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View Diary: Good news: ACA covers addiction treatment - Bad news: addiction treatment may not work (149 comments)

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  •  There are no figures published (10+ / 0-)

    by any rehab for the success rates. I believe they would if they worked worth a damn.

    Ibogaine works. But of course it's illegal in the United States. Especially effective on opiate addictions. No withdrawals, no cravings after one night-long treatment. Lesser and varying degrees of success for alcohol, meth and cocaine. Not at all for benzodiazepines.

    A miracle for opiate addicts, though. And totally illegal. You have to go to Mexico or Canada.

    •  In the book (8+ / 0-)

      He said that treatment centers rarely published any success rates.  He found an old one for Hazeldon, but it wasn't too good, and even then they had fudged by not discussing people who basically refused to be contacted by them for the survey.

      Manufacturing outrage; the only manufacturing jobs Republicans won't outsource.

      by get the red out on Wed Mar 26, 2014 at 08:01:34 AM PDT

      [ Parent ]

    •  I've read some, (4+ / 0-)
      Recommended by:
      Piren, mythatsme, jessical, spacecadet1

      put out by such treatment centers.  One springs to mind: they did not judge success by studying the actual behavior of their patients, post-release; they judged success by having counselors rate their own patients' long-term prospects based on how 'spiritual' they were.  Garbage, but it got published in a peer-reviewed journal.  

      Even with that insane methodology, they could not claim to hit the 50% mark.

      190 milliseconds....

      by Kingsmeg on Wed Mar 26, 2014 at 12:02:25 PM PDT

      [ Parent ]

      •  it's usually one year of sobriety (3+ / 0-)
        Recommended by:
        annecros, marykk, sydneyluv

        post treatment and staying in contact with the program so they know. Many programs have graduations, a year or more after the end.  Programs offer aftercare, and some have SLE's available.  The programs reach out, but if they can't find the previous client, it counts as failure.

        But when you work in addiction, there are always some who went through a previous program and learned a lot, but not quite enough, or didn't follow the program, or really didn't believe they had a disease and only had to break a habit.  But they learned enough to bring them back after a relapse.

        But there is no industry standard to measure success.

        I once interviewed a guy who'd been sober 7 years and relapsed after a head cold, when he took Nyquil.  he was no longer attending meetings, and he got the craving for alcohol that is common after exposure, but didn't speak about it so no one could ask him if he'd been exposed, and he wasn't then able to relate it to the Nyquil, so he got the idea that it was curiosity, and he'd have to 'satisfy' his curiosity to get the idea out of his mind. Within two months his use was higher than it had ever been, and he went back into a program.

        Success?  Measured by one year, yes, but a relapse can happen after exposure 50 years later, 75.  But he returned to treatment, so success?  

    •  That isn't true . . . (6+ / 0-)

      There is no evidence that AA works, because people aren't selected to do it randomly and there aren't any trials. But there is tons of evidence that other modalities work, and work well. This include Motivational Interviewing and other forms of counseling; and opioid replacement therapy (methadone and suboxone). This diary is quite misleading because it conflates 12 step with substance abuse treatment, which is not the same thing at all.

      I think this diary does a disservice, really.

      •  However, there are folks for whom it works. (3+ / 0-)
        Recommended by:
        wasatch, jan4insight, OIL GUY

        And every day, week, month, year that someone doesn't drink is a day they don't drink.

        If you think you're too small to be effective, you've never been in the dark with a mosquito.

        by marykk on Wed Mar 26, 2014 at 05:07:27 PM PDT

        [ Parent ]

        •  what I heard years ago (5+ / 0-)

          was that maybe 1 in10 stay sober, but that 10% is still more successful than anything else that's been tried. I have no citations to back that up. Since AA/NA/etc. are anonymous programs that don't keep records, the best one can do is speculate. Have seen a lot of turnover, have attended a lot of funerals.

          That's the thing. This is a very difficult disease to treat, relapse is high, and most people won't get better. There isn't some better idea out there  being ignored that will have a significantly higher success rate. Most addicts stay addicted, no matter what they try.

          It's worked for me for about 23 years. I didn't see how it could, but I was desperate, so I had to make it work. (and I'm still agnostic, simply didn't allow that to be a barrier, and it wasn't).

          Anecdotally, it seems like there are quite a few dual diagnosis people who need additional help from professionals. I needed a LOT of help. AA, counseling, medication, I needed it all.

          People in recovery are not doctors, and some are ignorant about categories of drugs (I knew one idiot who talked a guy into stopping his lithium, what a disaster that was). But many are in the same boat I am, and others are supportive of our getting the help we need.

           I just didn't let the people who didn't know what they were talking about stop me from doing what I needed to do for myself, and I don't feel a need to tell everyone in the room about it.

          Also, not everyone in AA is trustworthy. People walk in pretty sick, after all, and like everywhere else in the world, there's a mix of people, some helpful and wonderful, and some... kinda toxic.

          A couple of my long-time friends from recovery, even thought they are slightly phobic about any kind of pill or at least skeptical, can tell when I go off meds, they can see the difference, and they tell me to get back on. Those are people I can trust, but not everyone is, again, as is the case in any group of people.

          I landed in treatment first, and it was 12-step based, but they also got me to set up counseling with a professional and appointments with a psychiatrist. So perhaps the problem is lack of an industry standard for treatment centers making sure that this happens for those who need it?

          •  Keep in mind (2+ / 0-)
            Recommended by:
            ladybug53, marykk

            that there are people who go to AA without going to a treatment center (thus not a question of insurance at all), and some of them stay sober. It's not clear to me that they have more or less success than those who enter AA via an inpatient program, no idea. Again, success rate for the whole group of people trying to get clean is low, but success rate for an addict getting clean is low not going to AA is well. That's the sad fact. Research continues.....

      •  and they don't allow (1+ / 0-)
        Recommended by:

        data collection.

      •  AA isn't a treatment program (2+ / 0-)
        Recommended by:
        OIL GUY, anna shane

        it's a support group.  No different than any other support group.  A support group is only for the people who want to attend and who benefit from talking to others who have been through the same experience.  Not everybody does.  

        Ask the people who attend the meetings if they think it works.

    •  Ibogaine works? (2+ / 0-)
      Recommended by:
      Gottlieb, jan4insight

      It's a powerful hallucinogen, OK, and...

      One of the first noticeable effects of large-dose ibogaine ingestion is ataxia, a difficulty in coordinating muscle motion which makes standing and walking difficult without assistance. Xerostomia (dry mouth), nausea, and vomiting may follow. These symptoms may be long in duration, ranging from 4 to 24 hours in some cases. Ibogaine is sometimes administered by enema to help the subject avoid vomiting up the dose. Psychiatric medications are strongly contraindicated in ibogaine therapy due to adverse interactions. Some studies also suggest the possibility of adverse interaction with heart conditions.
      Sounds lovely!

      There are some animal-model studies that look interesting on rats physically addicted to opiates, cocaine and alcohol, but getting past physical addiction is just the bare beginning of recovery.

      I see claims on some pro-ibogaine sites that the drug permanently alters the brain's neural chemistry. Really? If true, worrysome.

    •  Ibogaine works (3+ / 0-)

      I actually know someone who did the Ibogaine therapy. It made a difference for this person. Of course other factors helped as well. A lot of the other treatments people are pushing didn't work either and I was astonished, and appalled, at how expensive and how much of an outright scam the other treatments were (there's a drug that is commonly used in treating addiction and is being pushed but my brain refuses to remember it's name right now).

      If actual research could be funded for Ibogaine, it could be combined with other therapies.

      There is a larger issue here though: while as some people note above, there are conventional medical treatments for diseases like cancer or high blood pressure that may not work for everyone. Of course, there are issues here as well about the priorities of funding for the drug companies and the pressure to market.

      On the other hand, I think that people severely underestimate how much outright quackery and abuse goes into conventional mental health treatment. It is a quandary: on the one hand, some people will really benefit from mental health treatment-if they are diagnosed correctly, treated correctly, etc.

      Yet the reality is that for the most part people are being treated in a field and with tools that are subjective and slippery in an authoritarian environment. But the psychological profession markets itself as an objective science with the same level of certainty and medical authority as a diagnosis of diabetes.

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