Go read “The Addictive Personality and the Non-Randomness of Addiction” by Rob Arthur on his blog, Narco Polo.
Harvard, Hazelden and the Center for Addiction Medicine conducted a study which shows a couple of things: 1. When young people enter treatment, their motivation is high, but their coping and self-efficacy skills are low; 2. Those who have the highest success rates, 3 months post-treatment, have the highest levels of self-efficacy and coping skills.
So, they spent money to figure that out.
When entering treatment, study participants reported high levels of motivation to remain abstinent but lower levels of coping skills, self-efficacy and commitment to mutual support groups. During-treatment increases in these measures predicted abstinence from alcohol or other drug use at three months post-treatment. Self-efficacy or increased confidence in ability to sustain recovery was the strongest predictor of abstinence.
When they say “support group,” what they mean is AA or NA. Twelve Step is the only treatment option these kids received. Therefore, what this study cannot demonstrate is any evidence of the efficacy of 12 Step treatment. It would be irresponsible to even make that suggestion.
Slaymaker of Hazelden adds, “The young people in our study were quite motivated to do well in treatment but lacked the confidence, coping skills, and commitment to AA that are critical to longer-term success. Treatment appears to work by increasing their confidence and ability to make and sustain healthy, recovery-related efforts.”
The findings suggest residential treatment provides the boost that the young people need. By reducing their psychological distress, developing their recovery-focused coping skills, increasing their commitment to AA and other groups [they mean NA, not SMART], and by enhancing their overall confidence to stay clean and sober, young people make meaningful changes in treatment that position them for improved outcomes. Because self-efficacy was a strong predictor of abstinence, it may serve as a useful clinical summary indicator to monitor change and relapse potential among young adults in treatment.
They’re not saying AA is important; they’re saying commitment to AA is. Still, the study doesn’t demonstrate this at all, except by default. Since AA is the only treatment option provided, the honest conclusion would have to be that commitment is important. Throwing AA in as a factor is disingenuous, akin to claiming that Pop Rocks are part of a balanced breakfast if you sprinkle them on your oatmeal and fruit.
Does it seem to anyone else that the conclusions they draw are inconsistent with the information they gathered in this study?
Young adults undergoing addiction treatment arrive ready and willing to make the personal changes that bring about recovery, but it’s the help and guidance received during treatment that build and sustain those changes, according to a longitudinal study published electronically and in press within the journal Drug and Alcohol Dependence. The study was conducted collaboratively by the Center for Addiction Medicine at Massachusetts General Hospital and Harvard Medical School and the Butler Center for Research at Hazelden.
By DOUGLAS QUENQUA
SAN DIEGO — Imagine a vaccine against smoking: People trying to quit would light up a cigarette and feel nothing. Or a vaccine against cocaine, one that would prevent addicts from enjoying the drug’s high.
Though neither is imminent, both are on the drawing board, as are vaccines to combat other addictions. While scientists have historically focused their vaccination efforts on diseases like polio, smallpox and diphtheria — with great success — they are now at work on shots that could one day release people from the grip of substance abuse.
“We view this as an alternative or better way for some people,” said Dr. Kim D. Janda, a professor at the Scripps Research Institute who has made this his life’s work. “Just like with nicotine patches and the gum, all those things are just systems to get people off the drugs.”
Dr. Janda, a gruff-talking chemist, has been trying for more than 25 years to create such a vaccine. Like shots against disease, these vaccines would work by spurring the immune system to produce antibodies that would shut down the narcotic before it could take root in the body, or in the brain.
Unlike preventive vaccines — like the familiar ones for mumps, measles and so on — this type of injection would be administered after someone had already succumbed to an addictive drug. For instance, cocaine addicts who had been vaccinated with one of Dr. Janda’s formulations before they snorted cocaine reported feeling like they’d used “dirty coke,” he said. “They felt like they were wasting their money.”
It’s a novel use for vaccines that has placed Dr. Janda, who is 54, in the vanguard of addiction treatment. Because addiction is now thought to cause physical changes in the brain, doctors increasingly advocate medical solutions to America’s drug problem, leading to renewed interest in his work.
So says ALVA NOË at NPR:
When the American Society of Addiction Medicine recently declared addiction to be a brain disease their conclusion was based on findings like this. Addiction is an effect brought about in a neurochemical circuit in the brain. If true, this is important, for it means that if you want to treat addiction, you need to find ways to act on this neural substrate.
All the rest — the actual gambling or drug taking, the highs and lows, the stealing, lying and covering up, the indifference to work and incompetence in the workplace, the self-loathing and anxiety about getting high, or getting discovered, or about trying to stop, and the loss of friends and family, the life stories and personal and social pressures — all these are merely symptoms of the underlying neurological disease.
But not so fast. Consider:
All addictive drugs and activities elevate the dopamine release system. Such activation, we may say, is a necessary condition of addiction. But it is very doubtful that it is sufficient. Neuroscientists refer to the system in question as the “reward-reinforcement pathway” precisely because all rewarding activities, including nonaddictive ones like reading the comics on sunday morning or fixing the leaky pipe in the basement, modulate its activity. Elevated activity in the reward-reinforcement pathway is a normal concomitant of healthy, nonaddictive, engaged life.
Doing drugs, in the name of science
U. of C. lab, led by respected researcher, studies implications and effects of Ecstasy and more
There is a place at the University of Chicago where you can get and openly take methamphetamine. Or Ecstasy. Or alcohol.
Or a placebo.
Because the place is a research lab, the Human Behavioral Pharmacology Laboratory, under the direction of psychiatry professor Harriet de Wit, which for decades has conducted some of the most important drug research nationwide.
She studies mind-altering drugs, including those that can be abused or lead to addiction. And she is one of only about 40 scientists in the U.S. who use human volunteers.
“We’re interested in how the drugs make people feel,” de Wit said. “The overall goal (is) to look at how people differ in their responses to drugs, (which) might predict what kinds of people might be at risk for abusing them.”
There are a few really interesting observations in this article, like this recovery culture heresy:
“Our perceptions are narrow; we only see certain things,” she said before she left Chicago for a vacation in Patagonia. A drug can be a “little like travel. It opens up new ways of seeing.”
(Don’t miss the sidebar link to “What’s Happening at the Lab Now.”)
Who Falls to Addiction, and Who Is Unscathed?
Here is what a NY Times writer has to say:
Is this good news or bad news? Mixed blessing? War?
There is an age-old debate over alcoholism: is the problem in the sufferer’s head — something that can be overcome through willpower, spirituality or talk therapy, perhaps — or is it a physical disease, one that needs continuing medical treatment in much the same way as, say, diabetes or epilepsy?
Increasingly, the medical establishment is putting its weight behind the latter diagnosis. In the latest evidence, 10 medical schools have just introduced the first-ever accredited residency programs in addiction medicine, where doctors who have completed medical school and a primary residency will be able to spend a year studying the relationship between addiction and brain chemistry.
“This is a first step toward bringing recognition, respectability and rigor to addiction medicine,” said David Withers, who oversees the new residency program at the Marworth Alcohol and Chemical Dependency Treatment Center in Waverly, Pa.
(h/t soberbychoice. Thank you!)
Plain language summary
Oral naltrexone as maintenance treatment to prevent relapse in opioid addicts who have undergone detoxification
Opioid dependence is considered to be a lifelong, chronic relapsing disorder. Substantial therapeutic efforts are needed to keep people drug free. Methadone treatment plays a vital role in detoxification or maintenance programs but some individuals who are on methadone continue to use illicit drugs, commit crime and engage in behaviours that promote the spread of communicable diseases. Naltrexone is a long acting opioid antagonist that does not produce euphoria and is not addicting. It is used in accidental heroin overdose and for the treatment of people who have opioid dependence. Naltrexone is particularly suitable to prevent a relapse to opioid use after heroin detoxification for those for whom failure to comply with treatment has major consequences, for example health professionals, business executives and individuals under legal supervision. Medication compliance and retention rates with naltrexone treatment are however low.
In this review of the medical literature oral naltrexone, with or without psychotherapy, was no better than placebo or no pharmacological treatments with regard to retention in treatment, use of the primary substance of abuse or side effects. The only outcome that was clearly in favour of naltrexone was a reduction of re incarcerations by about a half but these results were from only two studies. In single studies naltrexone was not superior to benzodiazepines or buprenorphine for retention, abstinence or side effects. The review authors identified a total of 13 randomised controlled studies that involved 1158 opioid addicts treated as outpatients following detoxification. Less than a third of participants were retained in treatment over the duration of the included studies. The mean duration was six months (range one to 10 months). None of included studies considered deaths from fatal overdoses in people treated with naltrexone.
A few days ago, I wrote to Ed Brayton, author of the awesome blog “Dispatches from the Culture Wars” on Science Blogs to see if he’d be willing give my Feminist piece a look, and he surprised the bejeebus out of me by responding. And today, he put up a post and opened the topic up for discussion on his blog! Go visit, please.
So, Ed agrees that this subject should be addressed in skeptic circles, but takes issue with my belief that “I would have died without AA” is a thought-stopping cliche. When I wrote that, I knew how provocative that line would be, especially because I know that there are people who would be dead had they not done something to overcome their addiction. Believing that it was literally AA that saved one’s life (as opposed to the assertion of one’s free will over ingrained habits and behaviors, or the decision to do something, whatever it is) prevents people from being able to think critically about it. They literally believe that outside of AA await jails, institutions, and death — and whether that’s true or not, believing it’s true is all that matters. Poking holes in a belief system that is keeping someone alive is not very nice.
A variation on this is the arguments that AA members, or people in the field, use to stop any criticism: “An alcoholic might read what you wrote, decide not to go to AA and die!”
So, I wanted to address that issue right up front, because it seems to be the thing that gets in the way of a genuine exploration of this issue. The bottom line is that if we are concerned about the one guy who might die because we criticize AA, we also have to be concerned about the many, many more people who have died of their addictions because we are not having this conversation.
Thank you, Ed.