Tuesday, November 24, 2009

from Stanton Peele

there seems to be much contradiction
about the disease concept of alcoholism...

The Stanton Peele Addiction Website, November 20, 2009. This blog post also appeared on Stanton's Addiction in Society blog at

United States Changes Its Mind on Addiction - It's Not a Chronic Brain Disease After All

Nora Volkow and the National Institute on Drug Abuse (NIDA) insist, based on peering at MRIs, that addiction is a chronic brain disease. You know - you saw it on HBO, and your kids learn this in school.

But, as I point out to Nora, she's looking in the wrong place. If you examine actual human lives, addiction is an interaction between people and their worlds that changes with time.

Now the NIDA's sister organization - the NIAAA or National Institute on Alcohol Abuse and Alcoholism (remember, Joe Biden wants to change the names of both organizations because he knows addiction is a disease) - agrees with me.

According to Dr. Mark Willenbring, director of treatment and recovery research at NIAAA, "We're on the cusp of some major advances in how we conceptualize alcoholism."

This discovery, which I have described for decades , is based on the most sophisticated study yet conducted of Americans' drinking histories. Called NESARC (National Epidemiologic Survey on Alcohol and Related Conditions), the study questioned a random national sample of over 43,000 Americans about their lifetime and current drinking.

Of this group, almost 4,500 had been alcohol dependent (read alcoholic) at one point in their lives. And, although 70% had never been treated or gone to Alcoholics Anonymous, most had ceased their alcoholism - even though most had not stopped drinking!

NESARC Past-Year Status of Alcoholics (columns percentaged)
Past Year Status Treated (n=1,205) Untreated (n=3,217)
Dependent 28 24
Abstinent 35 12
Drinking w/o dependence 36 64
Source: Dawson et al. (2005).

About 30% of Americans had experienced some kind of alcohol disorder, including abuse along with dependence, but about 70% of those quit drinking or cut back to safe consumption patterns without treatment after four years or less.

Only a tiny minority (1%) fit the stereotypical image of someone with severe, recurring alcohol addiction that Alcoholics Anonymous, addiction disease proponents like Volkow, and American mythology consider typical. According to Willenbring, "It can be a chronic, relapsing disease. But it isn't usually that."

Take that, Nora!

According to the lead researcher on the project, Deborah Dawson, NESARC data show that alcohol use disorders are "less a mental disorder than a maladaptive pattern of behavior."

In a three-year follow-up of initial respondents, Dawson and her colleagues found that alcohol dependence was "strongly associated with changes in mental/psychological functioning." Alcohol dependence causes significant decreases in mental health and coping, but social functioning and mental health underwent "significant increases among those who achieved full and partial remission from dependence" (meaning alcoholics who continued drinking with either no, or reduced, problems).

Now comes the most amazing part. The increases in social functioning and mental health "were equally great for abstinent and nonabstinent remission from dependence, but improvements in bodily pain and general health were associated with nonabstinent remission only" (that means the alcoholics who reduced their drinking).

My Life Process Program is exclusively abstinence based - although we recognize the reality that lifetime abstinence rarely occurs. But government researchers - based on the best epidemiological research yet conducted - now inform us that people who recover without quitting drinking are healthier than those who quit altogether.

Go figure.

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Health Pain said...

Responsible Use of Narcotics
These points to an interesting article in findrxonline where they talk about this subject it is necessary to inform the community.
It is ultimately the patient's responsibility to use narcotics responsibly.
A few years ago, narcotics were only prescribed after surgery, severe trauma, or for terminal cancer because of a concern over the possibility of addiction. Recently, they have been cautiously prescribed to treat moderate to severe non-malignant chronic pain in conjunction with other modalities such as physical therapy, cortisone and trigger point injections, muscle stretching, meditation, or aqua therapy. Unfortunately, the upsurge of narcotics as medical treatment also increased associated cases of abuse and addiction.
Derived from either opium (made from poppy plants) or similar synthetic compounds, narcotics not only block pain signals and reduce pain, but they affect other neurotransmitters, which can cause addiction. When taken for short periods, only minor side effects such as nausea, constipation, sedation and unclear thinking are noted.

However, when narcotics are taken for several weeks to months, these side effects can become more challenging: loss of effectiveness due to built-up tolerance, possible addiction, or overuse for a temporary "high," not for pain. Because of the potential for addiction, whether physical (anxiety, irritability, nausea, vomiting, abdominal cramps and insomnia) or psychological (compulsive use, craving the drug and needing it to "feel good," narcotics are considered controlled substances findrxonline indicated in their medical articles, which means that the FDA and DEA govern their distribution, prescription, and use and classify them into different schedules as per the Controlled Substances Act of 1970.

While weak narcotics such as Tramadol (Ultram) and Schedule IV opioids analgesics such as Darvon or Darvocet N 100 have a low risk for physical dependency and addiction with mild side effects such as dizziness, sedation, headache, nausea and constipation, Schedule III opioids analgesics such as Lortab, Tylenol #3, Vicodin and Vicoprofen have a low to moderate potential of physical or psychological dependence. Demerol, Dilaudid, Duragesic, Oxycontin and Percocet, which cannot be automatically refilled, fall under Schedule II because of their high abuse potential, and possible severe physical or psychological dependency.
In view of the fact that narcotics can be addictive, they should only be prescribed when no other alternative is available and should only be taken as directed by your doctor. Most often, patients are required to consent to adhere to certain rules regarding the use of their prescription listed in a "Narcotic Agreement" between the patient and physician. Often, violation of this contract, especially selling, sharing, or trading the medication, attempting to obtain duplicate pain medication prescriptions from different physicians, and attempting to have the medication refilled early, at night, or on the weekend, to mention a few, would result in the patient's discharge from the practice.
So, take responsibility for your actions and know all your treatment options. Narcotics are rarely your sole savior.

Shadow said...

i have a very controversial opinion on this... if treated (and going to meetings year after year) alcoholism stays in the forefront of one's mind. the focus is therefore on alcohol all the time. if one decides (and is able) to stop by oneself, the focus fades, and changes to a lesser important level in one's live, and therefore releases you from the bond/trigger/compulsion/awareness??? and release means recovery???

Recovering Son said...

If alcoholism and addiction are not a disease, why does AA and NA have such good results.

Isn't the purpose of clinical studies to find results, the truth of simply what works and what doesn't. And the 12 step groups work.

I see a couple of problems with their study.

One, they are assumming that alcohol abusers are honest. I've heard hundreds talk about how they duped the medical establishment - including psychologists - on their drinking habits. So, the whole study hinges on whether the population sample is telling the truth.

And from my 26years sober, I am not inclined to believe that somehow people who are naturally chronic liars are coming clean with shrinks.

Two, you have to look at the study's sponsor's motives. 12 steps programs takes alcohol treatment away from clinicians and puts in in the hands of the co-sufferers who help others for free.

The temptation to go "professional" has been a temptation for AA from the beginning. The founders found that out by hard won experience.

How much more money could the clinicians make if the treatmemt were transferred to their offices.

Rehabs and related counseling already is a multi-billion dollar business. It would grow exponentially.