The Irrationality of Alcoholics Anonymous
Nowhere in the field of medicine is treatment less grounded in modern science. A 2012 report by the National Center on Addiction and Substance Abuse at Columbia University compared the current state of addiction medicine to general medicine in the early 1900s, when quacks worked alongside graduates of leading medical schools. The American Medical Association estimates that out of nearly 1 million doctors in the United States, only 582 identify themselves as addiction specialists. (The Columbia report notes that there may be additional doctors who have a subspecialty in addiction.) Most treatment providers carry the credential of addiction counselor or substance-abuse counselor, for which many states require little more than a high-school diploma or a GED. Many counselors are in recovery themselves. The report stated: “The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.”And yet "Rehab" is subsidized by insurance. Thus it has proliferated like an invasive weed.
Finland’s treatment model is based in large part on the work of an American neuroscientist named John David Sinclair. I met with Sinclair in Helsinki in early July. He was battling late-stage prostate cancer, and his thick white hair was cropped short in preparation for chemotherapy. Sinclair has researched alcohol’s effects on the brain since his days as an undergraduate at the University of Cincinnati, where he experimented with rats that had been given alcohol for an extended period. Sinclair expected that after several weeks without booze, the rats would lose their desire for it. Instead, when he gave them alcohol again, they went on week-long benders, drinking far more than they ever had before—more, he says, than any rat had ever been shown to drink.And abstinence the standard protocol. Welcome to the Hotel California.
Sinclair came to believe that people develop drinking problems through a chemical process: each time they drink, the endorphins released in the brain strengthen certain synapses. The stronger these synapses grow, the more likely the person is to think about, and eventually crave, alcohol—until almost anything can trigger a thirst for booze, and drinking becomes compulsive.This is absolutely not how it works. This is not a reward system problem. Drinking affects your glucose metabolism, and chronic hypoglycemia causes binge intake behavior.
Just notice that, once again, for all the talk about "illness", nobody ever mentions actual disease processes.
There's a reason we drink- we are chronically infected, and the gastrointestinal effects of alcohol lessen the likelihood and severity of an acute septic episode. The medium term benefits have historically exceeded the long term consequences...
Alcohol is the reason most of us are alive.
I will have a lot more to say about the causes and effects and costs and benefits of alcoholism in a future rant.
