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You have inspired me, though…

I just want to encourage to to keep on keeping on… I promise that I will do the same. It’s not a perfect world, nor do I want it to be, but I wish you just one moment which feels perfect to you in the next week. You’ve already given me my moment, so wishing you the same is the least I can do.

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(Andy T on Dec 24, 2004 4:11 PM) I keep checking back and I'm glad to see some new stuff up. You're a really thoughtful guy so I am hoping to see more here. Congratulations on your work success, I understand the financial side of that.

(Chris on Dec 25, 2004 10:47 PM) I found your site through Andy T's blogroll. It's intriguing to me.

(doughgirl33510 on Feb 28, 2005 9:11 PM) Im really not sure how I got here, but this site is very interesting and provides a lot of information..look forward to reading more..thank you

(Grace on Mar 12, 2005 4:14 PM) I dont know how I got here either but great site. Its a while since you posted are you coming back?

(Bose on May 11, 2005 12:53 PM) here's a test

…former President Clinton, whose addiction to fast food is well known…

One more sign of cultural schizophrenia about enjoying the simple pleasures of life, eh? The disease model: Coming soon to whatever you enjoy most!

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(Faith on Sep 4, 2004 9:20 AM) Okay, here are the things I can think of that I've been accused of being addicted to in the last fifteen years: alcohol (check) cigarettes (check) men relationships sex chocolate internet television antidepressants working out cheese sunbathing cross-stitching shopping (check) gambling working loud music salt dieting blogging (check) The things I checked are things where I think signs of addiction could be there, meaning I can be fairly compulsive about those things. Can you sign me up for a BA?? Blogger's Anonymous? You make a good point, Bose...I've often said that anything that's fun is either illegal, unhealthy or fodder for a support group.

(Bose on Sep 4, 2004 12:47 PM) Yeah, the amazing thing to me is that some of the same folks who will use "addiction" to describe a pop phenomenon will use it in the next breath to describe a medical diagnosis. We often do the same thing with mental illness, like using "crazy" to describe being silly or goofy, but generally the professional wordsmiths in the media aren't that sloppy about it.

(Andy T on Sep 7, 2004 12:47 AM) Addiction is hard to define. I think I know what I am addicted to, but I have no idea what others are addicted to. Funny to see this here as I have been thinking about the dependance of the US on foriegn oil as a sort of addiction. Seeing this quote and feeling it was frivolous to link fast food to addiction is making me rethink my take on oil addiction.

(Bose on Sep 7, 2004 9:43 AM) In clinical terms, addiction has been defined in ways that don't seem to apply to Bill Clinton's eating patterns. In popular usage, it more often describes compelling, hard-to-shake habits. There's no shortage of disagreement between researchers and academics about using a broad, unitary disease concept. I like Bill White's summary from the end of this page where he notes that the disease model has worked and yet it needs some work to clarify the boundaries of what addiction is and isn't.

(particle on Sep 8, 2004 1:42 PM) Addiction is pretty simple to define. I heard a speaker who said he was asked to speak at an OA meeting and he accepted on the chance that his Espreince ,Strength, & Hope would help. However, when he heard a a woman share how she had eaten a whole Pepperidge Farm cake, he said to himself,"MyGod! You Pig! How could you do such a thing? Have you no slef control?" It then dawned on him that people who are not addicted to something cannot understand addiction. Simply put if you wake up in the morning and say" I am only going to have two drinks today" You are probably addicted as normal people would NEVER have such a thought! Food for thought! (Pun intended) ;)

(Bose on Sep 8, 2004 2:39 PM) Thanks for your thoughts, Particle. As I've noted elsewhere, I have used a number of different strategies to take responsibility for when and how much I drink. It really doesn't matter to me whether other folks think I am normal (happily, I'm not!), but I can tell you that my drinking doesn't fit the maladaptive patterns used to identify substance abuse within the DSM-IV criteria. I can't pretend to know what it's like to live with diabetes or epilepsy, but I can look up the signs and symptoms of each. And, it's reasonable to expect that talking heads in the media won't diagnose public figures as having epilepsy or diabetes without evidence of the symptoms or a direct quote from an expert. This news person didn't do that. Maybe the reference to addiction was intended as a metaphor, not a diagnosis, but that was not made clear.

(Sebastian on Sep 8, 2004 9:22 PM) Addiction...the way it is misused these days, you would almost have to say that as humans, we are all oxygen-addicts, food-addicts, shelter-addicts and water-addicts.

(Faith on Dec 7, 2004 10:19 PM) Hey, young man....where are some new posts from you???

(Mr A. Hill on Jan 3, 2005 2:21 AM) It is easy to sit in an ivory tower and attempt to discredit the disease model of treatment. It is tough to work on the front line of addictions treatment as I do. First off the American Medical Association identifies alcoholism as a disease. The AMA recognises that alcoholism meets the 5 criteria needed to be a disease, Patterns of symptoms, chronicity, progression, subject to relapse, and treat ability. Most recovered alcoholics talk of the phenomena of craving. Simply stated, once a drink enters their system they experience an uncontrollable craving for more. Here is a definition of disease from the Oncology department at The University of Newcastle upon Tyne An alteration in the state of the body or of some of its organs, interrupting or disturbing the performance of the vital functions, and causing or threatening pain and weakness; malady; affection; illness; sickness; disorder; -- applied figuratively to the mind, to the moral character and habits, to institutions, the state, etc. http://cancerweb.ncl.ac.uk/cgi-bin/omd?query=disease For those of us who have worked on the front lines of alcoholic and drug treatment we know from real world experience, over 10 000's of times that the disease model of treatment works. Since the inception of harm reduction into treatment DEATHS from addiction per year in Toronto shelters that deal with addiction have risen. Simply stated, harm reduction doesn't work. There are many people who have abandoned the harm reduction model because it is a colossal failure. I understand that many people would like to move away from the AA model of treatment because they have a problem with the spiritual aspect of AA. They guise this disdain as an attack on the disease and abstinence model of treatment. It is dangerous to sit in an Ivory tower and ignore decades of research that show that an alcoholic brain reacts differently to alcohol than a non-alcoholic brain. http://webpages.charter.net/rfhale/alcoholism.htm For the record in addition to decades in the field of addiction treatment I have a BSc in Biology, a MSc in Physiology, an MBA, and I am a certified addictions counsellor.

He has mentioned his drinking history prior to getting inpatient treatment in June 2002, but not dwelt not on it. Dire circumstances precipitated the hospitalization, which led to 10 weeks of sobriety.

Continue reading Martin's Alcoholic Diary...

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(Sebastian on Aug 31, 2004 9:10 AM) Thanks heaps for that rundown. i always find other people's journeys in recovery to be fascinating and empowering. Thanks for posting it.

(Faith on Aug 31, 2004 9:42 AM) Glad to see you back, Bose! Great rundown on Martin's struggle, I keep up with his journal day to day now, but aside from a few forays into his archives, didn't know the history. I too have a deep respect for his journaling about his journey...it is SO VERY HARD for me to write after I've screwed up...the guilt and shame makes it nearly impossible for me to write about what I've gone through at the very time when I need to do it most.

(Bose on Aug 31, 2004 10:53 AM) I think it's so easy to lose sight of the big picture in our own lives even when we've made great forward strides. I'd just been following Martin since May or thereabouts myself, and so it had been easy to assume that the most recent months were roughly representative of the nearly two years he's been writing. It was cool finding that he's had a full year with only one blip and that the most recent months, though not yet optimal in his eyes, are well ahead of some in the past. That is a tremendous reduction in harm, it seems to me. I've got some more stuff to talk about related to harm reduction, but Martin is a living example of it.

(Mike A. on Sep 12, 2004 12:02 AM) Bose, Many thanks for bringing Martin's journey to us. I was saddened today to read of his rapid downward spiral. I hope the Priory is able to help him turn things around.

(Bose on Sep 12, 2004 1:09 AM) I'm really glad that Martin is staying in touch with professional caregivers and insisting on escalating his expectations of treatment professionals in response to escalating problems. The thing I'm most concerned about is that he might benefit from, but may not know that he has the option to, seek out other treatment options. As a layperson, I can't assess his specific problems or recommend what is best for him. As a health care advocate, though, I can challenge folks in circumstances like his to hold their caregivers accountable for fully informing them of their options. Since not all treatment approaches require clients to declare their powerlessness, and evidence suggests that some of those that are not based on powerlessness are as effective or moreso than those that are, a person in Martin's shoes should be able to insist, "This approach isn't working for me. What else is available?" The same goes for pharmaceutical options. Martin has spoken of using Acamprosate, but hasn't mentioned any benefits from it. Folks in his position have every right to ask, "Was a sufficient dosage prescribed? What about Naltrexone? Topiramate?" It is no different from cancer patients who find that radiation is not working -- they are smart to insist on exploring chemotherapy and surgical options, especially if their primary caregivers appear to be uninformed or unconcerned about all available options.

(Ross on Dec 21, 2004 5:30 PM) Questions, Looking for advise, My husband and I like to drink :-) the problem is he likes to drink in the morning, sneak it, before work etc, you get the picture. He can quit for months as we have done on many occasions. Then we start drinking again, first once a week then twice then everyday, and when we drink everyday, he lose control and the sneaking starts again. The problem is we like to drink, we have no problems with money or fighting, just no control. So I have been reading about Revia, so my plan is no drinking through the week, and only on weekends if there is an occasion and he takes Revia,,,,do you think It will work or am I fooling myself. Suggestions please.

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Police in eastern Latvia were trying to determine Wednesday what charges to bring against a drunken horse-and-buggy driver who caused a drunken motorist to crash into a ditch, flipping his car.

Nobody hurt, the car driver fined and license revoked, but Latvian law doesn’t criminalize taking the reins while intoxicated.

Via Sarpy Sam at Thoughts from the Middle of Nowhere.

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(Faith on Aug 29, 2004 12:16 AM) *tap tap tap* :)

One of the drugs, Naltrexone (Nal), has shown promise both for folks seeking to abstain permanently as well as those who are drinking moderately or working toward a moderate drinking goal. Julie R., a Moderation Management member, has journaled vividly about her recent experience with it and has graciously agreed to let me share a bit of it with you.

Her experience with it strikes me as similar to that of folks using antidepressants — some trial and error is necessary to find the best dosage, results can vary from day to day, and the drug supports, not replaces, insight and effort — and you’ll see that she describes trade-offs in using Naltrexone, as well.

Dr. Alexander DeLuca, M.D. is a great online source for papers on this topic, updated regularly as new stuff is published.

Continue reading Julie R's Naltrexone Mini-Journal...

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The condition which the law requires the doctor to report is alcohol misuse — which Pennsylvania legal code doesn’t define any further — not addiction or dependence.

Let’s take a look at the sequence of events, how Emerich stacks up against the criteria for alcoholism, then sensible drinking, treatment options, and finally ethical perspectives.

Continue reading Joe Six Pack in the News...

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(Faith on Aug 23, 2004 3:15 PM) When I get insurance again, I will probably have to get a new doctor. I probably will not tell him off my alcoholism, because I feel that I do not get the same level of care as other, non-addicts. For instance, I get no help with pain, cough or anxiety. My current doctor doesn't want to give me "drugs" because I am an admitted alcoholic. I broke my butt bone falling once (no jokes here) and recieved no pain medication for a broken bone. I have chronic bronchitis, and recieve no cough medicine for it (because it contains codeine.) I have terrible panic attacks, and recieve no medication for that. I don't even bother to ask. Alcohol is my drug of choice, not pills. But my doctor won't hear that. Don't know why I brought this up...it's just one more reason to lie to my doctor.

(Bose on Aug 23, 2004 7:52 PM) Getting good health care is a very valid, reasonable concern, Faith. Dr. DeLuca just posted the article When Good Intentions Hurt, which talks about the barriers some folks who have never had substance use/abuse issues have had trouble getting effective pain relief. With drinking problems, the challenges can include:Being referred to peer support groups led by well-meaning laypeople when professional care is neededBeing refused care or treatment for co-occuring issues until after alcohol-related issues are addressedBeing referred to care for dependence (alcoholism) when a professional assessment would have revealed abuse (problem drinking) and often co-occuring issuesNot being heard or believed because of uncritical assumptions about clients being in denial. Here's an alternative for you to think about when it comes time to doctor-shop, Faith: Call around and ask the questions ahead of time. If it was diabetes instead of alcoholism, you'd be asking the docs about their expertise, so you could do the same: What percentage of your patients are recovering alcoholics?Are you familiar with some of the latest research in alcohol-related care? How are you applying it?How experienced are you in helping patients who happen to be alcoholics manage pain?What's your approach to helping patients who need support with relapse prevention?Have you prescribed naltrexone for any of your patients? Did you find it helpful? My point is not that you'd ever need or want to try the different options, but if you find somebody who is determined to serve their alcoholic clients well, they're going to know about these things. And, of course, you deserve nothing less than effective, evidence-based health care from an expert who is willing to get to know you and tailor your care to where you're at.

(Emily on Aug 24, 2004 9:57 AM) This is the sort of neo-prohibitionist hysteria that really gets my dander up. That MD ought to be ashamed of him or herself, and the state of PA ought to be even more ashamed of passing such a broad, relationship-destroying tattletale law. You *don't* take away someone's license when they have done nothing wrong. The last I heard, getting bombed in your living room is not illegal. If he is a habitual drunk driver, then by all means yank the license. But that's not what's going on here. I guess they'd better post the Miranda warning conspicuously at every doctor's office. I will certainly make sure to protect myself, in future, by refusing to answer any drinking-related questions on the grounds that it may be used against me. Although the disease model is not (AFAICS) gaining too much ground here in the UK, the anti-drinking sentiment surely is. "Unhealthy" and "binge" drinking keep getting defined ever downward...while most Brits simply keep on drinking as much as they always have, thank the gods.

(Mike A. on Sep 12, 2004 12:12 AM) Radley Balko offered additional insight about the Keith Emerich case on Sept. 4. Balko quotes extensively from his chat about the case with a representative from the Pennsylvania Medical Society.

(getMADD.com on Sep 15, 2004 12:49 PM) Reading Keith Emerich's case, you would think the ACLU would be all over this one. Unfortunately, they seem to stear clear of any confrontation with MADD or The State when it comes to the plethora of Constitutional violations involving alcohol and drinking. Hopefully a hot shot pro-bono lawyer will help Mr. Emerich appeal the judgement against him.

Jay Stahl hears that from time to time as an addictions counselor, but his clients learn it’s no way to bond with him.

“Be specific” is his reply. “Let’s talk about what works or doesn’t work for you about A.A.”

If the client has attended A.A. meetings where the group members seemed out of touch with his/her concerns, Stahl points out that any peer support group will have its own character, strengths and weaknesses. If the personality mix at a meeting wasn’t a good fit for the client, Stahl may recommend other A.A. meetings that could fit better.

“I’m not powerless.” “I’m not an alcoholic.”

Stahl welcomes these sorts of specifics. They are conversation-starters, not symptoms, in his work as a clinician.

So, Sharon feels responsible and empowered, but wants help asserting herself to quit drinking. Or, Shawn shuns the “alcoholism” label, but is ready to talk about solving the problems his drinking is causing. And, Mike resists committing to much of anything, but promised his wife he would talk to somebody.

Continue reading Clients Power Cincinnati Recovery Center...

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(Randy on Aug 22, 2004 5:40 PM) Hey Bose. I can't remember how I found this blog (technorati link to mine I think.) Anyway, as a person who had personal struggles with alcohol in my younger days, I can appreciate many of your thoughts on the subject. I was clean for 9 years outside of a 12 step program (although that is where I started and am grateful) then I lived in successful moderation like what you describe. Without having a personal crash or moral demise I have decided that total abstinence is the way to go for me. I related to this post very much. I will never knock 12 step programs. One saved my life. At the same time I do think some people can grow beyond the need for them. Today I stay "clean" for personal contentment...not because of "disease."

(Michael on Sep 12, 2004 12:20 AM) It's great to discover a program (like the RRC) that meets people where they're at; that treats the whole person rather than one symptom; and that seems willing to offer different responses and treatments to each participant (since people are, indeed, very different). I strongly believe that many more people would be helped out of their compulsions or problem behaviors if therapists would treat them as unique individuals, not clinical stereotypes.

Scene: A smoky pool room at a local neighborhood bar. Cigarette, Bourbon, Beer and Sinatra Tunes are shooting a game of doubles

Cigarette: (oddly enough, smoking a cigarette) Hey guys! How long has Coffee been missing? There were five of us here, even though you guys, Beer and Bourbon, are related. Now there’s only four of us!

Bourbon: (looks up from the pool table, where he is lining up a shot) Who cares? We were never that close anyway - he was the natural one to leave the group, damn stimulants. It was always the two of you in the morning - no one ever heard of Coffee and Bourbon hangin’ out.

Go read the rest. Really. It’s quirkygood.

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Naperville … already prohibited minors from attending drinking parties, but last year the City Council changed the wording to create a specific ordinance to ticket minors at the parties who aren’t drinking.

City officials say the strict rule is meant to protect minors by targeting unsupervised teen parties.

”We’re trying to be involved in the situation and recognize the tragic and sometimes horrific outcomes of these underage parties,” said Naperville Police Lt. Dave Hilderbrand. ”We’re trying to take a bit more of an ambitious step.”

Continue reading Preempting Harm Reduction...

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(Faith on Aug 16, 2004 1:49 PM) Like someone could have "controlled" me at 20. (Or 19, or 15 for that matter.) Let's just go ahead and ticket the passengers in cars when the driver gets a speeding ticket. After all, there they are, sitting calming beside someone committing a crime. Urrrgh!!!

(Bose on Aug 16, 2004 2:03 PM) Yeah, it occurs to me that this little ditty (Thanks, Thump!) fits the topic: A couple goes on vacation to a fishing resort in northern Minnesota. The husband likes to fish at the crack of dawn, the wife likes to read. One morning the husband returns after several hours of fishing and decides to take a nap. Although not familiar with the lake, the wife decides to take the boat out. She motors out a short distance, anchors, and continues to read her book. Along comes a game warden in his boat. He pulls up alongside the woman and says, "Good morning Ma'am. What are you doing?" "Reading a book," She replies, (Thinking, "Isn't that obvious?") "You're in a restricted fishing area," he informs her. "I'm sorry officer, but I'm not fishing, I'm reading." "Yes, but you have all the equipment. For all I know you could start at any moment. I'll have to take you in and write you up." "If you do that, I'll have to charge you with sexual assault," says the woman. "But I haven't even touched you," says the game warden. "That's true, but you have all the equipment. For all I know you could start at any moment." "Have a nice day ma'am", and he left.

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This weekend, another MM member put that principle to work. He wrote to the group just before heading out for the weekend and again after his return, and was good enough to let me share his thoughts here.

Continue reading Online Support: Not Just Vapor...

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I started 30 days of abstinence. With the support of folks in MM, it turned out that having alcohol-free days was kind of freeing, not the burden I had anticipated.

Taking my abstinence past the 30-day mark began to appeal to me by the half-way point. I was figuring some stuff out about myself and adding new habits and skills. All of that would be helpful once I was drinking (but moderately this time) in the future, and I figured a longer period of abstinence would probably be good for me.

Rather than commit to another specific timeframe, I set this framework in place: I could choose to have my next beer (or whatever) at any time, but the decision had to be made a week ahead of time. No moral significance was attached to the timing — I could do it the next week or the next year — but the timeclock was available, and seven days after hitting it I would be free to crack open a cold one or pour myself a glass of wine.

Continue reading Sticking, not Stuck...

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So, it’s as good a time as any to do a quick review of some of the solidly abstinence-based support out there which follows something other than the 12 steps. Along with that, a request to my readers: I’m looking for individuals who are talking about their experiences in these different groups at their personal websites. If you know of any, please drop links into a comment or an email message.

So, here’s a list of empowered alternatives:

Continue reading A.A. Alternatives: An Empowered Round-up...

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One of the concepts I worked through while abstaining was my fear that I’d slip right back into bad habits after the abs period finished, or even see my drinking escalate beyond where it had been before. It’s a pretty common sentiment; an MM member who is 10 days into his first 30 expressed a similar fear, and I responded:

Continue reading Demystifying My Drinking...

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(Faith on Aug 12, 2004 10:02 PM) I'm thrilled to see a blog on this subject. Although I believe nothing but abstinence will work in my case, (at least right now) I have long thought that AA is not the ONLY answer to addiction as seems to be the consensus in the medical and psychiatric communities. I wanted other options and other opinions, but couldn't find them. I will be back to find out more.

The Washington Post runs a short piece by Alicia Ault (free registration required) which includes:

Campral appears to work by restoring the balance between excitation and inhibition in nerve signals, a balance that gets altered by alcohol abuse. An older drug, Antabuse (disulfiram), makes people violently ill if they drink alcohol. Another, naltrexone, works by making people want to drink less, said Litten.

Only 5 to 10 percent of people treated for alcoholism are prescribed naltrexone or Antabuse, which don’t work for everyone and are not widely marketed, said Litten. Forest aims to market Campral broadly to addiction centers and physicians, said company president Ken Goodman, and persuade insurers to pay for the drug.He would not comment on price.

Continue reading Acamprosate Approval in the News...

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(Faith on Aug 13, 2004 10:10 PM) Again, I'm freakin' stunned here...I was thinking, yesterday as I was writing my comment about how cool some of these different approaches are...that I could never, ever, in a million years, talk to my mother about anything less then abstinence. If I ever drink again around her or near her or whatever, it's over. Nothing about controlled, or harm reduction would fly with her or ANYONE who knows me. Those alternatives are closed for me. And that makes me sad.

(Faith on Aug 13, 2004 10:11 PM) Oh, and thanks for the shout-out! *blush*

(Bose on Aug 14, 2004 10:17 AM) The important thing, for me, has been that I'm more focused on how I want to live than on whether or not drinking is part of my life. When I started working on healthier alternatives to the daily drinking patterns that were causing me problems, I didn't know whether the best solution would end up being abstinence- or moderation-based. I just wanted something better, something sustainable, something that demoted drinking and promoted life. It sounds like you're getting that stuff in your life, Faith -- you're focused on Sydney, you're indulging your creative side with your blog, you're connecting with people, and being there for your mom. I'm happy for you, and encourage you to stick with what's working. Sticking with it now doesn't mean that you're stuck with the current approach forever; twenty years down the road things may be different. The folks you love believe abstinence is the best way to keep you around and healthy. One of the things you can say to yourself is that "Well, even if this isn't the only option, for now it is my best option."

(Mike Wierzbicki on Feb 3, 2005 5:10 PM) Is Campral a replacement for antabuse? Can one consume alcohol in moderation, special situations, etc. without becoming ill? Thank you. Mike