12-step is proven ineffective, but the evidence for talk therapies in general isn’t much better. CBT has some evidence of efficacy for anxiety disorders, but the rest of 'em are pretty much confirmed useless.
There is no current effective evidence-based treatment for addiction. Or for most other psych problems; we can pharmacologically suppress symptoms for some, but that’s about it.
Clinical psych is, unfortunately, in a comparable state to conventional medicine of the mid-19th century. Most of what we’ve got doesn’t work, the bits that do work are often poorly understood, and the pharmaceutical options carry a high risk of nasty side effects and negative long-term consequences.
There’s a lot of promising candidates for many mechanisms of therapy for several drug addictions. The thing is they’re not getting a lot of grant money for study, and the ones already on the market haven’t seen much uptake.
It seems likely, to me personally, that there’s specific psychology in the way. People feel wary of the idea that taking one substance in order to avoid another would leave them at square one, still addicted to something. But drugs like ibogaine and scopolamine seem to fly in the face of such concerns. They aren’t replacements, they seem to actually modify how the brain works to have less triggering of the reward system for even thinking about engaging in the DOC. There’s a lot of work to be done for sure, but this isn’t just substituting heroin with methadone or bupenorphine. It’s got some preliminary evidence of actually helping people overcome their addictions, rather than continuing them in a less hazardous way.
The literature is quite interesting here. I’d recommend you to look up Rat Park, which is showing that the experimental methodology for researching addiction, back in the 1940s and 1950s caused addiction at a rate much worse than if lab animals were treated humanely. Rat Park shows that, at least in rats, addiction is more often caused by a Maslow’s Hierarchy-type need not being met by its environment, IE a single rat to a cage, under bright lights without the ability to interact with other rats.
I used to be a behavioural neuroscientist, working in the field of illicit psychopharmacology [1]. I’m familiar with Rat Park; some of my own early work was based around similar themes [2].
[1] I did some of the ground-level work that established the neural mechanisms, addictive potential and behavioural harms of 4-methylmethcathinone (AKA mephedrone, meow, plant food, bath salts [3] etc…). But then, ironically, I was involuntarily retired courtesy of a nasty reaction to some commonly-prescribed psych meds…
[2] I was interested in combining the Rat Park idea with the work of Rozenzweig (who was the first to demonstrate physical changes in brain anatomy in response to environmental enrichment). Never managed to get the logistics to work out on that one, though; resources were tight, and extra-large enrichment environments for a few dozen rats requires a lot of space, time and money to do right.
[3] 4-MMC was only one of many drugs sold as “bath salts”.
That’s a real doozy. Setting up a whole barn that won’t let the rats escape or let in new rats, possibly with a decontamination entrance and such would surely cost a lot. Those guys can chew through fracking anything short of concrete.
Rosenzweig’s original enrichment environments were just slightly larger cages and a handful of household objects (hairbrushes, spools of thread, etc) changed at regular intervals. That was enough to get clear physical changes in brain architecture, and improved performance on intelligence, anxiety and memory tests.
Rat Park used more of a big barn setup, and there was another slightly similar experiment run at the Uni of Hawaii called the Visible Burrow Project. That one didn’t involve drugs; they just wanted to observe lab rat behaviour close-up in a more natural environment, so they made an observable burrow system. They found all sorts of fascinating stuff.
You can also do it with high-tech automated systems full of motion sensors, trigger mechanism, cameras, lights, speakers and automatic food dispensers, but those things cost $20,000 per cage.
The really hard part is combining an enriched environment with a drug self-administration setup. Most psychoactive drugs taste awful; rats won’t eat 'em. Which leaves you with things like implanted IV catheter setups, which require major surgery followed by intensive post-op care, and don’t play nicely with the sort of rough-and-tumble that rats get up to when you give them a playground and a large social group.
Personally, I’d like to see an experimental model with something that’s a better analog for humans. Something really big. Maybe, say, capuchin monkeys on an island or something like that. Rats may not eat bad-tasting stuff if given other options, but us primates with powerful and generalized dopamine systems are pretty conclusively able to handle acquired tastes without necessarily needing much peer-pressure. Otherwise cocaine use or heroin injection wouldn’t have become a problem for us. Those are two fairly aversive administration methods (in my hey-day I’d snort literally anything someone said might get me high. I’m glad I still have a nose.)
Going from rats to primates, even small new-world primates, multiplies the logistical demands and expense by about a thousand. It also has a similar effect on the difficulty of getting your protocol past the ethics board.
Primates are insanely expensive to keep; they’re big, hungry, smart, and capable of lethal violence to each other and to their handlers. And keep in mind that statistical reliability is powerfully affected by the size of your cohort; unless you’re planning on burning hundreds of primates per experiment, all you’ll get is anecdote, not data.
There are some pretty compelling ethical and practical reasons why we try to keep our animal-based experimentation as far down the evolutionary tree as we can afford to. Cell, embryo, fruit fly, zebrafish, mouse, rat, cat, dog, new-world primate, chimp, human. Wild-arse hypotheses start on the left of that sentence, experimentation tends to gradually shift to the right as hypothesis turns into theory and fact.
I know. I’ve been so repeatedly horrified at what we as humans have done to other humans during just the 20th century. Even for the sake of getting to know the answer to a vitally important question doesn’t justify destroying many people’s lives.
I was mostly spitballing going for a pie-in-the-sky everything’s perfect and acceptable sense. I mean, gun to the head, the most efficient study would be doing RCTs and meta-analysis in humans, but that would never be ethical. Ends don’t justify means in such extreme cases.
No. You’re conflating “getting caught” with “having worse consequences happen than were intended”.
I honestly don’t see what’s wrong with my description of drunk driving. That is exactly what is happening. Somebody doing something which is a crime in itself and which includes the risk of killing someone (that risk is “too high”, but still “low” in absolute numbers).
Firing a gun into a crowd of people is very likely to be done with the intent to kill. That would be murder (life sentence). Something very different.
Now, if you’re part of the crowd, and you fire your gun into the air as a sign of celebration, and then the Law of Gravity strikes and your bullets injure or kill someone, then that’s negligent manslaughter again.
AA: the state ordering someone to attend a program that involves acknowledging belief in “a higher force”? No thanks.
Drug tests? Why? Talk therapy?
Next few decades? If your proposed therapies are that ineffective, why bother in the first place?
What are you attempting to cure here?
People who get drunk now and then are not alcoholics, so treating them for alcohol and drug addiction using unproven methods is pointless.
Mephedrone is some nasty shit habit-wise. I’ve seen it fuck people up badly. Though it doesn’t seem as hard on the body as old school speed. Sends you mad, though.
In self-admin progressive-ratio rat experiments, it gets the strongest response of any drug ever tested; blows cocaine and meth out of the water. And I found a very clear impairment on a recognition memory test, that was soon backed up with testing in human users.
Nobody knows yet whether the memory damage is permanent, though; they’re still looking for the physical mechanism of it.
That doesn’t surprise me at all. Is injection that common in users? It doesn’t seem to have any benefits over other routes, as there’s no immediate rush.
This is understandable. However I think it’s turned out to be short-sighted, since it’s garnered the kid so much media attention, none of it good.
I’d say the kid really does suffer from “affluenza”, and like drug addiction or leprosy it should be treated as a public health matter. The “cure” might be serving in the Peace Corps in some remote jungle where he can’t play beer pong, and his sustenance relies on helping gather the crops or hunt for bush meat with all the other villagers.
“Rush” effects in most stimulants tend to be enhanced by route of administration; swallow/snort/smoke/shoot, in that order. Most things will give a bit of a buzz if injected.
It was a thing amongst the homeless in Ireland for a while; I don’t think IV MMC has been reported much elsewhere. You also get random folks deciding to give it a go mid-binge as an experiment.
Have you been to AA meetings? First off there are plenty of non religious (as in completely non religious) groups. Second, the point isn’t really to stay sober (though they say it is, but it isn’t). It is to learn empathy for those you have hurt. Go do the steps, even as a completely sober person.
This kid needs to learn how to look through someone else’s eyes.
I could talk at length about what I like and dislike abouy mandatory counseling. But it is better than jail.
