Goodbye to the 12-Steps?

December 6, 2008 1:06 PM

French Doctor Finds Cure for Alcoholism in a Pill, Causing a Stir. Having himself suffered from dipsomania, Dr. Olivier Ameisen, claims in his book, Le Dernier Verre (The Last Glass), that the muscle relaxant bacloflen suppressed his craving for alcohol, curing his alcoholism. A top cardiologist in France, and doctor to a former French PM, Ameisen has called for clinical trials to verify his bold claim, while causing some in the field to accuse him of irresponsibility for suggesting alcoholism can be cured by a pill, although other pills are in the works.
posted by Azaadistani (54 comments total)

I have yet to read the links, but I thought I'd mention that my father who has low-grade multiple sclerosis (concentrated in the legs) is prescribed a ton of baclofen to combat his spasticity.
posted by pyrex at 1:11 PM on December 6, 2008

This guy wasn't drinking for lesure, he was self-medicating for an anxiety problem. Maybe the baclofen (which lets him "sleep like a baby") is just a replacement for the relaxing effects of alcohol.
posted by orthogonality at 1:13 PM on December 6, 2008 [3 favorites]

Heroin cured my morphine addiction.
posted by PeterMcDermott at 1:18 PM on December 6, 2008 [2 favorites]

Baclofen has already been tested for many addictions, including alcoholism, methamphetamine and cocaine. It is like every other addiction drug and treatment so far: works for some people, some of the time.

Ultimately, this will lead to many options for people, which is a good thing. Unfortunately, the resistance by proponents of 12-step programs (many of whom run treatment centers or work there and refuse to acknowledge that 12-steps aren't the best or only option) to the use of medications in addiction treatment has been a long-standing problem in the U.S.

Some 90% of American addiction treatment is still 12-step focused in such a way that people who don't find the program helpful are often told that their only alternative is "jails, institutions and death." This obviously can produce hopelessness and is malpractice in my view.

Because socializing is such a critical part of addiction, I tend to think social support for recovery-- which, contrary to 12-step myth can come from partner, family, friends, not just a support group-- will always be important in many cases. Similarly, because so much of addiction is learned, some sort of behavioral treatment-- whether that be a support group, a relapse prevention class, even just reading a book till you know about cues, etc.-- will probably always be needed for many.

But what I've learned in 20 years free of cocaine and heroin and studying this subject intensively is that there is no one way and there are exceptions to everything so there may well be some people for whom a pill is a complete cure. I just expect them to be doctors (if you limit your treatment program to doctors, you can get 80% clean pretty much no matter what you do to them) typically, not unemployed, uneducated homeless people.
posted by Maias at 1:21 PM on December 6, 2008 [14 favorites]

This guy wasn't drinking for lesure, he was self-medicating for an anxiety problem.

That's usually the difference between a casual drinker and an alcoholic. A lot of people who have problems with alcohol are self-medicating for one reason or another.

Maybe the baclofen (which lets him "sleep like a baby") is just a replacement for the relaxing effects of alcohol.

Could be. OTOH, it might not be as destructive, which is something. Getting to a place where you can deal, even if you're still self-medicating, is better than not being able to deal. Weed can do the same for some people.
posted by krinklyfig at 1:22 PM on December 6, 2008 [1 favorite]

I'm curious if the muscle-relaxant suppressed his craving, or the good doctor decided that no matter how sauced he may have wanted to be, the prospect of choking to death on his own vomit may have been unappealing. Hell, maybe he was just high and didn't feel like getting up to fix a drink.
posted by Dark Messiah at 1:23 PM on December 6, 2008

Also, this is another example of crap science reporting: five seconds on pubmed finds lots of info on baclofen for addictions including alcoholism, so crediting this guy with a new finding and not talking to the people who *have* actually already studied it is pretty lousy.
posted by Maias at 1:24 PM on December 6, 2008 [1 favorite]

Heroin cured my morphine addiction.

It's not that different from methadone or controlled dosage. Clean heroin at a maintenance dosage actually helps a lot of junkies maintain a more or less normal life, and at that point they can start dealing with the problems underlying the addiction and work on getting clean. It works better than you might think, but there's a lot of resistance to it, like the clean needle programs, which do work from a public health POV.
posted by krinklyfig at 1:25 PM on December 6, 2008 [6 favorites]

It's not that different from methadone or controlled dosage. Clean heroin at a maintenance dosage actually helps a lot of junkies maintain a more or less normal life, and at that point they can start dealing with the problems underlying the addiction and work on getting clean.

I wish my Mefi search skills were on par with some people's, but I recall -- years ago, sadly -- someone posted a very interesting study showing heroin addicts, if given a clean supply, live normal, productive lives exactly in-line with non-users. The study followed, IIRC, 100 users; all were healthy and lived 'normal' lives for the length of the study (can't recall how long, but it was at least 5 years, I think). Once the study was cancelled, over 50% died due to overdoses and complications involving tainted street heroin.

I really wish someone could dig up that article. And no, I am not advocating heroin use, but the current treatment methods -- through 12-step programs -- clearly needs heavily re-evaluation, if not outright abandonment.
posted by Dark Messiah at 1:30 PM on December 6, 2008 [4 favorites]

And one more thing, it's not the muscle relaxant effects of baclofen that seem to affect craving. It is one of a class of medications that affect GABA receptors (in this case, the B receptor) and this may reduce craving for alcohol in a kind of substitution effect (alcohol also affects GABA receptors similarly, but more globally).

So Peter is right about the methadone/heroin comparison, although interestingly GABA-B agonists also seem to help with stimulant addictions, where these drugs would not act like a substitute as they would have calming, rather than stimulant effects. Baclofen is being studied for anxiety and depression, at least in some animal models so far.

Also, baclofen is not believed to have abuse potential in itself, so it's more like Prozac for depression in that it won't get a naive user 'high" in the way methadone would.

There are GABA agonists that do cause a high, these are known as benzodiazepines.
posted by Maias at 1:30 PM on December 6, 2008 [2 favorites]

The cure for alcoholism is a muscle relaxant associated with CNS depression and increased GABA levels , with withdrawal symptoms similar to or exceeding those of alcohol withdrawal, and which most commonly causes drowsiness, confusion, and nausea (see page 3)?

I suppose a stiff Jack and Coke is also a cure for alcoholism.
posted by Benjy at 1:33 PM on December 6, 2008

Dark and Krinkly, there's lots of research on both methadone and heroin maintenance showing that they can be effective for many patients. Switzerland just legalized heroin maintenance and England uses it as well and is doing further research. Holland already has it. But there will always be a place for methadone even with heroin maintenance because a longer acting drug can lead to a more stable experience for some people.

Methadone only needs to be taken once a day, typically. Heroin needs to be used more often and so if you are trying to work, you probably want methadone. One size doesn't fit all!
posted by Maias at 1:35 PM on December 6, 2008

Not the first drug purported to cure alcoholism.
posted by StickyCarpet at 1:39 PM on December 6, 2008

Methadone only needs to be taken once a day, typically. Heroin needs to be used more often and so if you are trying to work, you probably want methadone. One size doesn't fit all!

I definitely agree with that. I'd prefer to have it all available, even experimental treatments like ibogaine.
posted by krinklyfig at 1:40 PM on December 6, 2008

Benjy, you are misunderstanding maintenance. Maintenance drugs often have the same effects as the drug being replaced but that doesn't mean they are useless.

The problem in addiction is *not* dependence on a drug. It is compulsive use of a drug that wrecks your life. If you can get someone on a safe, stable, regular dose that doesn't involve crime, they will build a tolerance to side effects like drowsiness, confusion and, in the case of drugs like methadone and heroin, to the "high." So now that you aren't chasing the drug any
more or high all the time any more or high then withdrawing most of the time, you can work and love.

If you replace addiction with dependence, you've done a wonderful thing. You've moved a person whose drug use was ruining their life to a point where the drug use is pretty much irrelevant. They take the drug and get on with it. So who cares if they are still taking the drug? Only people who don't realize that addiction isn't about drug use, it's about dysfunctional drug use.
posted by Maias at 1:40 PM on December 6, 2008 [16 favorites]

Maias: I know, for sure, the study was based in Europe. Damn, now I'm going to have to dig that up. I've always found the subject fascinating -- as well as utterly disturbing, especially when seeing just how far down someone can fall. My own personal belief is that the problem is just as much mental as it is physical; no one solution will ever 'cure' the problem, only correct application of behavioural and medical therapy. And then, of course, there are the iron-willed folks; everyone's different, hence my own pet theory.
posted by Dark Messiah at 1:42 PM on December 6, 2008

Not the first drug purported to cure alcoholism.

That's true, but the brush off by the blog is unfortunate. It did have a lot of promise when it was being used in controlled settings when it was still being used for psychological experiments. And I can say by anecdotal, personal experience that it can work. But I can also say that there's no guarantee it will work, particularly when not taken under controlled conditions.
posted by krinklyfig at 1:43 PM on December 6, 2008

Benzodiazepines have been used for this for awhile. So, no, a pharmacological approach isn't something new. The problem is in how we as a society view addiction as a personal weakness, and so approaches like the 12 step programs are what, in America at least, we are left with.
posted by Eekacat at 1:51 PM on December 6, 2008

So who cares if they are still taking the drug?

Maias, I care. People who are dependent on a drug - whether because they can't control their own blood sugar or might have dangerous seizures or start hearing the voices again or are HIV positive or want to be high - they are living a much less free life than most.

There's the schedule for taking the meds, the food and drug interaction concerns, usually extra stress one an organ or two, and there are women who want to have babies... None of that is dysfunction - that's the cost of drug use. If you can possibly not be dependent on a drug, then that's something you should want.

I'd call being merely dependent half a loaf.

Half a loaf at best.
posted by Lesser Shrew at 2:07 PM on December 6, 2008

12 step programs (at least the ones I know about) don't view addiction as "personal weakness." Far from it, they say addiction is a disease. Also, I've never heard any resistance among 12-steppers to medical treatments. If drugs can help, then by all means take the drugs. This one seems promising, and I pray it helps people. As others have said, tho, most addicts have problems that go far beyond dependence. Drugs are not going to help with most of those problems, again, IMHO.
posted by MarshallPoe at 2:08 PM on December 6, 2008

I love the idea of a pill that cures alcoholism; whatever gets addiction treatment out of the hands of predatory religious groups like AA is fine with me.
posted by Pope Guilty at 2:08 PM on December 6, 2008 [9 favorites]

The idea that AA is a "predatory religious group" is truly laughable.
posted by MarshallPoe at 2:16 PM on December 6, 2008 [4 favorites]

It's an organization which teaches that you are powerless to control your own behavior and can only be freed from dependancy on alcohol by surrendering control of your life to God. This message is not aimed at the populace as a whole, but specifically at people who are in a shitty situation; the majority of AA attendees are forced to either attend meetings or go to prison.

It's a distinctly religious message and it is aimed directly at people who are weak and at a hard time in their lives. I'm not sure what else you want.
posted by Pope Guilty at 2:21 PM on December 6, 2008 [18 favorites]

krinklyfig writes "It works better than you might think, but there's a lot of resistance to it, like the clean needle programs,"

Because addiction is a "sin" that should be cured by "willpower". Or if not cured, then punished.

Let's face it, a lot of people get off of punishing others. That's why the idea of Hell is so popular. That's a large part of why pleasurable drugs are illegal, even when, like marijuana, they are taken by the ill to ameliorate their symptoms.

People like to punish. Reformed "sinners", like those running AA meetings, are particularly zealous. Like the born again Christian who never tires of telling you what a Hell-raiser he used to be (until Daddy or the Army or Jesus beat it out of him), they feel that having overcome their "sin", they're in fact better than those whose sins were minor and who don't need to constantly announce them or a "program" to overcome them.

And of course, if you're not loudly proclaiming your former sins and current state of repentance, you're probably a secret sinner or closeted alky who most desperately needs the reforming only his Church or AA program or E-meter or cult can provide. Or, if you won't sign up for that, punishment.

(It's almost obligatory in the US for me to now state that I don't take any illegal drugs, and never have. Nor am I an alcoholic.)
posted by orthogonality at 2:25 PM on December 6, 2008 [4 favorites]

Whatever you do, for the love of god don't mix muscle relaxants and alchohol.
posted by dunkadunc at 2:26 PM on December 6, 2008 [2 favorites]

It's an organization which teaches that you are powerless to control your own behavior and can only be freed from dependancy on alcohol by surrendering control of your life to God.

Which demonstrates that you have no idea what you are talking about, but you have a rather sizable axe to grind. Grind away.
posted by MarshallPoe at 2:30 PM on December 6, 2008 [2 favorites]

http://www.southparkstudios.com/clips/155164/?tag=Alcoholics+Anonymous
posted by dunkadunc at 2:36 PM on December 6, 2008 [1 favorite]

People who are dependent on a drug - [...] and there are women who want to have babies..

Being on a prescription medication does NOT automatically equal "unsafe for pregnancy." There are different classifications of risk.

I have epilepsy and I plan to get pregnant by the end of '09, I've already discussed my medications with my doctor and with a few minor adjustments, it is SAFER for me and a potential fetus for me to be on medication than to quit the drugs entirely.

This sounds like an emotional plea along the lines of "Drugs are so HARD!" and not an argument based on actual fact.

Also: I'd much rather be "tethered" to my schedule of taking my meds on time than be "free" to have seizures every single day. Anyone who takes a medication because they NEED it will tell you that any accommodations necessary to get it are worth it because NOT having it is so, so, so much worse.

I imagine an alcoholic who got at least partial relief from the horrifying cravings of addiction would feel the same way about baclofen as I do about my anti-convulsants: You can have them OVER MY DEAD BODY.
posted by grapefruitmoon at 2:38 PM on December 6, 2008 [9 favorites]

http://www.southparkstudios.com/clips/155164/?tag=Alcoholics+Anonymous
posted by dunkadunc at 2:38 PM on December 6, 2008 [2 favorites]

Which demonstrates that you have no idea what you are talking about, but you have a rather sizable axe to grind.

While I have no doubt that 12-step programs have helped many, many alcoholics and addicts to daily recovery - indeed, I've seen the miracle it can work in more than a few friends and family - there is simply no denying that it takes an absolutist stance on it's understanding of addiction. It's my impression that the vast majority of people who are true believers in "working the program" are incapable of acknowledging that any other treatment is capable of the same or even better results.

Also, I've never heard any resistance among 12-steppers to medical treatments.

While there is apparently more tolerance for use of antidepressants in say, AA meetings, my impression is that, in an NA meeting, the breakdown would be 50/50 as to whether daily use of antidepressants is compatible with recovery, and about a 5/95 (for/against) breakdown as to whether daily use of maintenance opiates is compatible with recovery.
posted by irix at 3:14 PM on December 6, 2008 [1 favorite]

Irix, most 12 steppers I know take a completely pragmatic approach to the problem of addiction. If it works, do it. "Work your own program," as they say. I've never met any of the "absolutists" you mention, but I have no doubt they exist. I don't agree with them, and most of the people I've worked with in AA don't either. Most folks in AA just want drunks to get clean and be happy. End of story. There is "God talk" in AA meetings (though not as much as most imagine). Some people find it helpful. Others don't. It's just one of the "tools" that can be used to find recovery. It's funny, but I know literally dozens of atheists in AA. They don't hide it and no one cares.

I can't speak for NA, as I've never had the opportunity to work with that program, and of course I trust what you say is true (and sad).
posted by MarshallPoe at 3:28 PM on December 6, 2008 [4 favorites]

AA might not even be quite so bad if it weren't for the fact that Alcoholics Anonymous doesn't work.
posted by Pope Guilty at 3:32 PM on December 6, 2008 [3 favorites]

Maias, I care. People who are dependent on a drug - whether because they can't control their own blood sugar or might have dangerous seizures or start hearing the voices again or are HIV positive or want to be high - they are living a much less free life than most.

On the other hand, forcing them to suffer withdrawl and ritual humiliation in 12-step programs, or sending them to jail makes them more free!

Apparently freedom means the ability for people to do what you want them to. Here I had thought it was the ability to make their own choices, for good or ill.

A person with a drug addiction clearly loses agency. They can chose to fight the addiction, and perhaps prevail, or they can choose to integrate that biological need into their lives just as they do the realities of eating, and drinking, and sleeping and aging. They'll be comfotable, but their lives would be more complicated.

However, taking that choice away from them, making them take one path -- the more difficult one, clearly reduces their freedom even more.

And furthermore it replaces a biological imposition with a social one. Humans will never be free from the cruel hand of nature. Paraplegics will never walk, we'll always have to eat and sleep, and our bodies will always get weak and die. Nothing can be done about this. But what we can do is prevent humans from oppressing eachother. Slavery and discrimination are not innate in the world and can be removed. We'll always need to eat but we can make sure that people have enough food. We'll always need to sleep but we can make sure that everyone has a warm bed, for example.

And we can allow people to make choices we don't like so long as they don't hurt anyone but themselves.
posted by delmoi at 3:53 PM on December 6, 2008 [6 favorites]

I'd call being merely dependent half a loaf.

It is better than none. It needs to be said, though, that it shouldn't be up to you to decide what works for someone else's problems, especially if it works. Maybe for you, being dependent on a substance would be a serious degradation of your current lifestyle. You are not dealing with addiction, then. Being dependent and functional is a hell of a lot better than being dependent and non-functional, or even self-destructive.
posted by krinklyfig at 4:23 PM on December 6, 2008

For those of you advocating 12-step programs, here's a simple exercise for you: try to find some research that shows 12-step programs work better than psychology. Or better than nothing. Or even as well as nothing.

Anecdotes don't count. 12-step programs increase binge drinking due to the powerlessness and abstinence-only messages. Look at the data.
posted by callmejay at 4:25 PM on December 6, 2008 [3 favorites]

I started taking baclofen and about four years ago, along with a painkiller (tramadol), for a bad back injury. And it stopped me drinking alcohol completely...alcohol just became unpleasant, with spinning rooms and the like. Might have been the baclofen, might have been the tramadol. I haven't had an alcoholic drink since, but I cook with alcohol...maybe I used too much sherry in a trifle once and had a slight feeling of unpleasantness.

I moved off baclofen and onto something with less long-term nasty side effects called mobic after about six months. Those side effects sounded pretty sucky; I think it was the possibility of sudden death that got me to change prescriptions. I didn't experience renewed interest in drinking, although I have felt nostalgia occasionally. When eating a goat curry, for example, I want a Jamaican beer. Or a nice shandy gaff in summer, perhaps a Southwark bitter and lemonade, which was the low alcohol-content tipple of choice in my home state of South Australia, before the advent of light beers...
posted by chrisgregory at 4:25 PM on December 6, 2008

AA might not even be quite so bad if it weren't for the fact that Alcoholics Anonymous doesn't work.

Straw man. No one I know says AA or any other 12-step program is a cure all, or that it will necessarily work better than other alternatives. Sometimes it helps, sometimes it doesn't. That's it. Continue to grind that axe now.

And we can allow people to make choices we don't like so long as they don't hurt anyone but themselves.

Agreed. But that's an empty set, or very nearly so. Addicts almost always hurt people other than themselves. Family members, co-workers, people they kill while driving, etc.
posted by MarshallPoe at 4:26 PM on December 6, 2008

AA might not even be quite so bad if it weren't for the fact that Alcoholics Anonymous doesn't work.

Speaking as someone who's been through it and who has done a lot of research on the subject, it does work, but not any better than any other program or method, about 5% success rate. It tends to work a lot better if the person attending really wants to change coming into it, but that's true of anything, even quitting cold turkey without treatment. And like any other therapeutic method, it won't work if the person is not willing to change. Psychedelics can cause confrontation with one's own issues, even if someone has been unwilling to examine themselves. You can't really escape yourself, and in the proper setting, psychedelics can be the catalyst.
posted by krinklyfig at 4:30 PM on December 6, 2008 [1 favorite]

Agreed. But that's an empty set, or very nearly so. Addicts almost always hurt people other than themselves. Family members, co-workers, people they kill while driving, etc.

Criminalizing addiction doesn't make this problem go away, or even improve. Of course, people who harm others criminally have to be held to account, but their addictions don't have to be criminalized.
posted by krinklyfig at 4:31 PM on December 6, 2008

Straw man. No one I know says AA or any other 12-step program is a cure all, or that it will necessarily work better than other alternatives. Sometimes it helps, sometimes it doesn't. That's it. Continue to grind that axe now.

One of the problems with AA, however, is that the courts tend to see it and its offshoots (like NA) as the only acceptable court-mandated treatment choice. Unfortunate, because it won't work for everyone while other methods might work better for some people, but the law often doesn't understand these subtleties. Consequently, a lot of people who end up in legal trouble because of addiction aren't really getting the treatment they need to extract themselves from the criminal justice system and their burden on society.
posted by krinklyfig at 4:39 PM on December 6, 2008 [1 favorite]

One of the problems with AA, however, is that the courts tend to see it and its offshoots (like NA) as the only acceptable court-mandated treatment choice.

Yes, that's a good point. There are a lot of people "mandated" who don't belong in AA or NA. It would be better if the courts could mandate some sort of assessment to see what treatment might be best, I suppose. (And here I'm talking about cases where the person in question is a manifest danger to themselves or other, e.g., two DWIs, criminal acts while intoxicated, etc.).

Is there such an assessment available?
posted by MarshallPoe at 5:08 PM on December 6, 2008 [1 favorite]

Agreed. But that's an empty set, or very nearly so. Addicts almost always hurt people other than themselves. Family members, co-workers, people they kill while driving, etc.

I'm not advocating that drunk driving be legal. As for family being hurt, I understand that it's not fun, but it's a pain that stems from an inability to control what they do. Being gay and causes a lot of pain for intolerant parents, as did interracial dating back in the day.

And furthermore I'm not exactly clear why methadone maintenance would hurt family members.

As far as the legality goes (which is a side debate). It is very painful for family members to see their loved ones thrown into prison.
posted by delmoi at 5:10 PM on December 6, 2008

Pope Guilty, I might be more inclined to read your links, were it not for the fact that the guy who wrote the Orange Papers seems like a complete crank.

"It is what it is? The same is true of any organization, including the Catholic Church, the KKK, the Taliban, and the Republican Party."
posted by HopperFan at 5:24 PM on December 6, 2008

Background on the aforementioned Swiss heroin program that became law after this article was published, with accounts of how effective it has or hasn't been.
posted by Jaltcoh at 5:25 PM on December 6, 2008

I'm also not an AA member, but I'm pretty sure this is incorrect - "by surrendering control of your life to God." They always say "higher power," and when I've asked about it, they say this can mean whatever you choose.

"Majority of AA attendees are forced to either attend meetings or go to prison" - er, really? Are there statistics to support this? [genuinely asking, not snarky]
posted by HopperFan at 5:28 PM on December 6, 2008

Like other forms of menial illnesses (and I may be slammed for this but I tend to think of addiction as a form of mental illness), pills and other medication do not "cure" the illness, rather the goal is symptom management at best.
posted by edgeways at 5:33 PM on December 6, 2008 [1 favorite]

I spent 7 years in 12 step programs, going pretty much every day (mainly AA, even though my problem was cocaine and heroin: in NYC, in NA, there was an unfortunate lack of long-term recovery which meant most addicts who really wanted to get clean and not keep saying "I have 3 days" over and over and weren't into motorcycles and boasting about who did the most drugs went to AA).

I heard people tell schizophrenics and people with suicidal depression to come off their meds because they "weren't really sober." And NA absolutely did not accept methadone as recovery. Although, to their credit, people doing recovery activism now -- many of whom are 12 steppers--do accept that there are many paths and meds and maintenance counts.

I know there's a lot more acceptance of antidepressants now (this was in early 90's)-- but there is still a lot of rigidity and a sense that if you don't get clean/sober via AA you are a "dry drunk" (this is said a lot about George Bush. Much as I can't stand him, he actually represents the majority of people who recover in terms of their path-- they do so without AA or any other treatment, sometimes via religion, sometimes not).

Anyway, there is a much better system for "drug courts" devised by Mark Kleiman of UCLA who recognizes the problem with forced AA and forced treatment. It doesn't need any assessment other than one that the patient chooses.

His system mandates abstinence from the drug involved in the arrest-- if you achieve that with no treatment, with methadone, with anything else, it doesn't matter. As long as you test negative during your twice weekly tests and show up for your court dates, you're good. If you get positive drug tests, however, you get a few days in jail, immediately-- but an offer of treatment options to help, and no more than a few days for each positive test.

The idea is to make punishment quick, consistent and close in time to the offense-- which is the only way punishment actually works in changing any behavior. Our current laws make punishment disproprortionate, far in time from the arrest and very inconsistent-- this is part of why they are so ineffective.

Anyway, if you can stay clean without treatment, you don't waste time and money and treatment slots in it if you don't need it. If you think you can stay away from drugs without treatment and it turns out you can't, the pain in the butt factor of going to jail every time you test positive might get you to realize that treatment might be a good idea.

This way, people in treatment want to be there, you don't waste prison on nonviolent drug offenders, you use punishment sensibly and pretty much everyone benefits. Even more importantly, this means that treatment providers have to be attractive to patients, rather than relying on the courts to force people to come and having the patients punished when treatment fails, not the providers.

It also means the provider allies himself with the patient-- he's not an agent of the government and doesn't have to drug test and "rat out" his patients. Counselors can "meet people where they're at" and work on their goals, not the court's goals. The testing is done by the courts or a separate agency.

If you are a provider in this system and can't attract people, you don't get paid. So this improves treatment by forcing it to be more user-friendly-- the research shows that the more empathetic and kind treatment is, the better. But no one has any incentive to make it that way if the patients have no choice but to come. Of course, no one actually uses this system in full yet-- but where it's been tested partially, the results are good.
posted by Maias at 5:40 PM on December 6, 2008 [8 favorites]

What I gather from reading for some time over the subject of addictions is that people do love absolutes, one shot problem solving and believing there is one simplistic, one-time-only-forget forver solution to complex problems. Why? Because it requires less thinking, less working, less knowledge and it's damn reassuring.

Yet as there could be more than one reason for developing some kind of addiction, unless one tackles them all and at all times, there is going to be a chance, however small, of becoming addicted to something or relapsing into addiction.

Take me as an example. I relapsed into smoking cigarettes, up to a pack a day.I never expected that to happen to me, yet it happened. From my past experiences, I have learned that I can indeed quit smoking and I plan to stop again.

So far I have traced a possible reason back to an high stress period in my life, and as I realized that external attribution of cause is indeed more likely than internal, I was able to figure out that circumstances, the way I interpreted them, did indeed affect my behavior into smoking again, yet again I wasn't compelled into smoking by them. Therefore, It's in my power to stop smoking, as the circumstances no longer seem as stressful.

I was probably just trying again to "fix me up" from a down mood, in a way that does indeed work for me, at least temporarily. Yet as my accumulated experience taught me, smoking isn't a permanent fix , it's a chemical unbalance illusion that's harming me. My understanding of brain chemistiry isn't as deep and detailed as that of a specialist, so up to a point it's my belief in having understood how it works that's motivating me to quit again.

All of this understanding of my situation didn't require any AA training, I didn't start taking pills, I didn't start believing into metaphysical beings being all powerful and source of salvation. Therefore, there is at least one living example that, at least for nicotine addiction, some human can quit without any external motivatior and only relying on its own beliefs and will.

Yet this very same person has relapsed, proving that once-and-forever solutions may not exist, at least for me. Probably, other people out there are in a situation similar to mine and are feeling compelled to find just that one, forever, eternal solution to this particular issue. I think that, unless some solution proves to work well for them and without vicious side effects, they should reconsider thinking that they are helpless and should, therefore, start believing that unless somebody develops an one-pop-pill solution for them, they will be stuck with their problems forever. By this thinking they may be just be discarding solutions that may work for them, at least for some time.

Not smoking for three years straight was a great personal success, worth repeating and it's without any shadow of doubt better then not stopping at all, and with absolutely no side effects such as believing that one can't but be helped by some external agent, a god, or a man or whatever it may be.
posted by elpapacito at 6:05 PM on December 6, 2008

Which demonstrates that you have no idea what you are talking about, but you have a rather sizable axe to grind. Grind away.

No, it is you who don't know about AA.... it was founded by two ex-alcoholics who found TEH JEZUSES and turned it into a "program". AA simply gets credit for a lot of strong people's will-power, and avoid taking blame for those who can't make it.
posted by Dark Messiah at 7:20 PM on December 6, 2008

Benjy, you are misunderstanding maintenance. Maintenance drugs often have the same effects as the drug being replaced but that doesn't mean they are useless.

I came down hard with the snark, but I understand maintenance drugs--I was just kind of pissed that another piece of pop-science journalism was making the rounds. And in this case, it's being pushed by an ex-addict who suffers from anxiety disorder and is taking muscle relaxants, with literally the minimal amount of research performed. Muscle relaxers mixed with already existing substance abuse problems sound like a dangerous combination to me, and this guy has seemingly bypassed the research process by writing a book aimed directly at a troubled part of society promising a pill to solve their problems.

If this were a book about a pill that solves obesity, it would join the pile of other quick-cures that inevitably failed. Real medicine should have a little more peer review before hitting the bestseller list--see autism and vaccines or any other attention-gathering medical theory that you might see on the evening news.

That being said, I would love for this case to be the exception. I just don't want desperate people to take something that may not work, especially in this case--I shudder at what people who end up taking baclofen and then finding that one more drink sounds good might do to themselves.
posted by Benjy at 9:26 PM on December 6, 2008

People who are dependent on a drug - whether because they can't control their own blood sugar or might have dangerous seizures or start hearing the voices again or are HIV positive or want to be high - they are living a much less free life than most.

People who are dependent on electricity - whether because they can't breathe without a ventilator, need an electric wheelchair, work the night shift and need to see, or need it to play WoW - they are living a much less free life than most Amish. I say this as someone who while I do drugs chooses to more or less avoid dependence on them. Unlike many people I see every day I don't like to start the day with coffee every day till it gets that I "need my morning coffee," but I don't judge people for that.

People who are dependent on a drug ... want to be high

Nothing wrong with wanting to be high. Hypothetically earlier today I could have sat with my friend and shared a few bowls of cannabis while watching The Prestige. In this hypothetical situation I would have been smoking this marihuana because I wanted to be high. This is not a dependence on anything, to do it because I want to do it. Or did you mean that people who want to alter their state of mind and mental functions are bad and should feel bad? Like people who take naps, ride rollercoasters, have sex, stay up too late, sleep well, exercise and eat right, take therapy, eat SSRIs, etc.
posted by Sockpuppet For Naughty Things at 9:53 PM on December 6, 2008 [3 favorites]

12-step programs increase binge drinking due to the powerlessness and abstinence-only messages.

Source? Anecdotes don't count.
posted by netbros at 9:57 PM on December 6, 2008 [1 favorite]

So Peter is right about the methadone/heroin comparison, although interestingly GABA-B agonists also seem to help with stimulant addictions, where these drugs would not act like a substitute as they would have calming, rather than stimulant effects. Baclofen is being studied for anxiety and depression, at least in some animal models so far.

I'm currently taking 15 mg of Baclofen for my mystery muscle disorder, which was finally diagnosed as a version of Spastic Paraparesis once it started to fuck with my legs. I could easily say that this little generic drug has literally been a lifesaver. Finally - I have something that relaxes my muscles and removes the pain! I started it last December, on the 26th. What a great Christmas gift!

I read this article with interest, and had a small revelation. I haven't drank any alcohol since I was prescribed the drug, as it was contraindicated. I didn't drink a lot before that, but I did crave it once every month or so. But now, I have no cravings for it *at all*. It may be confirmation bias, but the desire to drink is totally gone. So is, ironically enough, my desire to play World of Warcraft - quit in March and haven't looked back.

I could also see it being used for depression. The first few days I took it, I was high as a kite, I was so happy! Everything was brighter, joy was more intense, and things just seemed calmer. That effect has waned away, but I do notice that I have more confidence in things, and thus the desire to make the various improvements in my life that I've been putting off. Baclofen is a fascinating little drug, and I wouldn't have it any other way.
posted by spinifex23 at 11:48 PM on December 6, 2008

I like how Amazon has the cover art for the book, but the publisher doesn't.
posted by cjorgensen at 2:36 PM on December 12, 2008