America’s Addiction Treatment Goal: Perpetual, Lifelong Abstinence

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On Sunday, in the morning before the Super Bowl was scheduled to be played, the tragic news broke that actor Philip Seymour Hoffman had been found dead, with a needle stuck in his arm, the victim of an apparent heroin overdose. The following day, on the Psychology Today website, frequent contributor Stanton Peele posted Another One: Why So Many Celebrities Die Following Rehab. Detailing Hoffman’s history, apparently he’d given up drugs and alcohol when he was 22 years old, and had been successfully abstaining for 23 years, when he reportedly “fell off the wagon.” He’d also sought help and had been in rehab over the past six months. Peele wonders why he, and so many other celebrities, overdose and die “after recently having been in treatment? After all, many people have lived long lives while using opiates.”

Interestingly, he says that this is not uncommon and cites our attitudes toward addiction and its “cure” as contributing factors. “What is dysfunctional is our temperance attitudes towards substances, their use, and their misuse. Our attitudes towards drugs are more lethal than the substances themselves,” he writes. While Hoffman was reportedly using heroin, the way we treat addiction for drugs or alcohol is exactly the same, and for purposes of AA and other rehab and treatment facilities, alcohol is considered just another drug on the panoply of addictive substances.

Peele has identified five reasons that he believes “these deaths occur so often following rehab.” Tellingly, he also believes they “stem from one basic fact of American rehab: the one and only goal of treatment is perpetual, lifelong abstinence. No treatment time is devoted to the essential truth that most rehab grads will use again, and to prepare them for this possibility.” This has long been my belief about what’s wrong with AA and other abstinence-based “cures” that don’t cure anything. They merely suppress a person’s impulses without addressing the underlying causes or finding a way to actually cure anyone, which should mean learning how to drink in moderation without returning to bingeing or over-indulging. Peele also believes that “all of these failures to prevent post-rehab deaths are due to the kind of unrealistic, perfectionist, just-say-no approach America takes to drugs, alcohol, and addiction.”

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But here’s an overview of the five reasons he believes people leaving rehab so often get into trouble, sometimes fatally:

1. Combining different drugs and alcohol. Rehab grads are not made aware that the worst usage pattern is to combine alcohol and other drugs, particularly depressants. What is usually mistakenly called “overdose” is in fact the result of such lethal combinations, which depress the nervous system and cause the person’s breathing to fail.

2. Lower tolerance. If rehab grads haven’t been using for some time (which is likely the case when they are fresh out of the rehab facility), their tolerance for their drug of choice has diminished. Rehab residents should be schooled in the basic facts of tolerance and alerted that, if they use, they should lower their accustomed dosage.

3. In for a dime, in for a dollar. Twelve-step programs teach people that any level of use of any drug or alcohol is the equivalent of a full bore relapse, so that addicts and alcoholics give up all efforts at self-restraint once they have consumed any amount of a substance. As a result, they often experience a complete relapse after a slip. The opposite approach is to train addicts in relapse prevention, which teaches methods for “getting off the runaway train” at any point, from exposure to a substance, to initial use, to excessive use — for all of which there are remedies or “off ramps.”

4. Failure to have safeguards in place. Since the only permissible stance post rehab is to vow never to use a substance again, graduates are not “allowed” (or alerted) to take safety precautions.

5. Failure to have available an overdose kit. If you are going to use narcotics, you should have readily accessible an overdose kit, the main ingredient of which is naloxone (brand name, Narcan), a narcotic antagonist. In many states, overdose kits are not even used by emergency workers.

Those seem right, at least to my way of thinking. This is, for me, more evidence that America as a society has an unhealthy relationship with drinking. We seem unable to be reasonable in our approach to so many aspects of alcohol consumption and its consequences. And prohibitionist groups fan the flames of our dysfunction and make unwitting accomplices of the health and medical communities because keeping the status quo also keeps the money flowing to them and rehab centers, treatment facilities, etc. It seems that anyone who challenges the twelves steps or abstinence only approaches is immediately shot down. I can’t help but think that any system should be able to stand up to criticism and scrutiny in order to constantly improve it, but it certainly feels like the idea of powerlessness and abstinence are treated as sacrosanct dogma. And that means we’ll always be a nation of addicts who can never change.

Are addiction treatment providers the new snake oil salesmen? Just takes some pills and never touch another drop for the rest of your life and you’ll be fine. Trust us.

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Nurses Know The Benefits Of Beer

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I’m sure it’s because my mother was an RN, but I tend to take the advice of nurses over doctors, since they’re the ones in the trenches who deal with the patients all the time. So I was pleased to see that the National Nursing Review recognizes the Benefits of Beer. According to the nurses. “Consumed in moderation, beer is good for health. Lowers cholesterol, boosts the immune system, antioxidant and, contrary to what many people think, the beer is not fattening.” They conclude.

Many benefits for our body which are possible thanks to the vitamins of Group B, fiber, phosphorus, magnesium and minerals, containing this drink. Recall that the beer is made with natural ingredients such as water, barley and hops.

Natural ingredients, little alcohol and only 45 calories per 100 milliliters, make beer in a very beneficial for our health drink. Conclusions that have reached numerous experts, through different medical studies.

My mom would be proud.

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Moderation Is Better Than Abstinence

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I’ve long believed that AA, while obviously effective for some, is not the only way to treat problem drinking. Especially given that drinking moderately can increase one’s longevity over those who abstain, I’ve always believed that a better goal would be to take people who can’t moderate their drinking and teach them how to do just that. That’s an approach often taken in other countries, but is one that can’t even be discussed here in the U.S. without an uproar from the addiction community and the anti-alcohol wingnuts. Several years ago, I wrote about this in a long post entitled Tipping The Sacred Cows Of Addiction. And Adi Jaffe, Ph.D. echoed the same sentiment in All About Addiction, a piece for Psychology Today.

The New York Times published an op-ed piece on New Year’s Day entitled Cold Turkey Isn’t the Only Route. In it, author Gabrielle Glaser also noted how entrenched Americans are in abstinence as the only cure for alcoholism.

The cold-turkey approach is deeply rooted in the United States, embraced by doctors, the multibillion-dollar treatment industry and popular culture. For nearly 80 years, our approach to drinking problems has been inspired by the 12 steps of Alcoholics Anonymous.

Developed in the 1930s by men who were “chronic inebriates,” the A.A. program offers a single path to recovery: abstinence, surrendering one’s ego and accepting one’s “powerlessness” over alcohol.

Despite the fact that studies have shown that AA doesn’t work, it’s undoubtedly the dominant treatment method in America. So much so, that most people do in fact believe that if you’re an alcoholic you can never ever touch a drop of alcohol for the rest of your life. But the obvious problem with that point of view is that it suggests that a cure is not only difficult but actually impossible. Because learning to deny yourself something you have trouble moderating is hardly a cure. It’s a band-aid at best that may remove some of the negative aspects of one’s drinking problem, but being based on the concept of “powerlessness” means not only giving up on yourself but it actually removes any possibility of real help. It’s a bad bargain, in my opinion. But that’s where the money is, sad to say. Addiction clinics, retreats, programs, along with insurance companies, etc. don’t make their money by curing people, they make money by treating them. And if the treatment lasts the rest of their lives, then that’s the best thing for the bottom line.

Despite the dominance of abstinence-based treatments, there are a growing number of alternatives, apparently, including Moderation Management, Moderate Drinking and others. Amazon now lists many books claiming to help people achieve moderate drinking, which is encouraging.

But I love her conclusion. “We don’t treat cancer, depression or asthma with the same tools we used in 1935. We need to get away from the one-size-fits-all approach to drinking problems.” Indeed, A.A. has changed little since its inception, while our understanding of addiction, its underlying causes and the benefits of moderate drinking have all grown immeasurably. It would be great if as a society we could eradicate alcoholism, but we can’t do that by simply burying our heads in the sand and just removing alcohol from the equation. If prohibition taught us anything, it’s that such an approach is doomed to fail. It’s time to change the goal from abstinence, a nation of teetotalers, to a society filled with only moderate drinkers. That would certainly make the world a better place.

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Why Are Doctors So Afraid Of Admitting Beer’s Health Benefits?

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There was an article in the New York Daily News earlier this week, though actually it was a question answered by a physician who refers to himself as “The Running Doc™.” The fact that it’s trademarked is, I think, pretty funny, but I suppose there’s no reason why he can’t brand himself like anyone else.

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A reader from upstate New York asks the doc if “beer is a cure for an upset stomach and kidney stones” and “[i]s drinking beer now a medical treatment?” But he begins his question with a request. “Please don’t laugh!” In this day and age, I suppose I should be happy enough with Dr. Maharam’s response. “I am really NOT laughing. Your friends are smart — beer actually does have some medicinal purposes. In moderation, obviously.” The Running Doc™ goes on to mention a handful of scientific studies that suggest drinking in moderation is good for what ales you, though considering how much there is now in the scientific literature, it’s a very small drop in the ocean of the body of ways in which responsible alcohol consumption can provide health benefits. And naturally he mentions the recent studies that suggest a beer after exercising — or running — but not the pièce de résistance, that total mortality is improved by moderate drinking.

Honestly, re-reading Lewis G. Maharam, MD’s response in The Running Doc says beer — especially ginger beer — has medicinal value but only in moderation, I think his answer is pretty good, and he at least treats the question seriously and also mentions that there is a body of scientific work that supports the idea of health benefits for drinking alcohol.

What bothers me, and was more of a camel’s back-breaking straw, was that he felt the need to mention, over and over again, moderation. It’s in the title, it’s the photo caption, and he mentions it twice more in the body of a very short article. Does it need mentioning? Maybe, but every time anyone from the medical or scientific community talks about any health benefits from drinking alcohol, they always qualify their statements with warnings like this. Really, they go out of their way to hit you over the head with them, as if we all need to hear it multiple times, or we might not understand. Is there really anyone alive today who’s missed the prohibitionist’s message that drinking too much is bad for you? It’s like the warning labels on packs of cigarettes; totally unnecessary, but covering their asses.

If the mounting evidence is showing, overwhelmingly, that alcohol can be good for you, then let’s just say so. We all know that a hamburger is a good source of protein but no one’s confused or has to be told that eating a ton of red meat might not be the best thing for your heart. Can they really be worried someone will go on a binge and blame the doctor for telling them it was okay to drink, saying they didn’t realize that they couldn’t just drink as much as they wanted? Honestly, this is, I think, the results of the bullying tactics of the prohibitionists, who’ve shouted down anyone who has a kind word to say about alcohol. They’ve made any health claims on beer labels verboten, tried their damnedest to limit where alcohol can be advertised, sold and even consumed, even by consenting adults. They’ve made it illegal in some states for parents to even educate their own children about it, while at the same time using only alarmist, fraudulent educational materials to lie to those same kids in public schools.

At this point, we all know that a beer or two a day can be good for us, both for physical and mental health, and over the past few decades, the scientific literature has caught up with what beer lovers have known all along. The only way to stop a bully is to stop giving him his power. Stand up to him, or her. If beer can be healthy, let’s say so. Sure, it’s best in moderation, but let’s not forget that numerous studies have shown that even drinking too much is, in the long run, better for you than not drinking at all. Overall mortality is improved most by moderate drinking, more so than by people who completely abstain, and yet even people who overindulge tend to live longer than the teetotalers, so all this qualifying of the results by medical science is not really helping anyone, it’s just continuing to pander to the prohibitionists, keeping the bullies mollified.

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[Illustration by artist John Hendrix in the September 2012 issue of Runner’s World.]

The Science Behind Sobriety Tests

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Today’s infographic is all about the Science Behind Sobriety Tests, and especially the three most common field tests that police officers administer on the side of the road when they suspect that someone might be driving with blood alcohol over the legal limit. It was created by Total DUI, a legal website specializing in helping people facing DUI/DWI charges.

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Click here to see the infographic full size.

Beer Birthday: Rick Lyke

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Today is the 53rd birthday of Rick Lyke, a fellow drinks writer in North Carolina. Rick writes for a variety of publications and online at Lyke 2 Drink. It’s especially terrific that we can all celebrate Rick’s 53rd today, because he recently fought and won a battle with prostate cancer, which prompted him to found the grassroots organization Pints For Prostates. Rick is a terrific champion for both great beer and men’s health. Join me in wishing Rick a very happy birthday.

Rick Lyke, Organizer of Rare Beer Tasting @ Wynkoop
Rick at the first Rare Beer Tasting at Wynkoop during GABF Week in 2009.

Carol Stoudt, Amy Dalton & Rick Lyke @ Rare Beer Tasting
Rick with Carol Stoudt and Amy Dalton at the first Rare Beer tasting at Wynkoop to raise money for his Pints for Prostates organization.

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Lew Bryson and Rick at the World Beer Festival in Durham in 2008.

Jeff Bearer, Stan Hieronymus, Stephen Beaumont, me and Rick Lyke @ Great Divide
Jeff Bearer, Stan Hieronymus, Stephen Beaumont and me with Rick at the Great Divide open house on the first day of GABF a couple of years ago.

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And finally, the ubiquitous Sam Adams brunch photo I use four times a year, with Daniel Bradford, of All About Beer, Jim Koch, Amy Dalton (also with All About Beer) and Rick.

All Hopped Up For The Cure 2013

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Yesterday I had lunch at Russian River Brewing, invited by co-owner Natalie Cilurzo as one of a small group of friends who had at least one thing in common: we’d each lost someone to breast cancer. For me, it was my mother when I was 22, and she was only 42. Each year, the Santa Rosa brewpub rolls out its biggest charity effort of the year to raise money for the local Sutter Breast Care Center. The entire month of October, which is Breast Cancer Awareness Month, the brewpub is festooned in pink and several great prizes are auctioned throughout the month.

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This is the eighth year they’ve made the All Hopped Up for the Cure charity effort, and last year they raised $76,000 for breast cancer. SO far, they’re on target to beat that total this year. Here’s Natalie Cilurzo writing on the brewery’s blog about this year’s charity drive:

So here we are and it’s already October, my favorite month of the year. Aside from it being beautiful in Sonoma County, we host our annual month-long fundraiser for the Sutter Women’s Health Care Center of Santa Rosa, which brings me great joy! All of the money we raise/donate goes directly to help uninsured or underinsured women AND men in our community receive life saving screening and treatment for Breast Cancer. Recently we have become acquainted with several recipients of our fundraising efforts. Some of their lives have been changed or even saved by the services offered by Sutter. Check out our special Breast Cancer Awareness Month page on our website during October for more info on raffle items, how to get this year’s cute shirt and other interesting things!

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This Saturday will be the final blowout of the month-long charity drive — a costume party — when the auction winners will be revealed. But there’s still time to help their efforts, both with donations and buying raffle tickets for the auction items. The big ticket item, a pink Genuine Buddy 50cc scooter, you can try to win for $10 a raffle ticker, or 3 for $25. The winner of the scooter will announced at 10 p.m. Saturday night.

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There are a few other terrific items being raffled, too. For instance, there’s a custom-made guitar by local luthier Tom Ribbecke of Ribbecke Guitars. To win the guitar, it’s also $10 a raffle ticker, or 3 for $25.

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There’s also a pink bicycle, an Electra Beach Cruiser, “graciously donated by The Bike Peddler in Santa Rosa.” Tickets for the bike are only $1 per raffle ticket, or 6 for $5.

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There’s also some cool t-shirts, designed by local artist Laurel Gregory.

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Gregory also created a pink painting of a Pliny the Elder bottle that will be auctioned Saturday.

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The scooter will be announced at 10 p.m., but the rest of the items will have the winners for them announced throughout the evening. So come and enjoy an evening at Russian River and help raise money for a very worthy cause. There will also be music, by Brothers Horse. In addition to Russian River’s regular beers, the special release Framboise for a Cure 2013 (bottles of which are sold out) will be tapped at 5:00 p.m. The beer uses Temptation as its base beer, to which 800 pounds of fresh raspberries are added (30 pounds per barrel), and then it’s aged for several months in Chardonnay barrels spiked with brett, lacto, and pedio. There are only two kegs of it left, and they’ll keep selling it until it runs out. This is your last chance to try this year’s version. There will also be 23 special growlers, screened in pink ink, and full of the Framboise beer available for a minimum donation of $100.

Come on down Saturday night and get All Hopped Up For the Cure!

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