Inside Out, Outside In

What we bring to the world, and what it brings to us

What Science Tells Us About Treatment of Addiction

In a recent NPR show, Radio Boston, on WBUR in Boston, Dr. Lance Dodes talked about his new book and stated that 12-Step programs not only don't work, but are not backed by scientific evidence. This statement is not only false, but dangerous for the many millions of individuals suffering from addiction, and from their families and friends who are deeply affected. Read More

Thank you Dr Lance dodes

Oh and Stanton peele.

They do speak the truth amen to that...

Rehab and AA load of bs, all that higher power and always an alcoholic crap keeps a person in constant fear, that is no way to live a life.

Reality versus Acadaemia

To make a statement of not attacking a person and then doing so is perhaps a refection of the personality of the author.
I have not read the article in question but find the academic vitriol of Professor Beresin quite unpleasant and unnecessary.
If one considers psychology being the servant of sociology then we see the academics using their cognitive abilities together with science to form an intransigent belief system more than often borne from their own childhood experiences. This undoubtedly will lead to denial in such matters as spirituality, which by nature has no scientific basis.
Alcoholism is a 'symptom' and not a disease. True treatment lies in addressing the underlying cause. The treatment of the symptom is very important but without addressing the cause will likely result in relapse and commonly a revolving door situation. Clearly Beresin is correct in his comment that treating the symptom is far better than doing nothing at all but perhaps a little lateral thought and understanding of Dodes meaning, rather than intellectual interpretation, would be more helpful.
The problem we face in substance abuse and indeed in the majority of anxiety and depression instances relates to how to deal with the underlying issue(s) and who is competent to do so. To understand the dilemma this creates we must revert to history to find the root causes. We can trace this clearly to circa 'the enlightenment' period, industrial revolution etc,. In the western world society had been controlled by the nobility and religion. Despite the corruption the importance of the existence after death was of paramount importance. In fact it was the advent of the printing press that allowed 'indulgences' to be printed en masse which paid for the Cistine Chapel. Control of society moved from the nobility and the church to that of sociology, where uneducated groups controlled society through the advances in science. Today the internet is sociology's greatest weapon. The greatest change and that which is the cause of the majority of the problems we are addressing has been the changing of the natural maternal role (nurturer) to that of co-provider. The importance of a mother to a child from the third trimester onwards is of paramount importance yet 'dumping' children to allow a mother to work is commonplace. We cannot expect balanced children to result from this situation and the majority of addictions etc. are a direct result of it. Yet the problem is compounded by the child's lack of love leading to a need for substitute satisfaction. This takes the form of gratification and it's easiest prey is the vulnerable. Hence the child becomes a mother who instead of loving her own child utilizes the child for that gratification. The problem is simply compounded generation by generation. If the cycle is to be broken it can only be by therapy that allows a willing mother to understand the truth rather than the illusion. And so to the question of who can do so? There we are faced with the dilemma that those visiting psychotherapists are vulnerable, and it is a perfect occupation for the abused child to receive the same gratification as the mother can with a child. Undoubtedly there are caring and effective psychotherapists but the epidemic is of such significance that one may be considered foolish to risk involvement with them. I welcome the opinions of social deviants, society has repressed freedom of speech enormously and whilst I may disagree with aspects of both Dodes and Besesin I fully respect and encourage them to voice their opinions freely without the stigmatization seen all too often, made in an attempt to control.

response

There is not always an underlying cause for someone with a chemical dependence. With many alcoholics their primary problem is alcohol. Many of their problems dissipate once they resolve to stop drinking. It is a complex issue. Everyone is different in why they drink and treatment should be treated as such.

I am wondering if Dr. Beresin

I am wondering if Dr. Beresin actually read Lance Dodes book or just listened to WBUR Radio Boston? I'm only half way through Dr. Dodes book but it appears that Dr. Beresin is taking Dr. Dodes findings out of context or misconstruing his opinion.

For example Dr. Beresin states: Why then, would anyone debunk care that works? The answer is axiomatic. There is nothing scientific about being dogmatic. Furthermore the public is ignorant about AA philosophy and efficacy. This book is an, "Expose," on AA, not a proclamation of abject failure.

You criticize Dr. Dodes for not elaborating on his own model of approach to the problem of addiction, but his book is NOT about his model, it is about AA.

You then go on to lump together and generalize that AA and other treatments that facilitate patient engagements with groups are, "among the most effective and best studied treatments for facilitating addictive behavior change." You then cite mainly government sources (that have their own agenda). Ok fair enough but again this book is about AA.

You site the Cochrane Collaboration findings as if Dr. Dodes speciously morphed the findings. I may have answered my original question here, apparently you did not read the book. You state the Cochrane study, "actually concluded that AA and 12-step treatment was shown to be as effective as anything else to which it was compared." Dr. Dodes in his book said the same thing! “No experimental studies unequivocally demonstrated the effectiveness of AA” in treating alcoholism.

I could go on and will after I finish Dr. Dodes book.

This is a great book if for no other reason than it brings to light the unscientific dogma of AA and how most Rehab facilities use the AA template in-house and also to farm out their expensive clients to free AA meetings!! That may make for a great, "Business Model," for Rehabs, but not always a good therapeutic or moral model.

I speak from experience. I had a heroin addicted son who went to multiple rehabs. They all promoted and fell back on the free non-educated baby sitter of AA.

I was unpleasantly surprised

I was unpleasantly surprised by this article- the attacking tone, references to Dr. Dodes' "agenda", "overwhelming scientific evidence" of which there is none cited, as it does not exist, and logical flaws throughout the piece. I expect better composure of two people who are professors of psychiatry at Harvard and I am not going to adjust my expectations.

Drop out rate, tracking the drop outs

Dr. Beresin dodges the elephant in the room: the huge drop out rate from AA. This has been estimated from as low as 75% to as high as 90% during the first year of treatment.

Only by tracking the dropouts and comparing them to those who sayed in can he determine whether the AA experience is helpful or not. If the dropouts were harmed by AA, that needs to be accounted for. No doctor would tout a medicine that harms as many patients as it helps. And obviouusly, except for the hopelessly self-destructive, those who dropped out of AA dropped out because it was not helpful.

What the best national government survey data compiled by the NIAAA shows is that most problem drinkers stop on their own, without any treatment, and that about half of them return to drinking moderately without any ill effectgs.

http://www.medscape.com/viewarticle/703483

Go and read the Wiley article referenced

Here's its conclusion:

"No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed."

That will tell you everything you need to know about the reliability of this submission.

Science?

How can religious conversion be supported as "addiction science"? Why do credentialed people consider this the "gold standard" that can never be surpassed EVER? Will someone wake up and realize that the idea of a "spiritual disease" is as idiotic as it sounds?

Solutions to addiction

By attending the classes of AA will really help the addicted people to get rid of these things. The 12 step mutual help is a right way to start get started. Thanks for sharing these useful post.

Obviously Beresin didn't read the book

Hard to know which is most objectionable here: Beresin's obvious failure to read a book he's critiquing, his serious misunderstanding of the studies he refers to, or his weirdly unprofessional, ad hominem tone. And Psychology Today gave him a blog? I'd be curious to know how they can justify that. For shame, Dr. Beresin.

Sounds like Dr. Dodes' disciples are out in force

AA does work, I've seen it myself.

One problem I have with most studies on the subject is that they use too short a time frame to measure success. Most people make many tries before finally conquering an addiction, so I think a ten-year window should be considered for determining whether treatment is successful or not.

addiction

In my experience as a person thirty-eight years in recovery,and twenty-five years in the field,Phyciatry has no business in the treatment of alcoholism. First,you hang labels on people that they usually do not deserve. Second,having done that,you treat the psychiatric diagnosis,and ignore the alcoholism. In effect you are simply treating a symptom,which may go away after the client gets sober. There is an assumption deep seeded in the psychiatric community that all alcoholics are mentally ill. To do that,one must also assume that all mental patients are alcoholics,which is nonsense. If the therapist has no personal experience he or she is useless. It is like going to an over weight dietician. I have no use for psychiatry in the treatment of addiction. They often do more harm than good. I am convinced that most shrinks get into the field,so they do not have to get a real job,to justify all those little letters behind their name. If a person who is an alcoholic,the mental problem is a symptom of his alcoholism,not the cause. My advice to psychiatrists is to get a real job.

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Eugene Beresin, M.D., is Professor of Psychiatry at Harvard Medical School.

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