Ten Chips Down

Now, the following is a repost of my own writing from the Substance Abuse forum so of course if you've read it already, then it's nothing new. OTOH, if'n ya haven't you might find it an interesting read.

My reading and searching have taken me back 25 years, to a day when the internet was unheard of. A few seminal names stood out immediately in my browsing such as George Vaillant's "The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery," a veritable "textbook for the masses" I practically studied from cover to cover, so fascinated was I with the material.

Please bear in mind that where ever you see the term alcoholism, the related discussion actually bear much applicability today to ALL addictions.

It is very relevant oddly enough, for the SA forum.

So, one person I dug back and found was George Vaillant M.D., a Harvard educated psychiatrist and noted researcher who dared ask some of the difficult; nay, even taboo questions for the day:

• Have we invented "alcoholism"? (The term itself is no more than "alcohol" with "-ism" attached. One might just as well
  created the term, nicotinism for addicted smokers.)
• Does treatment really work?
• What, other than abstinence, precisely is a "medical treatment" of an addiction?
• Are alcoholics doomed without intervention? Vaillant observed, through a landmark 16-year study, that many people either a) appear to "mature out" of their disease or b) follow an observable inverse bell-curve pattern which simply ends on its own.
• What were the socio-political benefits in raising addiction to alcohol from simple vice to official, recognized disease status?
• Is controlled drinking by the alcoholic possible and can cognitive-behavioral techniques (CBT) emphasizing the crucial element of self-efficacy over powerlessness help the patient achieve reasonable goals?
• Barring this, how about complete abstinence but without the mindset of powerlessness?

These and many more provocative questions are explored in his books from the 80s right up to near-present and I encourage the interested reader to visit his or her local library and do a little digging.

I focus mostly here on Vaillant because his work came after Jellinek's and indeed, was based off much of his research and studies.

Both men also sought to study how and why spiritually-based programs like Alcoholics Anonymous worked, but they didn't stop there, oh no. Vaillant for one, often quite matter-of-factly cited the difficulty in obtaining any empirical, outside (objective) data because of the Traditions and anonymity aspects.

Nonetheless, they did try. And, when measured against either CBT or no "treatment" at all, five-year follow-ups were often less than inspiring. The men found that AA works best when a strong motivation in the subject was present; however, in those for whom these programs just didn't fit (for whatever reasons, be it the "God" factor or the ritualistic characteristics of meetings), outcomes were predictably abysmal.

The following snippet is from "Broadening the Base of Treatment for Alcohol Problems." This is a report from the National Institute on Alcohol Abuse and Alcoholism of the Department of Health and Human Services, copyrighted 1990. It is authored by a committee of the Institute of Medicine and includes complete bibliographical references. The links and parenthetical commentary are mine to aid the reader.


Kinda says it all.

Ten