Alcoholism is a Learned Behaviour Disorder | 35 comments (35 topical, editorial, 0 hidden)

Re: Alcoholism is a Learned Behaviour Disorder (4.00 / 3)

My late wife worked in addiction therapy for many years. Alcohol addiction was often more difficult to treat than heroin and she become more and more convinced of the need for holistic methods including family support, peer support, alternative therapies (acupuncture, Reiki, etc.), drug substitution (methadone) together with training and employment programmes designed to build up self-esteem and self-sufficiency. The centre she built up has ended up having a very good success rate, but it often takes years - and yes it does take will-power and the active participation of the client and support of his/her family. To my knowledge there never was a particularly effective pharmaceutical solution - or at least one which worked in isolation. I doubt whether Nalmefene is a magic bullet either, but anything which improves on the very limited options currently available has to be a good thing. When is it likely to become generally available?

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by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Fri Dec 31st, 2010 at 11:36:10 AM EST

Re: Alcoholism (4.00 / 4)

It is available now, but there are still some regulation hurdles. I guess those should be cleared by 2012.

I disagree that willpower plays any part, certainly if a patient is up to a bottle of spirits a day - any more than willpower has anything to do with healing a broken leg.

The treatments carried out by the Sinclair Clinic in Espoo showed 70% of alcoholics who were approved for naltrexone (the toxic one) had got their drinking down to manageable levels within 6 months. As long as they took the blocker before drinking, they continued to recover. And many of these patients were bottle a day types.

The main problem is that for these people, drinking dominated their lives, and when that behaviour starts to be erased, there is a behavioural void for which counselling is needed.

But theoretically, opioid blockers work in such a way that IF every alcoholic drink contained a small does of nalmefene, nobody would become an alcoholic.

You can't be me, I'm taken

by Sven Triloqvist on Fri Dec 31st, 2010 at 12:09:08 PM EST
[ Parent ]

Re: Alcoholism (4.00 / 2)

Will power is needed even if only to be self-disciplined enough to keep taking the tablets. Willpower can even help you to recover from a broken leg quicker!

The medicalisation of addiction treatment has been a failure the world over, and better drugs, even if they help that situation will do nothing to address the economic, social, psychological, personal and cultural factors which can also contribute to addiction of various kinds. Simple counselling doesn't go very far either, although it too is part of the holistic approach used in the Muriel Boothman Centre.

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by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Fri Dec 31st, 2010 at 12:24:58 PM EST
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Re: Alcoholism (4.00 / 3)

The medicalisation of addiction treatment has been a failure the world over, and better drugs, even if they help that situation will do nothing to address the economic, social, psychological, personal and cultural factors which can also contribute to addiction of various kinds.

Every disease, e.g., alcoholism, has "economic, social, psychological, personal and cultural factors." Once a person is infected with cholera, say, giving them a job isn't going do a bit of good; neither is a heavy duty dose of "talky-talk" psychological therapy. Cholera needs to be treated by replacing fluids and salts and a course of antibiotics.

Alcoholism has the special kicker that the person having the disease is the vector of the disease. Interestingly, there seems to be a population with a neurological predisposition for alcoholism; anecdotal evidence (insert caveats as to the low quality of such!) informs us some people become alcoholics after one drink, even if they dislike the taste of alcohol. Other people require a continuous, long term, exposure to alcohol before developing the disease. This is in-line with other diseases like cholera were some people are quickly overwhelmed by the bacteria while others can resist the bacteria for some time before developing symptoms.

She believed in nothing; only her skepticism kept her from being an atheist. -- Jean-Paul Sartre

by ATinNM on Fri Dec 31st, 2010 at 01:54:18 PM EST
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Re: Alcoholism (4.00 / 4)

ATinNM:

Every disease, e.g., alcoholism, has "economic, social, psychological, personal and cultural factors." Once a person is infected with cholera, say, giving them a job isn't going do a bit of good; neither is a heavy duty dose of "talky-talk" psychological therapy.

There are differences, and I'm not even sure that alcoholism should be described as a disease. For instance there are v. effective medical treatments for Cholera and the disease probably wouldn't exist now but for "economic, social, psychological, personal and cultural factors".

The major difference is that there has (up until now in any case) been almost no effective purely medical treatment for alcoholism - the medical model hasn't done a whole lot better than faith healing in that respect.

I don't doubt that there are genetic and other neurological/physical factors which influence the likelihood of addiction, and hopefully effective gene or other therapies will be discovered which will eliminate those. Many children of alcoholics I know won't drink any alcohol for fear of addiction and having experienced the damage done at first hand.

I don't think we disagree all that much, I just think Sven's total denial of willpower/motivation as a factor is a bit strong and his faith in medical "cures" is not borne out by the evidence to date. As things stand, the medical profession's attempt to characterise alcoholism as a disease and control its treatment (thus excluding many alternative treatments and professions) is a power play which has been relatively unsuccessful in terms of actual achievement.

The narrative framing of alcoholism as a disease requiring a medically managed cure diminishes both the patient and their prospects of recovery.

If the medical profession DO come up with an effective treatment I am more than happy that they should take control of the therapeutic process, but even successful medical interventions often require a great deal patient advocacy and motivation and my biggest problem with "the conventional medical model" is that it dis-empowers patients and often actually hinders their recovery.

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by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Fri Dec 31st, 2010 at 03:10:56 PM EST
[ Parent ]

Re: Alcoholism (4.00 / 2)

I agree we don't substantially disagree.

Something may be incurable and still be a disease. Otherwise you'd have to say bubonic plague only became a disease when antibiotics were discovered. My point was: alcoholism has a physical component that must be addressed, solved, for the intervention to be better than the "cure" rate of a placebo.

This is not to say the "Mind" side is irrelevant. It seems to (un-professional me :-) the evidence strongly suggests alcoholism is a Mind/Brain disease and needs to be attacked with psychological as well as physical intervention. At a minimum, as you rightly pointed-out, the patient has to have the Willpower to take the damn pill. Something, BTW, not limited to alcoholics; in the US people are being forceably hospitalized for tuberculous since it has been proven enough patients don't take the full course of medication, they relapse, and TB is starting to develop resistance to antibiotics because of this.

She believed in nothing; only her skepticism kept her from being an atheist. -- Jean-Paul Sartre

by ATinNM on Fri Dec 31st, 2010 at 04:29:00 PM EST
[ Parent ]

Re: Alcoholism (none / 1)

my reasons for resisting the "alcoholism as disease" framing are not limited to the lack of efficacy of the medical paradigm, although that would be a major reason.

The "learned behaviour disorder" framing emphasises the fact that like all behaviours, learned behaviours can be unlearned and thus behaviour modification techniques, personal motivation, social interactions, institutional supports and alternative exemplars, mentoring and leadership take centre stage. Behaviour is not reducible to biochemistry even though the latter can of course be a major component of it.

Index of Frank's Diaries

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Fri Dec 31st, 2010 at 09:34:36 PM EST
[ Parent ]

Re: Alcoholism (none / 0)

Frank Schnittger:

there are v. effective medical treatments for Cholera and the disease probably wouldn't exist now but for "economic, social, psychological, personal and cultural factors".

Smallpox has been eradicated. Does that mean smallpox is not a disease?

Of all the ways of organizing banking, the worst is the one we have today — Mervyn King, 25 October 2010

by Carrie (migeru at eurotrib dot com) on Mon Jan 3rd, 2011 at 05:13:34 AM EST
[ Parent ]

Re: Alcoholism is a Learned Behaviour Disorder (4.00 / 4)

If the clinical trials referenced are phase I or II, then it will take until the middle of this decade. But Sven's comments lead me to believe that they're stage III trials. If so, and assuming the trials demonstrate efficacy and no unexpected complications show up relative to the phase II trial, it should be possible to get it approved for the sort of patients the trial(s) have demonstrated efficacy in before this time next year.

Normally, there will be subsequent clinical trials that seek to expand the drug to more marginal patient groups/disorders. Clinical trials usually start with the most promising uses, on the theory that if you don't get a signal from your most promising trial then you probably won't get a signal at all (and commercially it's better to start with a strong effect and then move to more marginal groups than the other way around).

- Jake

Friends come and go. Enemies accumulate.

by JakeS (JangoSierra 'at' gmail 'dot' com) on Fri Dec 31st, 2010 at 12:17:03 PM EST
[ Parent ]

Alcoholism is a Learned Behaviour Disorder | 35 comments (35 topical, 0 editorial, 0 hidden)

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