[throwaway20382]

"I urge people who have a problem with drinking and wish to quit, who for whatever reason do not feel that 12 step programs like Alcoholics Anonymous"

I urge people to see an addiction specialist first. Do not see AA first. See a doctor asap. This disease is serious and has a high fatality rate. AA meetings are like a club after you have it under control (EG. don't attend drunk).

Disulfiram: An old military drug. This will stop you drinking but you need a significant other or parent involved. Each morning you must take the pill and your significant other needs watch to double check. Doctors are scared to prescribe this and the drug companies are ramping down it's production. Hoarding the drug is common.

naltrexone: This comes in two forms. The pill and the shot. When you first take this you should do the shot form. The shot lasts 30 days and there is not a possibility of skipping out on pills. Naltrexone will ruin the Euphoria feeling of alcohol and opioids (so it's a kind of two for one). No addiction specialists back the 'the Sinclair Method' but do back daily use of Naltrexone.

Rehab: Good short term, bad long term. Rehab failure rate is over %90. A normal rehab will run 10-30k per incident. Do not leave unless you had a Naltrexone shot. Longer stays will impact work, an unemployed Alcoholic is dangerous.

Alcoholics Anonymous: Very* difficult for people with social anxiety. People that succeed here find a sponsor which is like dating. You will be rejected literally by tens of potential sponsors until one says yes (hang in there!). AA has a very high success rate for extroverts who become a sponsor - caring over others going through alcoholism seems to rewire the brain.

Baker Acted/Marchman: If you have a family member (or a friend but you have family contacts) drinking to a point where they are unable to make decisions - you can file a Baker act. [Name varies wildly state to state]. A court can determine the individual needs intervention and can use state authorities to detain. Depending on your court appearance after 72 hours (don't be drunk lol) - the judge orders more jail time or programs.

[QuantumYeti]

Another problem with AA is you don't know who is there voluntarily trying to get better, and who is there because they're a physically abusive alcoholic that was court-ordered to be there.

There was also an uncomfortable amount of "thirteenth stepping" going on in my groups, where the single males running them ended up in relationships with women in the groups.

[dclusin]

Kind of like vcs and startup founders who use their status to “mentor” women in tech just to try and get in their pants. Predation is not unique or exclusive to any organization or group.

[MissionInfl]

> No addiction specialists back the 'the Sinclair Method' but do back daily use of Naltrexone.

This is definitely not true having worked with addiction specialists on TSM myself. Plus I think it is safe to consider Sinclair himself as an addiction specialist

For those looking to learn more about different ways to use Naltrexone to treat alcoholism: https://academic.oup.com/alcalc/article/36/1/2/137995

[holler]

> You will be rejected literally by tens of potential sponsors until one says yes (hang in there!)

That's not true at all, but it's a club with millions of people. Other than that appreciate your breakdown.

[webmobdev]

I think s/he meant that finding a sponsor with whom you have a good rapport and willing to give you the time you need is the difficult part (hence, like "dating").

[JonShartwell]

Yeah, the 12th step is to sponsor people (among other things), there is no shortage

[hilbert42]

"Rehab: Good short term, bad long term. Rehab failure rate is over %90."

That's if you can even get the person into rehab at all! Just before last Christmas we buried a good longtime friend and colleague who'd died of liver cirrhosis. Nothing we did could get him into rehab.

'So what' you may say - he was just one more of many thousands. The trouble was that he was also an organic chemist by training yet even with this insight he couldn't stop his alcohol consumption. It was tragic really.

I've come to the conclusion that those of us who aren't alcoholics have little or no conception of how the mind of an alcoholic works or why he/she finds it necessary to consume alcohol in such damaging quantities. Simply, we cannot get into their minds and perceive the world from their perspective. This is a huge problem as it often stops friends and or family from being effective helpers.

As I see it, there's a perceptual barrier that separates alcoholics from those who aren't alcoholic. It's not a simple matter for a person who is not an alcoholic to put himself/herself into an alcoholic's mindset especially so if the alcoholic has no serious underlying psychological problems (if he/she did have then perhaps the person who's trying to help could envisage the alcoholic's state of mind - that of, say, depression, etc.).

Essentially, even those of us who aren't alcoholics but who've experienced the effects of alcohol can't use that experience (of say, being drunk) as an analog to understand the alcoholic's mindset as both perceptions of the effects of alcohol are fundamentally different.

Take my experience, I recall getting badly drunk in my student days and it was very unpleasant, since then on rare ocassions I've been what you'd call 'merry' from the effects of alcohol. Nevertheless, I find the effect of even a little alcohol both disturbing and mind-dulling and I deliberately avoid getting into that state. On the other hand, the alcoholic either experiences different physical effects from alcohol than I do and or his/her visceral perception of those physical effects of the alcohol are very different to mine.

It seems to me that this difference in percetion between the alcoholic and us who aren't alcoholics is one of the reasons why we're often unsuccessful in helping them. If we cannot communicate on their level then we're at a disadvantage when we try to help them and or offer them support.

That was what I experienced when I tried to help my former friend and colleague. Even though I knew him well and had done so for many years, it was clear to me that when it came to discussing alcohol that we spoke a different language. I'd hasten to add that at no time did I patronize him, nor was I intrusively paternalistic towards him. Essentially there was no effective communication between us on the matter of alcohol.

[JonShartwell]

I have been in and out of AA (thankfully in a good place currently) and I think this idea that addicts are fundamentally different from everyone else is a complete myth that only makes people with addiction problems feel more hopeless and separate from society. Have you ever had a harmful habit you have had difficulty breaking, or been unable to do something that you know will improve your health? Then you can relate to an addict. Their habit is likely a lot more harmful than yours, and affects their brain chemistry, but it’s the same mechanism that prevents you both from stopping even though you know it would help you.

Judson Brewer is a psychiatrist and neuroscientist who researches addiction and advocates this view. I found his book The Craving Mind[1] to be incredibly illuminating and true to my experience as a person who has struggled with drug use.

[1] https://yalebooks.yale.edu/book/9780300234367/craving-mind/

[hilbert42]

"...I think this idea that addicts are fundamentally different from everyone else is a complete myth"

That's absolutely not what I said, nor what I intended. Of course, addicts aren't any different to anyone else in the general sense (that of being human beings).

Nevertheless, their worldview is different to mine and to that of others - no two worldviews are the same, everyone has a fundamentally different worldview or we'd all be clones.

Yes, like everyone else, I have my addictions - cravings for certain foods, rich cheeses, certain types of cakes and so on but I simply never buy them or my belt would be about four notches larger. I'm constantly aware that I can't afford to give in to temptation and it's stressful.

However, that doesn't stop me looking at these foods and drooling over them whenever I go shopping.

Same with coffee: I drink coffee so strong that no normal person would ever touch it. Unlike those other foods mentioned, I do imbibe in this superstrong coffee and I have no intention of giving it up even though I know that it is not good for me.

The difference between my food addictions and alcohol addiction is the sheer scale of the damage alcohol does to the individuals involved not to mention the havoc it does to their families and to society at large.

Comparing my food addictions to alcohol or full-blown opiate addiction is a non sequitur, essentially there is no comparison even though they all initially started out as the cravings of one's mind. By comparison, my food addiction compared to alcohol or opiate addiction is like comparing a pop gun to an AK47.

We must be very careful when we equate all addictions down to a commom cause - one's craving mind and then proceed to imply that in the end there's little to differentiate between them. To say there's little between them is postmodernist nonsense in its extreme and it's very dangerous thinking. In the end, black is black and white is white and not some shade of nondescript amorphous gray.

That said, I'll restate the fact that I've just watched a longtime friend die of alcoholic poisoning and I've great sympathy for anyone who's in the grip of alcoholism.

If you think I'm being a righteous bastard for saying what I've just said then I can only say that it's definitely not true. I am only too well aware that there's the thinnest of thin lines between me (and most of us) and the alcoholic or opiate addict - or the haplessly addicted and desperate gambler.

As the old truism states, it is only but for the grace of one's deity go thee.

[callalex]

>”I find the effect of even a little alcohol both disturbing and mind-dulling and I deliberately avoid getting into that state. On the other hand, the alcoholic either experiences different physical effects from alcohol than I do and or his/her visceral perception of those physical effects of the alcohol are very different to mine.”

As an alcoholic I think an often overlooked aspect is the opposite of this: how it feels to NOT have the alcohol.

[hilbert42]

Right, what you said makes sense. Essentially, it's the same thing, that is, we're feeling at our best in opposite states.

My perception of the world and state of mind seems better to me sans ethanol, yours is the opposite. But that doesn't mean it's a bed of roses for me, it's just that ethanol doesn't work for me to make things better. This is a very complex matter of which millions of words have already been written and clearly I'm not going to come up with any new insights.

What I've tried to say is that these differering worldviews make it difficult to make life easier for alcoholics.

It's strange really why different people have such different responses to alcohol. Despite what I said about the negative effects of alcohol on me I nevertheless love the taste of good wine and I reckon it's a damn cruel act of fate that alcoholic drinks are so nice and yet at the same time alcohol is far from being just another innocuous additive.

Trouble is that the level of alcohol in many alcoholic drinks has increased in recent years when it ought to have been decreasing. For example, a top Bordeaux traditionally has 12.5% alcohol-that is, the world's best wine needs only that amount of alcohol, yet on the shelves of liquor stores where I live almost all wines now have 14.5% or more alcohol. It used not be like this but winemakers found that if they increased the level of alcohol then the wines needed almost no ageing and could be turned over more quickly.

That's a sore point with me, wines may be sold more quickly by increasing their alcohol content but good wines must still be aged. Again the quick buck has gotten in the way of better health and governments have done stuff-all about it.

I hope that alcohol eventually becomes much less of a problem for you.

[alar44]

Not sure how your missing the fact that people drink to shut off or dull their senses. No one drinks to become smarter or more perceptive. The very point is to get your brain to chill out in a sense, unwind, relax, etc.

Also a 2% increase in alcohol content isn't noticeable in any way other than MAYBE taste (and I'm sure most people wouldn't even notice that).

[hilbert42]

I haven't missed that point, see my comment to heavyset. It's not possible to cover every topic in these posts. If you want a more extensive view of my thoughs on these matters then you could search through my long-winded boring posts on the opioid epidemic, oxycontin, Purdue and the Sacklers and the miscarriage of justice - and the abject failure of the FDA to stop the epidemic (there are many of them). Better still, just take my word that I'm well aware of the issues.

I will disagree with you over the matter of the 2%. This extra ethanol does make a considerable difference and has been shown to do so for a number of reasons some quite complex that I cannot do justice to here. However, I'll mention a quick one for starters: the extra few percent spitit is significant as it often masks the high level of acids in young wine (malic, latic, bytric, sorbic, tartaric, etc.) with the consequence that many people drink considerably more wine in one go. Thus, they not only get the extra 2% ethanol but also an addotional amount from the extra wine they've consumed (and remember this wine already 2% stronger).

The acid levels drops significantly in older wines that have been left to age so that problem doesn't happen with them. Winemakers now actively cultivate and promote this high-alcohol, soft-style wine and they've been very successful in doing so over the last 30 or so years. It saves huge inventories of wine from being stored by over three years or more (there's much saved moolah there).

This then actively discourages research into producing flavorsome wines with much lower alcohol (at present, reducing the ethanol content to 10% or lower makes the wine thinnish in character and it spoils easily). Much oenological research is needed to boost the body and flavor in low alcohol wines and at the moment there's precious little incentive to provide money for this research. It urgently needs government intervention and regulation to overcome the problem.

BTW, decades ago I worked in a vinyard/winery for a short while.

[heavyset_go]

With regard to your point, most alcoholics and addicts will tell you that their substances of choice end up making them feel "normal", whereas other people can feel "normal" without substances.

[hilbert42]

I know, this is the utter tragedy of it.

Like others I've no additional wisdom to add except to say we need science to urgently find a less dangerous psychotropic substitute for ethanol - if such a substitute is actually possible.

[heavyset_go]

Alcohol acts a lot like benzodiazepines in the brain, and it inhibits the serotonin transporter like SSRIs do, and it has NDRI-like action, as well. Personally, I think a lot of alcohol consumption is self-medicating to treat symptoms that could be treated with drugs with better safety profiles. Of course, self-medication with addictive substances leads to physical dependence, making it harder to substitute other drugs for alcohol after awhile.

I'm friends with someone who went from multiple organ failure in the hospital from chronic alcoholism, to recovery with psychiatric treatment, and it seems like GABAergics like gabapentin and an SSRI help them feel okay without alcohol. At least in the US, this can be prohibitively expensive, and they're stuck with tens of thousands of dollars of medical debt, but that beats being dead.

[hilbert42]

I think there's little doubt that those who consume excessive alcohol regularly over long periods are self medicating. I'm almost certain this was so with my aforementioned friend and colleague who died from the effects of alcohol.

Decades earlier he'd been hooked on benzodiazepines and could never seem to get enough of them. He was always concerned about being caught short without them and that his supply might run out before he could get a renewal of his prescription (supply became a problem in the '70s/'80's when doctors became aware that they were addictive and that too many people were abusing them). As he was an organic chemist by training, I used to joke with him that he should concoct up a supply in his kitchen.

For him, benzodiazepines where highly effective (at least so over the short term). I've seen him in a jittering state of nervous anxiety and being totally unable to function yet an hour or so after swallowing a couple of 5mg Valium tablets he'd be as normal and calm as everyone else around him. Of course, by then, it was impossible for me to determine how much of his anxiety etc. was part of his condition and how much was attributable to benzodiazepine withdrawal.

You are lucky that your friend was saved from multiple organ failure just in time with proper care, but that wasn't to be with him. Two or three years ago it would have still been so technically, but in the end his medicos, psychiatrist and his friends were unable to help—as essentially he refused to help himself.

Obviously, good medical care often helps but it seems to me we've still a long way to go before we've alcoholism licked for good.