Hacker News Reader

Comment by hellodevnull | Hacker News Reader

As I read these techniques for fighting addiction - "solving emotional and behavioral problems, rather than having abusers forever swear off the substance", "hourlong meetings once a week at which they discuss their goals for moderate drinking, as well as tips, challenges and progress on avoiding triggers" and "motivational interviewing, a goal-oriented form of counseling" I thought it bizarre that they are considered new and an alternative. Perhaps I found them an obvious improvement to the AA model simply because we now have the hindsight to see how ineffective AA is.

View on HN

They're not necessarily new, but addiction (even for alcohol or gambling) is closely tied to drug use and thus it's sub-optimally political.

That's a shame because research is difficult and also ignored if politicians find it doesn't suit their view.

Substitution therapy (eg, methadone instead of heroin) has strong supporters and detractors and it's hard to get good quality research to see whether substitution is better than abstinence.

Indeed, Russell Brand (comedian, actor, addict) has been talking about the benefits of abstinence based treatment and asking why it's not more available in England, which suggests to me that most people don't get abstinence based treatment. (Although he's talking about drugs and not alcohol).

It is weird that cognitive behavioural models are really old now and are only just starting to get a lot of use.

> it's hard to get good quality research to see whether substitution is better than abstinence.

How about maintenance? There's ample evidence from the UK, Switzerland, and elsewhere showing that diacetylmorphine maintenance (treating heroin addiction with heroin) is incredibly effective[0][1].

The effectiveness of treating existing users is the primary concern, but a nice bonus is that it also seems to have served as a deterrent for new heroin users due to its social image as a medical problem, rather than a criminalized behavior[2].

(Remember that, when administered in a controlled setting and in predetermined quantities (and purity), heroin use carries few of the dangers commonly associated with its use on the street, and is fairly similar to the related drugs that you already receive in the hospital[3])

[0] https://en.wikipedia.org/wiki/Heroin_maintenance

[1] http://www.nejm.org/doi/full/10.1056/NEJMoa0810635

[2] https://en.wikipedia.org/wiki/Heroin_maintenance#cite_note-9

[3] Such as morphine (the similarity of the names "morphine" and "diacetylmorphine" is not a coincidence!)

I really wish that there was political will and bravery to allow maintainence with heroin and clinical injecting rooms.

That's obviously better for users, but it's better for wider society too. People who are addicted to drugs will take drugs, so forcing them to do so hidden away in places without safe needle disposal means members of the public or cleaning staff risk needle stick injury.

Not what the research actually shows: http://www.washingtonpost.com/blogs/wonkblog/wp/2014/06/09/h...

>to see how ineffective AA is.

Please dont speculate on recovery unless you have first hand experience. I know many people who have improved their lives from AA and other meetings of the same type.

There are many people with addiction problems who do not trust doctors or religion and a place of like minded people is the only option for them (AA).

Agreed. (I don't know why you're being downvoted.)

I've never been in AA but I am close to someone who has. The primary benefit I see AA provide them is a group of like-minded people who will do fulfilling non-drug-related activities with them.

Addiction is as much social as it is physiological. It's very difficult to quit an addiction if you continue to hang out with the same people in the same environment in which you developed your addiction. Replacing that social environment with a new one composed of people who are sworn to avoid those substances and which is filled with fulfilling activities unrelated to your addiction is a superb way to keep from slipping back into old habits.

> (I don't know why you're being downvoted.)

I didn't downvote but I have a knee-jerk reaction to want to downvote people using anecdotal evidence to support medical treatments.

People with first hand experience are not in a good posistion to judge how effective something is.

When doing scientific research, absolutely. When making a personal decision, it's foolish to ignore first-hand experience just as it's foolish to ignore advice from experts.

> When making a personal decision, it's foolish to ignore first-hand experience

Isn't this exactly the kind of thinking that makes people believe that homeopathy works?

Not exactly. You can have the opinion that Homeopathy as a medical treatment is a complete sham and 'does't work' and back up that opinion with research, but while there is debate as to the relative merit of 12-step programs compared to other forms of treatment, it would be strange to assert that they simply don't work for anyone ever.

Good point. I think homeopath is a load of bunk, but behavior modification deserves to be in another category. Especially considering the independent variables (going to an AA program) and dependent variables (substance abuse) tend to be clear in this case.

For example, saying "I put cumin oil in a vaporizer and now I don't get colds as often" is different than saying "I joined an AA program and now I have been sober for 10 years".

How is that different?

In this case:

* observation is simpler (are you in AA? are you still drinking?)

* so measurement is simpler (how much blortzroot do you add to your lotion to clear up that rash? can you show your rash is 65% better than last week?)

* AA attempts to provide a permanent solution, not a remedy for symptoms, so it's more clear when AA fails.

* Also the things homeopathy "cures" tend to be in a completely different class and severity than chronic substance abuse

Yes I'm sure you do and I too know many people who improved their lives without going to AA. We're not going to persuade anyone talking about our personal experiences and how this guy Bob we know is doing really well.

Also I'm not speculating and I do have personal experience since you ask, I didn't say you need a psychiatrist and a prescription but from years of talking to addicts and going through recovery myself I've found that setting goals and staying positive and within limits and simple things like looking at changes in a certain way is very effective compared to what seems like a New Years Resolution that you'll likely fail and beat yourself for failing to keep up. Such therapy mentioned in the article can motivate people more than AA-style regimes can and that's more important in the long run.

Reply on news.ycombinator.com