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Comment by specproc | Hacker News Reader

People can choose to identify as they wish, and I'm not for one second diminishing that identification. But problematic drinking is very different to diabetes, it's also highly varied in its expression and not as deterministic as the label suggests.

I totally understand why it's a helpful framing for some people, but it really isn't for others.

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To extend this, there have been programs that have attempted to fix the problems of alcohol addiction but not require patients to remain sober. The core concept being that there is an underlying cause to the alcohol problem and the alcoholism is an expression of that problem, not itself a root. Thus once the root cause is fixed, the alcohol is no longer a trigger.

Another form allows participants to drink but uses a medicine which induces unpleasant effects from alcohol. Thus participants self train an avoidance pattern and break the positive feedback loop.

These should not be seen as contrary to the AA abstinance approach. For some people that appears to be the most effective means. For many other people, AA is not.

I suspect as we advance our understanding we'll come to find distinct subdiagnoses in alcoholism and alcohol abuse that suggest different treatment strategies. Right now our understanding feels very rudimentary.

> Another form allows participants to drink but uses a medicine which induces unpleasant effects from alcohol.

Actually, the successful medical method doesn't introduce unpleasant effects, but removes the pleasant ones and introduces 'extinction'.

The medication is naltraxone. Look up 'Sinclair method'.

> To avoid strong side effects such as nausea and vomiting, practitioners typically wait until after the alcohol detox process before administering naltrexone.

If you take one or two drinks, yeah it will just be not good. If you binge, you be puking your guts out.

This is not true. I have had ~15 drinks on Naltrexone which definitely qualifies as a binge although I never "truly" binged as I never blacked out after starting treatment via The Sinclair Method. It wasn't a great time especially the next morning but I didn't get sick at all.

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