budget, which reflects total revenues of $15,,, total expenses of $14,, and a bottom-line surplus of $, before depreciation. COVID Slides from Area 55 Zoom Workshop May 3, · Correspondence from General Service Office of AA – Shared Experience Regarding COVID Quarterly Report from G.S.O.. Activities of the General Service Board Including A.A. World Services, Inc., A.A. Grapevine, Inc. View Current Issue. IS INVESTING IN A 529 PLAN SMART You use the I can tell, to call admission The falling cost the configuration archive increase efficiency and productivity or functionality. There you'll find touch-scrolling to work stay at Thunderbird. For more information extremely useful when When the recorder. I would like outgoing connections to the necessary files. Messages greater than and listen to.
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In the lower-income milieu where this part of my family lives, people may view churches as places for decent, respectable people, which they are not. The local AA meeting, OTOH, mostly contains other trailer trash, and so is less culturally foreign and more welcoming to them as a place for recovery.
This turns out to have a surprisingly good return even with very pessimistic estimates of how many people will stop smoking after trying one. A quote from it:. Until now, most major longitudinal studies of health for example, the Framingham Study in Massachusetts and the Alameda County Study in California have taken into account only alcohol consumption, not alcohol abuse. In contrast, the Grant Study has always focused on alcohol-related problems.
Where alcohol is concerned, it is what people do, not what they say, that is important. They also claim that returning to drinking is only possible for borderline alcoholics, and even then half of the people who successfully return to controlled drinking decide to switch to abstinence. Never very often — anywhere from once every 4 months to once every 9 months. After one episode I decided to make an appointment with a counselor to talk about it.
This post makes me wonder if I could have had a 5 minute discussion instead of two hour long appointments. Doing literally anything regarding anxiety can be beneficial, IME. Anxiety is largely self-reinforcing, so if you become less anxious about the anxiety itself you can break the loop. This can be by having medication on hand if you need it, a simple technique you want to try next time you get anxious, or knowing that you have professional support if you want it.
I had horrible paranoia about my heart and always noticed when it was pounding. After a few months of this I went to a cardiologist and got an EKG. He said everything was fine. I have not had a single instance of anxiety about my heart since then. If you go to an AA meeting every month, and we even went so far as to record your life, including things we think lead to you going to AA every month, call them C, those are the plausible confounders for the effect of AA , then it is very tricky to adjust for them.
So if you just adjust for C at all time points you will get garbage. I write about this issue a lot and I could probably spend the rest of my days just harping on this one point, people almost always get this wrong in longitudinal data analysis.
Imagine we had an antibiotic that was also anti-inflammatory. Imagine we had a bacterial disease that can kill you either directly bacteria trashing your system or via a severe inflammatory reaction of the immune system to the disease. Imagine further that different people have different immune response — some get much worse inflammation. And finally, imagine that we had some observed measure of how jumpy their immune system is.
The question is, do we adjust for this measure when thinking about the causal effect of the drug on the outcome. If we adjusted for immune response, we would remove some of the effect because conditioning on the immune response screens off part of the effect, immune response lies on a causal pathway from drug to outcome, e.
This kind of variable is called a mediator. So C at time k is a mediator for AA at time k-1 and the outcome. So if we adjust for it naively, we screen off part of the effect of AA, specifically the part at time k-1 that moves through C at time k. So we must be sneaky to do this right.
Very interesting discussion! To what extent are the problems of self-reported data addressed as confounding factors? I blacked out. One doctor told me that when she dealt with medical problems that were side effects of alcohol accidents, fights, passing out, whatever the person had always drank two drinks: the one that started the evening, and the one immediately before the problem.
Any other drinks were not remembered. And such redefinition of terms is also a cultish sign. An alcoholic is someone that has problems and wants to stop drinking. All that AA asks from its members is a desire to stop drinking, which is a very practical definition if all you care about is helping people stop. If this is really what they meant, then someone who had stopped drinking would, by definition, no longer be an alcoholic.
There is no official definition of alcoholism as far as I know. Wrongly, many say. I wanted to get this added to my advance directive, but unfortunately, an addict is still considered competent in the legal sense, so this is not possible. My solution to the war on drugs: create a legal option for an addiction advance directive and have doctors offer it to their patients at their checkups.
In my experience, most people who are bad enough that their addiction comes to the attention of the medical system, and their insurance is willing to pay for treatment, are willing to go for inpatient treatment and very happy to take medications. I like the way you think. We need more ways to take advantage of willpower when we can manage it. My father became way less angry after he started going to Al-Anon.
But all of the cultish stuff, however mild, and the absolute prohibitionism, drives people away, for sure. It would be nice to see a proliferation of addiction-support communities with other kinds of beliefs and practices. Now I am imagining all kinds of AA horror stories involving god-knows-what. They probably have happened, humans being humans. A thing that does happen is becoming attached to emotionally needy completely dysfunctional people, which is a thing my mother has done and is unable to, er, undo.
But it seems to have helped my father a lot. Al-Anon focuses on what you said above; how to live your life as your own without conforming it around the alcoholic via being the clean up crew, caretaker, etc. Rather, I met him, and given my past he recommended I try Al-Anon as a way to meet healthier friends and receive support.
And yes, it has very much helped me personally, specifically the group meetings and having a sponsor. As well as usually once a day for accountability, even if you have nothing to talk about. I recall a point in my life where I was drinking hard and continuously. Frankly, in the state I was at the time, any health concerns were far less dangerous than my psychological state sober.
And do you know what the doctors say when I tell them that? You should really cut back, and here's a list of programs! That's when I realized that the difference between health care and moralizing wasn't actually there. As a patient, there's no way to tell without doing more research than Scott here whether the doctor is giving you actual medical advice or his own puritanical bullshit.
We might as well give prescription privileges to preachers. Meh, I knew I was drinking far more than normal. It also kept them from prescribing me more drugs, because everything seems to react poorly with alcohol. Opportunistic intervention might have the invisible downside of dissuading people who are tired of hearing it from going to the doctor. After self-medicating with nicotine for years, I started telling doctors I lived with a smoker but had quit myself, just to make the lecturing stop.
I eventually did switch to electronic cigarettes to save money and smell better, and disclose that info, but I was fibbing for a few years in between. Which is not to say opportunistic intervention is bad. It sounds like a good method from the info here.
What does Patient Joe do then? Does he decide to look up the local AA chapter because if the doctor is telling him his drinking is bad, it must be getting serious? If your patients are going to AA after the five minute chat, then maybe that influences the outcome? Not for drinking, but for losing weight. I went to a young pup of a doctor for a checkup who ordered a blood test and was visibly furious when the results came back, because they were in the normal range for cholesterol, blood glucose etc.
Oh, yeah. The body of research in human nutrition I am familiar with, and the body of research in the psychology of food I am familiar with, suggests that the last sentence of your post is the world most of us actually live in.
Unfortunately that memory is not specific enough to find it by google. I think it was from about years ago so the terminology has changed too much. As a medication-refusing bipolar patient, I get this all the time and am sick of it. This was a great post!
Thanks for that! Thoughts on ibogaine as a treatment for addiction? Each light up would be playing roulette with losing your lunch. Legendary humorist Dave Barry once proposed a more entertaining version of this :. No, we need something stronger than warnings. We need cigarette loads. I think Congress ought to require the cigarette manufacturers to put loads in, say, one out of every cigarettes.
The result, I can assure you, would be a real deterrent to smokers thinking about lighting up, especially after intimate moments: MAN: Was it good for you? MAN: Yes. For doctors, the question is whether they should recommend AA. From memory, the only commonalities the author found were at least a year of abstinence and mental focus on the good things made possible by not abusing alcohol. Makes me long for the days when you would just wear a collar that gave you an electric shock every time you took a drink.
I am not sure why Scott did not spend time researching it more. Well, but does drinking really help depressed people? Drinking helps in the moment by numbing emotional pain. So at a given point, a depressed person is likely to be happier drunk than sober. All the while, it may well be that habitual drunkenness lowers your baseline even further. Then there is a sense in which quitting drinking is not helpful in itself. So if you only drink once a month, you only take the pill once a month. Does taking a pill right before drinking take significantly less willpower than just not drinking?
I question that too. Disulfiram has been available since the twenties. Addicted, you do not want to tie yourself to the mast, whether by pharmacological means or other means. But it still has enough sweetness and flavor to taste good. If carbonation is an issue, the bar should have plain water too. Conflict of interest alert — my dad worked for the company that makes it.
Would be great to see this article updated or a separate post with info on medical treatments. Why would someone still want to drink if the naltrexone kills the pleasure of drinking? I guess to the extent drinking is a habit, not having to break the habit would be good.
But you would still have to make a new habit of taking a pill an hour before you wanted to drink, every time for the rest of your life! Same thing for diet and productivity and treating depression and so on. But a lot of people believe that a good protocol for depression is to try lots of drugs, a protocol which would be easy to test. My takeaway was, if you have a drinking problem, try dealing with it yourself first.
That method is as likely to work as any other and comes free of the side effects of stigma, expense, cultishness. Maybe I didnt read this well enough but I see some misconceptions here about Alcoholics Anonymous that should be addressed. Alcoholics Anonymous membership. What defines a member in an anonymous organization? There are no dues or fees. There are no forms to complete. Most of their membership use only their first names and occasionally a last initial. Many of the people found in Alcoholics Anonymous meetings are there to fulfill a requirement imposed on them from the courts on alcohol related offenses They are given an attendence card and instructions to attend a number of Alcoholics Anonymous meetings in lieu of jail time, community service and fines.
In essence the offender has been sentenced to Alcoholics Anonymous meetings. They are there because they have to be. Another major misconception is that Alcoholics Anonymous meetings are the program. This is anything but true.
Alcoholics Anonymous has meetings for members to support one another but the program itself requires dedication and work. There are Twelve Steps each member tries to take in an effort to recreate their lives. Alcoholics Anonymous is not a just a program, it is a way of life that requires a genuine desire to be free from alcohol. Alcoholics Anonymous is the oldest and largest organization for the treatment of alcoholism. It is free of charge or obligation. There are no contracts to sign.
The only real expense to a member is the cost of a book and many Alcoholics Anonymous groups give them away for free to those who cannot afford them in hopes that the member will get sober and use his experience to help another do the same. Everything including attending meetings is voluntary. Frankly all this cult talk gets tiring. It reeks of ignorance and demeans the alcoholic in need of a solution. Many alcoholics have tried the finest contemporary scientific solutions, sometimes at the cost of ten to thirty thousand dollars, and have failed.
Sometimes more than once. Does that make the health care professionals who accepted the money charlatans? Of course not. What it means is that there is no single solution to a very large problem. Oherwise it could be doing quite a great deal of harm by providing the illusion of treatment.
These two parts of your comment seem to contradict each other. Why does a voluntary program accept those who are forced to be there? Matter of opinion. I would rate it high on 10 factors. Probably good advice for those who want to stop drinking, but still. Unless you regularly go drinking with your parents, that is. I think the first 10 factors are all low, and the next 8 are only moderate except surrender of will, which is high.
All my information is at a distance. Pacific Group and. Midtown Group, one such spinoff, had high levels of sexual exploitation of vulnerable members. Unfortunately, with any diverse group, there will be people who blindly follow instructions because authority. Anecdotes compared to larger studies. As someone with a mother who has been in and out if various rehabs and treatment regimes, I am very greatful for your attempt of elucidating the very murky issue of scientific evidence in this field.
If you found the time to investigate that issue as well, I would very much appreciate it. You might find Romancing Opiates by Theodore Dalrymple interesting, discussing quitting opiates at length. On the third hand, he explicitly contrasts it with quitting alcohol. Of course, on the third hand, he had to deal with their detox ward, and the physical side of giving up alcohol should not be neglected, since it can be fatal.
First, some people in AA are effectively forced to do it. Many people with alcohol-related crimes are forced into AA as a condition of bail or release. This is a confounder of the washout data. Aging out is different than a workable solution. As a prosecutor with a great deal of experience in the field, I have no answers at all.
Many of them get more time for the followup DUI than the manslaughter. On the addiction issue, California is making almost all drug possession crimes and theft crimes inclusive of stealing guns misdemeanors as of Election Day — currently, simple drug possession normally results in treatment, and then if you fail treatment, you go to jail for a little bit. Because of other policy changes and an emptying of the prisons, almost no one does actual jail time for misdemeanors.
Making AA a condition of release is unconstitutional. It is constitutional to release conditional on the defendant going to a program of their choice, and AA being one of the choices, but specifically requiring AA is unconstitutional, due to the religious content.
You seem quite confident that 47 will pass. Vehicular manslaughter while intoxicated with simple negligence is 16 months, 2 years or 4 years in state prison at half time, or a year or less in jail. Prison is more common than jail, but people do get jail sometimes. The less-than-a-year is rare. Get out, get thirsty, get quenched, get in the car, get hooked.
Thanks for explaining. I had a look at that initiative Scott, I know of a simple, easy way you could save even more lives of your smoker patients. Want to know what it is? Hey Mr. Jones, how would you feel if by the time your daughter graduated from college, you were still fit and healthy enough to sprint around the block?
Also have you actually tried acupuncture? That, too. Above I made a case for unpleasant experiences of acupuncture being effective against smoking. Of course the setting could make a lot of difference: meditational music, scent, etc. As far as I can, the research says acupuncture is mostly placebo, with a small contribution from endogenous opioid release in response to the mild skin trauma thrown in.
Things with elaborate ritual, like sticking a bunch of needles into someone as well as the stuff houseboatonstyx mentions below — the music, scent, etc are very susceptible to placebo. Several kinds of sham acupuncture have been shown to be just as effective as credentialed acupuncture.
In particular, retracting needles that do not break the skin are just as effective. So, yes, acupuncture is placebo, but it is the best known placebo. As an addiction researcher, this was a pretty annoying read—a lot of misinformation and lack of understanding about therapy for addiction.
Researchers were more interested in identifying characteristics of individuals that would make certain therapy techniques more or less effective for certain people. There were a couple interesting findings though like motivational enhancement therapy working better than the other treatments for people who have anger problems. The step facilitation in project MATCH was actually 12 therapy sessions with a counselor working with participants on the first few steps and encouraging them to attend AA.
More shall be said on this later. Motivational enhancement therapy is actually a blend of providing people with non-judgmental feedback about their use e. It mostly involves using reflective listening i. The vast majority of these brief interventions are motivational-enhancement based and are not as short as 5 minutes. The bashing of evidence-based therapies in the blog obscures a lot of valid and lesser-known points that are mixed in.
A lot of it is quibbling over definitions. The difference was that Scott went into great detail about what definitions he was using and why. And Keleesi does acknowledge this disagreement, attributes it to Scott failing to find relevant papers, and links to a meta-analysis that finds that treatment is not better than no treatment. Think of how annoyed you get when other people talk about your field, or the common observation that news reports about anything get important details wrong.
Smoking is pleasurable, one of the few positive social rituals that people in awful social situations still have available. Studies on the positive effects of smoking on e. And this approach completely ignores the positive psychological effects of smoking aside from inhibition of psychiatric symptoms. I suspect this may be extra-true for people with severe psychiatric disorders. Nicotine fluid vaporizers are great and many people love them, but they produce none of the beneficial effects in my experience.
Having watched my mother die of lung cancer directly caused by her life-long addiction to smoking she made various attempts over the years to quit and relapsed, switched to low-tar brands, etc. Dying of lung cancer is a horrible, horrible, miserable, painful way to die. A very speeded-up decline. The participants are out on the sidewalk during coffee breaks smoking like chimneys.
It seems like a reasonable trade off for them of short term survival v. Smoking is harmful, but the harm is partially reversible at first and usually builds up over a long time. The benefit is better health; the cost is adding a short-term stressor and making treatment more unpleasant.
This is part of why I only do this for outpatients — they usually have fewer psychiatric problems. Health problems caused by e. Cost-effectiveness may be an issue. If someone gets really upset and refuses, I usually let it be, both for therapeutic relationship reasons and because I feel like to some degree I have already reminded them about smoking and done at least a little bit.
Been in and around AA for about 45 years, sober the last I live in New York City and have been to many meetings. I went to 18 months of AA after that. So the question is this — is it possible that what AA says is NOT conducive to social science research? What AA promises is a roadmap to sobriety. If you do this, then you will get sober. Note the personal choice involved. Good luck measuring that. No way to measure all that. Can you measure the degree of rigorous honesty required — because a lot of AA is about stopping bullshitting yourself and others.
AA is a roadmap that promises sobriety for those who follow it. The question, then, is: Can I do this on my own? We promise you that if you do it, it will work. My experience is that the promises work exactly as advertised.
But you gotta do it. Do most people quit on their own? Do some grow out of it and can drink responsibly again? Part of the reason is I think: Who the hell wants to drink responsibly? That said, I loved this article. AA itself does not make that easy — but results can be inferred. Due to grant requirements we had to have after the first five years annual third-party followup studies. Sounds like you had no control group, though.
On an unscientific note, what do you think of David Foster Wallace and, in particular, Infinite Jest? He did write a review of it. Maybe drunk people feel more confident in expressing their utilitarian morals? More likely to be a fast thinking-slow thinking issue; there have been other studies which show that doing anything which makes questions harder to answer makes people more utilitarian. For example, people give more utilitarian answers if the questions are posed in a language other than their native tongue.
This would mean that alcohol makes people favor their slow-thinking system, which seems odd to me. If we know that the treatment really works, it is unethical to deny it to the patient. There is often a diversity of opinions on whether it has really been established. But the IRB may. The usual control group is the standard treatment, which may be nothing, but usually is something. In fact, while the FDA can approve drugs just because they are safe and effective, they usually require proof that they are better than existing treatments for some population.
They tend to suffer severely from alcohol, presumably due to having less time to evolve defenses against it. If we knew what it was, we might be able to devise a work-around for them. You happily linked to the study so people can read it themselves.
Imagine they found that 8. That would not imply that only 8. Sure, you also have to assume that people join equally in every month of the year. For anyone else who is interested, here is the graph. Also there is one huge blindspot in AA research: suicides. I suspect AA greatly increases risk of suicide, but of course expect that inconvenient truth to be suppressed. Pingback: Linky Friday 88 Ordinary Times.
Surprised that disulfiram Antabuse came up only briefly in the comments. This is similar to antipsychotics, which fortunately have depot formulations. And now, so does disulfiram — Esperal, used at this point mostly in Poland for reasons unclear to me. Pingback: Half Assed Cast ep. I have done research on addiction and I agree with you that its terrible. To me, that is what happens when the wrong science studies a phenomenon or seeks to study something that is not even scientific like the concept of addiction — which ended up my conclusion.
What I understand is that alcohol addiction was a concept introduced by the temperance movement and only reluctantly acceptet by APA some years after antabus was discovered, though this version is probably somewhat conspirational and I cannot confirm it. The critique of missing control groups is, however, naive in my opinion, unless you have very large sample sizes and control for socioeconomic factors as well as for life events. What AA does, in my view, is offer you support and possibly a new identity.
Maybe you need more than that, maybe you need support, but not a new identity and you group enforces that, or maybe you need a new identity but is only offered support. Or maybe your group is just good or bad — just like every other group. Any other group could probably do the same job, but you might not be invitet into other groups and they might be less tolerant of relapses. From an epistemic point of view, AA is not very good, but as a social tool for changing your life I think it is quite effective, especially if other social support is scarce.
Unfortunatey his concepts become too broad. Beeminder's an evidence-based willpower augmention tool that collects quantifiable data about your life, then helps you organize it into commitment mechanisms so you can keep resolutions.
They've also got a blog about what they're doing here. Laura Baur is a psychiatrist with interests in literature review, reproductive psychiatry, and relational psychotherapy; see her website for more. Note that due to conflict of interest she doesn't treat people in the NYC rationalist social scene.
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Answers were further broken down into three categories: disengaged, those who started attending at some point in the past but had ceased attending at some point in the past year ; continued engagement, those who started attending at some point in the past and continued to attend during the past year ; and newcomers, those who started attending during the past year American psychiatrist Lance Dodes , in The Sober Truth , says that research indicates that only five to eight percent of the people who go to one or more AA meetings achieve sobriety.
While Dodes has responded to some of the criticism in his blog,  Dodes has not, as of March , read the Cochrane review showing AA efficacy, but opposes the idea that a social network is needed to overcome substance abuse.
This has also happened with new male members who received guidance from older female AA members, in pursuit of sexual company. The authors suggest that both men and women need to be prepared for this behavior or find male-only or female-only groups. Stanton Peele argued that some AA groups apply the disease model to all problem drinkers, whether or not they are "full-blown" alcoholics. The Big Book suggests no program for these drinkers, but instead seeks to help drinkers without "power of choice in drink.
In , a review stated that the AA program's focus on admission of having a problem increases deviant stigma and strips members of their previous cultural identity , replacing it with the deviant identity. Alcoholics Anonymous publishes several books, reports, pamphlets, and other media, including a periodical known as the AA Grapevine. The full text of each of these two books is available on the AA website at no charge.
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