Thursday, January 16, 2014

Competition vs. cooperation

Well, today we're all talking about an article in Slate.  You can skip the comments in that one, BTW.  It's just a bunch of "AA sux!!! / AA rulez!!!"

We're talking about it because it mentions the Sinclair Method as "a slightly more radical approach" to medication-assisted addiction therapy.  The writer sums it up thusly:  it "encourages patients on naltrexone to continue normal social drinking. The idea is that the alcoholic will become deconditioned to the formerly pleasurable effects of drinking."

This is not a terrible summary, given that the writer had only a few lines to work with.  The trouble is that the writer then proceeds to ignore the targeted-naltrexone method and to talk only about daily naltrexone therapy (daily dose) and how well that translates to traditional goals (days of abstinence).  When success is measured that way, naltrexone is indeed only "sort of" effective.  There's no way for the casual reader to realize that the patients who "achieved" fewer days of abstinence may have actually made more progress in getting rid of their addictions.  

It's often said that alcohol is a problem if it causes problems.  If that's the case, wouldn't it make more sense to measure efficacy by looking for a decrease in alcohol-related problems?  Which group had fewer legal troubles, fewer missed work days, fewer spousal complaints?

Wouldn't the Slate writer be surprised to learn that the nonabstinent naltrexone users improved most of all?  Certainly a great number of the readers would be.  That's precisely what the research shows, and yet it isn't communicated.

No sensible person could disagree with the article's final conclusion, though:
Today, the most vocal critics on either side of the debate are stuck in the bad old days, when medical treatments were untested and mutual-help groups demanded immunity from evidence. The prescription is now collaboration, not confrontation.

I do this in my own little way.  I sometimes attend LifeRing meetings -- I find them useful in learning how to couple with my troubles and my past, now that I'm no longer addicted.  I'm always fully honest about having used the Sinclair Method, despite LifeRing's official abstinence-only policy.  Their information on how to live without alcohol is useful to me, and my information on how to extinguish addiction is useful to them.

Sure, there are hidebound folks who just can't wrap their heads around it.  There are also people, especially online, who'd rather argue than move forward.  The rest of us, though, can progress further when we cooperate.

Even AA says that "someday there may be a cure."  If the entrenched establishment insists that someday cannot have come, they will be replaced in their turn by others who've grown up seeing the impressive results from fresh approaches.

We must keep Steps-only people from continuing to dominate, since thousands of people would die before they gave up control voluntarily, but we should remember that some of them are Steps-only through honest ignorance rather than conscious control-freaking.  The truth speaks for itself, and it's often better demonstrated than argued.


  1. Unless ones drinking is completely out of control. They should just keep drinking. Also eat good food, take Milk thistle. Anyway even heavy drinkers out live non-drinkers:,9171,2017200,00.html

  2. Yeah, I was surprised to find that heavy drinkers and binge drinkers live longer than teetotalers. I think more research is needed there, though. We shouldn't conclude too much from one study.

    Most people do just keep drinking, throughout their lives, so I'm not quite sure what your point is in the first sentence. Wouldn't most people interested in the Sinclair Method or other MET be those whose drinking is out of control?

  3. People who seek out help for out of control drinking, e.g drinking that is ruining their lives, would be the ones needing some form of help but only if they want to change.

    I suppose my point is we are starting to live in the "nanny state", where the state wants to tell us how much we can drink, eat and so on.

  4. I live in the USA, and here there is no limit on how much alcohol we are allowed to drink. If I were in my own home, I could quite literally drink myself to death without breaking any laws.

    However, courts sometimes either force or coerce people into "alcoholism treatment" (usually the failed Minnesota Model) after the people break laws against drunk driving or suchlike. I disapprove of that strongly, in part for reasons I've already discussed and in part because coercing people into 12 Step groups is a violation of religious freedom, and also because it's just dumb. Although that last one is kinda subjective. :)

    I suppose there are restrictions we could get along without, like "open container" laws. If someone wants to stand on the sidewalk with a beer, who's harmed? It's really quite asinine that a pub-goer who smokes has to ditch the beer for a smoke and lose the smoking while he grabs a drink. Revolving door, anyone?

    In between the "necessary laws" and the "oppressive laws" is an absolutely huge group of "silly laws." To me, the ban on open containers of alcohol seems more silly than oppressive.