A Different Path to Fighting Addiction

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

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

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

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

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

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

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

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

Fruit Loops sound like they wouldn't be too bad. Instead, the Kellogg's product is called Froot Loops.

It's a bit fitting: a bastardization of the spelling which underscores the bastardization of nutrition going on with the product.

The galling thing about AA/NA in the US is that judges often mandate attendance as condition for release of a DUI. The problem being, this violates the defendants 1st amendedment rights by the state forcing a religion on him.

> Eight trials involving 3417 people were included. AA may help patients to accept treatment and keep patients in treatment more than alternative treatments, though the evidence for this is from one small study that combined AA with other interventions and should not be regarded as conclusive. Other studies reported similar retention rates regardless of treatment group. Three studies compared AA combined with other interventions against other treatments and found few differences in the amount of drinks and percentage of drinking days. Severity of addiction and drinking consequence did not seem to be differentially influenced by TSF [Twelve Step Facilitation] versus comparison treatment interventions, and no conclusive differences in treatment drop out rates were reported. Included studies did not allow a conclusive assessment of the effect of TSF in promoting complete abstinence.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005032...

The language of AA and other programs like them have failure as a built-in premise of attendance. Just by insisting on abstinence assumes that failure is the only possible outcome of non-abstinence, however moderated or controlled that non-abstinence is.

First and foremost obviously one has to clear themselves of physical addiction, which in most cases should be done with professional medical guidance. Afterwards comes the psychological compulsion to use. For me the best thing was to think rationally about the decision to use, and whether it was going to give me the benefit I sought. In most cases, having a drink doesn't help with the situations in which I wanted it, except for very short-term (hour or two); clearly not a long term solution to problems like anxiety, social awkwardness, depression. I think rational positive thinking like this can be made habitual with practice. Having group support from something like A.A can be beneficial in the early days of this process.

The issue with abstinence based programs is that they don't treat the underlying cause of the problem. Their focus is purely on a singular behavior which the problem led to. People in them are terrified of a single drink because it represents failure, but they don't identify what that single drink really means to them psychologically and how to address that problem in a rational way.

I know people who have benefited from AA, but their attitudes generally seem to be "don't throw the baby out with the bathwater." They take out the positives and ignore the negatives.

There are alternatives to A.A. however, for example SMART: http://www.smartrecovery.org/