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Sobriety startups shaking up the 12-step model

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Re: Sobriety startups shaking up the 12-step model

#101
post #5

I want to see data driven novel approaches to addiction management. The 12-step model has dismal success rates [0]. Virtually all of the novel programs and facilities either do not report a success rate or their reported rate is highly suspicious. There are some exceptions [1]. The global addiction market is $4 billion and growing [2]. Any company working in the addiction space should keep accurate records of their s…

Let's not throw the baby out with the bathwater. New programs are not competing against the actual success rates of 12-step variants, but their highly propagandized perceived success rates.

Judges and prosecutors aren't reading published, peer-reviewed science when deciding what to do with an addict that has committed a crime. They are listening to people who tell them "12-step programs just work, so send addicts to my 12-step program, instead of to prison!" And these people are claiming that, because the shipping and handling of convicted criminals is a big business, and they want to get at some of that money.

The programs from the article seem to be targeting non-criminal addicts that simply want to stop using without also having to prove it to their probation/parole officer. By that approach, even if they have a 100% relapse rate, they still might be more effective in terms of cost per month saved by abstinence or reduction in use. If someone has a $X/month drug habit, and pays $Y one time from their own pocket on a program that gets them to kick it completely for N months, before relapsing to $Z/month, they still got to spend part of the money they saved from not burning up their whole paycheck, on something other than drugs or drug treatment, and they might still be able to repeat the program before backsliding all the way. That's a different market from the guy caught stealing televisions to pay for meth, who has no money or earning potential left, but the state might still be willing to pay any price less than what it would cost for full imprisonment, to anyone that can manage to keep that one guy from causing more trouble.

While those people are burning up their brains and spare time on para-religious, pseudo-scientific procedures, they might also be holding down a regular job and not stealing stuff. That's a success, in that they are not actually wasting away in prison limbo or out actively tearing down society. That's the standard of success that the 12-step program has to meet. It isn't managing the addiction, but managing the addict. It's not part of the addiction market, but part of the criminal justice market.

That's a somewhat cynical and skeptical view of the system, from someone who hasn't been in it. From the outside, the 12-step program more closely resembles a cult than a valid psychiatric therapy. If your addiction hasn't cost you your job, your savings, and your friends, that 12-step program is probably not for you. And the rehab center designed around capturing some of the not-going-to-prison money is not for you. The online seminar that tries to teach you to recognize how much is enough, and to stop somewhere before getting there, might be.

It's very likely that it's just another package of woo-woo bullcrap that worked for one person, anecdotally, but it is still a valid tactic to try the cheaper options first, on a cost/perceived-utility basis.

Re: Sobriety startups shaking up the 12-step model

#102
post #5

I want to see data driven novel approaches to addiction management. The 12-step model has dismal success rates [0]. Virtually all of the novel programs and facilities either do not report a success rate or their reported rate is highly suspicious. There are some exceptions [1]. The global addiction market is $4 billion and growing [2]. Any company working in the addiction space should keep accurate records of their s…

Let's not throw the baby out with the bathwater. New programs are not competing against the actual success rates of 12-step variants, but their highly propagandized perceived success rates. Judges and prosecutors aren't reading published, peer-reviewed science when deciding what to do with an addict that has committed a crime. They are listening to people who tell them "12-step programs just work , so send addicts to…

> Judges and prosecutors aren't reading published, peer-reviewed science when deciding what to do with an addict that has committed a crime. They are listening to people who tell them "12-step programs just work, so send addicts to my 12-step program, instead of to prison!"

No, they are largely listening to and applying the laws of their state which set standards for such diversion. The problem is legislatures aren't looking at evidence, either.

> From the outside, the 12-step program more closely resembles a cult than a valid psychiatric therapy.

AA is actually one of the examples given detailed consideration in one of the seminal works on cults, Marc Galanter’s Cults: Faith, Healing, and Coercion.

Re: Sobriety startups shaking up the 12-step model

#103
post #52

Earlier quoted context omitted.

That's a pretty broad brush to paint all of religion with. There are plenty of rational arguments for Christianity for those willing to do due diligence: https://www.thegospelcoalition.org/article/countering-a-dist...

> There are plenty of rational arguments for Christianity No there aren't. Faith, by its very definition, is irrational.

The subject matter of faith may be irrational, but faith-based communities have benefits that ratheists miss out on.

Re: Sobriety startups shaking up the 12-step model

#104

Earlier quoted context omitted.

It used to be much more ingrained. Factory or construction workers used to drink during work, and if those old movies are to believe men would pour themselves drinks all the times. These days it is mostly acceptable to decline alcohol.

It's interesting that you cite factory or construction workers. I'm a first-generation college graduate, who grew up around skilled (and unskilled) labor. I've never heard of this being prevalent, even from old-timers discussing how things used to be way back when. Quitting time is one thing... but the last environment on earth in which you'd want to drink alcohol is around power tools or heavy machinery! My own firs…

> Has this culture ever really gone away?

It's possible I'm being naive as to what my coworkers are up to, but the "Man Men", 3 martini lunch culture has certainly gone away.

It's fair to complain that a company's social events revolve around alcohol, but, explicitly, when people talk about "company culture" and "good fit", internal company norms around alcohol are a huge part of it. There are workplaces that are basically a continuation of college frat houses, down to the levels of sexual harassment that make Uber look hospitable. There are also workplaces where everyone goes leaves at 5pm on the dot to get home to be with their partner/kids, and the Christmas party is a potluck with very limited amounts of wine.

Pick your poison. The recruiter is there to, well, recruit you, and they can't know how a given candidate feels about alcohol consumption, so if they too-gleefully show off their bar - push back! Ask how much people actually drink - there's a difference between between zero and one beer after work with coworkers (I just drink a la croix/talking rain while my coworker who does drink, drinks a beer), vs drinking liquor to excess.

Re: Sobriety startups shaking up the 12-step model

#105
post #74
post #11

After years and years of struggling with alcoholism and AA, I got sober with naltrexone using the "Sinclair Method". I followed the treatment plan for a few weeks and at the end quitting drinking was easy and obvious. That was just over ten years ago and I haven't had a drink or gone to any meetings since. I'm only one person and I'm fully aware that the plural of anecdote isn't data. However, the experience was so d…

Does this only work for alcoholism, or does naltrexone work for any compulsive behaviour?

Apprently its an opioid receptor antagonist and its mechanism of action for treating alcoholism isn't well understood. Since it modulates the reward system of the brain it could potentially be useful for any addictive behavior, however there's probably a reason it doesn't seem to be prescribed outside of alcoholism or opioid addiction.

Re: Sobriety startups shaking up the 12-step model

#106
post #40

Earlier quoted context omitted.

First congrats on finding something that works for you and making it stick! From that perspective, I can see why you would not like folks that insist on AA being a monopoly, but I'm curious about that position. I've seen a lot of people that hate AA and a lot of people that think it saved their lives, but I've never seen anyone say that AA must be the only way to sobriety. What's the angle?

I can't speak from first hand experience or actual knowledge, but I've seen several articles over the years about AA being the only US court approved treatment, leaving some people with the choice of accepting only AA or jail. Atheists in particular have commented on this, but also people that take issues with certain other AA stances (such as "you will forever be an alcoholic"). I have no idea if this was federal, s…

> "you will forever be an alcoholic"

That doesn't seem like an unjustified statement to me. I'm not an alcoholic, but I am a food addict and the experience of losing half my body weight and keeping it off for years has only reinforced, to me, the idea that I will always be a food addict.

Re: Sobriety startups shaking up the 12-step model

#107
post #19

Earlier quoted context omitted.

Depends on the quantity I guess, but... why is drinking 4-5 times a week not ok? Something like a glass of wine or a small beer should be fine, right? In some countries (e.g. France) it's a wide-spread habit to drink a glass of wine at lunch, and it doesn't seem to harm public health.

New findings show there’s no such thing as a “safe amount of alcohol” https://www.npr.org/2018/08/24/641618937/no-amount-of-alcoho...

Eh, so what. To a certain extent everything enjoyable about life is harmful to your health. Ice cream, pizza, cigars, staring at screens while sitting for hours at a time, playing sports..

Re: Sobriety startups shaking up the 12-step model

#109

Earlier quoted context omitted.

I can't speak from first hand experience or actual knowledge, but I've seen several articles over the years about AA being the only US court approved treatment, leaving some people with the choice of accepting only AA or jail. Atheists in particular have commented on this, but also people that take issues with certain other AA stances (such as "you will forever be an alcoholic"). I have no idea if this was federal, s…

> "you will forever be an alcoholic" That doesn't seem like an unjustified statement to me. I'm not an alcoholic, but I am a food addict and the experience of losing half my body weight and keeping it off for years has only reinforced, to me, the idea that I will always be a food addict.

Many agree with you. I've not encountered an addiction myself, (yet, at least, knock on wood), so I have no stance one way or another, but I've read accounts where many people have experiences similar to yours, and yet there are others that (claim to, at least) encounter it like an illness. They were sick, got treated, and now are not sick. Perhaps the Sinclair method that others discuss does that, breaking the longing for the alcohol, perhaps not.

From where I sit, if you're in a place where you are no longer suffering and others are no longer suffering, you get to define how you relate to the problem you had. Having your only option be a group that insists you must be a victim when you don't agree feels wrong. Now, do we have real people in that situation - not a perma-alcoholic but somehow being forced to join AA or go to jail?. I don't know.

Re: Sobriety startups shaking up the 12-step model

#110
post #11

After years and years of struggling with alcoholism and AA, I got sober with naltrexone using the "Sinclair Method". I followed the treatment plan for a few weeks and at the end quitting drinking was easy and obvious. That was just over ten years ago and I haven't had a drink or gone to any meetings since. I'm only one person and I'm fully aware that the plural of anecdote isn't data. However, the experience was so d…

Wouldn't you consider beating an addiction to actually being able to take one or two drinks and leaving it at there?

In other words, if you're constantly counting the days without a drink and struggle with yourself to not drink, are you really "cured" from the addiction?

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