Addiction science

[easychair]

Methamphetamine abuse and distribution has been a topic in the news in my region. Children as young as twelve are using and dealing

What progress have we made in treating the substance hungry brain? Are there pharmaceuticals in the works that will calm the receptors in the brain that demand stimulants or the calming effect of tranquilizing agents?

I understand that there are antagonists that block the effects of certain addictive substances like narcotics but when are we going to be able to soothe the addicted brain and free it from chemical dependence?

I'm tired of hearing about the devastaion caused by chemical addiction. We need a cure.

[sakrilege]

IMO, the money used in the 'War on Drugs' would be better put to use doing addiction research. I see 2 things needed, first to break an addiction and second to sober up quickly.

[Schneibster]

easychair, I could not agree more. This highly politicized issue makes victims of everyone who cannot break their chemical dependence; however, we still have no idea how to treat individuals who have other chemical problems that result in severe mental aberrations such as psychosis and schizophrenia. We are continuing in our investigation of the brain, but we are hampered by two problems:

1. We do not understand enough about how the brain works, or how the mind works, to cure a single psychological disease not caused by a gross organic defect (brain damage) by any means but permanent medication; and even in causes of brain damage, it is frequently impossible to do anything. People whose brains have been damaged in their youth and therefore became violent are frequently put to death without ever being diagnosed or treated in our society; many members of our society perceive any defense of this type as some kind of "weaseling out" of "responsibility." People who experience such diseases without an apparent organic cause (by far the vast majority) only get better because they got better, not apparently because of anything we can do. Their only other choice is to take a medication that may or may not have debilitating side effects for the rest of their lives.

2. The culture of blame, which begins with religions, pervades our society. It is an addict's "fault" that s/he became addicted; society is not responsible and need do nothing to help. This is the most destructive possible attitude, especially for the addict who absorbs it from everyone s/he deals with, and it leads to unimaginable misery and frequent death.

Until we admit that the addict is not even capable in some cases of formulating the desire to stop, and deal with this problem as the mental disease it is instead of using the medieval methods currently employed, we will continue to promote some of the most reprehensible behavior in the history of our race. The medieval people at least had the excuse that they knew no better in their treatment of the insane; we, on the other hand do know better, but choose to do nothing about it.

[B_Sharp]

IMO, the money used in the 'War on Drugs' would be better put to use doing addiction research. I see 2 things needed, first to break an addiction and second to sober up quickly.No. No research required.

The cure for addition is well known. But it first requires the cure for coercion.

The answer is maximum liberty. 1) Give Gov't the money and they waste it. 2) Give Therapists the money, and they get addicted to patients. 3) Best to give everyone, even victims their money back to seek help. Otherwise the cure is too expensive and fewer seek help.

[easychair]

easychair, I could not agree more. This highly politicized issue makes victims of everyone who cannot break their chemical dependence; however, we still have no idea how to treat individuals who have other chemical problems that result in severe mental aberrations such as psychosis and schizophrenia. We are continuing in our investigation of the brain, but we are hampered by two problems:

1. We do not understand enough about how the brain works, or how the mind works, to cure a single psychological disease not caused by a gross organic defect (brain damage) by any means but permanent medication; and even in causes of brain damage, it is frequently impossible to do anything. People whose brains have been damaged in their youth and therefore became violent are frequently put to death without ever being diagnosed or treated in our society; many members of our society perceive any defense of this type as some kind of "weaseling out" of "responsibility." People who experience such diseases without an apparent organic cause (by far the vast majority) only get better because they got better, not apparently because of anything we can do. Their only other choice is to take a medication that may or may not have debilitating side effects for the rest of their lives.

2. The culture of blame, which begins with religions, pervades our society. It is an addict's "fault" that s/he became addicted; society is not responsible and need do nothing to help. This is the most destructive possible attitude, especially for the addict who absorbs it from everyone s/he deals with, and it leads to unimaginable misery and frequent death.

Until we admit that the addict is not even capable in some cases of formulating the desire to stop, and deal with this problem as the mental disease it is instead of using the medieval methods currently employed, we will continue to promote some of the most reprehensible behavior in the history of our race. The medieval people at least had the excuse that they knew no better in their treatment of the insane; we, on the other hand do know better, but choose to do nothing about it.

I realize that psychiatric treatment is mostly trial and error and that we don't fully understand thought disorders. More research dollars are definitely needed.

It just seems to me that we should have made more progress by now on treating drug craving and if we could decriminalize illicit drug abuse and focus on research we might find a cure.

The statistics on drug addiction (including prescription drugs) in America are staggering but all the emphasis is on trafficking and law enforcement. I don't get it.

[evil-religion]

Can only speak from a UK pespective but I think the issues are fairly universal.

Chemical cures are not the answer to this problem.

I know many junkies. Some of my very best friends have gone through the whole junkie - rehab - junkie -rehab - junkie etc process. Not just on junk but crack as well (the two drugs actually often have a symbiotic relationship most crack addicts use heroin to bring them down it actually keeps them sane in a strange way!).

From speaking with my friends and from learning about causes of addiction it seems to me that it is not the actual drugs that are the problem. This may seem a strange idea at first but really if you think about it the drugs use are simply a symptom of a deeper illness. My friends that went through the rehab process learnt to address the issues that made them addicts. These vary from person to person but include things like

- Bad relationship with parents.
- Low self esteem
- Child abuse
- Mental illness of other type (depression, anxiety etc)
- Lack of opportunities in life

These factors where all in play before their drug use started. They caused the addictive behavior not the other way around.

No sensible person would want to become a junkie, it is a shit life style. We all know this its drummed in to us at school. So we can only conclude that people that become junkies are not sensible they are not making rational decisions. Now it is also the case that anyone who wants to get drugs can. It ain’t difficult. I could go and get crack or heroin within a few hours if I wanted to. I’m not even within the drug scene any more I have not done any crack for a good 3 years or so and I’ve never done heroin but none the less I could still get some within a few hours. The point is I choose not to do this because it not the way I wish to lead my life. Any rational person would choose the same.

So we have irrational people that choose to be junkies. The factors that cause this are not to do with the drugs themselves but everything to do with psychological factors and social factors. These drugs are readily available any way. So banning drugs will not in anyway stop people from becoming junkies. What prohibition does do is force these people to mix with criminals on a daily basis. It means they are buying their drugs from highly dodgy and unethical people they charge extortionate price and cut the drugs with a load of crap.

Since the prohibtion of drugs over the last 50 years drug use has risen every year. The policy simply is not working! This is because we are trying to treat the symptoms rather than the causes of the problem. No amount of pain killers is going to cure you of cancer. It may help the pain but it is not curing the disease. Prohibtion is a pain killer, it eases our consience about these issues but it does not address the cause of them.

The cure is not an easy one. It involves reducing poverty, spotting and addressing psychological problem from an early age and improving the parenting skills of all parents. NOT easy at all! This is why our politicians keep on bleating about being tough on drugs and "cracking down on crack". Its all piss easy rhetoric and chest beating and sadly it wins the vote of the "moral majority" who seem to have their head so far up God's ass that they cant see the real see the real causes of this problem.

All that being said the some of the chemical drug inhibitors can play their part in rehab. But the only real way to solve this social issue is to address what causes people to become addicts (i.e. what triggers addictive behaviour) and prevent these from happening. Sadly I know of only 1 friend who has totally kicked heroin, most of them sometimes go back but still manage to live a fairly normal life and sadly two of my good friends are permenantly cured of their addiction in so far as they are dead.
:( :( :(

[li po]

Can only speak from a UK pespective but I think the issues are fairly universal.

Chemical cures are not the answer to this problem.

I know many junkies. Some of my very best friends have gone through the whole junkie - rehab - junkie -rehab - junkie etc process. Not just on junk but crack as well (the two drugs actually often have a symbiotic relationship most crack addicts use heroin to bring them down it actually keeps them sane in a strange way!).

From speaking with my friends and from learning about causes of addiction it seems to me that it is not the actual drugs that are the problem. This may seem a strange idea at first but really if you think about it the drugs use are simply a symptom of a deeper illness. My friends that went through the rehab process learnt to address the issues that made them addicts. These vary from person to person but include things like

- Bad relationship with parents.
- Low self esteem
- Child abuse
- Mental illness of other type (depression, anxiety etc)
- Lack of opportunities in life

These factors where all in play before their drug use started. They caused the addictive behavior not the other way around.

No sensible person would want to become a junkie, it is a shit life style. We all know this its drummed in to us at school. So we can only conclude that people that become junkies are not sensible they are not making rational decisions. Now it is also the case that anyone who wants to get drugs can. It ain’t difficult. I could go and get crack or heroin within a few hours if I wanted to. I’m not even within the drug scene any more I have not done any crack for a good 3 years or so and I’ve never done heroin but none the less I could still get some within a few hours. The point is I choose not to do this because it not the way I wish to lead my life. Any rational person would choose the same.

So we have irrational people that choose to be junkies. The factors that cause this are not to do with the drugs themselves but everything to do with psychological factors and social factors. These drugs are readily available any way. So banning drugs will not in anyway stop people from becoming junkies. What prohibition does do is force these people to mix with criminals on a daily basis. It means they are buying their drugs from highly dodgy and unethical people they charge extortionate price and cut the drugs with a load of crap.

Since the prohibtion of drugs over the last 50 years drug use has risen every year. The policy simply is not working! This is because we are trying to treat the symptoms rather than the causes of the problem. No amount of pain killers is going to cure you of cancer. It may help the pain but it is not curing the disease. Prohibtion is a pain killer, it eases our consience about these issues but it does not address the cause of them.

The cure is not an easy one. It involves reducing poverty, spotting and addressing psychological problem from an early age and improving the parenting skills of all parents. NOT easy at all! This is why our politicians keep on bleating about being tough on drugs and "cracking down on crack". Its all piss easy rhetoric and chest beating and sadly it wins the vote of the "moral majority" who seem to have their head so far up God's ass that they cant see the real see the real causes of this problem.

All that being said the some of the chemical drug inhibitors can play their part in rehab. But the only real way to solve this social issue is to address what causes people to become addicts (i.e. what triggers addictive behaviour) and prevent these from happening. Sadly I know of only 1 friend who has totally kicked heroin, most of them sometimes go back but still manage to live a fairly normal life and sadly two of my good friends are permenantly cured of their addiction in so far as they are dead.
:( :( :(

you've really only addressed prevention, tho. what about the folks who already have the disease. what are they to do? what do you think about AA?

[evil-religion]

Sadly the cure is very very difficult. But it must lie in addressing the underlying psychological issues that cause addictive behavior. There is far to much focus on the symptoms (the drug use) rather than the real cause.
AA would be good if they would drop the Christian bullshit. I don't see any point in replacing a heroin addiction with a God addiction!! Sadly this is what these organizations sometimes do.
Narcanon is another one it simply replaces drug addiction with an addiction to scientology (which will probably work out more expensive and will be less fun than getting high!!!)

There are good rehab programs out there but there simply are not enough of them. All the governments resources seem to be devoted to looking tough on drugs. Sadly these measures don't work, just look at how miserably the war on drugs has failed. But providing a real cure by funding more rehab centers will cost a lot of money and will look all "soft and liberal" it isn't a vote winner in this right wing environment. So it ain't going to happen.

[Clivedurdle]

evil -religion, I agree completely with what you have written.

We as humans spend our lives moving between various states of consciousness - asleep and awake, drowsy, day dreaming, active, angry, sad, joyful, thoughtful, playful. Some of us for various reasons get stuck in damaging and very damaging patterns, causing ourselves and others a lot of trouble.

In some ways, I see criminal, fundamentalist and terrorist behaviour as addictive, as altered states of consciousness that also need tackling.

Maybe the way politicians react glibly with stupid catch phrases is also an attempt to alter states of consciousness.

To get to the root of this we need to be clear what a state of good health means - there are clues available - healthy hearts show more chaotic (non-linear) behaviour than the stability of unhealthy hearts.

Proper sleep, recreation, healthy food all also seem very important to avoid getting stuck into various types of strange attractors.

[easychair]

People often get hooked on prescription pain medications during a course of treatment for disease or injury but normal people don't have an intense psychological craving for narcotics after they've recovered from physical withdrawal. They are glad to be over it.

In the addict the brain gradually adjusts to the absence of an addictive substance but a pyschological craving for sedation or stimulation persists. Why? I think it is more than just a need to escape from life's problems.

Some researchers suspect that addicts may lack some chemical in the brain that makes them build tolerance to addictive substances faster than normal people. Maybe the receptors in the brain that addictive substances bind to are different in addicts. I don't know. I just believe that addicts are born with addiction prone brains. In fact, I have a physician friend who firmly believes that because addiction clearly runs in families.

Yes, there a lot of psychological factors that lead certain people to drug abuse but people with psychological problems and bad life situations aren't all doomed to become addicts. Some experiment with drugs and move on while others are hooked the instant they use certain substances. If we could identify potential addicts through genetic testing and somehow treat them so that they wouldn't have a natural appetite for pleasure inducing substances that would be great progress.

[Clivedurdle]

The medieval people at least had the excuse that they knew no better in their treatment of the insane;

Be careful about believing medieval people were ignorant! Byzantium had superb facilities for the mad, beautiful buildings in beautiful areas with superb food and care. Arguably, the monasteries and traditions of allowing people to be mystics and hermits, to see visions, and to spend lives in prayer are examples of allowing people to get on with their specific altered states of consciousness.

There is a strong argument that our current scientific world view, with its logical thinking, does not easily allow people to be mad and different.

[epepke]

Methamphetamine abuse and distribution has been a topic in the news in my region. Children as young as twelve are using and dealing

What progress have we made in treating the substance hungry brain? Are there pharmaceuticals in the works that will calm the receptors in the brain that demand stimulants or the calming effect of tranquilizing agents?

If we're going to talk about science, I think it's better to use the terms used by researchers, so it would be "dependence" rather than "addiction."

But anyway, there are several factors:

1) A lot of people who take drugs get into it as a means of essentially self-medicating for conditions that have better treatment. This is by no means the only reason for starting on drugs, but it's one of them. One gets relief for what is actually a bona fide problem. Then of course, after a certain point, the drug itself changes the way the body or mind works, and one becomes dependent upon the drug. This can happen with a lot of things that we don't normally consider dangerous, such as antacids (the stomach just gets used to making more acid).

So, prevention might be well addressed by getting people into treatment before they smoke the first crack pipe. However, that would require removing the stigma of mental disorders, something which I have no evidence any society wants to do. For example, Blue Cross/Blue Shield will never sell individual health insurance for the rest of their life if they have ever been diagnosed as bipolar, even if someone has been asymptomatic for years and does not require treatment. This is not justified by "pre-existing condition" clauses, which only specify illnesses that have required treatment in the past six months.

2) For curing addictions, there are several ways of doing it, with antagonists such as Naltrexone, substitutes such as Methodone, etc. but many of these have dangers, especially in an out-patient setting.

3) For keeping people from rescidivism, there's not a lot to do, because an ex-addict still has to go back to the empty little life, the abusive parents/friends/children/spouses/whatever, and probably has a bad credit rating and a criminal record to boot.

I understand that there are antagonists that block the effects of certain addictive substances like narcotics but when are we going to be able to soothe the addicted brain and free it from chemical dependence?

I'm tired of hearing about the devastaion caused by chemical addiction. We need a cure.

Do we? I'm being cynical, now. I want a cure, but I don't think most people do. I think they get off on feeling superior over and judgemental toward anyone who is worse off than they.

[Schneibster]

I realize that psychiatric treatment is mostly trial and error and that we don't fully understand thought disorders. More research dollars are definitely needed.

It just seems to me that we should have made more progress by now on treating drug craving and if we could decriminalize illicit drug abuse and focus on research we might find a cure. I agree completely. Unfortunately, the "culture of blame" means that addicts are "at fault" and "causing a problem" rather than "ill" and "in need of help." Our government thus spends millions or billions of dollars to intervene in other countries that need help because of bad government or natural disaster, but ignores the very real tragedies happening every day because they are not "sexy" enough to get the members of the government votes.

The statistics on drug addiction (including prescription drugs) in America are staggering but all the emphasis is on trafficking and law enforcement. I don't get it.It's about getting votes, and about the "culture of blame." I don't get it either; nor do I get why people who have plenty seem to feel that there have to be as many others as possible who do not so that they can be happy with their plenty. There appears to be a powerful faction in our country that cannot be happy if everyone has plenty, and they go around justifying their apparently subconscious motivation to take what others have by saying that "not everyone can be rich."

[Schneibster]

Be careful about believing medieval people were ignorant! Byzantium had superb facilities for the mad, beautiful buildings in beautiful areas with superb food and care. Arguably, the monasteries and traditions of allowing people to be mystics and hermits, to see visions, and to spend lives in prayer are examples of allowing people to get on with their specific altered states of consciousness.

There is a strong argument that our current scientific world view, with its logical thinking, does not easily allow people to be mad and different.While all of this is true, it is also true that many people with mental problems were mistreated in ways that were truly barbaric. The insane were whipped, bled, and subjected to various personal indignities up to and including out-and-out torture during medieval times, and many were accused of being witches or other undesirable elements and killed. The behavior of a person suffering from mental illness can be frightening or disgusting, and as a result, most people prefer to eliminate the mentally ill from society. In some cases, the mentally ill may even behave violently, and it is not always possible to predict when they might change from merely frightening to truly violent, making this a very popular option, whether it is humane or not.

You might want to look up the history (http://en.wikipedia.org/wiki/Insane_asylum#History_of_psychiatric_hospitals) of psychiatric hospitals or of psychiatric treatment (http://cscwww.cats.ohiou.edu/~ridges/history.html) to get a better idea of how things were. For a really in-depth look, try this (http://www.mdx.ac.uk/www/study/mhhtim.htm#1188).

We know more now than we ever have; yet, many of the insane, and especially the criminally insane, are treated as badly as ever. The treatment of drug addicts is merely an aspect of this. Perhaps when we understand these problems better, we will begin to treat sufferers better; but certainly that is not the case now, and we treat such people worse now than we did in the 1970s, so it is apparent that social attitudes have worsened since then.

[epepke]

While all of this is true, it is also true that many people with mental problems were mistreated in ways that were truly barbaric. The insane were whipped, bled, and subjected to various personal indignities up to and including out-and-out torture during medieval times, and many were accused of being witches or other undesirable elements and killed. The behavior of a person suffering from mental illness can be frightening or disgusting, and as a result, most people prefer to eliminate the mentally ill from society. In some cases, the mentally ill may even behave violently, and it is not always possible to predict when they might change from merely frightening to truly violent, making this a very popular option, whether it is humane or not.

I worked in a mental hospital.

It isn't much better now. It's a little better, but not all that much.

Edited to add: Ken Kesey pulled his punches. It's worse than Cuckoo's Nest.

[easychair]

While all of this is true, it is also true that many people with mental problems were mistreated in ways that were truly barbaric. The insane were whipped, bled, and subjected to various personal indignities up to and including out-and-out torture during medieval times, and many were accused of being witches or other undesirable elements and killed. The behavior of a person suffering from mental illness can be frightening or disgusting, and as a result, most people prefer to eliminate the mentally ill from society. In some cases, the mentally ill may even behave violently, and it is not always possible to predict when they might change from merely frightening to truly violent, making this a very popular option, whether it is humane or not.

You might want to look up the history (http://en.wikipedia.org/wiki/Insane_asylum#History_of_psychiatric_hospitals) of psychiatric hospitals or of psychiatric treatment (http://cscwww.cats.ohiou.edu/~ridges/history.html) to get a better idea of how things were. For a really in-depth look, try this (http://www.mdx.ac.uk/www/study/mhhtim.htm#1188).

We know more now than we ever have; yet, many of the insane, and especially the criminally insane, are treated as badly as ever. The treatment of drug addicts is merely an aspect of this. Perhaps when we understand these problems better, we will begin to treat sufferers better; but certainly that is not the case now, and we treat such people worse now than we did in the 1970s, so it is apparent that social attitudes have worsened since then.

Now that you mention it, we really are treating the mentally ill worse than we did in the 70s. More of them are homeless and in spite of advances in pharmaceutical treatment more of them are going without treatment.

I'm a firm believer in committing schizophrenics to the community for their own protection but I think that's harder to do these days.

As far as social attitiudes go, people like Rush Limbaugh who call the homeless "human debris" aren't helping the situation.

[B_Sharp]

Chemical cures are not the answer to this problem.Well said evil-religion.

The rule of thumb is that when you ever see a therapist to discuss life's problems and he proposes to give you a medicinal drug prescription, give the therapist two options.

Option 1: If you ever propose to put me on prescription drugs, I will leave you forever.

Option 2: Otherwise, let us continue.

Many professional therapists would love to be your drug pusher.

[epepke]

I'm a firm believer in committing schizophrenics to the community for their own protection but I think that's harder to do these days.

Many, perhaps most schizophrenics are high-functioning and can get along in society.

As far as social attitiudes go, people like Rush Limbaugh who call the homeless "human debris" aren't helping the situation.

You mean Rush "Where's My Oxycontin?" Limbaugh, don't you?

[Schneibster]

The rule of thumb is that when you ever see a therapist to discuss life's problems and he proposes to give you a medicinal drug prescription, give the therapist two options.

Option 1: If you ever propose to put me on prescription drugs, I will leave you forever.

Option 2: Otherwise, let us continue.

Many professional therapists would love to be your drug pusher.I think that this is potentially harmful. I would recommend instead getting a second opinion if you suspect that a doctor is prescribing a drug for a reason other than your benefit. This would be unethical; I don't think you'll find many doctors who behave unethically, because they would not be allowed to practice if they did.

I recommend that you carefully consider the potential consequences of refusing medication when it might be the best treatment option. But you will have to do as you see fit; if avoiding medication is more important to you than your life or your happiness, then more power to you.

[Deacon Doubtmonger]

There's one crucial piece of the puzzle under US law: the snail-like grind of the FDA approval process. For example:

Buprenorphine is a low-voltage opiate which was first made in Europe circa 1973. Although it was approved for chronic pain treatment in the US, it was soon found to be useful in opiate detox, as it hits the same receptors methadone does but with much less potential for addiction. Some were able to use it in detox with no more withdrawal symptoms than some bad headaches and severe tiredness.

The National Institute on Drug Abuse (a US gubmint agency) published a paper on buprenorphine as a viable alternative to methadone in 1992; nonetheless, it wasn't until ten years later that the FDA approved it for detox use. So that's one gov't agency at cross-purposes with another. Plus, buprenorphine treatment is set up in private doctors' offices and carried out at home -- no daily reporting to a gov't-run methadone clinic, which of course won't want to lose funding at budget time if the newer treatment were to take off.

[Clivedurdle]

I gave examples from the Eastern Roman Empire and early medieval periods - the real growth in lunatic asylums occurred with the renaissance and industrial revolution - witch burning was quite late in the Inquisition wasn't it?

I've also worked in a psychiatric hospital and run mental health services in the community and thinks things are both better and worse - therapeutic community ideas are still around if you look, the long stay back wards have gone, some people are getting superb support, but nowhere near enough.

I know several people who had spent most of their lives in bins and were completely institutionalised, but are no longer.

I suppose people have always been capable of treating each other badly or well. Modern society is probably not that supportive of us being sane and healthy, and that might be related to not enough tree hugging!!! It might be interesting to treat religion as emotional psychological activities and work out what sorts of ritual are better at leading towards health - now that would be an interesting way to approach drugs!

[Clivedurdle]

I knew that wasn't original - religion as the opiate of the people - OK, let's work out some safe doses!

[HaysooChreesto!]

Simple. We need better drugs. I don't know about anyone else here but I'll cop to using both cocaine and crystal meth in my day. The feeling they give a person is absolutely wonderful. I can't overstate that. It's the come-down that's a motherfucker. Many people find themselves feeling so awful once the high is gone that they have to get more. To me, that's where addiction begins.
I was the classic "recreational" user so "addict" is not a word that would apply to me. The come down of these drugs was so hard and so depressing that it always kept me from abusing them. Therefore my heaviest use would involve a crazy weekend about every 6 weeks or one brain busting 36 hour chemical fest every month or so.

But it's occured to me that if drugs could be produced that mimicked the effect of meth and cocaine without the ill effects that a lot of problems would be solved.
People like drugs. Look at alcohol. It's been around for thousands of years because people enjoy the way it makes them feel. Same with marijuana. So a line of party drugs that didn't do hellish damage to the user might be a viable alternative.

I know this point of view is out of left field and no doubt there would be huge hurdles to overcome the chemistry involved, but it's just a thought.

[epepke]

I've also worked in a psychiatric hospital and run mental health services in the community and thinks things are both better and worse - therapeutic community ideas are still around if you look, the long stay back wards have gone, some people are getting superb support, but nowhere near enough.

Community mental health services are, in my experience, gigaparsecs apart from dedicated residential facilities. Community services still suck, because the only people you're likely to meet are borderlines and sociopaths (and I'm not counting the other clients).

Dedicated residential facilities practice are, at best, warehousing, and at worst, systematic abuse. Occasionally someone gets in there who makes a difference, but they don't last long.

Art Speigelman's book Maus describes an inpatient facility where his mother spent time in the 20s which read a lot more humane and health-giving than modern facilities. They had bands and dancing in the evenings, and relatives could come and stay at the same facility, even in the same room. Just from the clues in the book, I'd guess that the mother was probably borderline, and she eventually killed herself much later (but that was in our nu-perfect modern world).

[B_Sharp]

Art Speigelman's book Maus describes an inpatient facility where his mother spent time in the 20s which read a lot more humane and health-giving than modern facilities.I see the reason for this comes from the author of "Underground History of American Education". To paraphrse,
an Institution's primary need is to maintain funding which only comes from a system that remains purposefully broken. Contrarily, if the institution is well run, caring, successful then there is wrongly no reason to give it extra funding.

Evidence is the election bond propositions:

Successful institutions are overlooked.
Terminally broken institutions get most of the bond funding. :rolling:

[Clivedurdle]

epepke, it sounds like there are huge differences in UK and American practice. We have national minimum standards, that although not properly in place, are being audited and implemented.



National Service Framework (http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4009598&chk=jmAMLk)

[B_Sharp]

National Service Framework (http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4009598&chk=jmAMLk)That's terrible. A One-Size-Fits-All National Standard for mental health. No competition. That's a loser.

What happens when intelligent people disagree?? Hell is what happens. Totalitarian dictates stamp out better ideas.

You need to kick your King & Queens & other National diasasters out on their fannies.

[Viking]

The sad fact is that few people seem to understand addiction at all. The bottom line is that addiction is a brain illness with a very strong genetic component. There is no "addictive personality" or underlying psychopathology in addicts any more than the non-addicted population. Unfortunately, it is not possible to determine ahead of time (as of now) who will become an addict and who will not. Ten people are exposed to the same stimulus (alcohol, cocaine, slot machines) at the same time. One or two of those ten have an abnormal reaction to that stimulus. Their desire to continue very quickly exceeds their ability to exert self-control even though they have as much "will power" as the other 8 people. Once the addiciton takes over, sometimes called the craving brain, the drug seeking behavior follows. It does not take long for an addict to reach a point where the drug (or other addictive agent) is necessary for normal function, due to adaptive cell metabolism etc. At that point, the addict is no longer able to achieve a high, but needs the drug to function at all. It is a really nasty problem which leads people into a nightmare existence. When your own brain is lying to you about what you really need, it is extremely difficult to reason your way out.

Nearly every addict has tried to control, modify, or quit their using behavior. The psychosocial and environmental factors really come into play when we start talking about recovery from, not the beginning of addiction. Because I have worked with addicts for 30 years, I can tell you that some of the most difficult to treat addicts are highly intelligent, educated people. They can't seem to grasp the simple fact that they are totally incapable of controlling their behavior toward their addictive substance or behavior.

The best way to describe it is that it is like being lost in the woods. Every really experienced outdoors person knows that when you are lost you have to rely on your compass, EVEN THOUGH every fiber of your being tells you the compass is wrong! Modern addiction treatment assesses the stage of change a person is at: pre-contemplative, ambivalent, prepared etc. to design an individual strategy for change. In short, we try to raise consciousness enough so that the person can see their compass and begin to find their way out of the woods. It's hard work and we support a wide variety of approaches, including drug therapy, to help the process. Organizations like Secular Organization for Sobriety offer good alternatives to AA and NA. The point of all of these is that it is very difficult for the non-addict to understand addiction, and it helps to have someone who has been there to help out.

Sorry for the long post. I am dramatically over-simplifying the theory of addiction and recovery, but hopefully you get the gist.
Gary

[epepke]

epepke, it sounds like there are huge differences in UK and American practice. We have national minimum standards, that although not properly in place, are being audited and implemented.

I'm quite sure that there are huge differences. Mental health services took a big blow under Reagan and have not recovered.

On the other hand, I have to say that my small experiences with UK mental health services, both personal and of friends, have not exactly been salutary.

[easychair]

Simple. We need better drugs. I don't know about anyone else here but I'll cop to using both cocaine and crystal meth in my day. The feeling they give a person is absolutely wonderful. I can't overstate that. It's the come-down that's a motherfucker. Many people find themselves feeling so awful once the high is gone that they have to get more. To me, that's where addiction begins.
I was the classic "recreational" user so "addict" is not a word that would apply to me. The come down of these drugs was so hard and so depressing that it always kept me from abusing them. Therefore my heaviest use would involve a crazy weekend about every 6 weeks or one brain busting 36 hour chemical fest every month or so.

But it's occured to me that if drugs could be produced that mimicked the effect of meth and cocaine without the ill effects that a lot of problems would be solved.
People like drugs. Look at alcohol. It's been around for thousands of years because people enjoy the way it makes them feel. Same with marijuana. So a line of party drugs that didn't do hellish damage to the user might be a viable alternative.

I know this point of view is out of left field and no doubt there would be huge hurdles to overcome the chemistry involved, but it's just a thought.

In Woody Allen's film, Sleeper, the people of the future pass around a spherical device called an "orb" (instead of a joint) to induce pleasure. In one scene Woody is in a group setting enjoying a normal size orb and in the next he is by himself holding on to an oversize orb.

Maybe in the future people will use some sort of neurological device to get high. But will they be able to control their desire for pleasure?

[epepke]

In Woody Allen's film, Sleeper, the people of the future pass around a spherical device called an "orb" (instead of a joint) to induce pleasure. In one scene Woody is in a group setting enjoying a normal size orb and in the next he is by himself holding on to an oversize orb.

Maybe in the future people will use some sort of neurological device to get high. But will they be able to control their desire for pleasure?

Spider Robinson. Mindkiller. You can probably only get it as Deathkiller these days, in which case it is superglued onto another book. Read only the first half, if that's the case.