And to a degree, that makes sense. Your mental, physical, and emotional well-being are influenced by your mindset. Not everyone has enough money to let them take the kind of professional and financial risks that might lead to greater happiness, for example. Things like systemic racism can wear on a person to the point that it degrades her health at the same time it restricts her access to good health care, resulting in higher rates of chronic disease and shorter life expectancies for black women than white women.
You can, but you would be wrong. And cruel. Thank you for hollering at the other girls on your MLM team to read it! Elissa Johnson, a year-old mom in St. She decided to go back to college last year to get a degree in occupational therapy. I can do hard things. I can do things that scare me. Yes, I have a family, a special needs kiddo, a husband who travels internationally, but I can do this. I define my reality. The video includes an image of Hollis running through a crowded room, high-fiving the people who have gathered to hear her speak. There is something to this, and something to hearing it from a woman, at least in a way that trades on a certain kind of privilege.
I do get to decide, I want to tell myself. And I can decide. Being empowered to let go of my anxiety or self-criticism as a wealthy white woman is certainly helpful to me, and I appreciate that message from Hollis on a certain level. In one anecdote about the power of setting goals, Hollis recounts her obsession with buying a Louis Vuitton Speedy bag, which cost a thousand dollars. And she takes that brand of feminism a step further by marrying it with Christianity, in what is essentially a Pinterest-worthy version of the prosperity gospel.
This attitude has a historical context in the Pentecostal religious tradition in which Hollis was raised. Pentecostalism has always been the slightly embarrassing uncle at the evangelical family reunion — its unfiltered and emotional expressions of faith can make it look a little unseemly to outsiders. A patina of racial diversity has been another hallmark of Pentecostalism, although during the civil rights era, racism from white leaders of the church caused a division that lasted through the s, and well into today in some parts of the country. In the United States, the movement gained momentum in the early days of the 20th century with several well-known revivals, the most famous of which was the Azusa Street Revival in , led by a black preacher named William Seymour.
And as far back as the Azusa Street Revival, white Pentecostals displayed a religious version of black cultural appropriation. Interestingly, this kind of appropriation echoes throughout Girl, Wash Your Face. The trouble with, and the appeal of, curated imperfection is the assumption that all imperfections lie in the past — they have supposedly been understood, integrated, and learned from in order to create a present that is blissfully free from earlier mistakes.
Since , research has shown that 95 to 98 percent of attempts to lose weight fail and that two-thirds of dieters gain back more than they lost. She imbues fatness with the shame of moral failure and demeans women who struggle to — or do not want to — lose weight. Hollis and her husband went through a difficult time before adopting their daughter Noah, now about a year and a half old, in They signed up to be foster-to-adopt parents, and Hollis talks throughout the book about their wrenching experience with the adoption process.
It was in the middle of these tumultuous few years, full of long days spent in survival mode, that Hollis started drinking more. But she has little to no empathy for the birth parents or family of the children she and her husband thought they would permanently adopt. When Hollis recounts waiting for the birth parents of one child to show up, her attitude of superiority and willful ignorance is almost breathtaking:.
In either case, the reason for the success of the particular treatment may have been due more to the patient's by-now greater pain and desperation than to the nature of the treatment or the context of beliefs. But few patients can see this at the time and they become loyal to the "successful therapy" — and, unfortunately, sometimes antagonistic or unfavorable in their attitude toward other therapeutic programs. Now, I submit that this is quite standard human behavior. But it is one of the roots of misunderstanding, distrust, and strain in AA-professional relations.
Maxwell, Ph. Yes: "they become loyal to the 'successful therapy' — and, unfortunately, sometimes antagonistic or unfavorable in their attitude toward other therapeutic programs. The Harvard Medical School says that the vast majority of the people who successfully quit drinking for a year or more — eighty percent of them — do it alone, all by themselves , without any treatment program or "support group". Naturally, those do-it-yourselfers will also insist that they have the sure-fire solution that really works: "Just don't drink any more alcohol, not ever, no matter what.
You won't hear from the Jesus-freak Christians, or the gung-ho V. You will only hear from the A. A bunch of people went to a Baptist church for years. During those years, many of the women got pregnant and had babies. That proves it: Going to Baptist churches causes women to get pregnant and have babies. That goofy logic is the same logic as A. Many A. They fail to see that they go to A. And the reason that they finally quit drinking is because they really want to quit — want it so strongly that they finally really do it.
And the commonest reason for quitting is because people just get sick and tired of being sick and tired, and wish to avoid death. The Harvard Mental Health Letter , from The Harvard Medical School, stated quite plainly: On their own There is a high rate of recovery among alcoholics and addicts, treated and untreated. According to one estimate, heroin addicts break the habit in an average of 11 years. Twenty-nine percent said health problems, frightening experiences, accidents, or blackouts persuaded them to quit. Others used such phrases as "Things were building up" or "I was sick and tired of it.
See Aug. Part I , Sept. Part II , Oct. Most successful people do. And note that the Harvard Medical School says that the support of a good spouse is more important than that of a step group. But A. Helping others is the foundation stone of your recovery.
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A kindly act once in a while isn't enough. You have to act the Good Samaritan every day, if need be. Your wife may sometimes say she is neglected. Wilson, Chapter 7, Working With Others , page And a rehash of the Big Book that is targeted at youths tells this story of an allegedly-successful recovery: Even after she remarries, she doesn't lose sight of her priorities. She places God first and A. Her husband is never more than the third most important aspect of her life.
The husband is less important than A. He rates third in importance? That is good for destroying a lot of marriages. And it does. Psychology Today magazine reported that the divorce rate of couples where one partner joined A. For it, they interviewed over 43, people. Using the criteria for alcohol dependence found in the DSM-IV, they found: "About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol rehab programs and AA. Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment. Gurion, American Health Magazine , March In his book on the treatment of alcoholism, Dr.
Bailey and Stewart interviewed alcoholics after three years without treatment and found that about 27 percent of the former patients denied alcoholism. Cahalan in a national drinking practices study noted that drinking problems decrease in men after age 50 and the amount of alcohol consumed also decreases. Cahalan, Cisin, and Crossley 11 in another national survey of drinking practices found that about one-third more individuals had problem drinking in a period before their three-year study period than during the study period itself, suggesting a tendency toward spontaneous remission of drinking problems.
Goodwin, Crane, and Guze found that on an eight-year follow-up with no treatment about 18 percent of the alcoholic felons had been abstinent for at least two years. Lemere reported long-term abstinence in 11 percent of untreated alcoholics over an unspecified interval. Kendall and Staton reported 15 percent abstinence in untreated alcoholics after a seven-year follow-up.
Kissin, Platz, and Su reported a 4 percent one-year improvement rate in untreated lower class alcoholics. Imber et al. It was noted that the rate of abstinence was 15 percent at one year and 11 percent after three years. In sum, the preponderance of these studies suggests that a spontaneous remission rate for alcoholism of at least one-year duration is about percent. Successful treatment would, therefore, have to produce rates of improvement significantly above this probable range of spontaneous remission.
Imber, S. The Fate of the Untreated Alcoholic. Nerv and Ment. Cahalan, D. Kissin, B. Bailey, M. Kendall, R. The Fate of Untreated Alcoholics. Lemere, F. What Happens to Alcoholics. Goodwin, W. The key sentence is the last one — for a treatment program to claim success, it would have to produce recovery rates greater than the usual rate of spontaneous remission. Alcoholics Anonymous comes nowhere near exceeding a 4 to 18 percent per year recovery rate. Personally, I find the 18 percent number to be far too high to believe. Obviously, that has not happened.
I agree with R. Smart , who calculated a spontaneous remission rate for alcoholism of between 3. As a simple rule of thumb, the middle value of 5 or 5. Still, the claimed success rate of Alcoholics Anonymous does not even exceed that much lower rate of spontaneous remission. Some people are confused by the spontaneous remission rate and how it works. Unfortunately, it doesn't work that way. It's a logarithmic curve, like a radioactive half-life.
Imagine that we have 10, alcoholics, and they are spontaneously recovering at a rate of five percent per year. The math works out like this: Year Alcoholics recovered this year Alcoholics remaining 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Even after 21 years, one third of the alcoholics are still drinking. In addition, in those 21 years, another whole new younger generation of alcoholics has matured and started drinking so, theoretically, we have at least another 10, new alcoholics added to the mix. So no way does the problem spontaneously disappear, even though almost two-thirds of the original group of alcoholics are no longer drinking.
Many, many alcoholics do just recover spontaneously, and yet, the problem still never goes away. Actually, we haven't computed the deaths from alcoholism and subtracted them out. That will make the number of remaining alcoholics decline much faster. And we haven't even considered the deaths from tobacco. Most alcoholics are also heavy smokers, and more than half of the time, tobacco kills them before the alcohol does. The real numbers are more complex than this chart indicates, but it is accurate enough for you to see the principle at work. Likewise, the younger generation of alcoholics does not all start drinking at 21 years of age.
They may start at any age from 12 to 35, or even later. So, in the real world, we have many successive waves of alcoholics starting and quitting simultaneously, producing very complex patterns of numbers. But the one simple, undeniable fact is that generation after generation, while all of the individual alcoholics do either quit drinking or die, the problem doesn't go away. Hester and William R. Miller eds. New York: Pergamon , page AA research has been mostly pre-experimental in design, has failed to use instrumentation of established reliability, has usually not attempted to check for the validity of the self report data obtained, has inadequately assessed the nature of subjects' alcohol problems, has been deficient in describing demographic characteristics of the sample and has sampled an unrepresentatively large number of middle-aged people and an unrepresentatively small number of women Emrick, Tonigan, Montgomery, Little "It has often been alleged, but the allegations never substantiated experimentally, that behavior and conditioning therapies represent purely symptomatic treatment and that such treatment is usually ineffective in the long run.
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Franks, Ph. Ruth Fox, ed. A recent review by the Cochrane Library, a health-care research group, of studies on alcohol treatment conducted between and states its results plainly: "No experimental studies unequivocally demonstrated the effectiveness of AA or TSF [step facilitation] approaches for reducing alcohol dependence or problems.
It doesn't even work. Bankole A. Look here. In spite of the scarcity of good, properly run randomized longitudinal controlled studies of the effectiveness of Alcoholics Anonymous, there are still several good tests and studies which were done properly, and give us a good idea of what is happening. There is experimental evidence that the A. In a sophisticated controlled study of A. Those results are almost unbelievable, but are easy to understand — when you are drunk, it's easy to rationalize drinking some more by saying, "Oh well, A. I can't control it, so there is no sense in trying.
I'm doomed, because I already took a drink. One drink, one drunk. I'm screwed, because I already lost all of my sober time, and I have to give back all of my sobriety coins. Might as well just relax and enjoy it now.
Pass that bottle over here, buddy. I can't help it. The Big Book says that I have no defense against those strange mental blank spots when I'll drink again. Bottoms up! Jeffrey Brandsma and his associates Dr. Richard J. Welsh did a study where they took some alcoholics who had been arrested for public drunkenness, and randomly divided them into three groups, which got one of: A. Maxie Maultsby and Dr. This was the control group. And the results were: The variables that showed significant differences at outcome could be organized into three categories: treatment holding power, legal difficulties, and drinking behavior.
Less than one-third Table 32 highlights these differences. Table Mean number of treatment sessions and days in treatment Group N at intake N at outcome Mean number of sessions Mean number of days treated AA 38 12 The lay-RBT group had significantly fewer arrests and convictions than did the control group. All of the lay-RBT clients reported drinking less during the last 3 months. This was significantly better than the AA or the control groups at the 0. The lay-RBT group also reported on two variables one a direct question, the other a summated series of questions that it was less important to drink now to be sociable.
In this regard the lay-RBT group was significantly different from the control group, whereas the AA group was not differentiated from either of the other two groups. Three months after terminating treatment the only variables that revealed differences concerned drinking behavior. In this analysis AA was five times more likely to binge than the control and nine times more likely than the lay-RBT.
The AA group average was 2. That is a clear description of a real disaster. Alcoholics Anonymous greatly increased the amount of binge drinking that the alcoholics were doing. On the other hand, Rational Behavior Therapy, as taught by laymen amateurs, non-professional counselors , really did help the alcoholics to cut down on their drinking. They were doing less binge drinking than the control group. Notice the statement about "holding power". Obviously, A. And at the month follow-up: There were no significant results to report at month follow-up. In certain cases where the data were inspected, part of the reason for this seemed to be the improvement of the control group.
Over the long haul, the no-treatment control group did just as well as the others. That was spontaneous remission at work, again. A lot of people, even hard-core alcoholics, really do just quit drinking when they get sick and tired of being sick and tired. The superior holding power of the lay-RBT method with this population is a definite advantage for it. As Armor et al. The greater the amount of treatment, the greater the improvement rate.
At the very least it would seem to be a reasonable alternative for those alcoholics who refuse AA or do not seem to benefit by it. The 3-month follow-up indicated that AA members had increased their binges and more often drank in order to feel superior. Perhaps the philosophy of total abstinence did not work well for these men — perhaps it led to depression and a tendency to go from one extreme to the other.
This is admittedly speculative, but it adds a qualification to Emrick et al. In other words, Emrick was wrong when he suggested that the untrained lay therapists of A. Again, RBT was far superior to A. And RBT reduced binge drinking, while A. And note how Doctor Brandsma reported that "The 3-month follow-up indicated that AA members had increased their binges and more often drank in order to feel superior.
But what Dr. Brandsma saw was that people responded to such treatment by drinking to get their egos back. But of course. The urge to heal oneself, to fix whatever is broken, is one of the most deep-seated basic drives in life. Attack people's egos and selves, and they will respond by trying to repair their egos and sense of self. Many will drink so that they can feel good about themselves again.
People will fight oppression however they can. Ditman, M. Crawford, LL. Forgy, Ph. The offenders were randomly divided into three groups: a control group that got no treatment at all, a second group that was sent to a professional alcoholism treatment clinic, and a third group that was sent to Alcoholics Anonymous.
All of the subjects were followed for at least a full year following conviction. Surprisingly, the no-treatment group did the best, and Alcoholics Anonymous did the worst, far worse than simply receiving no treatment at all. Clearly, Alcoholics Anonymous "treatment" had a detrimental effect.
That means that A. Not only was A. And the A. The rate of rearrests was the same for the no-treatment and A. And, strangely enough, the professional treatment program had the same problem. Their patients' rate of rearrests also increased with time, by the same amount. The more 'treatment' the patients got, the more they got rearrested. Let me guess: The professional treatment program also included lots and lots of A. They almost always do. Some of the present writers were quite optimistic about the possibilities of enforced referral to treatment, but the early encouraging anecdotal reports are not borne out by present data.
Forced referrals to Alcoholics Anonymous and to an alcoholism clinic treatment program failed to reduce the likelihood of recidivism among a population of convicted chronic drunk offenders. Although those who completed the program did better than untreated offenders, those who entered but did not complete the program did worse. Moreover, probationers enrolled in treatment in Texas had an overall higher recidivism rate than non-participants.
Two explanations could account for such findings. One possibility is that, while treatment and non-treatment groups are equally likely to be recidivist, those who quit treatment are those who were more likely to relapse anyway. Thus, counting only those who remain in treatment and aftercare is cherry-picking those most likely to succeed in the first place. The other possibility, which would scandalize A. Peele also wrote: The two randomized studies in which AA treatment was assigned found AA to yield worse outcomes than other forms of treatment — or no treatment at all.
See Brandsma et al. But Walsh et al. AA's role in society — more negative than positive? Those patients who got no A. In addition, Stanton Peele has argued, in an article in The Sciences , that the most widely used alcoholism treatments Twelve-Step are the least effective. Peele, Stanton. The Sciences , , vol. This is the study by Dr. Employee-assistance programs sponsored by companies or labor unions identify workers who abuse alcohol and refer them for care, often to inpatient rehabilitation programs.
Yet the effectiveness of inpatient treatment, as compared with a variety of less intensive alternatives, has repeatedly been called into question. In this study, anchored in the work site, we compared the effectiveness of mandatory in-hospital treatment with that of required attendance at the meetings of a self-help group and a choice of treatment options. We randomly assigned a series of workers newly identified as abusing alcohol to one of three rehabilitation regimens: compulsory inpatient treatment, compulsory attendance at Alcoholics Anonymous AA meetings, and a choice of options.
Inpatient backup was provided if needed. The groups were compared in terms of 12 job-performance variables and 12 measures of drinking and drug use during a two-year follow-up period.
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All three groups improved, and no significant differences were found among the groups in job-related outcome variables. On seven measures of drinking and drug use, however, we found significant differences at several follow-up assessments. The hospital group fared best and that assigned to AA the least well ; those allowed to choose a program had intermediate outcomes.
Additional inpatient treatment was required significantly more often P and the choice group 38 percent than by subjects assigned to initial treatment in the hospital 23 percent. The differences among the groups were especially pronounced for workers who had used cocaine within six months before study entry. The estimated costs of inpatient treatment for the AA and choice groups averaged only 10 percent less than the costs for the hospital group because of their higher rates of additional treatment.
Even for employed problem drinkers who are not abusing drugs and who have no serious medical problems, an initial referral to AA alone or a choice of programs, although less costly than inpatient care, involves more risk than compulsory inpatient treatment and should be accompanied by close monitoring for signs of incipient relapse. Diana Chapman Walsh, Ph. Hingson, SC. Merrigan, S. Adrienne Cupples, Ph. Coffman, M. Becker, M. Barker, M. Hamilton, Thomas G.
McGuire, Ph. Kelly, C. On four of the measures of drinking mean number of daily drinks, number of drinking days per month, binges, and serious symptoms , we found no significant differences among the three groups at any follow-up point. On the remaining eight measures of drinking and drug use any drinking, intoxication, blackouts, Iowa stage, Rand impairment score, definite alcoholism, cocaine use, and time to additional treatment , however, there were statistically significant differences among the three groups at one to four follow-up points.
In terms of all but two of these measures, the hospital group had the fewest problems On most, the compulsory A. The hospital group was significantly more likely to include continuous abstainers 37 percent vs. In addition, patients who were abusing cocaine, together with alcohol, did especially poorly in the AA group The 30 cocaine users who were assigned to the AA group had the most evidence of problems on these measures of drinking, and they were the most likely, at every follow-up assessment, to report continued use of cocaine Page Note that most of the people who were sent to A.
In addition, they actually got worse while they were in A. The total cost savings from sending people to the "free" A. This contradicts the often-repeated A. It isn't cost-effective or "free" when all it does is make the patients worse, and make it more expensive for some hospital to clean up the mess later on.
Walsh et. Even though the initial referral to AA was free, the AA group had much higher rates of additional treatment; 63 percent of subjects randomly assigned to AA eventually required hospitalization. And using A. Once again, A. Walsh and associates concluded: To a company or union counselor or a clinician advising patients, our findings argue for hospitalizing problem drinkers who are also using cocaine or other drugs. For other problem drinkers with reasonable job stability and no serious medical needs, an initial referral to AA or the offer of a choice of treatment is somewhat less costly about 10 percent , but it entails extra risk.
Employees sent only to AA, and those offered choices, are more likely to have their drinking problems resurface. The less costly intervention may be more efficient in the longer term if the money saved is spent to identify and refer more substance-abusing employees or if nonhospital options encourage seeking help.
But if AA alone is mandated, or if choice is offered, our study shows that close monitoring is essential, because many employees have serious relapses in the first six months. In other words, you have to watch them like a hawk because A. Unfortunately, this otherwise excellent study did not have a control group, so we cannot determine what the overall success rate of any kind of treatment was, compared to the normal rate of spontaneous remission.
And there was also no group that got only threats of firing. That is, take one group of employees aside and tell them in no uncertain terms that if they don't immediately cut way down on their drinking that they will lose their jobs. The people in that study were undoubtedly made to understand that because 31 of the employees were fired during the 2-year follow-up period , but the study did not test for what percentage of the employees would cut down or quit drinking of their own accord, rather than get fired, without any "treatment".
That number has to be greater than zero, and may, in fact, account for a significant percentage of the successes in all three groups, all of which "improved during treatment". The authors recognized the effect of threats of firing, and found it in all three groups, but lacking a control group, were unable to measure it: We found no differences among the three groups in any job outcome, including being fired.
All three groups evidently brought their drinking problems under sufficient control at work for group differences in job performance to be rendered statistically insignificant. A team of British researchers, lead by Doctors Jim Orford and Griffith Edwards, also tested the effectiveness of Alcoholics Anonymous treatment of alcoholics, and they also found it to be completely useless.
The receiving psychiatrist confirmed that each of the subjects met the following criteria: he was properly referred for alcohol problems, was aged 20 to 65 and married, did not have any progressive or painful physical disease or brain damage or psychotic illness, and lived within a reasonable distance of the clinic to allow for clinic visits and follow-up home visits by social workers.
A statistical randomization procedure was used to divide the subjects into two groups comparable in the severity of their drinking and their occupational status. For subjects in one group the "advice" group , the only formal therapeutic activity was one session between the drinker, his wife, and a psychiatrist. The psychiatrist told the couple that the husband was suffering from alcoholism and advised him to abstain from all drink.
The psychiatrist also advised the husband to stay on his job or return to it and encouraged the couple to attempt to keep their marriage together. There was free-ranging discussion and advice about the personalities and particularities of the situation, but the couple was told that this one session was the only treatment the clinic would provide.
They were told in sympathetic and constructive language that the "attainment of the stated goals lay in their own hands and could not be taken over by others. Each drinker then met with a psychiatrist to work out a continuing outpatient treatment program, while a social worker made a similar plan with the drinker's wife. The ongoing counselling was focused on practical problems in areas of alcohol abuse, marital relations, and other social or personal difficulties. Drinkers who did not respond well were offered inpatient admission, with full access to the hospital's wide range of services.
Twelve months after the experiment began, both groups were assessed. No significant differences were found between the two groups. Furthermore, drinkers in the treatment group who stayed with it for the full period did not fare any better than those who dropped out. At the twelve-month point, only eleven of the one hundred drinkers had become abstainers. Another dozen or so still drank but in sufficient moderation to be considered "acceptable" by both husband and wife. Such rates of improvement are not significantly better than those shown in studies of the spontaneous or natural improvement of chronic drinkers not in treatment.
Or, as Vaillant once ironically remarked: "The best that can be said for our exciting treatment is that we are certainly not interfering with the normal recovery process. There results were of the same kind: After one year there was no evident difference between drinkers who had received intensive treatment and those who had received minimal treatment and had been told that the patient, not the program, had to deal with the problem. Such experiments suggest that anything more than an hour or two of commonsense advice from an authoritative person may be a waste of time, money, and resources.
Orford and Edwards , For the researchers' description of the experimental protocol summarized here, see pages ; for their statement of their key findings, see pages Vaillant, "The Doctor's Dilemma" , Herbert Fingarette, Heavy Drinking , pages and footnotes on page Reader in Drug Dependence, University of London, Institute of Psychiatry Honorary Consultant, Bethlem Royal Hospital and the Maudsley Hospital Honorary Director, Addiction Research Unit, Institute of Psychiatry You might notice that eleven out of one hundred is a rather high rate of success, when so many other tests and studies reported something closer to a five percent success rate — the usual rate of spontaneous remission in alcoholics.
The two most obvious differences here are: All of these patients were married, while a random selection of alcoholics will include many singles. In test after test, an intact marriage was shown to be a valuable asset. Married alcoholics recover at twice the rate of singles. As the Harvard Medical School pointed out, the support of a good spouse was more helpful than a treatment program or a support group. In addition, patients who are still married still have something left to lose — their marriage, and their spouse. Another study found that the people who do the best in recovery are not those who have "hit bottom" and lost everything; it's those people who still have something left to lose, and who will work to save it.
Patients who were suffering from other serious mental or physical illnesses were filtered out and did not take part in this test. Some people who are terminally ill really are drinking to die, and there is little that can be done for them except give them better pain-killers. And many people who drink too much are actually suffering from other underlying disorders, either physical diseases or mental illnesses like depression, anxiety disorders, or a bipolar disorder. George E. In , he published his book The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery , where he described the natural healing process associated with individuals addicted to alcohol — "spontaneous remission" — where some of the people who are addicted to alcohol will simply quit, and choose to stay abstinent of their own volition, without any Alcoholics Anonymous meetings, or any therapy program, or any other outside intervention at all.
Vaillant's question was: does the A. Following the passage of the Hughes Act, the U. It featured hour walk-in services with medical treatment for detoxing. It treated new patients per year, did detoxifications per year, and had 20, outpatient visits per year. To study the effectiveness of various methods of treating alcoholism "treatment modalities" , Vaillant compiled forty years of clinical studies. Vaillant and the director William Clark also conducted an eight-year longitudinal study of their own where Vaillant reported having followed patients who had undergone Twelve-Step treatment.
That was an unusually large and long-term study.
Vaillant compared those people to a group of several hundred other untreated alcohol abusers. The treated patients did no better than the untreated alcoholics. Professor Vaillant candidly reported: When I joined the staff at Cambridge Hospital, I learned about the disease of alcoholism for the first time. My prior training had been at a famous teaching hospital that from past despair had posted an unwritten sign over the door that read "alcoholic patients need not apply.
At Cambridge Hospital I learned for the first time how to diagnose alcoholism as an illness and to think of abstinence in terms of "one day at a time. To me, alcoholism became a fascinating disease. It seemed perfectly clear that by meeting the immediate individual needs of the alcoholic, by using multimodality therapy, by disregarding "motivation," by turning to recovering alcoholics [A. But then came the rub. Fueled by our enthusiasm, I and the director, William Clark, tried to prove our efficacy.
Our clinic followed up our first detoxification patients, the Clinic sample described in Chapter 3, every year for the next 8 years. Table 8.
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After initial discharge, only five patients in the Clinic sample never relapsed to alcoholic drinking, and there is compelling evidence that the results of our treatment were no better than the natural history of the disease. In table 8. The Clinic sample results are also contrasted with three studies of equal duration that purported to offer no formal treatment. Although the treatment populations differ, the studies are roughly comparable; in hopes of averaging out major sampling differences, the studies are pooled.
Costello , Emrick , and Hill and Blane have reviewed many more disparate two-year outcome studies and have noted roughly similar proportions of significantly improved and unimproved alcoholics. Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling. TABLE 8. Study n in original sample n followed up Duration of follow-up years Abstinent or social drinking Improved Abusing alcohol Clinic sample [A. Because at 1 year there was no difference between Orford and Edwards's treated and control populations and because at 2 years their report did not clearly separate the two populations, all 85 of their subjects on whom they had a 2-year follow-up are included.
Once again, our results were no better than the natural history of the disorder. Study n in original sample n followed up Duration of follow-up years Abstinent or social drinking Improved Abusing alcohol or dead Dead Gamma alcoholics Clinic sample [A. Lundquist 9 27 20 53 The A. Zero improvement. And it was even worse than no help: Look at the " Abstinent or social drinking " and " Improved " columns of Table 8. You have to add the numbers together to get the over-all improvement rate for that item. So, for "A. Those numbers are basically the same.
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There is no statistically significant difference between 33 and 32 percent, and hardly any between 33 and 37 percent. After two years of A. That's a dismal result. Look at the " Abstinent or social drinking " and " Improved " columns of Table 8. Again, you have to add the numbers together to get the over-all improvement rate for that item. Two of the programs, those in the Bratfos and Voetglin-Broz studies, seem to have been much worse than average, but all of the rest of the programs, including A. What caused the poor results in the Norwegian Bratfos study is unknown.
Look at the " Dead " column of Table 8. And those five people out of the hundred in the A. As Professor Vaillant reported, the A. Remember this the next time you hear somebody say " Keep coming back! It works! If you make it work He is "under God-control", and he's trying to get everyone else under God-control too. Even if A. Vaillant's own words on the subject were: Recently the Annals of Internal Medicine editorialized that "the treatment of alcoholism has not improved in any important way in twenty-five years" Gordis Alas, I am forced to agree.
Perhaps the best that can be said for our exciting treatment effort at Cambridge Hospital is that we were certainly not interfering with the normal recovery process. How can I, a clinician, reconcile my enthusiasm for treatment with such melancholy data? The answer derives from addressing the second horn of the dilemma. The problem of alcoholism is too immense and the pain it causes too severe to suggest that hospitals once again hang out signs that read "alcoholics need not apply.
It is not a step forward to say that alcoholism is the sole responsibility of families, of the church, and of the police. Therefore, if treatment as we currently understand it does not seem more effective than natural healing processes, then we need to understand those natural healing processes. We need also to study the special role that health-care professionals play in facilitating those processes. Consider tuberculosis as an analogy.
In a well-known textbook of medicine advised, "Since there is no known specific cure for tuberculosis, treatment rests entirely on recognition of the factors contributing to the resistance of the patient. In saying this the textbook did not recommend that the government and doctors get out of the business of treating tuberculosis; nor did it suggest that because genes and socioeconomic factors were etiologically just as important as contagion tuberculosis was really just a social problem and not a medical disorder.
Rather, the text suggested that doctors learn more about natural healing processes. Throughout history, physicians faced with disease that they can neither comprehend nor cure have played invaluable roles in capturing these natural forces. In his classic monograph, Persuasion and Healing , Jerome Frank, professor of Psychiatry at Johns Hopkins University, offered a transcultural model for healing that is nonspecific for disease or patient; but Frank's model maximizes both the relief of suffering and — of special importance in alcoholism — attitude change.
Frank acknowledges the paradox that demand for therapy may seem increasingly insatiable at the very time of mounting complaint that such therapy may represent expensive fraud. What feeds such demand is not the patient's need for cure as much as his need to elevate his morale. First, alcoholics feel defeated, helpless, and without ability to change. If their lives are to change, they need hope as much as relief of symptoms. Second, alcoholics often have an ingrained habit that is intractable to reason, threat, or willpower.
To change a maladaptive habit, be it smoking or getting too little exercise or drinking too much alcohol, we cannot "treat" or compel or reason with the person. Rather, we must change the person's belief system and then maintain that change. Time and time again, both evangelists and behavior therapists have demonstrated that if you can but win their hearts and minds, their habits will follow. In other words, if we can but combine the best placebo effects of acupuncture, Lourdes, or Christian Science with the best attitude change inherent in the evangelical conversion experience, we may be on our way to an effective alcoholism program.
I shall describe Frank's view in general terms and then illustrate his points with four relatively successful programs. Frank's prescription for an effective "placebo" therapy that is, for a modern-day Lourdes has as its goal to raise the patient's expectation of cure and to reintegrate him with the group.
The sanctioned healer should have status and power and be equipped with an unambiguous conceptual model of the problem which he is willing to explain to the patient. The common ingredients of such a program include group acceptance, an emotionally-charged but communally shared ritual, and a shared belief system.
Such a ritual should be accompanied by a cognitive learning process that "explains" the phenomenon of the illness. The point is that if one cannot cure an illness, one wants to make the patient less afraid and overwhelmed by it. Frank's prescription for attitude change is initially interrogation by and confession of sins to a high-status healer. We should keep on trying something. I totally agree. And he wants the government to keep on funding his programs. That's understandable.
I don't necessarily agree, but it's understandable. Then Vaillant wrote, "Perhaps the best that can be said for our exciting treatment effort at Cambridge Hospital is that we were certainly not interfering with the normal recovery process. Vaillant clearly demonstrated that that was exactly what they were doing: interfering with spontaneous remission, causing his group, his "Clinic Sample", to have a much higher death rate than anybody else was getting.
Then Vaillant asked the key question: "How can I, a clinician, reconcile my enthusiasm for treatment with such melancholy data? Notice how Vaillant slickly equated A. That is a deceptive word game. That is an example of the propaganda stunt " False Equality " — imply that two different things are equivalent, when they are not. If you want "treatment", why not send the alcoholics to any of the other treatment programs that had the same dismal failure rate as Alcoholics Anonymous, but much lower death rates?
In trying to answer that question, Vaillant went, by some lengthy, tortured logic, from admitting that A. Yes, and I might get lucky and win the lottery tonight, too, but I'm not holding my breath. Vaillant wants us to send more people to the program that had the highest death rate of any of the programs that he examined. Where is the sense in that? I smell a rat. Vaillant has cards he isn't showing, beliefs he isn't revealing to us, like religious beliefs that A. Vaillant is a true believer in Alcoholics Anonymous. All through the rest of his book, Vaillant described how he used A.
The eight-year study described here is just a summation of that on-going program. Vaillant's enthusiasm for A. How can that be? The answer is, "Easy. You don't have to be an alcoholic to join a cult religion. Just look at the Moonies, or Scientology, or the Hari Krishnas They aren't alcoholics or drug addicts, but they are still irrational true-believer cult members, as crazy as a loon, as buggy as a flop-house blanket. And, occasionally, they even have members who are doctors. The People's Temple had a doctor and a nurse who mixed up and dispensed the cyanide drinks at Jonestown.
And Synanon had a doctor who performed vasectomies on all of the men. George Vaillant, there was Dr. Harry Tiebout , who was also not an alcoholic — he was a real, certified, psychiatrist — and he also abandoned his training and became a true believer in using Alcoholics Anonymous "treatment" to force his patients to "surrender". And then there is Dr. So there is no shortage of insane doctors, mad scientists, and other sick "therapists" who love to torture their patient-prisoners with fascist medicine. See Straight, Inc. Notice that Vaillant used the same old stereotype of "The Alcoholic" as A.
Deceptive recruiting is also what cults do. Deliberately giving people a treatment program that is a proven failure Vaillant himself proved it , while calling that failed program a "placebo", and then telling the patients that they are in the greatest, most exciting, alcoholism treatment program in the world, sounds like a good way to bring on a host of malpractice lawsuits.
I don't know how anyone can call that ethical behavior, especially considering that people's lives are at stake. The law says that patients must give informed consent. The doctor must truthfully explain the treatment and how well it works, and what the odds of success are, and then the patients can give informed consent.
Lying to the patients and deceiving them is not "informing" them. Martin Ingvar, of the Cognitive Neurophysiology Research Group in Stockholm, and colleagues compared regional cerebral blood flow measured by positron emission tomography while inducing pain or a control stimulation in nine subjects.
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Their findings appear in the February 7th issue of Sciencexpress, the online edition of the journal Science. Ingvar told Reuters Health. The placebo effect is influenced by several factors, including a person's expectations of the treatment and their desire to feel better, the investigators point out. By showing that placebo and an opioid agonist activate the same brain regions, the findings suggest that some of these same factors may be involved in triggering the pain relief. Despite the evidence that placebo can affect the brain, Dr.
Ingvar said that the report "does not support the use of placebo alone in treatment. The Swedish doctors didn't say anything about placebos being useful for curing alcoholism or any other deadly illness or disease. Note that Vaillant didn't give us even a vague hint of treating alcoholics like adults who are responsible for their own lives or deaths, which they really are, in the final analysis — they will live or die by their own hands.
Vaillant just displays an arrogant, condescending attitude of " We'll fool those alcoholics into being good by playing mind games on them. Also note that you are supposed to get a religious "evangelical" conversion experience from this A. Vaillant chose Jerome Frank's "transcultural model for healing that is nonspecific for disease or patient". What that means in plain English is that it is a generic cure-all. It's a cure-all that was designed with no particular disease or patients in mind ; it's just supposed to be a general-purpose cure-all that is good for curing whatever ails you, just like good old-fashioned snake oil.
It's just like the Twelve Steps, which are supposedly able to cure anything and everything from alcoholism to compulsive shopping to schizophrenia. And it's almost comical how Prof. Frank admits that such "therapy" suffers from "mounting complaints that such therapy may represent expensive fraud. It sure resembles A. The similarity is far too much of a coincidence to assume that Prof.
Frank did not write up his "model" in order to recommend the A. What was it I said, "There is no shortage of insane doctors, mad scientists, and other sick 'therapists' who love to torture their patient-prisoners with fascist medicine"? Vaillant describes Prof. Frank's ideal therapy program as: There should be a "sanctioned healer The explanations don't have to be true, just "unambiguous". The program should offer "group acceptance, an emotionally-charged but communally-shared ritual, a shared belief system", and some phony dogma that "explains" the phenomenon of the illness. In other words, the program should be Alcoholics Anonymous, with its groups, ritualistic meetings, shared beliefs, and dogma.
Note how Vaillant put quotes around the word "explains" when he wrote: Such a ritual should be accompanied by a cognitive learning process that "explains" the phenomenon of the illness. The dogma isn't supposed to really explain "the phenomenon of the illness"; it is just supposed to mollify the stupid patient with some unambiguous simplistic fairy tales.
Cult true believers really like black-and-white thinking and simple, "absolutely-true" statements. Vaillant clearly states that the goal is to use emotionally-charged rituals and "unambiguous" misinformation to play games with the patient's mind, and he rationalizes it this way: The point is that if one cannot cure an illness, one wants to make the patient less afraid and overwhelmed by it.
So that he can die comfortably, I guess — die comfortably as a "less afraid and overwhelmed" member of Vaillant's religion. Likewise, Prof. Frank said that the goal was not to cure the patient, but rather it was just to "elevate his morale. Apparently so, because that is what the real results are. Personally, I'd rather really fix the problem, and I'd call quitting drinking, and staying quit, a workable cure. So some kind of a "cure" is possible, so there is no need to yammer about how we can't cure the illness, so let's play mind games on the patients.
Speaking of mind games, did you notice how Professor Vaillant's mind jumped from: "A. That program might capture some 'natural healing process'. Vaillant's plan for a treatment program is another example of The Enlightened Counselor's Deception , where "enlightened" counselors will tell public officials, "Of course we know that this nutty religious or spiritual or superstitious stuff that is at the heart of the A. It might save their lives. So let's encourage it. And finally, Frank and Vaillant want to get the patient to confess his sins to a "high-status healer" to get an "attitude change".
Just who or what on Earth is a "high-status healer"? A sponsor who reputedly has a lot of status? A lot of status, according to whom? Since Vaillant already showed that Alcoholics Anonymous doesn't work, and doesn't heal anybody, an A. And why should the patient confess his sins to that "healer"?
Because it will make him quit drinking? Of course not. Vaillant knows full well that that doesn't really work. Vaillant has already candidly reported that the A. Eight years of thorough testing showed A. And yet Vaillant wants to send all of the alcoholics to A. The real reason for such confessions is because Vaillant is a thinly-veiled Buchmanite , or an A.
So, in order to better serve God, Vaillant has given himself the task of trying to get as many people as possible to confess their sins to each other, as well as to convert to his religion. What does any of this have to do with curing alcohol abuse?! This is cult religion, not the treatment of alcoholism. What Vaillant has done is pick out a "treatment model" — Jerome Frank's model — that matches his own Buchmanite religious beliefs, so that he can then recommend a religious program, specifically the Alcoholics Anonymous program, while pretending to be recommending a psychologically-oriented alcoholism treatment program.
Vaillant wants to send more people to A. It was a disaster. The best thing that Vaillant could say for A. But, the truth is, A. Over-all, A. Look at the " Dead " column in Table 8. Vaillant clearly demonstrated that A. That really is appalling. That is nearly one out of every three patients, dead. That's the Bataan Death March. Compared to the other programs, the A. So there is absolutely no sane reason to be sending more patients to Alcoholics Anonymous, or any program based on Alcoholics Anonymous, or any program that is even like Alcoholics Anonymous, when all of the other treatment programs killed fewer patients.
But there is a dishonest, ulterior religious motive for doing so, if you are a Buchmanite or a member of Moral Re-Armament , or perhaps a hidden member of the Alcoholics Anonymous religion. Then, you would want to send people to A. To expect anything different is insane. And if you keep on sending patients to A. For a final laugh, you might be curious to know where Vaillant was going with his argument. We stopped quoting him at the point where Prof. Frank was advocating sending all alcoholics to some program where they would confess their sins to "a high-status healer.
Now, he never used those exact words, "dogmatic cult religion"; he just said: Frank's prescription for attitude change is initially interrogation by and confession of sins to a high-status healer. This process involves four components: indoctrination, repetition, removal of ambiguity, and opportunity for identification.
It has been demonstrated that the patient's active participation in such a process "increases a person's susceptibility especially if the situation requires him to assume some initiative" for his own attitude change p. In their efforts to reduce coronary risk in large populations of patients, they found that explanation of risk and rational advice by physicians are less useful than systematic indoctrination and repetition using mass media and opportunity for identification through peer support groups.
Frank writes: "the greatest potential drawback of therapy groups is their tendency not to supply sufficient support, especially in early meetings, to enable members to cope with the stresses they generate" p. One of the functions, then, of the medical-care system is to facilitate the transition of the isolated patient to group membership. Finally, if attitude change is to be maintained, repetition of group rituals and the group support that they engender must be sustained after clinic discharge. The table reflects the early treatment results reported by the Shadel clinic using emetine Shadel ; Voetglin and Broz , by the Menninger Clinic using disulfiram Antabuse and group therapy Wallerstein , by Beaubrun using an imaginative combination of indigenous paraprofessionals and medically sanctioned Alcoholics Anonymous, and by Sobell and Sobell using behavior modification ,