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Feb 10 2012

Secular Addiction Recovery Part Two: Alternatives

I’m rather sick today. Lungs full of gravel again. That’s twice now over the past few months… grrr. I didn’t get sick at all last year while I was all super unemployed and idle, but now that I have a (fake) job and (fake) responsibilities, it’s all WHOOO! VIRUS PARTY IN NATALIE’S MUCOSAE! BRING YR FRIENDZ!

So I’m afraid I’m going to just take it easy and initiate lazy weekend mode a day early.

Anyway, I’d like to revisit the theme of dealing with addiction from a secular standpoint, mostly to remind you all that I am totally keeping this as one of the recurring topics here, and didn’t suddenly change my mind and decide this blog will be exclusively about trans-feminism and ponies. So I just wanted to quickly assemble a little list of alternatives to 12-step for atheist and secular addicts in recovery.

But first I’d like to point out an interesting new blog I found yesterday via a pingback. Foster Disbelief. It’s written by another atheist who has recovered from heroin addiction. I have no idea at all why I find the existence of another ex-junkie atheist blogger so much more surprising than I did the existence of other transsexual atheist bloggers. Assessment of probability is one of the things human brains aren’t all that good with.

Percentage of people in North America who are transgender: <0.03%

Percentage of people in North America who have been heroin users at some point in their lives: 2% (ish)

But probability is a funny thing. You know that there are, in addition to myself, two other trans people who are regulars in the Vancouver skeptic scene? And, as far as I know, almost nobody who is openly gay or lesbian? In a mathematically perfect world that functioned only in accordance with the most salient variables, statistically there should be 150 or so gay/lesbian people for every 3 trans people! It makes things much more interesting, however, that we don’t live in a mathematically perfect world that functions only in accordance with the most salient variables. Makes for interesting questions. Like WHY the overlap between the trans community and the skeptic/atheist community? It is there.

Anyway, the blog I found by another former heroin addict is called Foster Disbelief. He does seem interested in delving into the drug war and related issues, which I think is great. There DEFINITELY needs to be more attention paid to this by the skeptic community, IMHO. For a very long time the scientific evidence has strongly favoured harm reduction approaches to drug policy, yet world governments have repeatedly gone for enforcement / deterrence approaches, which have been soundly proven ineffective. What we have here is a spectacular example of scientific evidence and consensus being undermined, suppressed and ignored in favour of the more “intuitive” approaches, “common sense”, bigotry (along associated lines of race, class, various socio-economic positions common to addicts, the stigma of addiction itself, sexuality, etc.), and good old fashioned politics. An intersection of the value of skepticism, science and knowledge and the pursuit of social justice if ever there was one. Yet we don’t seem to talk about it much.

I’d love to help remedy that silence.

When I’m feeling better! In the meantime, go ahead and check out Foster Disbelief!

Now, I think I had some kind of topic here…? oh yeah! Alternatives to 12 step!

At some point soon, I’d like to do a nice, thorough debunking of everything fucked up about 12 Step organizations like Alcholics Anonymous, Narcotics Anonymous, Al-Anon, etc. But in the meantime, it’s probably enough to just know that they have a very strongly religious tilt, and most atheists and secularly-minded folk aren’t going to feel too comfortable with how they approach things. PLEASE don’t let them convince you that they’re the only option, or that they’re more effective than the alternatives. Those are lies, plain and simple. There definitely are alternatives.

-SMART (Self-Management And Recovery Training)

This was one I mentioned in my first post on this subject. I mentioned it first because of all the secular-oriented addiction recovery organizations, it’s the largest, and the one most likely to be operating in any given city where someone reading this may live.

SMART is modeled after cognitive behavioural therapy. Cognitive behavioural therapy is a very simple, pragmatic form of therapy, geared not so much towards dealing with underlying psychological issues or traumas but rather addressing the actual symptoms, thoughts and behaviours. Basically, the idea is that by changing your cognitive approaches to certain situations or triggers you can change your behavioural response, while also by gradually adapting how you behave in certain situations you can change your cognitive response. This approach is very well suited for addiction in that it addresses the sort of feedback loop of how addictive behaviour leads directly to reinforcement of the cognitive structures that create that behaviour, and works by breaking that loop and providing an opposing one.

In SMART you’re provided with literature that provides a number of cognitive and behavioural tools. Things like tips on avoiding your triggers, little cognitive processes to go through when experiencing cravings or addictive “need”, ways to develop coping strategies, relaxation techniques, advice on finding healthy replacement behaviours, and tips on things you can do to non-medically improve your mental health (like exercise, meditation, etc.). That kind of thing. It’s surprisingly useful.

SMART also usually provides support groups. These are structured mostly around discussing specific “tools” contained within the literature, rather than on sharing of experiences and the usual kind of support group stuff. More of a workshop, really.

Personally, I didn’t get too much out of the support groups, in that I felt very alienated from the other people attending them, like my own experiences and mentality didn’t relate very strongly, and also I felt… well, scared, to be honest. The other attendees were all men, all straight/cis, and all older than me. It was very intimidating, and I didn’t feel safe discussing anything about myself or what I was going through.

Dealing with addiction is hard. Dealing with addiction when you’re also dealing with another highly stigmatized, terrifying and emotionally draining personal issue is really fucking hard.

Needless to say, I found a great deal of value in the literature and tool SMART provides, and every individual, and every support group, are unique. Just because the actual group setting didn’t work for me (and my very specific situation and needs) doesn’t mean it won’t work for you.

A few other similarly secular addiction resources include:

Addiction Alternatives – A pretty cool, useful website covering a variety of “science based solutions” to addiction. Offers a wonderful overview of resources.

LifeRing Secular Recovery – Much more centrally structured around the support-group model than SMART, and a bit more similar to 12 Step in their overall approach, but nonetheless they’re specifically secular in nature.

Rational Recovery – This one is a bit woo-ish, seem to make some very grand, “too good to be true” statements, and set off a lot of my skeptic warning klaxons, but are probably worth mentioning anyway. They’re based around something called the “Addictive Voice Recognition Technique”, which is probably just a trumped up version of one of the basic skills offered in SMART and typical drug counseling: the ability to recognize when your thoughts aren’t really your own but rather just the addiction “talking”.

Secular Organizations For Sobriety (SOS) – A smaller network of group meetings. They maintain a 24 hour online chat meeting, though, which is kind of interesting.

-One-on-one Counseling

Like SMART, finding a good therapist or counselor can provide a lot of benefit just in terms of developing coping strategies and new cognitive approaches to the problem. One-on-one drug counseling also has the benefit of being able to structure it around your specific, particular needs.

Any urban area of any significant size at all should have plenty of counselors and therapists who have specifically studied, specialize in, or have experience working with, addiction. Many will also have other areas of specialization, too, allowing you to seek out someone who can meet the intersection of specific needs rather than presenting a “one size fits all” answer like 12 step. For instance, a counselor who is trained in addiction may also be trained in LGBTQ issues, pain management, disability, concurrent mental health disorders or unemployment and poverty. ALL of those things have a tendency to overlap with addiction, and any good therapist / counselor will understand those intersections.

If money is a problem, it’s not uncommon for such practitioners to charge on a sliding scale, or even work for socialized programs that don’t charge at all.

One-on-one counseling can also be used alongside other methods, like support groups or medications, and can even be an excellent means of finding and pursuing the programs that work for you, and you’ll have the opportunity to specify your needs and requirements (for instance, that any programs or treatment you participate in be secular and evidence-based).

The one bit of advice I’d caution in finding a counselor or therapist is to do your research. Shop around a bit. Find out about a given practitioner before committing to an appointment… compare them against others. It’s important to find someone who’s a good fit for you, whom you’re able to trust and open up to, and with whom you’re able to work in a meaningful way. If, after a few sessions, you find that no real progress has been made and you’re not getting much out of it, it might be wise to ask for a referral elsewhere. Remember: you are their employer. Their job is to meet your needs, and you’re in charge of the relationship.

-Medication

Addiction is a medical problem. It is not a moral failing, or a personal flaw, or a sin, or a spiritual emptiness, and it probably has nothing at all to do with that time your mom threw your stuffed porcupine in the lake. There are very literal chemical pathways and structures in your brain that have wired you to instinctively pursue the object of your addiction as though it were a physiological need. It is maladaption of the human body, like an auto-immune disorder.

It is not a failure or weakness to treat it from a medical perspective, or to pursue medical help.

In fact, having a doctor involved is an extremely wise choice in any recovery. There are significant medical risks associated with withdrawal from most addictive substances. At the very least, a doctor can ensure that you detox safely and aren’t risking your health. But beyond that, they can also help make that process a lot less uncomfortable.

There are lots of medications that can ease the unpleasant side effects, and health risks, of alcohol withdrawal. Nicotine patches, gum and inhalers, e-cigarettes and Champix can all drastically improve your chances in quitting smoking. Anti-depressants or anti-anxiety meds can help provide a regulated, controllable approach to managing whatever mental health issues may have led to self-medication through drugs.

And then there’s methadone. Methadone not only completely sidesteps the issue of opiate withdrawal (a very, very, VERY unpleasant thing to deal with), it also has the additional benefit of blocking the opiate receptors in the brain, making it effectively almost impossible to get high if you do “slip” and use again. It does a very good job. There’s also the new opiate-replacement drug suboxone which can provide similar effects.

There is an enormous difference between an addiction and a dependency. Many people have dependencies. Caffeine, anti-depressants, chocolate, marijuana, xanax, etc. It’s okay. There’s nothing at all wrong with that. Being human is tough, we don’t all have brains that work the same way, we don’t all function the same way, and sometimes we need things to help us get through life. You don’t point to a man with a broken leg and say “that’s just a crutch”!

Even an addiction doesn’t carry anything intrinsically horrible about it. Where the problem comes in is the consequences. How it effects your day-to-day life, and the people around you. That’s what matters, not what chemicals are or aren’t in your body. Chemicals don’t have ethical implications. Actions do. If a dependency allows you to live a functional and happy life, reduces or eliminates the harm of the addiction (to self and others), and returns you to agency over your actions, well… mission accomplished. That’s a win. And a dependency is far easier to negotiate escaping than is an addiction.

-Local Groups

Finally, it’s often worth a shot to just ask around and see what’s going on in your area. Sometimes there are addiction groups set up as extentions of non-profits set up addressing other social issues. For instance, women’s health centres, gay and lesbian non-profits, or even trans health programs can run small addiction recovery groups. For a short while I was actually attending a group specifically for trans people dealing with addiction (it didn’t go very well for me, though, sadly… got a couple really funny stories out of it though, which I’ll tell some day).

Point being, there’s lots of people out there who have dealt with addiction and want to help others. There are all kinds of little groups going on all over the place, and not ALL of them are religious in nature. You never know… a little poking around could find you exactly the group of people you need to meet in order to make it through this.

Anyway, I hope this little post is helpful in some way. I’ll come back to this topic again soon, hopefully when I’m feeling a little better and can put a little more energy into it.

Sorry this hasn’t been my best week, guys.

64 comments

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  1. 1
    Anders

    What is your (fake) job and (fake) responsibilities, if the question is not too stalker-ish or private? They’re not paying you with fake money, are they.

    On to the article: There could be way more than 0.03% transgendered people in the U.S. Check your g-mail, there’s a mail with my name on it and in there is a link to an article about TG prevalence that looked kosher to me, but I only skimmed it. You’re in a better position than me when it comes judging that.

    Hmm… there is a clinical trial going on using a SMART-based web application for alcoholism, but no results yet (http://clinical-trial-studies.findthedata.org/l/111961/Overcoming-Addictions-A-Randomized-Clinical-Trial-of-a-Web-Application-Based-on-SMART-Recovery). The study looks good, although I couldn’t find exclusion and inclusion criteria. And my posts would be much shorter if someone taught me how to embed links. Just sayin’.

    Nothing in the literature on SMART what I can see (http://www.ncbi.nlm.nih.gov/pubmed – bookmark this link, for it is the key to all medical scientific knowledge), but it would be pretty new. CBT hasn’t been popular for very long, has it? So the scientific status of SMART is still up in the air. Still, CBT would seem a fairly natural fit for addiction so it’s not in any way strange.

    Take some mollipect, have some chicken broth, go to bed and rest. I’m sure no one here will fault you. And I’ll promise not to have anymore embarrassing mental breakdowns on the premises.

    1. 1.1
      Ace of Sevens

      I assume she’s referring to the blog.

      1. Anders

        I don’t think so. She twittered something about picking up a paycheck. Ah well, if she doesn’t want to answer it’s really not our business.

        1. Natalie Reed

          No, I do mean the blog. FTB does pay its writers.

    2. 1.2
      Sheila Crosby

      Tutorial on HTML at tizag.com. The bit on links is at http://www.tizag.com/htmlT/links.php Hope it helps.

  2. 2
    kim

    “The one bit of advice I’d caution in finding a counselor or therapist is to do your research. Shop around a bit. Find out about a given practitioner before committing to an appointment… compare them against others. It’s important to find someone who’s a good fit for you, whom you’re able to trust and open up to, and with whom you’re able to work in a meaningful way. If, after a few sessions, you find that no real progress has been made and you’re not getting much out of it, it might be wise to ask for a referral elsewhere. Remember: you are their employer. Their job is to meet your needs, and you’re in charge of the relationship.”

    I encourage changing if you don’t feel you are getting what you need. If you didn’t like the way a person cut you hair you’d go somewhere else. Your health and well-being is much more important than a haircut so you should absolutely be comfortable shopping around and changing if you want.
    You don’t become close friends and feel comfortable telling your secrets to just any person you meet . You shouldn’t feel bad or reluctant to find a different therapist. It is common.

  3. 3
    embertine

    Natalie, I’ve been doing some reading up about methadone, and I hadn’t realised that the withdrawal symptoms are generally even worse than they are from heroin. Sounds like a bit of a poisoned chalice? Are you on a programme to reduce your dosage with a view of coming off opioids altogether? I’ve known of some addicts who have chosen to go cold turkey on the heroin instead, although I recognise that different things might work for different people. I hope this isn’t too personal and understand entirely if you prefer not to answer.

    1. 3.1
      Natalie Reed

      Well, yeah, quitting methadone cold turkey is much harder than quitting heroin cold turkey. But methadone can be tapered off slowly, and removes the psychological component of the addiction (it doesn’t get you high).

      1. Anders

        What would you do if you needed to travel? Say that James Randi says you are giving the keynote speech at next year’s TAM (hey, stranger things have happened) – would you take a case with you? Would you arrange something with the local pharmacies? Would you have to say no?

        1. Natalie Reed

          It depends. I’d either arrange to take “carries” with me for the duration of the trip, or arrange my prescription to be available for pick-up at a local pharmacy. It would be tough in the case of traveling to the States, though. I’m not even sure methadone is even all that available down there.

          1. Claire

            Methadone is available at certain clinics in the U.S., but not sure how someone who is traveling would access these programs.

      2. Anders

        And then there’s methadone. Methadone not only completely sidesteps the issue of opiate withdrawal (a very, very, VERY unpleasant thing to deal with), it also has the additional benefit of blocking the opiate receptors in the brain, making it effectively almost impossible to get high if you do “slip” and use again. It does a very good job. There’s also the new opiate-replacement drug suboxone which can provide similar effects.

        In case anyone is interested (and because I love to see myself writing…), there are three opiate receptors known: mu, kappa and delta. Mu-receptors stand for most of the undesired effects of opiates (from the standpoint of medicine) – addiction, highs, respisatory depression, constipation. All morphine derivates are highly selective for the mu receptor. Kappa produces analgesia effect and dysphoria and a feeling of unreality. We don’t know what delta receptors do.

        Methadone acts at the mu receptors. But like the phytoestrogens discussed in an another post, it’s a partial agonist with 70% of the potency of morphine. Heroin isn’t really more potent than morphine, but because of it’s structure it passes the blood-brain-barrier much quicker than morphine, giving a higher peak concentration and a more effective high.

        So, I read up on trigger warnings and they discussed trigger warnings for rape victims. Are there trigger warnings that should be issed for heroine addiction as well? Things that trigger your craving? Might be good to know, for future reference.

  4. 4
    embertine

    P.S. Hope your gravelly lungs get better very soon. :)

  5. 5
    Anna

    I have heard the 0.03% number for number fo trans people but it seems a bit suspicious to me. I am wondering if that number is old when trans was much more closeted and when doctors only labelled certain traditional types of trans people as actually trans.

    Based on the number in southwestern ontario versus population either we are way out of whack for some odd reason or that 0.03 seems suspicious to me. Also, the numbers here are just out of the closet people.

    1. 5.1
      Anders

      According to the paper I sent to Natalie, if the prevalence was 0.03% you’d have fewer transgender people total in the USA than there are SRS performed every year. Unless the attrition rates in SRS is truly murderous, this seems unlikely.

      They say it’s more like 1:1000 to 1:100. I have no idea how realistic that is.

      1. Natalie Reed

        0.03% is 1 in 333.

        The figures you presented aren’t that different. And if the incidence was as high as 1 in 100, there’s no way we’d be hearing all these other figures being thrown around so regularly like “1 in 1000″, “1 in 2000″ and “1 in 10,000″.

        1. Anders

          I get it to 1 in 3333. *confused* 1/0.03=33.3333*100=3333.

          Yeah I don’t believe in 1:100 either, but that’s their lower limit. DSM-IV gives 1 in 30 000 I believe.

        2. Anders

          Also (must learn not to submit too quickly), don’t confuse incidence and prevalence. Incidence is the probability of developing a condition over a period of time (typically a year). Prevalence is the number of people with the condition in a given time.

          So if I say that the incidence of GID in Southern Ontario is 1 in 1000 per year, that means that every year 0.1% of the population gets added to the pool of people with GID.

          If I say that the prevalence of GID in Southern Ontario is 1 in 1000, that means that the pool of people with GID is 0.1% of the population.

          So it’s growth rate vs. total number.

          1. Natalie Reed

            Damn. I’m making all kinds of mistake today.

            Can I just blame the cold?

            Anyway, I can’t remember exactly where I got the 0.03% figure, but miscalculating it at the time I figured “1 in 333 is pretty damn high. I’ll just use that from now on so no one can accuse me of underestimating”. Oops.

            I really wish I knew which figures to trust. When you’re highest estimate is 1 in 100 and you’re lowest is 1 in 30,000, you might as well have no data at all.

          2. Anders

            You’re not the only one who makes mistakes. Incidence is number of new members per time period, it’s not growth rate. For that you need additional information – how many are leaving the pool.

        3. Xanthë, Amy of my threads

          As pointed out, you made an error of one power of ten. :-)

          Have you read the Oyslager and Conway paper on transsexual prevalence? They suggest a prevalence somewhere between 1:200 and 1:1,000; some countries which have cultural traditions of third gender, such as Thailand are on the high-end for prevalence, which is possibly as high as 1:200.

          But yes, whether 0.1% or as much as 0.5% of the population, such low prevalence makes us totally reliant on allies.

          1. Xanthë, Amy of my threads

            (Reading between the lines, I think the paper Anders sent, and the one I linked to, are one and the same.)

          2. Anders

            They’re not the same paper but Lee Conway is the author of both (http://ai.eecs.umich.edu/people/conway/TS/TSprevalence.html). And yeah, 1:100 and 1:30 000 is a wide range but if transsexuals continue to come out (like Lana, like the Canadian politician whose name escapes me, like Natalie) and get a media presence we will get a positive feedback loop and we will get more accurate estimates. The transphobes know this, and that’s why they’re so dead set against any positive representation of transsexuals.

            It also comes back to understanding. We fear what we do not know.

          3. Xanthë, Amy of my threads

            Lynn Conway, Anders. :-)

          4. Anders

            *string of curses*

            I suffer from premature submit-comment disorder…

    2. 5.2
      Natalie Reed

      The trans population in South Ontario is going to be significantly higher than other than the trans population in general. LGBTQ migrate to urban areas, and LGBTQ people in other areas are much more likely to stay closeted. Not to mention that services and treatment for trans people aren’t always accessible outside of majour cities like Toronto.

      1. Christianne

        Yeah. The population of trans people isn’t homogeneous across geography. I used to think that the 1 in 2000 number was pretty valid because the rural Missouri town where I live has ~4000 people and there are two transsexuals living here (including myself, and that I know about, obviously). But when I remove to Columbia, twenty miles to the south, the numbers change dramatically, though I doubt that they approach 1 in 333 (Columbia has 88,000 people plus a transient college population). Probably more like 1 in 1000, which means that there are ~88 trans people here, which jibes with my experience if we allow for people who are in the closet. If the number is 1:333, then that number expands to 264, which seems large compared to the trans people I actually know about (and I recognize the danger of arguing from personal experience; and 264 trans people is still a number that I can believe). But, again, Columbia is a small (though very trans friendly) city in a very red state. Some cities attract GLBT people more than others. I wonder what the prevalence of trans people is in someplace like Seattle or Atlanta. As an aside, I wonder what the prevalence of trans men is in my area compared to trans women, because the vast majority of trans people I know are trans guys. Social stigma is probably responsible for this, I guess. (I should probably add that this is all anecdotal from the point of view of someone who runs a trans support group for our local GLBT center).

        1. Natalie Reed

          Trans support groups have a bit of a tendency towards ending up either dominated by women or dominated by men. So if most of the trans folks you know are through the same group, it’s understandable that they’d mostly be of one spectrum or the other.

          1. Anders

            I wonder why that would be? Maybe it’s because they both strive to attain what the other group strives to escape?

          2. Natalie Reed

            Probably just want to be around similar people, people who understand. It’s a bit intimidating to enter a trans space and realize there’s not many people there like you.

        2. Rasmus

          Not to be a smartass or anything, but I think 2 of 4000 and 88 of 88,000 are both consistent with the same (unknown) underlying probability of being born trans.

          You have a huge random variance in a statistical estimate when your sample has a very small number of people with a certain property, like you had in that small town where there were only two trans people. I mean, consider for example the dramatic effect that your single decision to move had on the numbers – from 2 in 4000 to 1 in 4000, just like that…

  6. 6
    Quietmarc

    I’m glad you’ll be returning to this subject in the future, since my attempt at sobreity is fairly new (4 months already, woot!), so I’m definitely motivated to find resources and perspectives on addiction that are geared towards a)atheists and b)queer folk.

    Do you happen to know why there doesn’t seem to be any local SMART groups located in Toronto? (I guess I should ask them….) Maybe the centre of the universe doesn’t need addictions help? I dunno….

    1. 6.1
      embertine

      Sending you a little supportive virtual fistbump on your sobriety. Hope it continues to work out. :)

      1. Anders

        I prefer hugs. They can also be used to restrain violent people.

        *hug*

        1. Quietmarc

          Fist bump is totally acceptable, especially if it includes the “explosion” afterwards. Hugs are okay, but my social anxiety tends to flare up and I panic about all of the details that surround the social activity of hugs. Through the magic of the internet, I have converted your hug to 1.035 fist bumps (the exchange rate is slightly in fist bump’s favour today).

          Thanks! :)

          1. embertine

            *bump* KSHHHHHHHHHFOOOOOM!!!

            You have to do the sound effect, right?

          2. Anders

            I’m from the LGBTA threads in Giant in the Playground forums (if you don’t read Order of the Stick, do. It’s an awesome D&D-based webcomic). We do most of our communication via hugging. And really bad puns.

          3. Quietmarc

            I’ve just started a D&D campaign with a bunch of noobs (who, unlike me, did not spend their high school days calculating ThAC0s), and I’ve been getting really close to order of the stick (I did a marathon read of DM of the Rings last week) so maybe today is when I should check it out….

          4. Anders

            Join the forum while you’re at it. We have an LGBTA thread there that’s on the 20th incarnation now (they close the thread every 50 pages).

    2. 6.2
      Cynthia

      So glad to hear you are managing to stay away from alcohol – so pleased to hear it’s working for you. I know it’s hard and if it helps, I’ll send you all the virtual support and fist bumps and hugs you need. Booze is such a hard thing to walk away from, I’m proud of you being able to manage it.

      It sounds really self righteous when I re-read this post, but I truly mean it in the best possible way. Support is out here and we really want to see you do well. After all, we skeptics need all the friends we can get. So please forgive me if I offended you in any way.

  7. 7
    HappiestSadist, Repellent Little Martyr

    This post is really interesting, and I hope you feel better soon.

  8. 8
    Alexis

    There seems to be a high incidence of alcoholism among the trans people that I’ve met. I think that is because of the way society treats us, and it is easier for us to slip into addictions and dependencies to cope with this treatment. And due to the way we are viewed, it is easy for us to develop extremely low self-esteem. I think that low self esteem and addiction are linked. And what is the first thing that AA does? It drags you down further into admitting that without their invisible friend you are nothing. This seems to me to be just the opposite of what we need. We need an approach that builds us up. You have the power. It may be hidden for now, but you have the power to pull yourself back up, and to succeed.

  9. 9
    Delictuscoeli

    Even an addiction doesn’t carry anything intrinsically horrible about it…If a dependency allows you to live a functional and happy life, reduces or eliminates the harm of the addiction (to self and others), and returns you to agency over your actions, well… mission accomplished.

    This. I have been using opiates (though not heroin) for a few years and find my quality of life greatly improved by them. The dependency is admittedly a hassle but it sure beats the alcohol I was self-medicating with beforehand, a long family tradition that must relate to genetically deficient dopamine levels.

    I agree that it’s not the substances, but the behaviours that are the problem. That’s why I bristle at the distinction between “hard” and “soft” drugs, where it mainly has to do with social permissibility couched in terms of chemical dependency.

  10. 10
    Anders

    Speaking of social politics, Sweden is a hard-line state when it comes to narcotics. ‘Harm reduction’ is a dirty word and needle exchange programs are vilified and talked about in terms of ‘enabling abuse’. And no political party strays from the orthodoxy.

    1. 10.1
      Delictuscoeli

      It’s baffling sometimes, the way governments handle things. Can’t they look at Portugal? The numbers support a harm-reduction policy. Ah, well.

      1. Natalie Reed

        Vancouver itself offers some wonderful data on the efficacy of harm reduction approaches. We have North America’s only safe injection site, for instance, and it’s been an enormous success.

        If nothing else, if it weren’t for them I wouldn’t be here writing any of this.

        But yeah, I’ll be doing a post on some of the data that has emerged from Vancouver harm reduction experiments very very soon.

        1. Delictuscoeli

          Yes, and we’re lucky the Supreme Court agrees on that one.

      2. Natalie Reed

        Vancouver itself offers some wonderful data on the efficacy of harm reduction approaches. We have North America’s only safe injection site, for instance, and it’s been an enormous success.

        If nothing else, if it weren’t for them I wouldn’t be here writing any of this.

        But yeah, I’ll be doing a post on some of the data that has emerged from Vancouver harm reduction experiments very very soon.

      3. James K

        It’s baffling sometimes, the way governments handle things. Can’t they look at Portugal? The numbers support a harm-reduction policy. Ah, well.

        I think you’r making a fundamental error here – you’re assuming that government policy is in any way empirical. Seriously, politicians say and do things based on how much they appeal to the median voter or some key demographic or interest group. Whether or not it corresponds to reality is entirely incidental.

        1. Delictuscoeli

          That was, in essence, the point I was making.

      4. Anders

        I would guess it’s something like this.

        It’s a question of sin, of purity. Putting these dirty drugs into your body pollutes it, makes it less than human. It’s inherently degrading, and fighting that is more important than any harm the policy actually causes. Whether it’s actually effective or not is besides the question, the important thing is to fight the good fight.

        Jonathan Heidt (http://pculpa.com/anarachy/34-blog-entry/394-jonathan-heidt-shedding-light-on-the-left-right-divide.html) gives an interesting speech on the difference of morals to the left and right (although he has added ‘liberty’ as a dimension to the model discussed in the link). It’s worth a look.

        1. Rasmus

          Here’s an attempt at an introduction to modern Swedish drug policy that you might want to look at.

          It is basically a societal mass delusion unleashed by a single scientist called Nils Bejerot.

          Bejerot considered drug addicts to be carriers of an infectious social disease. Like with any infectious disease the focus, he argued, ought to be on limiting exposure of the population until you get to a point where the epidemic tapers off.

          In accordance with that idea, the Swedish drug policy is basically designed minimize contact between people who are doing drugs or selling drugs (other than alcohol and nicotine) and people who aren’t.

          Bejerot also had the idea that drug users should be punished harshly, because he argued that the users are the only ones in the drug production-distribution-consumption complex that are irreplaceable. If demand drops, so does distribution and production.

          The funny/sad thing depending on how you look at it is that Sweden has a very successful harm reduction program for alcohol and nicotine based on information, education, distribution control and very high taxes.

  11. 11
    JesseW, the Juggling Janitor

    I’m not sure I understand the difference between “dependency” and “addiction”. WordNet gives the same definition for both: “being abnormally tolerant to and dependent on something that is psychologically or physically habit-forming”. (via OneLook.com)

    Anyone want to suggest some clarifications?

    1. 11.1
      Delictuscoeli

      These words have gotten muddled together in a way that, in my opinion, really gets in the way of serious discourse about drug policy. Here’s a good way to think about it: A diabetic is dependent on insulin, but not addicted to it. The same can be true of any medication or substance (like caffeine).

      Addiction is a kind of compulsive behaviour that is mainly rooted in the brain’s reward pathways and pleasure centres. This can be associated with substances that affect these channels directly (like opiates, cocaine, or cannabis) or it can be triggered by other behaviours (like gambling).

      Substances that are “habit-forming” (like opiates or benzodiazepines) easily produce chemical dependency (i.e., tolerance and adverse symptoms upon cessation). When habit-forming substances are also pleasurable to use, this creates a double problem and a higher addiction risk: the desire to avoid withdrawal symptoms becomes intertwined with the pleasure-seeking and coping behaviour that are the (initial) driving force behind use.

      This is my personal understanding of these terms and how I use them. Obviously language is fluid and not everyone may agree.

      1. Natalie Reed

        Very well put!

      2. Anders

        Yes, very well put. As far as I can tell, addiction has to do with dopamine release in areas of the brain. There are drugs in the pipeline to block the addictive effect, but the trick is to do it in such a way as to not block ‘natural highs’ like you get after a really pleasurable experience (good sex is always a good example).

  12. 12
    Amanda

    I wouldn’t say that gay and lesbian people are “almost non-existent” in Vancouver’s skeptic scene. Granted, I think there should be (and I wish there were) more, but I can think of a couple of other gays/lesbians who attend events, and a whole whack-ton of people who are bisexual.

    1. 12.1
      Natalie Reed

      Yeah, I’m sure they’re there. I just haven’t met many queer folks in the skeptic scene. and it IS a little bit weird to have three trans people and only a couple LGB people I can think of. But then again, maybe it’s just a case of not being all that out about it? But that in itself raises interesting questions…

      (a really simple explanation is that I just personally haven’t been around long enough to meet them all, but what trans folks there are in the scene have intentionally introduced themselves)

  13. 13
    ttch

    Re “Rational Recovery”, here’s the front page of the Rational Recovery website, 12 Feb 2012:

    The Family Strikes Back!

    ©2010, Jack Trimpey. All rights reserved.

    No family can survive addiction of even one of its members. Addiction is a black hole that consumes all of a family’s finances and emotional resources, and then still demands more. Families of addiction live under a cloud of deceit that surrounds addiction, not only the lying, betrayal, and manipulation of addiction, but also the deceit of the disease concept of addiction, which transforms a perfect ass into a sacred alcoholic.

    (continues…)

    The first two assertions are simply false. Not a good beginning.

    1. 13.1
      Natalie Reed

      Eww. That’s HORRIBLE.

      1. Anders

        Apparently no one has told them that coffee is addictive.

  14. 14
    Setár, Elvenkitty

    Being human is tough, we don’t all have brains that work the same way, we don’t all function the same way, and sometimes we need things to help us get through life. You don’t point to a man with a broken leg and say “that’s just a crutch”!

    I think that this point deserves to be expanded upon. The “crutch” bullshit as applied to dependencies is absolutely dripping of the (annoying, awful, stupid, etc etc etc) just-world fallacy, where everyone is a mental clone and any psychological failings are assumed to be personal failings.

    Case in point, I have a marijuana dependency. Why? Pot is the only thing I have found that will get me out of an emotional meltdown (the triggers for which are rooted and buried so deep in feedback loops as to almost be random; I can get sent into meltdown on an otherwise amazing day because one small thing goes wrong) aside from actually burning through the state, which is an utterly awful emotional pinball machine for me as I bounce at extremely high speed from anger to depression and right back again, and awful for others as the volatility makes me lash out at just about anything because most of my mental faculties are bent on trying to get myself to stop fucking bouncing.

    Anyone who tries to demean my dependency as a “crutch” has most likely never had to deal with me in that state.

    1. 14.1
      Anders

      Have you tried mood stabilizers like Lithium or Lamotrigin?

  15. 15
    ttch

    Regarding alcoholism especially, you might want to investigate the work of the psychologist Stanton Peele. He writes a couple of interesting columns, one for the on-line edition of Psychology Today, another for The Huffington Post. He also has his own website, has authored/co-authored numerous books on the subject, etc.

    Peele is of the opinion that addiction is not a disease, that people often “grow out” of it, and he promotes his own CBT-like therapy for its treatment. He’s not fond of AA.

  1. 16
    Social welfare and foodstamps | The Laughing Linguist

    [...] than others? Yeah, that’s why). Natalie Reed explains this way better than I could here, here and here. So basically, as a society, we are compassionate towards people with all sorts of [...]

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