A drug that cures alcoholism may be the next anti-anxiety medication
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I quit drinking after more than 25 years of problematic drinking using naltrexone (The Sinclair Method) and, given my experience with alcohol, it was the easiest thing I've ever done.
I urge people who have a problem with drinking and wish to quit, who for whatever reason do not feel that 12 step programs like Alcoholics Anonymous are right for them to find a doctor who is willing and able to prescribe naltrexone and have a serious discussion with them. Had I known it was effective as it is I probably would have been able to stop drinking 20 years sooner than I did.
I urge people to see an addiction specialist first. Do not see AA first. See a doctor asap. This disease is serious and has a high fatality rate. AA meetings are like a club after you have it under control (EG. don't attend drunk).
Disulfiram: An old military drug. This will stop you drinking but you need a significant other or parent involved. Each morning you must take the pill and your significant other needs watch to double check. Doctors are scared to prescribe this and the drug companies are ramping down it's production. Hoarding the drug is common.
naltrexone: This comes in two forms. The pill and the shot. When you first take this you should do the shot form. The shot lasts 30 days and there is not a possibility of skipping out on pills. Naltrexone will ruin the Euphoria feeling of alcohol and opioids (so it's a kind of two for one). No addiction specialists back the 'the Sinclair Method' but do back daily use of Naltrexone.
Rehab: Good short term, bad long term. Rehab failure rate is over %90. A normal rehab will run 10-30k per incident. Do not leave unless you had a Naltrexone shot. Longer stays will impact work, an unemployed Alcoholic is dangerous.
Alcoholics Anonymous: Very* difficult for people with social anxiety. People that succeed here find a sponsor which is like dating. You will be rejected literally by tens of potential sponsors until one says yes (hang in there!). AA has a very high success rate for extroverts who become a sponsor - caring over others going through alcoholism seems to rewire the brain.
Baker Acted/Marchman: If you have a family member (or a friend but you have family contacts) drinking to a point where they are unable to make decisions - you can file a Baker act. [Name varies wildly state to state]. A court can determine the individual needs intervention and can use state authorities to detain. Depending on your court appearance after 72 hours (don't be drunk lol) - the judge orders more jail time or programs.
There was also an uncomfortable amount of "thirteenth stepping" going on in my groups, where the single males running them ended up in relationships with women in the groups.
This is definitely not true having worked with addiction specialists on TSM myself. Plus I think it is safe to consider Sinclair himself as an addiction specialist
For those looking to learn more about different ways to use Naltrexone to treat alcoholism: https://academic.oup.com/alcalc/article/36/1/2/137995
That's not true at all, but it's a club with millions of people. Other than that appreciate your breakdown.
That's if you can even get the person into rehab at all! Just before last Christmas we buried a good longtime friend and colleague who'd died of liver cirrhosis. Nothing we did could get him into rehab.
'So what' you may say - he was just one more of many thousands. The trouble was that he was also an organic chemist by training yet even with this insight he couldn't stop his alcohol consumption. It was tragic really.
I've come to the conclusion that those of us who aren't alcoholics have little or no conception of how the mind of an alcoholic works or why he/she finds it necessary to consume alcohol in such damaging quantities. Simply, we cannot get into their minds and perceive the world from their perspective. This is a huge problem as it often stops friends and or family from being effective helpers.
As I see it, there's a perceptual barrier that separates alcoholics from those who aren't alcoholic. It's not a simple matter for a person who is not an alcoholic to put himself/herself into an alcoholic's mindset especially so if the alcoholic has no serious underlying psychological problems (if he/she did have then perhaps the person who's trying to help could envisage the alcoholic's state of mind - that of, say, depression, etc.).
Essentially, even those of us who aren't alcoholics but who've experienced the effects of alcohol can't use that experience (of say, being drunk) as an analog to understand the alcoholic's mindset as both perceptions of the effects of alcohol are fundamentally different.
Take my experience, I recall getting badly drunk in my student days and it was very unpleasant, since then on rare ocassions I've been what you'd call 'merry' from the effects of alcohol. Nevertheless, I find the effect of even a little alcohol both disturbing and mind-dulling and I deliberately avoid getting into that state. On the other hand, the alcoholic either experiences different physical effects from alcohol than I do and or his/her visceral perception of those physical effects of the alcohol are very different to mine.
It seems to me that this difference in percetion between the alcoholic and us who aren't alcoholics is one of the reasons why we're often unsuccessful in helping them. If we cannot communicate on their level then we're at a disadvantage when we try to help them and or offer them support.
That was what I experienced when I tried to help my former friend and colleague. Even though I knew him well and had done so for many years, it was clear to me that when it came to discussing alcohol that we spoke a different language. I'd hasten to add that at no time did I patronize him, nor was I intrusively paternalistic towards him. Essentially there was no effective communication between us on the matter of alcohol.
Judson Brewer is a psychiatrist and neuroscientist who researches addiction and advocates this view. I found his book The Craving Mind[1] to be incredibly illuminating and true to my experience as a person who has struggled with drug use.
[1] https://yalebooks.yale.edu/book/9780300234367/craving-mind/
That's absolutely not what I said, nor what I intended. Of course, addicts aren't any different to anyone else in the general sense (that of being human beings).
Nevertheless, their worldview is different to mine and to that of others - no two worldviews are the same, everyone has a fundamentally different worldview or we'd all be clones.
Yes, like everyone else, I have my addictions - cravings for certain foods, rich cheeses, certain types of cakes and so on but I simply never buy them or my belt would be about four notches larger. I'm constantly aware that I can't afford to give in to temptation and it's stressful.
However, that doesn't stop me looking at these foods and drooling over them whenever I go shopping.
Same with coffee: I drink coffee so strong that no normal person would ever touch it. Unlike those other foods mentioned, I do imbibe in this superstrong coffee and I have no intention of giving it up even though I know that it is not good for me.
The difference between my food addictions and alcohol addiction is the sheer scale of the damage alcohol does to the individuals involved not to mention the havoc it does to their families and to society at large.
Comparing my food addictions to alcohol or full-blown opiate addiction is a non sequitur, essentially there is no comparison even though they all initially started out as the cravings of one's mind. By comparison, my food addiction compared to alcohol or opiate addiction is like comparing a pop gun to an AK47.
We must be very careful when we equate all addictions down to a commom cause - one's craving mind and then proceed to imply that in the end there's little to differentiate between them. To say there's little between them is postmodernist nonsense in its extreme and it's very dangerous thinking. In the end, black is black and white is white and not some shade of nondescript amorphous gray.
That said, I'll restate the fact that I've just watched a longtime friend die of alcoholic poisoning and I've great sympathy for anyone who's in the grip of alcoholism.
If you think I'm being a righteous bastard for saying what I've just said then I can only say that it's definitely not true. I am only too well aware that there's the thinnest of thin lines between me (and most of us) and the alcoholic or opiate addict - or the haplessly addicted and desperate gambler.
As the old truism states, it is only but for the grace of one's deity go thee.
As an alcoholic I think an often overlooked aspect is the opposite of this: how it feels to NOT have the alcohol.
My perception of the world and state of mind seems better to me sans ethanol, yours is the opposite. But that doesn't mean it's a bed of roses for me, it's just that ethanol doesn't work for me to make things better. This is a very complex matter of which millions of words have already been written and clearly I'm not going to come up with any new insights.
What I've tried to say is that these differering worldviews make it difficult to make life easier for alcoholics.
It's strange really why different people have such different responses to alcohol. Despite what I said about the negative effects of alcohol on me I nevertheless love the taste of good wine and I reckon it's a damn cruel act of fate that alcoholic drinks are so nice and yet at the same time alcohol is far from being just another innocuous additive.
Trouble is that the level of alcohol in many alcoholic drinks has increased in recent years when it ought to have been decreasing. For example, a top Bordeaux traditionally has 12.5% alcohol-that is, the world's best wine needs only that amount of alcohol, yet on the shelves of liquor stores where I live almost all wines now have 14.5% or more alcohol. It used not be like this but winemakers found that if they increased the level of alcohol then the wines needed almost no ageing and could be turned over more quickly.
That's a sore point with me, wines may be sold more quickly by increasing their alcohol content but good wines must still be aged. Again the quick buck has gotten in the way of better health and governments have done stuff-all about it.
I hope that alcohol eventually becomes much less of a problem for you.
Also a 2% increase in alcohol content isn't noticeable in any way other than MAYBE taste (and I'm sure most people wouldn't even notice that).
I will disagree with you over the matter of the 2%. This extra ethanol does make a considerable difference and has been shown to do so for a number of reasons some quite complex that I cannot do justice to here. However, I'll mention a quick one for starters: the extra few percent spitit is significant as it often masks the high level of acids in young wine (malic, latic, bytric, sorbic, tartaric, etc.) with the consequence that many people drink considerably more wine in one go. Thus, they not only get the extra 2% ethanol but also an addotional amount from the extra wine they've consumed (and remember this wine already 2% stronger).
The acid levels drops significantly in older wines that have been left to age so that problem doesn't happen with them. Winemakers now actively cultivate and promote this high-alcohol, soft-style wine and they've been very successful in doing so over the last 30 or so years. It saves huge inventories of wine from being stored by over three years or more (there's much saved moolah there).
This then actively discourages research into producing flavorsome wines with much lower alcohol (at present, reducing the ethanol content to 10% or lower makes the wine thinnish in character and it spoils easily). Much oenological research is needed to boost the body and flavor in low alcohol wines and at the moment there's precious little incentive to provide money for this research. It urgently needs government intervention and regulation to overcome the problem.
BTW, decades ago I worked in a vinyard/winery for a short while.
Like others I've no additional wisdom to add except to say we need science to urgently find a less dangerous psychotropic substitute for ethanol - if such a substitute is actually possible.
I'm friends with someone who went from multiple organ failure in the hospital from chronic alcoholism, to recovery with psychiatric treatment, and it seems like GABAergics like gabapentin and an SSRI help them feel okay without alcohol. At least in the US, this can be prohibitively expensive, and they're stuck with tens of thousands of dollars of medical debt, but that beats being dead.
Decades earlier he'd been hooked on benzodiazepines and could never seem to get enough of them. He was always concerned about being caught short without them and that his supply might run out before he could get a renewal of his prescription (supply became a problem in the '70s/'80's when doctors became aware that they were addictive and that too many people were abusing them). As he was an organic chemist by training, I used to joke with him that he should concoct up a supply in his kitchen.
For him, benzodiazepines where highly effective (at least so over the short term). I've seen him in a jittering state of nervous anxiety and being totally unable to function yet an hour or so after swallowing a couple of 5mg Valium tablets he'd be as normal and calm as everyone else around him. Of course, by then, it was impossible for me to determine how much of his anxiety etc. was part of his condition and how much was attributable to benzodiazepine withdrawal.
You are lucky that your friend was saved from multiple organ failure just in time with proper care, but that wasn't to be with him. Two or three years ago it would have still been so technically, but in the end his medicos, psychiatrist and his friends were unable to help—as essentially he refused to help himself.
Obviously, good medical care often helps but it seems to me we've still a long way to go before we've alcoholism licked for good.
I don't like the idea of court compelled psychiatric or addiction treatment possibly putting people in situations where they might have to take it or otherwise be considered non-compliant to the courts.
The Marchman Act in Florida is particularly worrying in that aspect, as it doesn't require someone to have committed a crime at all to be involuntarily ordered into rehab, and non-compliance can mean being in contempt of court.
It's cliche, but it reminds me a little too much of the Ludovico technique.
Likewise. Fortunately, I'm not an alcoholic nor have I ever been one but it's always been my understanding that disulfiram was a pretty brutal way of dealing with the problem. I've seen pharmacology texts written in the 1960s warn of the dangers of disulfiram (I had the impression that by the end of the 1950s it was already recognized as a brute force method that was not that effective).
Moreover, as disulfiram inhibits acetaldehyde dehydrogenase, the build up of acetaldehyde in the body alone is pretty nasty and ought to be avoided (there's nothing subtle about this chemical. (I hesitate to use the word 'drug' even though it may have effective uses in completely different areas of medicine.)
Making someone feel ill by essentially 'pickling' - or should that be 'poisoning' - him/her from the inside strikes me as a treatment that should have gone out with Galen.
I had to go out of country for it, doctors do not like to prescribe it. I hoard it.
I know it works for some people and I knew that before I posted that comment. Again, that's truly great for them. However, it's my understanding that all too many do not have your level of self-perception nor do they have the same level of self-control that you do and so they end up on a horrible carousel ride until they fall off - big-time.
This seems to be the major reason why doctors do not want to prescribe it. The fact that these concerns about disulfiram have been reoccurring in the literature since the 1960s is pretty much proof of the fact.
I suppose the real problem is the difficulty in determining who will actually benefit from it and who will not, and that's an age old problem that medicine hasn't solved as yet (or as I reckon won't take the necessary time with individual patients to determine those who are suitable - thus it all gets chucked into the 'too-hard' basket).
Just keep at it. Best of luck.
:-)
I assume you mean ethanol, because methanol is highly poisonous (even a fraction of a shot will make you go blind).
But yes, alcohol is broken down into acetaldehyde.
From my understanding acetaldehyde is formed in the body by the partial oxidation of ethanol—if one's body oxidized it completely then I guess there would be little problem (but it doesn't)! Instead, the body has two goes at 'neutralizing' ethanol, acetaldehyde being the first metabolite and the second is that acetaldehyde is converted into vinegar (acetic acid) which is essentially harmless.
Methanol is worse—much more so. It's first-pass metabolite is formaldehyde (right, it's an excellent 'pickling' preservative), and the second-pass metabolite is formic acid (that's the stuff ants sting you with). Thus methanol double-whammies you and unfortunately it does it par excellence.
Methanol is damn horrible stuff really, less than 100ml can kill one outright and if you survive then, as chimeracoder says correctly, you'll likely be left permanently blind not to mention ending up with other serious problems. In fact, one of the emergency procedures for methanol poisoning is to repeatedly give copious quantities of ethanol for quite some length of time—as in the first instance it substitutes for methanol, ethanol's delaying action then gives the body much longer to metabolize methanol and this delay has the effect of ameliorating some of the damage it causes. Here, ethanol is much the lesser of two evils.
That said, acetaldehyde is more toxic than ethanol and it's far from being benign (for starters it's what gives you your hangover but that's not the end of it). Whilst it doesn't have the immediate punch of formaldehyde, acetaldehyde is nevertheless still dangerous for several reasons, first the body is capable of metabolizing ethanol in the liver with the enzyme acetaldehyde dehydrogenase however this process is not exactly straightforward nor is the metabolism of ethanol completely benign; second, the dangerous aspects of acetaldehyde dehydrogenase's metabolism of ethanol is that it often results in cumulative damage to the liver over the long-term, especially so when ethanol is taken in large amounts.
There's a few Wikis on this but they're a bit complicated for a quick understanding, nevertheless the second link on alcoholic liver disease has a nice diagram that illustrates how long-term liver damage happens:
https://en.wikipedia.org/wiki/Acetaldehyde_dehydrogenase
https://en.wikipedia.org/wiki/Alcoholic_liver_disease
Right, I shouldn't have used the word 'pickling' but I was using it in the vernacular and, as here, I did actually use it in inverted commas.
Another way of looking at it is that long-term ethanol/acetaldehyde damage to the liver leads to cirrhosis of the liver—and cirrhosis is in effect the death of liver cells which are then replaced by scar tissue (that's close enough to 'pickling' methinks).
> "Opioid Systems. Endogenous opioids are small molecules naturally produced in the body that resemble morphine and have long been implicated in the actions of opiate drugs and alcohol. There are three classes of endogenous opioids: endorphins, enkephalins, and dynorphins. They all exert their effects by interacting with three subtypes of opioid receptors—μ, δ, and κ. Researchers have hypothesized that positive alcohol reinforcement is mediated at least in part by the release of endogenous opioids in the brain. This hypothesis is supported by numerous studies demonstrating that opioid antagonists acting either at all opioid receptor subtypes or only at specific subtypes suppress alcohol drinking in a variety of species and models (for a review, see Ulm et al. 1995). Moreover, complete inactivation (i.e., knockout) of the μ-opioid receptor blocks alcohol self-administration in mice (Roberts et al. 2000b). The agent naltrexone, a subtype-nonspecific opioid receptor antagonist, currently is approved as a treatment for alcoholism in humans and is particularly effective in reducing heavy drinking."
Neurobiology of Alchohol Dependence, Focus on Motivational Mechanisms https://pubs.niaaa.nih.gov/publications/arh313/185-195.htm
Psychedelic drugs have also been used very effectively under controlled conditions (clinical settings) to break both opiate and alcohol addiction with remarkably high success rates. This is an entirely different approach than using blockers like naltrexone. For example:
"Psychedelics as an emerging novel intervention in the treatment of substance use disorder: a review " https://pubmed.ncbi.nlm.nih.gov/33231817/
> "It is believed that these agents allow for the reorganization of disordered neural pathways in the default mode network and attenuate maladaptive signaling in mesolimbic reward circuitry. The aim of this review is to examine the current standing of evidence regarding psychedelic psychopharmacology and to provide an overview of the use and effectiveness of these drugs in the treatment of SUD, alcohol use disorder, and for smoking cessation."
Naltrexone doesn't work for me. It is not very effective for some people.
So yes, taking the one that doesn't actually make the poison _more toxic_ - just a less pleasant experience - is probably the preferred route so you don't endanger yourself. But it's still forcing yourself to extreme negative consequences and conditioning your brain to associate alcohol with misery.
I eventually quit last fall but I am not actually sure what I did differently that made it seem to “stick” this time. I didn’t take naltrexone though.
I've seen a family member successfully win over an alcohol abuse issue by changing their job and getting therapy after detoxing safely in a hospital. Disulfiram should be bottom of the list for anyone, I've not heard of Naltrexone, but a quick google makes it sound like a superb option too.
A search brought up this interesting thing.
Is there a problem where the anesthetic won’t work?
This question is also why it's important to have your prescriptions you're taking up to date with your emergency information / contact.
Like you say: the drinking culture must change.
Why? Because a small fraction of people can't handle alcohol? If you don't want to drink, don't. But don't tell me how to live.
That's an assumption. If you have, and still believe the above, then your ethics may be obscuring your compassion or pragmatism.
Most people think slapping a line of coke on a kids birthday is not done, but drinking alcohol is. But alcohol is 3 times as destructive as coke.
And I also think the minority of people can't handle alcohol but most people can hide this.
Interestingingly in Norway and Sweden the alcohol stores are also nationalised, run by the government.
In Central Europe and other places drinking is incredibly ingrained into social mechanics, making it very hard to quit or stay sober.
Personally I still like to drink on occasion, but seeing the amount of damage alcholics do to themselves and the people around them has really opened my eyes.
Even worse, some people see recovered alcoholics as „weak“ (because they „can’t handle their drinks“)… nothing could be farther from the truth.
Even though I’m a libertarian at heart, I really wish the government would restrict alcohol sales so you don’t have to face shelves full of booze when you shop for groceries.
Looking back when I was with my Dad little things now stand out more quirks as to why small things now upset him. As Dad's illness got worse I could see the anxiety but still I wasn't sure what I was seeing. My Dad a blue collar worker arms the size of my legs, impervious to anything, stoic. But to see the affects of anxiety on him was terrifying.
Thank god for these types of drugs it made my Dad's life bearable. It's not perfect but living in terror versus being a bit drowsy is the better choice. I wouldn't wish anxiety on my worst enemy.
His mind was clear up until the last two months because he was in the hospital and then palliative care. So that was not unexpected to be said since he'd never be home again.
It was quick really only about a month until he died once in palliative care. Although I could tell he was putting on a brave face. Dad died by my side in his sleep in palliative care but he was clear of mind two days before. He was never alone at home, in the hospital, or in palliative care I was always there.
Anyway I could ramble on about it more but really my family is lucky to live in a country with socialized medical system. I'm also thankful for drugs there are some amazingly helpful drugs can ease suffering of many people.
This is all to say, if you or a loved one is struggling with alcoholism, I highly recommend looking into The Sinclair Method. Check out /r/alcoholism_medication or this accounts recent comment history. That community supports those that use disulfiram as well, but I cannot comment on that medication myself
The medication has helped all 3 issues, a lot. How much it's worked is incredible. I don't know how hard it would've been to stop alcohol without it, but I'm sure I would've failed more before succeeding. Honestly, I'm more impressed by how it's helped me manage my relationship with food. I've spent the last 15+ years obsessing over food. I still think about it far more than people without eating disorders, but my self-worth is not tied to whether or not I eat. I think my mood was better managed on my old antidepressant but things now feel... how I think "normal" is?
That said, I do need to get a medical bracelet of some sort. My doctor didn't mention exactly how naltrexone worked and it wasn't until I stumbled across /r/alcholism_medication that I realized that if I got hit by a car or had some other accident, was unconscious and administered opiates - they wouldn't work, and being on naltrexone could have harmful effects if I underwent emergency surgery if the medical personnel were unaware of my prescription.
They would give the standard amount of opioid (say fentanyl) and if they don't see the desired response they'll up it. Eventually you can "out compete" the naltrexone for the opioid receptor and get an effect.
If they do give 2-3x the dose, they'll be sure to monitor closely after to make sure everything goes well.
So can a slew of other drugs. You should see the drug risks for stuff folks take for autoimmune disorders. It isn't just up to the doctor to mitigate the risks: Patients must do their part as well (blood tests and so on).
And most importantly: So can alcoholism. Alcoholism kills slowly. Withdrawal can kill not-so-slowly. Somehow, do you think the doctor is not responsible for refusing help when the alternative risks include death as well?
That said, I'm not a doctor and there are generally (but not always) good reasons to avoid a drug or another. The risk of drugs by itself usually isn't it, though, as it depends on effectiveness compared to other drugs/methods and comparing the risk of cure to the risk of continued disease.
Dr isn't legally liable for drugs you find on your own.
>Individuals who experience the alcohol flushing reaction may be less prone to alcoholism. Disulfiram, a drug sometimes given as treatment for alcoholism, works by inhibiting acetaldehyde dehydrogenase, causing a five to tenfold increase in the concentration of acetaldehyde in the body. The resulting irritating flushing reaction tends to discourage affected individuals from drinking.[9][10]
I literally have a negative feedback loop from drinking alcohol, it makes me feel really bad, my skin flushes, I feel my heartbeat in my chest/neck/head, and I literally feel miserable.
Honestly, it kind of sucks, because when you can't drink you notice how much socialising is based around alcohol. I've found ways to cope with this and am on good terms with myself now but it really took me a long time. Especially to get around the social/peer pressure of having to drink.
On the bright side, I'll likely never become an alcoholic.
The mechanism is similar, you're right, but not quite the same.
I chose to seek Antabuse of my own volition some years ago after failing repeatedly with every other method including naltrexone and rehab. It worked for me brilliantly to stop my brain from sabotaging my life. Humans are not immune to the biological and evolutionary mechanisms that every other animal also suffers from, and there's just as much no reason to ignore things that can work.
I know this'll just get labeled as shill post since it's anon throwaway, but I promise I'm not. It does work for some people and gave me my life back. Maybe not that many, but more than zero.
But the article is reporting a different effect altogether. Disulfiram indirectly inhibits glutamate signaling, which produces a putative "antianxiety" effect in an animal model of anxiety. It makes sense in that glutamate is the primary activating neurotransmitter in the brain.
After all existing antianxiety agents like benzodiazepine drugs work by binding to GABA receptors. GABA is the primary inhibitory neurotransmitter. The logic is increase inhibitory effect == reduce activating effect. BTW it's not coincidence that alcohol also binds to GABA receptors, the reason people reach for a drink when they're feeling nervous.
But the problem remains that taking disulfiram for anxiety means using NO alcohol at all. Maybe a few people are OK with this but I bet most will be unwilling to give up having a drink now and again. So it creates a problem since people will forget and with both on board it can be a big headache, in more ways than one.
Whether this inherited intolerance of alcohol is the norm depends on which populations we're talking about. For example among people with European ancestry this genetic variation is uncommon. And indeed alcohol dependence is a huge issue in many parts of the world.
In my experience disulfiram is only useful with people who are motivated to quit drinking. Forcing alcoholics to take disulfiram is asking for catastrophe. (Courts used to impose this condition on people charged with driving while intoxicated.) I've known individuals who drank anyway and wound up in the Emergency Department. Fortunately none died but it can happen. Anyway it's an issue because having an anxiety disorder often leads to abusing alcohol.
But the article's real story is not only the potential antianxiety benefit of disulfiram, but the intriguing finding regarding novel mechanisms of action, and that is worthwhile exploring further whether the drug ever gets approved for this new use, or not.
Not at all contradicting your point. It just goes to show we have to take things in context, the context itself being subject to infinite variation.
Social pressure to drink can be a problem but usually saying you can't because of medication will get people off your back.
www.reddit.com/r/decaf for lots of anecdotal stories
Alcoholism is an umbrella term for 2 co-occurring disorders, one physical and one mental. On the physical side, alcohol produces an allergy which manifests as an intense physical craving for more alcohol - craving in the sense of a physiological need, which the alcoholic experiences on equal footing as a need for food, water or oxygen. The mental side of things (often referred to in AA as a spiritual ailment) is a sort of compulsive disorder in which the alcoholic becomes absolutely obsessed with proving to himself and others that he can "drink normally". The obsession is why the first drink is taken and the allergy is why it will never be enough.
Now, the allergy is relieved immediately by removing the allergen, say by going to rehab or drying out at home, but as anyone who has spent any time at all around one of us knows, this purely physical "sobriety" is usually short lived if the mental obsession is left untreated. The proposition of antabuse is basically identical. Everyone I've ever known who took antabuse simply stopped X days ahead of a relapse. It is completely useless.
As for whether or not it alleviates anxiety in rodents, I will leave that to the people who are studying it.
The AA community generally considers this a disease that has no cure. Once an alcoholic you are permanently an alcoholic. So that is why you'll see people pushing the idea that it is similar to an allergy. They are correct that genetic differences exist, but in the real world, many people have substance abuse problems due to stress or anxiety or childhood trauma. Meaning the biological components are far less of an issue than the psychological and mental health component in most cases of substance abuse. A well documented point of evidence of this is heroin use in Vietnam [2]
[1] https://en.wikipedia.org/wiki/Type_I_hypersensitivity [2] https://jamanetwork.com/journals/jamapsychiatry/article-abst...
Most individuals either find that model sufficiently useful that they don't need to expand it. Or, they're more or less fully aware of the gaps but still find that model useful. Or they don't find it useful and quietly use another model personally. All kinds of approaches in there.
If we're talking about 'the real world' then "It is never safe for you to begin drinking again, in any context" is a highly conservative and risk-averse approach, but it has been valuable for so many, and the consequences of relapse can be so high. AA is full of people who "went back out there" after 2, 5, 10+ years of sobriety because they thought they could reintroduce it into their lives and were wrong. Also many stories of people who did and just straight died in the relapse. Often our support networks can't handle another round, plus kindling is a real thing.
AA is where I first heard about van der Kolk's research, which demonstrates very convincingly that in some very real ways there's not a meaningful difference between "biological" and "psychological" components of trauma or addiction.
The AA framework has some incredible faults don't get me wrong. But above all those people are intensely, almost pathologically sometimes focused on "the real world." You'll hear some weird shit coming out of there sometimes because of that, but it doesn't mean they're not aware of the contradictions, or unwilling to apply more "scientific" models. Just, they have a system that works for a lot of people so they keep it going.
The problem with groups like AA is that they seem incapable of revising their dogmatic beliefs when presented with new evidence. What if opiate addiction and alcohol addiction are not 'lifelong diseases' at all, but simply treatable conditions? Would AA revise its claims if presented with such evidence?
And look, I'm not saying the medical model isn't more effective. But "new evidence" isn't always easy to apply even when it is clear, and with addiction it very often is not. AA's method despite its serious serious flaws has worked for a lot of people over many decades, so yes there is some natural conservatism about updating it every decade to keep up with new research.
You're on the right track though with the dogma thing. If you're familiar with the sociological study of religions, looking at it through that lens can be very valuable. It has a cultus of belief and ritual, it has a community of believers, and yes a dogma. It doesn't never change, but it is slow to.
To understand this thing you need to try to understand what value it has to people. If you want them to switch to another approach you need to demonstrate the actual practical value of that approach to people. This is literally life and death shit, people aren't going to part with it just because some le atheist engineers don't like that they call it an allergy and ask god for help.
Of course, science provides no ultimate answers of the type religious fundamentalists (a group which includes the dogmatic atheist IMO) seem to be seeking. For example, it's impossible to use science to test the 'simulation hypothesis', i.e. the notion that we're all living in a perfect VR sim.
Expecting people to abandon a belief that they can plausibly claim has saved their life because it isn't scientifically true is a radical ideology.
Very much good has come from it, true or not. If you think you can do better then pick up a shovel man, and get to work. Because one of the other things AA provides is practical advice on how to work with people you don't understand or like, towards the shared goal of healing and sobriety.
Regardless, promoting bogus scientific claims in the name of social good does actual harm to people. It's one of the reasons for the whole anti-vax thing, and the resulting measles outbreaks, for example.
It's especially funny because I am knowledgable on this subject, sympathetic to your concerns, had time and energy this morning to go into depth on the details and problems of AA and how I have chosen to engage with them over the years, and why so many of us continue to.
If you had wanted to learn anything about the day to day fights against addiction as they are experienced, contradictions and all, this was a great opportunity. But you just couldn't get over this specific hangup of yours, and pissed it away. Good luck out there man I hope you never need us but we'll be here if you do.
Scams to make money like MLMs and Scientology prioritize payment over adherence to the tenants of the organization. And the leaders are paid millions of dollars and live luxurious lives. AA is more like the Salvation Army. It is a group that clearly believes things that are not scientifically true, but most people join with good intentions.
I looked at the "Beliefs" section of their Wikipedia page but couldn't find, after 1 min or so of looking, a clearly stated scientifically false belief.
Are you referring to this, which sounds similar to AA? https://en.wikipedia.org/wiki/The_Salvation_Army#Adult_Rehab...
The American Medical Association has never suggested there is scientific data proving this therapy to be successful at changing sexual orientation, in fact the scientific data proves the opposite, it is harmful.
Open meetings permit anyone to attend as a visitor.
first there's the philosophy itself and all the associated dogma and religious aspects. I found this pretty weird and not my cup of tea, but I have no problem with it existing and people adhering to it if it helps them.
then there's the community. thirteenth stepping aside, these are mostly people genuinely trying to help themselves and others. I noticed some odd things, like some AA meetings banning the mention of drug use (?) and the fact that people are often preaching total abstinence in between gulps of coffee and drags off a cigarette. but whatever, not a big deal. what was a big deal to me was the attitude some members take towards people who don't find success with the process. the big book is quite clear that it does not claim to have a solution for everyone, only one that worked for the writer. and yet I often heard some variation of "it works if you work it" if I voiced anything like this, the implication being that it would work for me too, if only I tried harder, surrendered more fully, etc. very toxic imo, not sure if all meetings are like this, but it was a persistent theme in the ones I went to.
but the biggest issue I have with AA is not the philosophy/organization/community, but its place in recovery in general. it's not just the default option; it's often the only one. you really have to dive deep to find any alternatives. even if you pay to see a psychiatrist or therapist, they will often just tell you to go to meetings, maybe prescribe some suboxone/naltrexone if you're lucky. rehabs (the ones that will take your insurance at least) are heavily based on the AA model. some of the lazier ones basically are just a series of AA meetings that you can't get away from. it sucks all the proverbial air out of the room. on top of all that, the relationship with ostensibly secular government (ie, court-ordered meeting attendance) is highly inappropriate.
this was a pretty negative comment, so I want to be clear that I do respect what you do. "free" and "works for some people, at least" is a pretty hard combo to beat when it comes to recovery. I don't want to pressure anyone to change something that helps them with such a serious problem. I do wish that, as a group, AA would just stay in its lane though. it should not have the relationship with government and medicine that it currently does.
Judges and mental health professionals sending people to AA without specifically understanding its practices and how those will help that individual is terrible and I hate that it's as common as it is.
And speaking from within the US, a lot of the weird AA-isms I think are adaptions to our fucked up healthcare system and general attitudes towards personal agency and addiction. No one is picking people up off the streets and giving them top-notch medicalized in-patient addiction treatment you know? AA isn't ideal or even necessarily very good for a lot of things. But it is there and it is free, and no matter how fucked up your life is they won't turn you away. Can't really say that about many other treatment paradigms right now.
You seem to express contempt without prior investigation.
I can assure you that much good has come of it.
It would be great if there was a sister organization to AA that was more of a group therapy session, without the spirituality and alcohol abstinence components. But maybe that wouldn't work, since there would be no rules and groups could diverge toward unhealthy behaviors.
They're based around harm reduction, so no day-counting or rigid definition of sobriety like AA which honestly is wonderful and AA could (and does!) learn a lot from it. Alcoholics already carry a lot of shame, increasing it isn't helpful imo.
It doesn't have the reach or widespread cultural awareness that AA does but they still seem pretty common. I think AA is only really a good fit for people who are already religious or are open to becoming so. Otherwise I generally do suggest people try smart recovery first.
Hypothetically I guess it could have been the case that... I dunno, an allergic reaction to alcohol could produce a different type of experience for the person who'd ingested it, which could have been subtly more enjoyable, which could have resulted in a tendency toward alcoholism. That would have been interesting, as tinkering with the immune system could have been a path toward preventing that skew.
I think AA really works for some people. Not sure why they decided to stick with this confusing lingo, though.
The term itself is less important than the understanding it conveys both to the afflicted and a judgemental public. The alcoholic craving is not similar to desire, there is no agency involved, and you can't think or will your way out of it. I have extensive personal experience with basically every other treatment modality for alcoholism that modern medicine has to offer and the allergy/obsession framework is the reason I am alive. It's not just me. The rooms of AA are filled with people who have tried everything else and been failed by it; nobody wants to wind up in AA.
At any rate, if it's not an allergy anymore, it's something else in it's own category that is indistinguishable from an allergy to laymen.
I'm not saying AA should be tossed out (it has helped people I care about), it just seems weird to stick to using a pretty well understood word wrong. This is not a grand philosophical statement, just a matter of not using intentionally confusing lingo. If there's anyone out there who actually thinks it is an allergy, they should understand that current research into treating allergies won't help them, that specialists who treat allergies are the wrong ones to go to, etc etc. Surely there's a better word for a physiologically based tendency toward addictions.
Also I'm impulsively here to query the use of Physical vs Mental components of alcohol abuse.
I personally find it difficult to separate the two domains. I understand one is referring to detoxification and the other to habbit and belief. Both those are simultaneously physical and mental, and benefit from support within both those frames.
Mind brain dichotomy is not very useful IMO. Happy to be shown counter examples.
Part of my understanding is that for at least some of these folks they never learned to deal with emotions. They never learned how to feel and accept that feelings exist. Alcohol is the agent that they utilize to help keep those feelings at a level they can manage. It’s a numbing agent.
The social chaos that these individuals because of their alcoholism is so enormous. And I’m at a point where I can see how it influences their adult children and it’s depressing. You can see how the disease is transmitted from generation to generation. Someone might be disposed towards alcoholism, but coming from an alcoholic family and the chaos that comes from that makes it even more likely that the kids will become alcoholics.
I’ve seen people take obscure research benzos that led to weeks long blackouts, belladonna alkaloids that led to assaulting firefighters, bath salts that led to arson charges… and I’d suggest any one of those over the absolute abject misery that I’ve seen disulfiram cause.
Anybody that calls a drug that’s essentially a form of torture a “cure” for something as complex as alcoholism is at the very best dangerously stupid, at the very worst a liar with a conscious fetish for abusing strangers, and on average somewhere in between. No matter what, they aren’t real scientists by any stretch of the imagination.
I have some experience with this med and it does work as intended for alcoholism. Plus it does the job a lot more gently than what I imagine disulfiram does.
> Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study
Mushrooms will help us.
(from of a card carrying neurogeneticist who uses mice and rats to study the biology and treatment of human diseases, specifically alcoholism and substance use disorders)
Step 1: Go to Methods section of the paper and check the SEX, AGE, and TYPE(s) of mice or rats that that the team used.
Here is what this team writes:
“Male ICR mice were used for behavioral experiments (age: 6–10 weeks; Tokyo Laboratory Animals Science Co., Ltd., Tokyo, Japan). The total number of animals used in the study were 232 animals.”
So SEX = all males
AGE = 6 to 10 wks, which in human terms is roughly 12 to 19 years-of-age — teenagers.
TYPE = ICR = Imperial College Institute of Cancer Research albino outbred mouse stock
Do you see any problems yet with the design?
Step 2: How many mice did they study? ANSWER = 232. This is a substantial number of mice to study, so we expect to see dense data plots and low error terms.
Step 3: Check if they tried to do the work blinded to the treatment groups.
Step 4: Review the individual case data and statistics only if you feel the work passed steps 1, 2, and 3, above.
The goal of the first four steps is to establish the likely relevance of results and their generality to both sexes, multiple ages, and to other types of mice or rodents. Once that is established then and only then can we speculate in relevance to humans.
This study FAILS on all three of the first steps—one sex; one narrow age range, one quirky type of outbred stock.
Do not even bother to read the results. Instead send the authors a letter asking them why they thought they could ignore studying female mice. Ask them why they only studied juveniles. Ask them why they did not study other types of mice before getting their public relations team all fired up. Ask them if they think this work robustly generalizes from young male iCR mice to humanity at large.
I love using rodents in research because you CAN do the studies right! Work using rodents CAN be highly relevant to humans heath care.
Mice and rats can be great models for human disease but only if used correctly—rodents and primates are in the same super-order of mammals—the euarchontoglires, aka the superprimates! They are evolutionarily a bit closer to us than are cats, dogs, pigs, bats, whales, and giraffes.
Below is a link to my first study using mice if you want to see how research using rodents should be done. I was a young assistant professor with little funding at a second tier research institution. If I could do this then, then researchers at the top research institution in Japan should be able to do the right thing today.
This kind of easy to follow step-by-step breakdown of the method section should be included as an obligatory abstract of its own if one really is willing about improving the readability for people outside of the field. It actually takes a lot of time (most people don't have) in identifying all the technical terms and then to recognize what their actual experiments/basis were so that one can actually follow their arguments.
Not to mention, most of the illegal compounds have pharmacological activity that would be nearly impossible to get from a prescription for most people.
Not dismissing anxiety and a desire from those suffering to get out of it, but this wreaks of another case of solving difficult/complex problems with 'simple' solutions...
A better alternative to treating alcoholism and anxiety are gabapentinoids and gabaergics. There are a few of them, and indeed Gabapentin has been known to be used exactly for these purposes in the US (not Europe, God no, they'll think you're fucking insane).
At low-moderate dosages, they give the anxiety relief/relaxation effects of alcohol with none of the negative effects, except withdrawals - several days of insomnia/nightmares if stopping them abruptly. They work on the same receptors as alcohol, so it's kind of a replacement, and it's much easier to taper off them. However if you start taking them together, that can be a problem, as they complement each other. You can end up drinking less... or getting even more fucked every night. As always, gotta be really careful and follow some rules.
I have quit alcohol completely after more than a decade of use and abuse, I realized it's fucking me more than helping (actually always knew, but it was irresistible). Lately I was mainly using it to go to sleep, so I found this wonderful drug called Tizanidine, an alpha2 agonist prescribed as a muscle relaxant, but at slightly higher doses it quite literally knocks you tf out.
No major negative side effects besides indeed, relaxing muscles (so it's best to exercise when waking up or your joints may be in danger), no withdrawals. Tolerance builds up rather fast, after 2 weeks you need double the dosage. But 4 weeks was enough for alcohol cravings to subside a bit. I still miss the taste of beer hah.
Since I could fall asleep at any time, that was one major reason to not need alcohol. I even stopped myself from going to the store by taking Tizanidine as soon as I started thinking about beer (which was almost always in the evening). Then I found something for depression (SSRIs don't work).
You'll say, "you just traded one drug for another" - yes, I did, however the positive:negative effects ratio has massively shifted towards the former.
And I regularly quit my (self-made or self acquired... man, fuck mental healthcare) medication so I can test how addicted I am. It's nothing like alcohol was, that is absolutely life destroying shit that I hope I never taste ever again for the rest of my life.
Gabapentin(and pregabalin), while a GABA analogue, doesn't actually interact with GABA receptors og GABA itself at all. It acts on voltage-gated calcium channels, which is in part similar to the downstream signalling effects of GABA, and hence gives the effects you describe.
I can only say for sure the effects are very similar to alcohol's positive ones at low dose, somewhere between alcohol and cannabis at higher doses, and not everyone reacts to it.
Myself, after using it for about a year as an anxyliotic (it can also have some interesting effects on creativity), I stopped for half a year and upon trying it again, I get zero effects. Usual dose was 0.9-1.2g. Now, no effect. I tried up to 6 grams at once, still no effect.
It is very strange, like some sort of permanent tolerance. From what I can gather, others have had the same experience, and some can still get an effect at very high doses. Sad, it was pretty good while it worked.
Pregabalin still works on me, but the effects are less pronounced at low doses and too blunt and stupefying at higher doses... may work well for some people, though.
One of the upshots of the current trends in psilocybin treatment is that it at least places an equal emphasis on a therapeutic environment.
I wanted to try my comment again to see if I could rectify my error and apparent hypocrisy.
If anyone is still reading this thread and desires freedom from alcohol I will try to expand on this while it is still up. My desire to not die a drunk came suddenly to me late last year when one my beloved neighbor died one unfortunate night after a lifetime of alcoholism due to her drinking. She was a confessing christian and was not able to drive anymore because of a license suspension. I thought I too was a Christian.
Because she could not drive and since I too was an alcohol abuser I sought to please her by answering her request to buy cheap liquor for her from the place she wished while I was pounding cheap six packs night after night day after day for years.
Then one day her eyes turned yellow and I pleaded with her to seek medical attention. I said you probably better lay off the sauce for a while until you get well but she did not. Even if she had, it was already too late for her. A week later she was taken to the hospital and that night she died.
My brother also went to the hospital a couple years ago because of a lifetime of strong drink and he was also near death. By God's mercy he survived and though he is still a drinker he only drinks beer now and we both enjoyed about a hundred gallons of cheap beer since that time.
He was not a christian but I thought I was. I thought everyone who confessed the name of Christ was his and that his mercy could overlook such depraved behavior. I thought my neighbor was a confessing christian. When I was depressed she exhorted me over and over to read the book of Romans. Yet Paul had the harshest words for drunkenness. We tend to pick and choose what to accept and what to reject with what is already in our hearts and when our hearts are set one way we do not often let the truth in.
When she died I felt not only grave sadness for her loss but also deep guilt in my own conscious for not only being exactly like her but also enabling her death. I had defeated the enemy in me at that point concerning pornography (which to this day I have been free of for 6 months) I thought man I've done it, I'm now a christian for real. I had an abundance of confidence. But it was not so at all true that I really knew Christ.
Since December 27th I've been free of being a continuous alcoholic. I have to confess I did have one day of drink just recently but I did not seek any after. I do not intend on buying drink ever again. The drink I had was a gift from a friend (my landlord) who made wine with his own hands. I could not refuse. I did not feel the same pull I always did to have more and more. Indeed one drink ought to take me back to the abyss.
My life has been in turmoil all year yet I refused to see it until I dreamed an extraordinary dream of my Dad fist fighting me and being unable to get away from his wrath. There was no where to run, there was no where to hide.
I sought the meaning earnestly and received 2 other dreams. Some other dreams I had were completely humiliating. But all this was leading to something that I was not doing what I ought to do. I was proud, I needed a great deal of humility and I was unable to see that from what my peers were telling me.
I had to seek my Heavenly Father's countenance earnestly to find peace.
Dear friends, alcohol is a cruel master, it strips away your whole life. It will take the lives of those around you and leave you with guilt to consider what you did. It will take your job and your freedom. It will separate you from your family. It will even take away your communion with the Almighty.
I'm not writing this to condemn but to help. I love Christ because he first loved me! Love is not mere acceptance, nor is it slave to us. It is our master. Christ is love and he is truth. Christ does not reprove people he hates, reproof is love. The loving son accepts his father's reproof. The unloving son hates reproof.
The death of my neighbor may have indeed saved my soul. Because until that point I was living in grave error. Her death still reverberates day after day with her sister which is also now my beloved neighbor.
That is why I said only the desire to not be an drunk will save you from being one. But we are powerless to do this on our own. Alcohol has a very strong hold on some of us trying to cure or fill something in us which only the spirit of God can fill with concrete.
If you make Love your master, Christ incarnate is Love, instead of Alcohol, then nothing will be truly impossible for you if you remain in him. Pray earnestly for his splendid countenance and you will receive it.
That's interesting...
That said, there is value in studying the texts of AA. They contain a lot of wisdom. The 12 steps as written by Bill Wilson in Akron and modified through debate with other real alcoholics are especially interesting and are based on time tested methods of self-examination. The "God" word doesn't have to be a hangup. Bill Wilson and Dr. Bob were Christians, so they used God in the sense of the creator of the Universe, but it's acceptable and encouraged that a person substitute their own conception of God.
You don't have to go to a meeting to find a sponsor. A sponsor is only supposed to explain how the 12 steps work. A sponsor is not your therapist, guru, priest or companion. This is often lost in modern AA since so many people are accustomed to talk therapy. You could call the AA hotline in your town and tell them you are looking for someone to take you through the 12 steps.
People say a lot of things about AA without ever talking about the steps [1], which are the core of AA. It's hard to overestimate the brilliance of what Bill Wilson came up with on Dr. Bob's kitchen table. A quick summary:
Steps 1 to 3: Getting clarity about how bad the problem is, about whether you can solve it by yourself, and if not, who can you ask for help and how willing your are to humble yourself to ask for help. Are you done yet? Are you ready to surrender?
Steps 4 to 7: Cognitive Behavioral Therapy (CBT), Dialectic Behavioral Therapy (Wise Mind [2]), with Step 5 being Cognitive Processing Therapy for trauma, which entails telling your trauma to someone as a way to acknowledge and release it. In all this you learn meta-cognition or thinking about thinking and feeling. Are my feelings based on anything real or am I practicing one of the cognitive distortions [3]? You learn to be the observer of yourself, which is the key into meditation. Becoming the witness is that path to your higher power, so the last part of this phase is to resolve to not spin your wheels in repetive thoughts and emotions, but turn them over to your observer and witness of yourself. From that mental standpoint, it becomes much easier to ease your mind into a calmer state and hopefully eliminate what drove you to drink in the first place.
Steps 8 to 12: Rejoining the human race, since most severe alcoholics end up isolated and alone. Getting right with others is an important part of maintaining getting right with yourself. This maintanence is extremely important and most successful recovery persons "carve out a little part of each day" to practice this maintenance. An important part of this maintenance is helping other alcoholics, which is expressed in the saying "You have to give it away to keep it"
If you go to an AA meeting and no one there understands any of this, then find another meeting.
I have previously written about this here: https://news.ycombinator.com/item?id=29951607
My not real name email is my profile if anyone has any questions about the 12 steps
[1] https://www.aa.org/the-twelve-steps
[2] https://dbtselfhelp.com/dbt-skills-list/mindfulness/wise-min...
[3] http://www.pacwrc.pitt.edu/curriculum/313_MngngImpctTrmtcStr...
When you have an error, you have to handle it, or someone up the chain has to, or the program crashes(Or behaves in an undefined way, if it's a language like C that makes it way too easy to ignore return codes).
Try/catch directly expresses all that in a language construct without requiring you to explicitly think about it much, except in functions that throw or functions that catch.
Requiring functions to declare throws fixes most of the issues with it.
Whether we create a "Soma" type drug from Brave New World which in little doses provides enough pleasure to forget our painful addictions, are we actually solving problems or simply inhibiting them so long as the drug is used? Does this now create a new dependency on another drug that can lead to other life ruin?
I'm a firm believer in the duality of the world. The pain we go through in terms of alcoholism/anxiety can be life's cruel way of teaching us. In other words, the pain doesn't leave until it's done teaching you(in one way or the other). Having friends and family who coped with alcohol and are extremely anxious, you can see it as both the best and worst thing that has happened to them.
To make real change away from alcoholism or anxiety, there's much more work than simply inhibiting the pain or providing more pleasure outweighing it. I believe this is more alongside the self and understanding one's purpose as both of these things are typically "symptoms" of the bigger human condition problem.