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What Science Says to Do If Your Loved One Has an Opioid Addiction

fivethirtyeight.com

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Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#171

Post by betenoire »

javajosh wrote: post #154
betenoire wrote: post #131

Earlier quoted context omitted.

I'm sorry you felt I was being confrontational. But I stand by it. Telling someone there is a reason for what they are going through, then saying, "now find it and fix it" is NOT helpful. I sincerely believe that anyone that thinks pointing out the obvious to an addict will help has not actually done it. And I consider "It's something in your environment" to be obvious, true, and totally not actionable. Furthermore,…

I didn't say any of that, addressing the context in which people become addicted is actionable and valuable, and I'm bowing out of this conversation.

I was replying to the second part of your comment, where you accused me of pedantry for some reason. I'm explaining to you why I commented that "it's the environment" wasn't helpful, in spite of your downvote.

peace out :)

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#172

Post by taxicabjesus »

GatorD42 wrote: post #151
tptacek wrote: post #118

Earlier quoted context omitted.

It's useful to remember the ADAA in the broader context of the 1980s push towards harsher federal sentencing across the board. It's not a coincidence that federal sentences were revised and federal parole abolished just a few years prior, or that the Willie Horton ad would run in the next Presidential election. It's true that there was mainstream black support for anti-crime legislation, but that support wasn't disti…

I see many of these discussions that focus on federal sentencing laws without considering that state laws and enforcement practices are far more important. State laws are varied and complicated - some states are far harsher than others. Yes the federal laws are and were unfair and stupid, but the large majority of prisoners and drug offenders are in state prisons. John Pfaff has been on a lot of podcasts, he is the m…

Thanks for the link. I'm working on a post for my site about the recently deposed/pardoned Sheriff (Joseph Arpaio) and will probably quote something like this:

> Pfaff tries his hand at some of the messaging that will be needed here: He argues that incarceration is simply an ineffective way to combat crime, while it imposes all sorts of costs on individuals and society that likely outweigh its benefits.

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#173

Post by Karunamon »

newsmania wrote: post #163
kirse wrote: post #158

Earlier quoted context omitted.

actively resists any data collection What an overly dramatic way to restate that these orgs are anonymous. collective refusal to take the problem of addiction seriously Incorrect. The church, particularly Jesus, does take it seriously. Addictive and destructive behavior patterns are called sin, but because this "progressive" society continues to water down right vs. wrong and tread down a path of moral relativism (th…

Thanks, glad to see someone stand up for Jesus on HN. People act like religion is stupid here, but you make a great point to the contrary. If everything truly is relative and all that matters is what you want, why is opioid addiction a problem if that's what you want? There is good and there is evil. The attempt to deny it, as you correctly say, causes huge problems. Like how we tell school children that they are no…

Slight issue: I don’t think opioid addicts want to be addicts. When an externally introduced chemical is hijacking your neurochemistry and making you feel some of the worst pain imaginable when it’s not there anymore, wanting the pain to stop is the most natural desire - it just happens that more of the chemical is the fastest way to do so.

There’s also the fact that it’s objectively destructive, simultaneously to society, personal relationships, and the addict. No need to even invoke philosophical good and evil there.

And I say this as a religious person myself.

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#174

Post by warcher »

ThrustVectoring wrote: post #161
warcher wrote: post #153

Fun fact: The current standard within the US is AA/NA. AA and NA are not only wholly unscientific, being invented of whole cloth by a layperson in the early 20th century (for context, lobotomy was a totally accepted psychological treatment for decades after 1935). There was no science whatsoever involved in AA, and indeed Alcoholics Anonymous actively resists any data collection about the efficacy of its techniques w…

The only way to fairly evaluate a program is on the difference between it and a control intervention of some sort. Like, you can't just claim that the best students must have had the best teachers. A fair chunk of data supports the claim that people have gotten sober while in AA, which is significantly different than the claim that AA helps people. Unless you've got comparisons with control groups, "good work being d…

AA is all volunteer, run by people who are doing their level best to help with a monstrously difficult problem, with demonstrable success. I do think they got some things right. I don't think their work is finished, and they do need to examine their methods and the efficacy of the same.

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#176

Post by aaron695 »

warcher wrote: post #153

Fun fact: The current standard within the US is AA/NA. AA and NA are not only wholly unscientific, being invented of whole cloth by a layperson in the early 20th century (for context, lobotomy was a totally accepted psychological treatment for decades after 1935). There was no science whatsoever involved in AA, and indeed Alcoholics Anonymous actively resists any data collection about the efficacy of its techniques w…

>refuses any objective evaluation of its efficacy, or changing its methods.

The reason AA works is it refuses to change. It refuses to follow fads. It makes it imperfect but also makes it very resistant to politics.

> actively resists any data collection about the efficacy of its techniques whatsoever.

Because it's Anonymous. This is part of what it is. Sucks, but that's what it is. It's an important part.

> it's super churchy.

True, it's full of atheists though, I'd be interested to see if it has more atheists than the general population. But true it does use a cult model for positive change.

> There was no science whatsoever involved in AA

But there is solid science that backs AA. Even if it was started without a scientific underlying idea.

People love to bag out AA, but as your last line says it is working for some people, studies back this.

In a future utopia where healthcare is free and drug abuse is treated appropriately there might be better but we can't toss out one of the best treatments while we wait.

The article is about family (Nar-Anon) and opioids (NA) so my comment is all a bit OT.

But let's take CRAFT from the article, without the culty bit of Al-Anon/Nar-Anon, which CRAFT removes, can it be self sustainable across the world? If not, then is it really a better cure.

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#177

Post by warcher »

rajacombinator wrote: post #157
warcher wrote: post #153

Fun fact: The current standard within the US is AA/NA. AA and NA are not only wholly unscientific, being invented of whole cloth by a layperson in the early 20th century (for context, lobotomy was a totally accepted psychological treatment for decades after 1935). There was no science whatsoever involved in AA, and indeed Alcoholics Anonymous actively resists any data collection about the efficacy of its techniques w…

Got any better suggestions? Genuinely interested, not sarcasm. (Mostly.)

It's happening, it's just happening slowly.

Point of fact, addiction is a disease and must be treated like a disease. This is pretty mainstream and not really all that controversial. The issue we're working through, glacially, is that in the US healthcare is for-profit and junkies are not profitable. So we just.... throw those people in the garbage. I think that's both immoral and economically wasteful. I know former junkies. Personally. And they're not garbage-- they have value and if you can get them well, they want to live a productive life.

The plain fact of the matter is that there's no business case for treating these folks-- the government is going to do it or nobody is going to do it. And the status quo is "Fuck it, send them to church. I'm not paying for a bunch of crackheads to get clean. They need to find jesus." Which is another way of saying "Let them eat thoughts and prayers."

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#178

Post by warcher »

aaron695 wrote: post #176
warcher wrote: post #153

Fun fact: The current standard within the US is AA/NA. AA and NA are not only wholly unscientific, being invented of whole cloth by a layperson in the early 20th century (for context, lobotomy was a totally accepted psychological treatment for decades after 1935). There was no science whatsoever involved in AA, and indeed Alcoholics Anonymous actively resists any data collection about the efficacy of its techniques w…

>refuses any objective evaluation of its efficacy, or changing its methods. The reason AA works is it refuses to change. It refuses to follow fads. It makes it imperfect but also makes it very resistant to politics. > actively resists any data collection about the efficacy of its techniques whatsoever. Because it's Anonymous. This is part of what it is. Sucks, but that's what it is. It's an important part. > it's sup…

> Because it's Anonymous. This is part of what it is. Sucks, but that's what it is. It's an important part.

Dude, there is no reason you can't collect medical data responsibly and with respect to privacy. Cmon man. We do a whole lot of this, all over the place. They can, they just won't.

> But there is solid science that backs AA. Even if it was started without a scientific underlying idea. > People love to bag out AA, but as your last line says it is working for some people, studies back this.

It would be untrue and unfair to say that there's nothing to AA. It's been successful, but how successful? Compared to what? IMHO, the greatest aspect of its success is its ability to let people off the hook. This is just a way for politicians to throw some 'thoughts and prayers' at a hard problem and call it good.

It's not good. It's not all bad, but you start digging into the social science research and there's a lot of progress that's been made since the 30's that AA just won't touch. AA isn't working for a whole lot of people.

But it's cheap and it doesn't trigger certain populations within our democratic society, so it's gone on and on. I think we're running out of road here, but... well, we'll have to see.

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#179

Post by tudorw »

taylorswift_ wrote: post #121

I read this, as a recovering addict that went through my own hell mostly from alcoholism, and wondered where the "science" part was? For instance this sentence "More than 13 percent of its participants died after treatment,1 mainly of overdoses that could potentially have been prevented with evidence-based care." The argument is that they "could" have been prevented but how do they really know that? How many people i…

I have a couple of friends on methadone, they are cordial, relatively together and in a totally safer place than prior. I would rather that than the other so it's legitimate approach in my eyes, they have the rest of their lives to figure out when they can stop.

"Detoxifications and drug free modalities, although appealing to an understandable desire for recovery without medications, produces only 5-10% success rate. Methadone maintenance is associated with success rates ranging from 60 - 90%. The longer the people are in this modality the greater their chances are of achieving stable long-term abstinence."

http://www.csam-asam.org/methadone-treatment-issues

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#180

Post by ThrustVectoring »

warcher wrote: post #174
ThrustVectoring wrote: post #161

Earlier quoted context omitted.

The only way to fairly evaluate a program is on the difference between it and a control intervention of some sort. Like, you can't just claim that the best students must have had the best teachers. A fair chunk of data supports the claim that people have gotten sober while in AA, which is significantly different than the claim that AA helps people. Unless you've got comparisons with control groups, "good work being d…

AA is all volunteer, run by people who are doing their level best to help with a monstrously difficult problem, with demonstrable success. I do think they got some things right. I don't think their work is finished, and they do need to examine their methods and the efficacy of the same.

Oh, I completely agree. I don't think AA is run by bad people or anything - my disagreement is with the level of institutional support given to AA. Decisions come with opportunity costs, and the cold logic of prioritization means that sometimes the best thing to do is to give less money to "people who are doing their level best to help with a monstrously difficult problem, with demonstrable success".
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