a lifetime of treatment or else we are going to fall back into our old behavior.

I also believe the fact that these people are not entering treatment is probably the reason that they are able do so. They are not influenced by the current dogma of addiction treatment and do not have to consider their alcohol consumption to be an all or nothing affair. If they go out and have one drink instead of getting drunk, then this is a good night for them. Had they just left a rehab and had one drink, it would have been considered a massive failure.

Now compare this to the success rates of rehabs. Is it 10%? 5%? They all seem to offer some pessimistic odds that they will be open about, in order to make the point that dependence is a serious issue not to be taken lightly. And certainly it shouldn't.

But I just have a few questions based on this, and I'd be interested in hearing what people have to say:

-Why do the majority of rehab centers teach that abstinence is the only viable solution, if half of those that overcome alcohol dependence on their own are able to now drink moderately?

-Why are we being told that we absolutely must seek treatment, if the majority of people who quit or reduce consumption do so without any treatment at all?

-Do actual diseases typically go into natural remission without treatment?

-What do you think is allowing these people to quit/reduce on their own?

I don't mean to put down rehab centers, or to in any way discourage people from going to one if they think it will benefit them. I went to one in the past and have no regrets about that. But looking at their effectiveness, I'm just not convinced that they're doing as much good as we would hope.

So what do you think?

 

[villian]

i think it's all about stopping when you are ready to stop..

 

[Missykins]

What constitutes "treatment?" What constitutes quitting "on your own?"

Where do you get the "5-10%" rehab success rate?

 

[Lolie]

It's worth noting that addiction, abuse and dependence all have quite specific meanings in this context and that they're not interchangeable.

What is really frustrating if the circular reasoning which often gets used in these arguments - that if you were able to stop abusing alcohol on your own then you were just a problem drinker or you just had a habit because addicts cannot control their use so the only hope addicts have of recovery is abstinence.

Stanton Peele is one of the people who heavily promotes questioning of the disease model of addiction and he relies a great deal on the empirical evidence that the majority of people who abuse substances at some point stop on their own (he's fond of using the example of college students binging during their college years and becoming non-abusers in early adulthood).

There is certainly a core group of people (I often see this estimated at around 10% regarding alcohol) for whom their drug/alcohol use has a major destructive impact on their lives and who do seem unable to get it under control without assistance. And despite the fact that all treatments for drug and alcohol abuse have a pretty low longterm success rates it is understandable that when substance use is severely compromising someone's ability to function normally in society, people will seek out anything that offers hope of a remedy even if its success rate is low.

 

[Bojangles69]

This is because too many rehabs/na teach "learned helplessness" and external locusts of control to people.
They tell addicts if they don't get away from certain environments they are doomed some miserable existence of hell for the rest of their lives. We are all "powerless" over drugs/alcohol once we have been addicted to them. "Once an addicts always an addict". Almost like the same way religion presents life to us, with a bunch of bs metaphors and analogies.

A lot of the models/diagrams these places teach are gross generalizations that only apply to a specific population of people (those 5-10% that DO succeed). While if those other 90% were taught that THEY control their environments, maybe they'd actually start acting like it too.
Like I can't stop myself from calling a drug dealer or driving to cop or hanging out with drug addicts UNLESS I burn my phone and leave the state.. or start hanging out with all recovering junkies.

Fuck that. I see these people who go to rehab countless times and wind up randomly getting a year or 2 clean, then they become spokespeople for all these same meems that were initially promoted through the programs. They come into threads like this telling others "once an addict always an addict", "read the 12 steps or your addictions gonna kill you".

Its nothing but all scarcity thinking and generalizations. I've been to rehabo SO MANY fucking times its pathetic. Once I finally accepted responsiblity for my actions and realized what rehab actually was, I finally accepted the objective truth that ONLY I am the one who will ever really get myself clean.
Why are rehabs willing to tell you this... but they still try to make you believe you can't do it w/out them? It makes no sense.
"Only you can get yourself clean... but if you're not here with us then you're fucked"
Well why do I even need you in the first place?
I don't.
It all comes down to money imo.
Rehab is no different than these same bs manufactures promoting nicorette gum. And nicorette gum has a significantly higher failure rate then merely cold turkeying tobacco. Its the same fucking thing. Teach someone they need a gum to quit, or a program to quit, and the second that gum/program is gone watch them cower to their drug of choice.

ALL YOU TAUGHT them was to be helpess. Teach people that they have control, power, CAN avoid environments w/out needing to relocate planets away, and maybe people will start actually feeling/acting like its true. Same way you teach them weak ways to deal with shit and most of them fail. People are extremely impressionable, I think a lot of rehabs/na forgets this. The same time you're trying to teach them that they have a disease, is the same time they actually start to act like they have one... relapse relapse relapse.
"if you think about it you already did it". FUCK THAT. So because I think about killing someone on the road at least once a day I should just go do it?

I made the decisions that taught me how to be an addict, and I will be the one who also makes the decisions to learn how to live life w/out drugs. But for the most part I'm done with rehabs/NA. Complete fucking waste of time. No single person will ever tell me what I need for myself but myself. Call me stubborn, naive or jaded I don't really care. I've gained more confidence and self-esteem doing this by myself these last 5-6 months than I did trying to work rehab programs for years on end. Strength is something you work for yourself, the more you look to other people for strength the more and more you lose on your own.

 

[Legerity]

@villian: I agree that people can stop using just about any method if they are completely determined to. But if this is a case, wouldn't a particular method that says the opposite, that says that the particular treatment is an absolute lifetime necessity, does that not teach the person that it is NOT up to them and they are dependent on something else for themselves to stay clean?

@Missykins: On that page when they mention treatment they are referring to rehab/AA. In Stanton Peele's response at http://www.psychologytoday.com/blog/addiction-in-society/201010/what-percentages-people-in-recovery-are-treated-and-untreated he also mentions "general therapy". So "on your own" means just that, without any kind of formal treatment whose goal is to overcome alcohol dependence.

My rehab told me that 10% get clean. I had just read some other dismal statistics in another thread, and have heard similar numbers being thrown around. I don't know what the specific success rate is, and I think these numbers are based on observation rather than any actual study. My point was rehabs themselves will often admit to low success rates in an attempt to get people to take their problem seriously so that they beat the odds.

@Lolie: Yes it was at Stanton Peele's blog that I read about this, I find that he is often very insightful. I would agree with you that there some people who will most likely do much better with formal treatment and complete abstinence for the rest of their life. My issue is more with the fact that just about everybody is being treated in this way, rather than the sub-group for which it is effective. There are not really many treatments or programs that will offer support to people who want to moderate or practice harm reduction. Moderation Management is one that I know of, for people who want to reduce their drinking. It's pretty much up to the individual to do their own research and come post on online forums.

@Bojangles69: I enjoy your feedback, you put your heart into just about every post of yours. Learned helplessness and self-fulfilling prophecies really do seem to play a huge part in this. People usually go into a rehab when they are pretty beaten down, and unless the counselors really know what they are doing (addiction counseling does not require much training), they can also cause a lot of harm. I hope things are going well for you...

So to it's really a very individual thing. What works for one person does not necessarily work for another person. I just don't think there is enough support those who do not want to go with the dominant treatment approach in North America....

 

[Cyc]

If someone offered me a millions dollars to moderate my drinking to one night a week for 10 years straight, you bet I would.

If someone installed a device that would zap me every time I took a sip of alcohol over and above 10 drinks a week, I'd drink 10 drinks a week.

The idea that moderation is impossible is a lie. Feel free to test me on the first one, and I'll prove it.

 

[donnie080208]

^ha ha very good post, it seems if an addict has something they think is truly worth stopping for they will, simple as that.
imo the 12 steps is dragging down addicts, in what is the 21st century with its outdated, unproven, superstitious nonsense

 

[Jabberwocky]

Everything should be examined from time to time for efficacy. I think all the quantifiable data that we can get out to be examined and utilized.

I read a book by a neurobiologist that posited that humans have raised serotonin and better cognitive function when they felt themselves to be a part of a tribe. Having a social group that one finds OK and from whom one feels acceptance might be a primary component for AA's efficacy for some people.

I run hot & cold on AA. Even when I'm not positively disposed towards AA one has to give them credit for availability and affordability if nothing else. For many people there aren't any other options so I have been trying to remember that my big picture societal and public policy issues don't matter much to the people who have got to take some action right now.

There was a local news story about acamprosate and naltrexone a couple years ago. Someone from a local alcoholism council (AA but not AA because AA can not have spokespersons on the TV) ranted against drugs to treat alcoholism. He said it was dangerous because it would make people think they could drink with impunity and give up support groups which are the only proven treatment available.

I'm guilty of considering AA/NA the same movement as NIDA and the treatment industry. Its more complicated than that but there is a huge interdependence between treatment & drug counselors as an industry and AA/NA. AA folks can say we have no lobbyists or people trying to influence public policy.Sinn Fein could always say that they were political and not terrorist or military but we did always kind of know who they were talking for.

I think many drug counselors, drug policy, and treatment folk are shocked and appalled that their are inquires into efficacy or motives because they see the movement as "all good and deserving of all our love". The press has had a love affair with 12 step and treatment for quite a while. Can you picture being almost anywhere asking for help and not hearing AA/NA as the first recommendation. So that story I saw with the alcoholism council guy bashing naltrexone ignited a fire in me regarding the public policy cabal that exists around AA. I know AA says its not them. Most AA people are not involved in trying to keep AA preeminent in the area. AA is though, the locus of the movement. And AA folk do tend to violate their traditions when conveniant but use them as a steadfast defense at other times. AA & NA have both run TV ads in my market. Attraction rather than promotion clearly prohibits that. But when it comes to court cards or coercion by courts and prisons they cite "no position on outside issues" and "each meeting is autonomous"

Edit: I think if the disease model is used then there does have to be an acknowledgment of the spontaneous remission phenomena mentioned in the first post. Further if the disease model does get used I don't think treating alcoholism/drug dependence as a single clinical entity is good at all. "Alcoholism is alcoholism-you got the same thing millions have had before you and we know what what to do with you."Probably no method is going to score a hundred percent except by confinement and zero access to substances. I know some treatment centers do try to develop individualized plans and utilize different modalities. Some do their assesment in a cursory way but end up finding about everyone to be the "garden variety" who get standard treatment.

-Why do the majority of rehab centers teach that abstinence is the only viable solution, if half of those that overcome alcohol dependence on their own are able to now drink moderately?

Telling people abstinence is the only way leaves you without moral or legal liability. If they drink and kill themselves or others- "Hey I told them not to." Also its likely very experience based that many people fail at abstinence. Lot of reasons for that. I know abstinence has many failures as well. Some authors state that binges in relapse are much worse for 12 step participants then other groups. I suspect prophecies of how bad it will be if you leave these rooms are a big factor. Anyways recommending moderation seems the more dangerous option to the treater and the treated. I think Puritan residual effects are involved too. Abstinence isn't always just about health and well being- sometimes its about penance and atonement as well.

 

[donnie080208]

@enki good post cant disagree with anything youve said there. I do think in the last 20 years or so the 12 steps and a.a. has become somewhat fashionable in the media, with all the so- called T.v./Film stars talking about their recovery/working the program etc.., etc..
Also like you pointed out , the 12 steps are nearly allways the first thing a doctor will tell a person with a drink problem to try . This is wrong imo as a.a. has no statistics showing its sucess rates and from my experience A.A./N.A. isnt allways the best place for advice for people who are vunerable coming of drugs/alcohol, Professional psychologists and doctors should have the main imput in a damaged addicts early efforts to get sober, so they can see what else may be mentally wrong. Ive overheard a.a. members tell others in the group to stop taking psych meds etc..disgusting and dangerous advice

 

[Legerity]

@Cyc: Good point. That reminds of a study where they gave cocaine users "vouchers" that could be used for movies or sports equipment if they were able to prove they were abstinent with urine tests. A full year after the program, the voucher group had double the success rate of those who received only counseling (80% to 40%). This can be read at http://www.thecleanslate.org/self-change/addiction-is-not-a-disease-and-it-matters/ under the section "Substance Use Is Not Compulsive, It Is A Choice". References are listed at the bottom of the page.

@Donnie: I do think that 12-step programs are outdated. But at the same time I don't want to deny the help that they are providing for many people. They offer a huge social support network which many people need. But I do think that what they are teaching is untrue, and for many people completely ineffective.

@Enki: Yes it really does seem that feeling part of a group is healthy and pretty much necessary for our well-being. I think this is what most cults provide - and instant group of intimate friends. I think it's overly simplistic to call AA a cult, there are some major differences between AA and cults that have leaders dictating the followers' lives. But I do think there are some cult-like characteristics in that people decide to join and follow the teachings because they want to feel part of the group. And this can allow a lot of people to live better lives than they otherwise would have. But if somebody is not willing to agree with the philosophy, then it just doesn't work.

And it's a good point that one-size-fits-all treatment is not the best approach. For some people, 12-steps WILL be the best approach. For other people, moderation may suit their needs. For those that do not want to completely abstain, they need to be taught that it IS possible and that they do have a choice over how much they consume. How else would movie vouchers be enough motivation to get people to abstain? I'm sure this isn't a good approach for some people. but for others it is completely valid.

The idea that once a substance is consumed a person is no longer in control and will continue to consume more and more is completely ridiculous. Sure, there is TEMPTATION to continue to use. And maybe a person isn't willing to stop if they can continue. But it's not IMPOSSIBLE. There have been plenty of times when I've had the options of doing drugs and not doing them, or of stopping once having started. I'm sure most people can think of some time when it just wasn't worth it and so they make the decision to call it a night and use the rest another time.

So I think many approaches all have their own place. But regardless of people's individual choices, I think that the whole idea of addiction is in general misunderstood. Decisions should be made based on accurate information, not dogma.