Friday, June 27, 2014

Treatment or Penance?

Targeted naltrexone administration ("the Sinclair Method," our focus here) is the bee's knees for people addicted primarily to the opioid reward.  For people whose addiction functions more via GABA receptors, daily high-dose baclofen has some risk but also some good results.  Baclofen is still in the "early results are promising" stage, but the Sinclair Method's efficacy is well-established.

What disturbs me is that this has been well-established for some time and yet we still think people should just abstain from alcohol and join a support group.  That approach pretty much doesn't work.  95% of the people who try it will fail.

Why do we most strongly promote the method which is both most difficult and least successful?  I think we believe that addicts deserve to suffer.

If someone has a broken leg, we fix the problem.  We don't get into a pointless argument about whether he jumped off the roof, fell by accident, or was thrown by an assailant.  We fix the leg first.  But if someone develops an addiction, hoo boy does the blame start flying -- and the addict should be forced to do it the hardest possible way, as penance.

If the guy jumped, he was foolish to do it.  Whether he jumped or was pushed, he still deserves reasonable medical care.  The guy who jumped shouldn't be denied proper medical care on the grounds that he did something foolish.

If we denied real medical care to everyone who contributed to his/her own problem, there would be no cardiac care for anyone who ever ate fast food or drank coffee.  Cancer treatments would be denied to anyone who ever went near carcinogens.  The entire field of sports medicine would disappear.  Since none of us are perfect, most of us would die young.

It's time to stop insisting that addicts need spirituality instead of proper care.  It's time to treat addicts with no more but no less respect and concern than anyone else with a health problem.  It's time to let addicts have proper medical treatment.


  1. I think some of the resistance actually comes from a healthy skepticism about quick fixes for complicated problems. When you tell someone that there's a pill that has the potential to cure alcoholism, they're very likely to jump to the conclusion that they're being scammed before even seriously considering the matter. The only way most people know to address alcoholism is through lifelong abstinence; a solution that makes it sustainable for an alcoholic to drink moderately just sounds too good to be true.

    I've mentioned TSM in the context of a few online conversations about alcoholism, and gotten virtually no response. I've spoken to friends about it, and while some have been inquisitive and supportive, others have nodded politely and bided their time until the subject changed. Even when I point out how dramatically my own life has changed (and I've really gone in the last couple of years from being a low-life to being a responsible adult), no one quite seems to believe me.

  2. That's what I would like to change. Healthy skepticism is all well and good in most contexts, but the idea that lifelong abstinence is required is one from the past several decades. Head back in time fifty years and you wouldn't find many people with preset beliefs about lifelong abstinence. Accordingly, what seems like healthy skepticism now is really a belief in one particular paradigm -- and not one that's particularly well-supported.

    If we can program the public, we can deprogram it. We have a hard task because programs, unlike simple facts, have zealots and missionaries.

    I've noticed the same lack of curiosity that you have. It's like most people don't even care -- and that, I believe, is an outgrowth of the idea that addicts are bad people who should be redeemed via meetings and Steps.

    That's assuming the person even has a clue what AA is actually like, of course. Many don't. Many assume it's actually some sort of quit-drinking program, with no idea that it's really all about seeking God.

  3. Nicely said !!