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Thursday, September 22, 2011

Our Government At Work


I ran across this statement in a Time Magazine article recently:


Research shows that the majority of people who receive a diagnosis of addiction or alcoholism actually recover without treatment or participation in self-help groups. In a 2005 study involving 4,442 people with alcoholism who were not in treatment, researchers found that one year after their initial interview, a full 75% had improved to the point where they were no longer considered to be actively alcoholic.

And being the inquisitive type of guy that I am, I read the study, brought to us by our friends, the PhD's at NIAA. Here it is, in a nutshell:


Recovery from DSM-IV alcohol dependence: United States, 2001-2002.

Source
Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA. ddawson@mail.nih.gov
Abstract
AIMS:
To investigate the prevalence and correlates of recovery from Diagnostic and Statistical Manual version IV (DSM-IV) alcohol dependence by examining the past-year status of individuals who met the criteria for prior-to-past-year (PPY) dependence.
DESIGN:
Cross-sectional, retrospective survey of a nationally representative sample of US adults 18 years of age and over (first wave of a planned longitudinal survey).
METHODS:
This analysis is based on data from the 2001-02 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), in which data were collected in personal interviews conducted with one randomly selected adult in each sample household. A subset of the NESARC sample (total n = 43 093), consisting of 4422 US adults 18 years of age and over classified with PPY DSM-IV alcohol dependence, were evaluated with respect to their past-year recovery status: past-year dependence, partial remission, full remission, asymptomatic risk drinking, abstinent recovery (AR) and non-abstinent recovery (NR). Correlates of past-year status were examined in bivariate analyses and using multivariate logistic regression models.
FINDINGS:
Of people classified with PPY alcohol dependence, 25.0% were still classified as dependent in the past year; 27.3% were classified as being in partial remission; 11.8% were asymptomatic risk drinkers who demonstrated a pattern of drinking that put them at risk of relapse; 17.7% were low-risk drinkers; and 18.2% were abstainers. Only 25.5% of people with PPY dependence ever received treatment. Being married was associated positively with the odds of both AR and NR, and ethanol intake was negatively associated with both. Severity of dependence increased the odds of AR but decreased the odds of NR. The odds of AR (but not NR) increased with age and female gender but were decreased by the presence of a personality disorder. Treatment history modified the effects of college attendance/graduation, age at onset and interval since onset on the odds of recovery.
CONCLUSIONS:
There is a substantial level of recovery from alcohol dependence. Information on factors associated with recovery may be useful in targeting appropriate treatment modalities.

I'll cut through the bullshit here just give a summary. Somehow, these researchers came up with a pool of over 4,000 people who were diagnosed as alcohol dependent using DSM-IV criteria. Where they got these folks is a mystery. Treatment Center patients, therapy patients, wet house occupants? Who knows.
But I'll leave that question open as they ain't tellin'.

I have two big problems with the study. First is the use of DSM-IV criteria to determine alcohol dependence. Using this as a guide, I could develop a tolerance for alcohol over the years, have a desire to cut back on my drinking, and drink in spite of the fact that I give up important social activities as a result of my drinking and according to DSM-IV I'm an alcoholic!

Then to see if I've recovered from this alcoholism over a 12 month period, the folks at NIAA talked to a "randomly selected adult in each household". Wow! Now there's great source of information. Ask my co-dependent spouse or my alcoholic father how I'm doing.

But damn if they don't come up with the conclusion that 75% of the 4200 alcoholics in the study got well, or at least weren't classified as alcohol dependent after a year regardless of the treatment received during that period. In fact, only 25% received any treatment at all. All based on the word of a "randomly selected adult in each household.

I'm all for studies on the effectiveness of various treatments for alcoholism. But this is ridiculous.

Discuss.


25 comments:

  1. How ironic, that these researchers selected 4422 alcoholics that were 100% honest throughout the study. That’s a fricken miracle in itself!

    "Psychologists are inclined to agree with us. We have spent thousands of dollars for examinations. We know but few instances where we have given these doctors a fair break. We have seldom told them the whole truth nor have we followed their advice. Unwilling to be honest with these sympathetic men, we were honest with no one else. Small wonder many in the medical profession have a low opinion of alcoholics and their chance for recovery!"

    I recall that, while in my deluded state, I would quit drinking in my head, relapse and proceed to speak of the virtues of sobriety at the bar....while drinking. I would also humbly share all the wonderful plans that i had for my future, the classes I would take, the jobs I would get.....it was as if I had already accomplished those things. The heck with "fricken", that would a been a real fucking miracle!!!



    Colter

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  2. Thanks for the article Joe.

    This is typical Agent Orange Raysny ST induced rhetoric.

    They've been on this info for at least a few years now.

    Get used to it. A.A. bashing is quite en vogue now. So are limey accents.

    But yeah, "Just say no!".

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  3. The trouble here is that if someone reads shit like this, coming from an "authoritative" source such as the NIAA, they have a very valid argument when stating that there's a substantial level of recovery from alcohol dependence.

    I don't blame our little friends at ST when they say that AA isn't necessary for recovery when they can quote stuff like this. It shows you the danger of a little knowledge.

    I guess what gripes my ass is not the argument itself about dependence and recovery, but the shoddy way the study was conducted and then signed off on by the very people who are supposedly the font of knowledge on addiction.

    I used to refer to NIAA studies, but seeing this shit being signed off on has made me wary of the validity of any study these clowns conduct, whether or not it's pro or anti 12- step recovery. To me, anything these clowns now say is meaningless, even if it supports my arguments about recovery.

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  4. I don't really have a problem with this survey, other than some of the points Patrick brought up. NIAA means well, but they sure don't seem to understand guys like me. The 75% spontaneous remission rate sure seems like a stretch, but I can't back this up, I know a shit load of people who are now dead, maybe death is a form of remission.

    I am currently of the mind that Alcoholism manifests in various ways. Some folks appear to just have the phenomena of craving. They take the drink and it's go time. These people can just not drink. I've seen a few of these types, they are happy and productive, they don't do AA and they aren't dry drunks. They just don't drink. Good for them. Maybe these are the subjects of this study.

    Then there are types who have the craving, mental obsession and God sized hole in the soul. I would be one of these types. Drinking was just a symptom for me. My issue is a disconnect from Spirit. This is where the folks @ ST start salivating over how ridiculous this sounds. With all the love I can muster, they can pound sand. The spiritual path is the only way I have ever found a way to live a happy productive life.

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  5. Hey Rob!

    Seeking spirit is also how I would approach other serious problems.

    What some folks call depression I would call apathy and boredom.

    The power of intention and a well placed decision, and I'm dancin' again.

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  6. I think one of the things we're running into these days in talking about recovery from alcoholism is the issue of dependence vs. addiction. There's a big difference.

    When DSM-IV was written, the committee that viewed the criteria for alcoholism frowned on the word addiction as it was considered demeaning. When they voted on addiction vs dependence, dependence won by one vote. So the shrinks talk about alcohol dependence, not addiction. Yet they considered the terms synonymous.

    There's a problem here. Dependence and addiction are different animals. Addiction is a primary, chronic neurological disease. Dependence is a physical issue manifested by withdrawal symptoms when the person stops using the drug. An addict is always dependent, but a dependent person isn't always an addict. Whether DSM-V clarifies this remains to be seen.

    So over the years the talks about alcoholism have gotten muddied by the term alcohol dependence, as that's what DSM-IV uses. But a person who has become dependent on alcohol isn't necessarily an alcoholic. A person who is addicted is.

    Now we have studies about people who are alcohol dependent, but not necessarily addicts. An alcohol dependent person, like an alcohol abuser, can stop drinking or learn to drink in a responsible manner. An alcoholic as we know one, a person addicted to alcohol, can't do this.

    So now we have studies galore talking about alcoholism, but most often dealing with people who are merely alcohol dependent. And, like the one I refer to above, suck to begin with. I won't argue with their conclusions, but rather the methodology used to arrive at them. I suspect that of the 4000+ subjects in that study, very few were true alcoholics, that is, addicted to alcohol. So the 75% recovery rate may be very plausible even if the methodology isn't.

    Which leads me to our friends at ST et.al. When they argue that alcoholics can recover and drink normally, they may be right. It all depends on how you define the term alcoholic.

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  7. 10% of us are alkies and 10% of us are just potential hard drinkers, but may one day cross the line into alky.

    Anti/XAers will deny this to the death.

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  8. I didn't mean for us to go off an a tangent here, but this dependence/addiction shit is troublesome. And I hate troublesome things. And yeah, Patrick, 10% of us are alkies as we know the term.

    But in the long run it doesn't make a great difference. Let the shrinks and researchers waste our tax dollars by studying the subject of alcoholism to death without ever finding any answers.

    We in AA could give a shit. We're concerned with the alcoholic, not the disease. If someone has a problem with the way AA works, they're free to leave.

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  9. Easy now. Someone has a right to attend A.A. so they can properly develop a hatred for it first.

    Then they can leave... so they can go bitch about it over at ST ... for the rest of their lives.

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  10. Would it help if the researchers were on belladonna, or the data was transcribed by a dead monk?

    Anyway, the real reason I came by is because I posted a follow-up comment the other day, and it disappeared. What the fuck?

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  11. My computer is down and I'm getting along with my stupid phone... so I don't know exactly wtf.

    Please repost.

    Oh BTW... some of your comrades have been less than kind to me lately. Surprise surprise.

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  12. Now MA, let's be nice. No belladonna or dead monk jokes please.

    Face it, this study sucks. I don't care about the conclusions. There are a lot of studies out there that look at alcoholism and recovery rates, and many of them arrive at similar conclusions. Most are well conducted and scientifically accurate. This one isn't.

    Collecting data from personal interviews of a "randomly selected adult household member" implies that every person in the study lived with at least two other adults. Huh? Know a lot of people in that category? I don't.

    And I'm sure that the co-dependent spouse or resident in-law was brutally honest in their answers.

    Observing that "ethanol intake was negatively associated with both (AR and NR)" makes me wonder what these guys were smoking. Lessee. Drinking has a negative effect on recovery. No shit? I wonder how they arrived at that conclusion?

    As I said, aside from this study much confusion exists because of DSM-IV. The shrinks steer away from the nasty word "addiction" because it's so derogatory. And DSM-V won't change, either. But while they use the term dependence to mean addiction, everywhere else the two are separate animals.

    And it's this dependence vs. addiction that's causing the problems. As I said, it's all in how you define the terms.

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  13. I'm sorry you aren't being treated well, Patrick. If it's any consolation, I haven't been treated particularly well by some of them lately, either. I can't really control what they say, trying to mollify some of that crazy is like herding cats. I mostly just avoid the comment section myself. It stresses me out.

    Joe, have you read the actual study, or just the abstract? It's done with accepted epidemiological protocol. I used to have it, but my computer crashed. I'll be back at Harvard doing some research in October, and I can access all of these journals at no cost. I'll shoot you out a pdf then if you wish. Any other study, for that matter. Just let me know.

    I doubt it will change your mind, simply because of the disconnect between old-school AAs and the treatment centre and research crowd.

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  14. I think we can all agree that treatment centers suck and I personally think therapists and pharmaceuticals are criminal.

    I know the anti/XAer bunch think A.A. is abusive.

    I think booze is moreso.

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  15. Oh, also. I know you spiritual types wouldn't every stoop so low as to read Playboy, but Ilse (FTG) actually cites this study in something she wrote for the magazine. Check it out this next month, but for research purposes only, of course.

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  16. I appreciate what Hugh Hefner has done for civil rights, insane sex laws, and 14 year old boys and dirty old men.

    Love his documentary too.

    Not all of us red-necked conservative Republicans are prudes.

    However, some of your boney-fingered minions have accused Tony J and I of indulging in soft-core porn over here for posting a few lady pics... so I guess It's all relative. But, we do read the articles too.

    If Playboy prints it, it must be pretty good.

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  17. Hey MA, send me the entire study if you will. jdris@cox.net. I haven't been able to locate the entire thing, and pdf is fine.

    I'll try and find the Playboy, but will only read the articles of course. Patrick lies. He drools over the pictures. We know.

    It'll take some doing to change my mind, not about the conclusions but rather the methodology of the study. The conclusions may well be true, but the study still sucks.

    Please, please promise that your research is at least somewhat accurate in it's methods.

    And where's that entry that Patrick deleted?

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  18. There's glitch in the blog software, so it just disappeared. I may have done something wrong. I knew I wasn't deleted. I don't remember what I wrote, except that it was brilliant. That was a week ago.

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  19. Brilliant? You need to come on over, MA. We could use a little brilliance. And I'll vouch for Patrick. He doesn't normally delete, and his computer is mostly FUBAR.

    Oh, and if you don't watch how you're signed in, your comment may end up in never-never land.

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  20. Hi guys,
    Sorry I haven't been around much-I've had a lot of stuff going on the last several months, all good stuff, but boy has my life been full!



    We received news at work a few weeks ago that the governor of Washington is proposing a 4.17 billion dollar cut to human services, which would practically eliminate all adult CD & mental health services. I work for a publicly-funded non-profit agency, and if these cuts go through, it will effectively gut, maybe even kill the agency.

    Oh well, I am moving to Canada anyway.

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  21. Canada ehay? What's this all aboot? In any case, you'll make it wherever you go.

    In cyberspace, such as the world of the Spirit, you don't have to move at all... or something like that.

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  22. Well, if you must know, there's a woman there.

    Back to these useless studies....here's a good one: The agency I work for participates in these studies conducted by the University of Washington...why? Because we get money for participating, that's why.

    Currently, one study offers incentives to the client participants. Stuff like George Foreman grills, iPods, etc. One day the executive director asked me if I would have stayed sober for an iPod. I told her maybe just long enough to convince everyone I was sincere so that I could get the iPod. I also told her that I thought the whole thing was a crock. She said "I know, but they pay us lots of money to participate."

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  23. I think that's as good a reason as any, Jim. You'll undoubtedly be leaving friends behind though.

    My experiential and unsolicited advice on recovery relationships... autonomy... as if you didn't know.

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  24. Secret of AA: After 75 Years, We Don’t Know How It Works
    http://www.wired.com/magazine/2010/0...nonymous/all/1

    Does AA work tentatively, Yes.
    http://www.scientificamerican.com/ar...anonymous-work

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