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Old Dec 27, 2013, 08:17 PM   #1
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Why are some 12 steppers worse off in sobriety?

I have a friend who died recently and he died a very bitter and angry person, but when he was the self-proclaimed "town drunk" he was a happy guy and very personable and everybody liked him. Whether he drank to hide personal demons or he simply had a physical addiction to alcohol, his persona took a turn for the worse when he became sober.

The local AA rents a building I help maintain and it's a real walking on the eggshells experience if I see many of the AA people. Many of these people who I remember at the bar, or the shows I played when I was a musician, were much more personable when they drank. I can see a strict adherence to walk a straight line and not drink, but does that give a person the right to treat everybody not in AA, or even in AA, like dirt? Then there's the pushing of god on everyone, or higher power. Even my former employee who took to a well known door to door cult isn't as Taliban as the people in AA. What the f is with that?

Does meaning that being sober is now about becoming a terrible human being the in thing?

I just don't get it.
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Old Dec 27, 2013, 09:41 PM   #2
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I have a friend who died recently and he died a very bitter and angry person, but when he was the self-proclaimed "town drunk" he was a happy guy and very personable and everybody liked him. Whether he drank to hide personal demons or he simply had a physical addiction to alcohol, his persona took a turn for the worse when he became sober.

The local AA rents a building I help maintain and it's a real walking on the eggshells experience if I see many of the AA people. Many of these people who I remember at the bar, or the shows I played when I was a musician, were much more personable when they drank. I can see a strict adherence to walk a straight line and not drink, but does that give a person the right to treat everybody not in AA, or even in AA, like dirt? Then there's the pushing of god on everyone, or higher power. Even my former employee who took to a well known door to door cult isn't as Taliban as the people in AA. What the f is with that?

Does meaning that being sober is now about becoming a terrible human being the in thing?

I just don't get it.
I have found it the opposite. Most friends and family members that have gone through AA have become a much better person because of it. Sorry you are not seeing it on your end. Addiction is a tough thing, so keep in mind that during the early start of going through the process they will be going through a hard time, but after a while, they become an even better version of their old self. Make sure and continue to help any friend that is going through this tough time, and try as hard as you can to steer them away from this addiction.
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Old Dec 27, 2013, 10:24 PM   #3
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I have found it the opposite. Most friends and family members that have gone through AA have become a much better person because of it. Sorry you are not seeing it on your end. Addiction is a tough thing, so keep in mind that during the early start of going through the process they will be going through a hard time, but after a while, they become an even better version of their old self. Make sure and continue to help any friend that is going through this tough time, and try as hard as you can to steer them away from this addiction.
I would be less hard on AA if the people I met didn't seem like they belonged to a cult.

Some members of my church and others in my area categorized AA as a cult but I thought they sounded like a cult themselves by being so against it. But I have to admit I have met some 12 steppers that put even the Scientologists to shame.

It's OK to have a belief but to ram it down somebody's throat and consider any view I have as different from them a sure sign that they may be a cult or at least an authoritarian religion.

If some are in a time of recovery, then why the aggressive attitude? I may not be addicted to anything but I have struggles too so what makes them so unique? And if they are so successful like they say then why this?:

http://www.orange-papers.org/orange-not_good.html
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Old Dec 28, 2013, 03:46 AM   #4
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I think the environment helps a great deal. Just because they're on the 12 steps and sober doesn't make them productive and happy. There was a reason these people started drinking, and if you take the drink out, the problems and angst are still there. Dealing with those problems also will lead to a happier more content life.
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Old Dec 28, 2013, 05:16 AM   #5
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It depends on the why
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Old Dec 28, 2013, 07:35 AM   #6
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12-step programmes for quitting addiction have very little effectiveness - frankly, I fail to understand why they persist. One cannot talk somebody out of altered neural function in primitive brain centres dealing with emotion and reward.

However, to answer the OP's question, acute withdrawal from alcohol is no picnic - indeed it can be lethal. However, even after prolonged abstinence there is likely to be long-term effects on the connections of the nerve cells in the brain (certainly this seems to be true in studies of cocaine). Also, it is possible that alcoholics drink because they are self-medicating for impaired neurotransmission, and thus they are likely to be somewhat down when they are no longer drinking. Finally, if you give anybody alcohol, their frontal lobes rather shuts down, which allows emotions to run rampant (hence 'beer goggles', for instance). So a person who you knew while they were drinking is likely to look like they have blunted emotions when they are not drinking.
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Old Dec 28, 2013, 07:51 AM   #7
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During my period of "self medicating" the only way I could even be tolerated by people was "medicated". I still probably drink more than most people do but it's because I spend so much time uptight trying to control my every action the the back lash is I live with far more stress than most do.
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Old Dec 28, 2013, 07:56 AM   #8
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12-step programmes for quitting addiction have very little effectiveness - frankly, I fail to understand why they persist. One cannot talk somebody out of altered neural function in primitive brain centres dealing with emotion and reward.

However, to answer the OP's question, acute withdrawal from alcohol is no picnic - indeed it can be lethal. However, even after prolonged abstinence there is likely to be long-term effects on the connections of the nerve cells in the brain (certainly this seems to be true in studies of cocaine). Also, it is possible that alcoholics drink because they are self-medicating for impaired neurotransmission, and thus they are likely to be somewhat down when they are no longer drinking. Finally, if you give anybody alcohol, their frontal lobes rather shuts down, which allows emotions to run rampant (hence 'beer goggles', for instance). So a person who you knew while they were drinking is likely to look like they have blunted emotions when they are not drinking.
It seems to me that the highlighted section above suggests that behavior change mediated by verbal instruction (employing cognitive behavior therapy, for example) is impossible as talking is involved in instructing the individual in the behavior change techniques which aids in the behavior changes which the individual desires.

I'm guessing that was not your meaning, but I'd be interested in your clarifying the assertion.

I will not argue with your discussion of the neurophysiology of alcohol misuse. While I share the reasonable questioning of AA (and other 12 step programs) and AA's frequent, and empirically unsupported, assertion that it is the sine qua non of alcoholism treatment, I have certainly seen a positive effect of the program for many folks, just as I have seen many failures. And it should be pointed out that there are a number of other treatment techniques with good empirical support.

As for the "personality" issues...even AA acknowledges that discontinuing alcohol use is not going to suddenly make one's life wonderful, nor turn an obnoxious individual into a charming saint. Not to belabor the obvious, but there are alcohol abusers who are pleasant individuals after discontinuing alcohol use, and those that are even more unpleasant than they were when using alcohol.

I would question OP's correlation as an overstated generalization with an implied causal connection between 12 step programs and the post drinking personality characteristics of the ex-drinker.

Again...and in full knowledge of the cliché nature of the following...there are lots of ways to attempt to treat alcoholism, and no one system fits all.
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Old Dec 28, 2013, 07:56 PM   #9
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Again...and in full knowledge of the cliché nature of the following...there are lots of ways to attempt to treat alcoholism, and no one system fits all.

http://www.orange-papers.org/orange-not_good.html

I look at this ^^^ line by line and while it's disturbing, I find it hard to refute.
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Old Dec 28, 2013, 11:45 PM   #10
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I have a friend who died recently and he died a very bitter and angry person, but when he was the self-proclaimed "town drunk" he was a happy guy and very personable and everybody liked him.

I can see a strict adherence to walk a straight line and not drink, but does that give a person the right to treat everybody not in AA, or even in AA, like dirt?

Does meaning that being sober is now about becoming a terrible human being the in thing?

I just don't get it.
I don't have the resources to study this myself, and, I have only hearsay to rely on, but, I would suggest checking out Cognitive Behavioral Therapy as an approach to a substance abuse problem. Or, rather, checking out therapy from a Cognitive Behavioral Therapist. That could be individual therapy or a combination of individual and group therapy, with the groups run by a professional.

The theory behind some of the groups structured like AA, being that getting together with a group of substance abusers is the best way to treat substance abuse-- well, I think that sort of approach could be pretty dangerous. I would suggest that a trained professional is a better bet.
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Old Dec 30, 2013, 10:06 AM   #11
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It seems to me that the highlighted section above suggests that behavior change mediated by verbal instruction (employing cognitive behavior therapy, for example) is impossible as talking is involved in instructing the individual in the behavior change techniques which aids in the behavior changes which the individual desires.

I'm guessing that was not your meaning, but I'd be interested in your clarifying the assertion.

I will not argue with your discussion of the neurophysiology of alcohol misuse. While I share the reasonable questioning of AA (and other 12 step programs) and AA's frequent, and empirically unsupported, assertion that it is the sine qua non of alcoholism treatment, I have certainly seen a positive effect of the program for many folks, just as I have seen many failures. And it should be pointed out that there are a number of other treatment techniques with good empirical support.

As for the "personality" issues...even AA acknowledges that discontinuing alcohol use is not going to suddenly make one's life wonderful, nor turn an obnoxious individual into a charming saint. Not to belabor the obvious, but there are alcohol abusers who are pleasant individuals after discontinuing alcohol use, and those that are even more unpleasant than they were when using alcohol.

I would question OP's correlation as an overstated generalization with an implied causal connection between 12 step programs and the post drinking personality characteristics of the ex-drinker.

Again...and in full knowledge of the cliché nature of the following...there are lots of ways to attempt to treat alcoholism, and no one system fits all.
I need to make clear that I am not a clinician. However, I am a neuroscientist who has studied some of the brain circuits that are affected by alcohol and other addictive drugs. One of those systems, the dopamine system, evolved long before language and symbolic reasoning. The cell bodies of the dopamine neurons are in the midbrain, but they send information to forebrain structures involved in decision making and action planning (namely, the frontal lobes and basal ganglia). Unless we are seriously misunderstanding decades of data, which is a possibility given the complexities involved, the dopamine system causes 'plasticity' when it is activated by changing the ways forebrain neurons are connected to each other. Addictive drugs cause a massive release of dopamine, rather putting the system into overdrive and possibly resulting in abnormally strong learning. Under normal circumstances the dopamine system guides animals and people to recreate the conditions which activated the system previously. This is fine when the dopamine system is activated by life-affirming natural rewards such as food, water, etc., but when it is activated abnormally for drugs it is possible it creates an abnormal drive to seek drugs. Given the evolutionary primitive nature of the dopamine neurons, I doubt that simply using words is going to mitigate their influence on behaviour. Indeed I wonder if we are even aware of the dopamine system's influence on behaviour, and thus I wonder if addicts confabulate when asked about why they take drugs. That is the main reason why I am sceptical about counselling in addiction, and unfortunately the relatively low success rate of counselling in treating addicts strengthens my scepticism.

Quantitative studies that pool data across studies ('meta-analyses') tend to indicate a barely detectable positive effect of 12-step programmes. However, they also identify a huge degree of potential biases in the research. For instance, there is a massive selection bias in most studies of the effects of 12-step programmes: the people who stay in the programme might be more motivated from the onset than those who have dropped out or those who decided not to join the 12-step programmes at all. Thus, the apparent impact of AA might simply reflect the greater desire of the people who join the AA to abstain from alcohol than those who do not. The problem is that truly well controlled randomised studies have not been (and possibly cannot be ethically) performed. Thus, the evidence for the ability of AA to treat alcoholism is far short of what is typically required for medical treatments. That does not mean that AA and other 12-step programmes do not work, but it does mean that joining one of these programmes is an act of faith in absence of definitive evidence.

The question is not whether 12-step programmes work, but how they could possibly work and whether they are better than the alternatives (including 'placebo' treatment)...
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Old Dec 30, 2013, 12:40 PM   #12
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Originally Posted by VulchR View Post
I need to make clear that I am not a clinician. However, I am a neuroscientist who has studied some of the brain circuits that are affected by alcohol and other addictive drugs. One of those systems, the dopamine system, evolved long before language and symbolic reasoning. The cell bodies of the dopamine neurons are in the midbrain, but they send information to forebrain structures involved in decision making and action planning (namely, the frontal lobes and basal ganglia). Unless we are seriously misunderstanding decades of data, which is a possibility given the complexities involved, the dopamine system causes 'plasticity' when it is activated by changing the ways forebrain neurons are connected to each other. Addictive drugs cause a massive release of dopamine, rather putting the system into overdrive and possibly resulting in abnormally strong learning. Under normal circumstances the dopamine system guides animals and people to recreate the conditions which activated the system previously. This is fine when the dopamine system is activated by life-affirming natural rewards such as food, water, etc., but when it is activated abnormally for drugs it is possible it creates an abnormal drive to seek drugs. Given the evolutionary primitive nature of the dopamine neurons, I doubt that simply using words is going to mitigate their influence on behaviour. Indeed I wonder if we are even aware of the dopamine system's influence on behaviour, and thus I wonder if addicts confabulate when asked about why they take drugs. That is the main reason why I am sceptical about counselling in addiction, and unfortunately the relatively low success rate of counselling in treating addicts strengthens my scepticism.

Quantitative studies that pool data across studies ('meta-analyses') tend to indicate a barely detectable positive effect of 12-step programmes. However, they also identify a huge degree of potential biases in the research. For instance, there is a massive selection bias in most studies of the effects of 12-step programmes: the people who stay in the programme might be more motivated from the onset than those who have dropped out or those who decided not to join the 12-step programmes at all. Thus, the apparent impact of AA might simply reflect the greater desire of the people who join the AA to abstain from alcohol than those who do not. The problem is that truly well controlled randomised studies have not been (and possibly cannot be ethically) performed. Thus, the evidence for the ability of AA to treat alcoholism is far short of what is typically required for medical treatments. That does not mean that AA and other 12-step programmes do not work, but it does mean that joining one of these programmes is an act of faith in absence of definitive evidence.

The question is not whether 12-step programmes work, but how they could possibly work and whether they are better than the alternatives (including 'placebo' treatment)..
.
I agree completely with the highlighted section above. To be totally fair (not my general wont), there are many accepted medical treatments that have not been subjected to the gold standard of double blind, or even control group, experimentation. That said, I still agree that AA, and other 12 step programs, totally lack empirical evidence to support their approaches, or even any superiority to placebo.

I'm not a neurobiologist, but it is my impression that the neurobiology of the brain can be effected by behavioral change. Therefore, methods influencing behavior (e.g. CBT) can effect brain chemistry and the behaviors attendant to that biochemical activity.
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Old Dec 30, 2013, 01:37 PM   #13
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....
I'm not a neurobiologist, but it is my impression that the neurobiology of the brain can be effected by behavioral change. Therefore, methods influencing behavior (e.g. CBT) can effect brain chemistry and the behaviors attendant to that biochemical activity.
The dopamine system (and likely the other systems involved in addiction) react to the environment, so they would be affected by changing beliefs and behaviours. However the problem appears to be that these brain systems are hypersensitive to contexts associated with drug taking - when an addict encounters cues associated with drug-taking it causes the systems to react strongly and draw the addict toward drug-taking. Available evidence suggests that we are not aware consciously of this kind of conditioning when it occurs to natural rewards such as food, and I have no doubt it is as strong - if not stronger - in addiction to chemical rewards.

To the extent that CBT gets an addict to avoid the drug-taking context, I suspect it would be partially successful. However, I doubt 'insight' therapies will ever be the key to treating addiction. They might help a person who has low self-esteem or who has to deal with the collateral damage of their drug-taking or with stress, but not in fighting primitive conditioning. Unfortunately, even CBT has the ultimately limitation that drugs are so widespread that it's hard to avoid drug-taking contexts. I think that addicts basically are walking through a motivational minefield of drug-related cues that trigger a lot of information processing that we're not aware of and cannot control.

The pattern seems to be that short- and medium-term abstinence is achievable by many, if not most, addicts. However, long-term relapse tends to be the norm up to middle age or so, no matter what talking treatments are used. Personally, I think the best hope at this point are the vaccines designed to knock the drugs out of the bloodstream before they reach the brain, but that's probably a decade away....

EDIT: FWIW - I know of no charities that fund brain research on addiction - they all seem to be devoted to the delivery of talking therapies. Also, in a moves that highlights the fact that addicts are valued the least in our society, at least two EU countries are considering specifically banning animal research related to addiction (presumably because it is a human lifestyle issue and therefore addicts deserve their misery somehow - as if diabetes, heart disease, and cancer have nothing to do with lifestyle). In the UK ones needs the signature of the Home Secretary to give even so much as a drop of ethanol to a research animal, but routine procedures are used to licence the administration of psychostimulants, opiates, etc.
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Old Dec 30, 2013, 02:04 PM   #14
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The dopamine system (and likely the other systems involved in addiction) react to the environment, so they would be affected by changing beliefs and behaviours. However the problem appears to be that these brain systems are hypersensitive to contexts associated with drug taking - when an addict encounters cues associated with drug-taking it causes the systems to react strongly and draw the addict toward drug-taking. Available evidence suggests that we are not aware consciously of this kind of conditioning when it occurs to natural rewards such as food, and I have no doubt it is as strong - if not stronger - in addiction to chemical rewards.

To the extent that CBT gets an addict to avoid the drug-taking context, I suspect it would be partially successful. However, I doubt 'insight' therapies will ever be the key to treating addiction. They might help a person who has low self-esteem or who has to deal with the collateral damage of their drug-taking or with stress, but not in fighting primitive conditioning. Unfortunately, even CBT has the ultimately limitation that drugs are so widespread that it's hard to avoid drug-taking contexts. I think that addicts basically are walking through a motivational minefield of drug-related cues that trigger a lot of information processing that we're not aware of and cannot control.

The pattern seems to be that short- and medium-term abstinence is achievable by many, if not most, addicts. However, long-term relapse tends to be the norm up to middle age or so, no matter what talking treatments are used. Personally, I think the best hope at this point are the vaccines designed to knock the drugs out of the bloodstream before they reach the brain, but that's probably a decade away....

EDIT: FWIW - I know of no charities that fund brain research on addiction - they all seem to be devoted to the delivery of talking therapies. Also, in a moves that highlights the fact that addicts are valued the least in our society, at least two EU countries are considering specifically banning animal research related to addiction (presumably because it is a human lifestyle issue and therefore addicts deserve their misery somehow - as if diabetes, heart disease, and cancer have nothing to do with lifestyle). In the UK ones needs the signature of the Home Secretary to give even so much as a drop of ethanol to a research animal, but routine procedures are used to licence the administration of psychostimulants, opiates, etc.
Just for the sake of accuracy, and apart from the issue of addiction treatment, CBT (Cognitive Behavior Therapy) is not an insight oriented therapy. It is a blending of operant conditioning, some classical conditioning techniques, and cognitive change techniques. It has very strong and solid scientific evidence supporting the approach's efficacy in a variety of disorders.

I respect your knowledge of neurobiology, but I would suggest that commenting on psychotherapeutic techniques might be best avoided. No one can know everything, and your knowledge base is genuinely impressive, but commenting on areas where your knowledge is less intensive might, I suggest, be avoided.

I hope that didn't come out sounding rude or offensive...it was not my intent. Just a suggestion...
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Old Dec 30, 2013, 06:46 PM   #15
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Again...and in full knowledge of the cliché nature of the following...there are lots of ways to attempt to treat alcoholism, and no one system fits all.
You are going to spoil the whole internet if you keep on being reasonable and sensible....

That said, I'll confess to a more than creeping suspicion that the OP may be on to something regarding the "sacred cow" nature of the way our society treats AA.

Its been less than two months since I attended the funeral of a friend of mine who died at age 39. He'd been diagnosed with cirrhosis of the liver about 9 months previously. The strange thing was, he talked constantly about going to his (sometimes twice-daily) AA meetings - but I never heard him talking about actually seeing a physician to treat the physical effects of his condition. And so that evening he collapsed and bled to death in his bathroom from an untreated upper-GI bleed, all the sponsors and happy-clappy AA crap didn't do him a damn bit of good.

I don't blame AA for killing Matt: He did that to himself, with his secret drinking and his stubborn refusal to see a Doctor. (Of course, his Tea-Party belief in the inherent wickedness of socialized medicine, the $48,000 debt he owed for his original cirrhosis treatment, and his lack of adequate health-insurance may have also played their parts...)

But AA certainly didn't save him. And apparently a lot of other people either.
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Old Dec 31, 2013, 10:22 AM   #16
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Just for the sake of accuracy, and apart from the issue of addiction treatment, CBT (Cognitive Behavior Therapy) is not an insight oriented therapy. It is a blending of operant conditioning, some classical conditioning techniques, and cognitive change techniques. It has very strong and solid scientific evidence supporting the approach's efficacy in a variety of disorders.

I respect your knowledge of neurobiology, but I would suggest that commenting on psychotherapeutic techniques might be best avoided. No one can know everything, and your knowledge base is genuinely impressive, but commenting on areas where your knowledge is less intensive might, I suggest, be avoided.

I hope that didn't come out sounding rude or offensive...it was not my intent. Just a suggestion...
I am perfectly aware of what CBT is. The 'cognitive change' you refer to is in my opinion very much like insight therapy. They both have the same result - changing a person's beliefs about the world. Don't take this wrong, but when therapists can cure addiction, then I can be lectured to about my lack of knowledge in the field. Mind you, it's not as though the neurobiologists have come up with much useful in treating addiction so far, so we are limited to contributing to the understanding of the disorder...
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Old Dec 31, 2013, 06:57 PM   #17
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Unfortunately, even CBT has the ultimately limitation that drugs are so widespread that it's hard to avoid drug-taking contexts. I think that addicts basically are walking through a motivational minefield of drug-related cues that trigger a lot of information processing that we're not aware of and cannot control.

The pattern seems to be that short- and medium-term abstinence is achievable by many, if not most, addicts. However, long-term relapse tends to be the norm up to middle age or so, no matter what talking treatments are used.
Unfortunately, I believe you. That is to say, most old-timers have seen not a few family, friends, and acquaintances not make it over the years. Drug-taking contexts seem to be as widespread again as they were in the 70's. I keep hoping that more effective medical treatments for drug abuse will be developed one of these years.

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Old Dec 31, 2013, 09:23 PM   #18
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haiku perspective, will be my response to this, because it is late.

nothing is certain

addiction is difficult.

Shrink is likely right.
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Old Jan 3, 2014, 09:45 PM   #19
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The taxation approach to sobriety

Mark Kleiman on why we need to solve our alcohol problem to solve our crime problem

(I'm trying to shorten this, but, there are a lot of angles in this short article.)

Quote:
Matthews: Roughly how much of the crime problem would you attribute to alcohol, percentage-wise?
Kleiman: Half the people in prison were drinking when they did whatever they did...Of the class of people who go to prison, a lot of them are drunk a lot of the time. So that doesn't mean that they wouldn't have done it if they had not been drunk. It's just that being drunk and committing burglary are both parts of their lifestyle. Still, alcohol shortens time horizons, and people with shorter time horizons are more criminally active because they're less scared of the punishment. Most people who drive drunk are sensible enough to know when they're sober that they shouldn't be driving drunk. It's only when they're drunk that they forget they're not supposed to drive drunk.

We need to keep them from drinking, which is what the 24/7 program does.
Quote:
Matthews: Excuse my ignorance, but what's the 24/7 program?

Kleiman: This is something that a guy named Larry Long, who's now a judge but was a district attorney and then attorney general in South Dakota, invented. A second time DUI in South Dakota is prison time. A third of their prisoners are in for DUI. They have miles and miles with nothing to do and no other means of transportation, so they're the perfect storm for drunk driving.

Long got tired of sending people to prison, so he invented a program where they could agree to come in at 7 a.m. and 9 p.m. every day for a breath test with the promise that they'd be in jail if they failed. Forty-seven percent of the people screw up at least once, but more than 99 percent of the tests are taken and passed, and the result is reduced recidivism for DUI and assaultive crime. Beau Kilmer at RAND has a couple of papers showing the impact. It's a proven program for alcohol. We're learning that testing and sanctions is the right way to deal with drug use linked to crime, whatever the drug is and whatever the crime is.
Quote:
The real problem is beer. The beer guys are powerful. It's two thirds of the market. Not only do they have heavy campaign contributions to politicians, because they're state regulated and thus have a stake in state politics, but customers don't dislike their beer company, so if they get a political message from the beer company, they'll respond.

It's easy to say it's just a tax on responsible drinking until you do the math. It would cost a typical beer drinker $36 a year. The man who'd get hit is the 10 beer a day drinker, and he's the guy we want to hit.

Taxation is just about the perfect way to control alcohol use. It's not complete, because you need controls for the real problem drinkers. But if we tripled the alcohol tax it would reduce homicide by 6 percent.
Quote:
Matthews: I know you think the price should be much higher than it is now, but what's the ideal price, do you think, for alcohol once you've taken all the social costs into account?

Kleiman: That's a really really interesting and hard question. The idea of an externality, or specifically of a Pigovian tax, is based on the notion that the harms are homogenous. You figure out what the cost of each and every ton of carbon dioxide is and put a tax on it.

The external costs of drinking are heterogeneous because drinkers are heterogenous. The cost of the second wine you have every day is negative. It's probably good for the world. The cost for the next drink for a mean drunk is going to be dollars, while the average price of the actual drink is about a buck. So there's not a single tax that's the right number both for the casual drinker and for the mean drunk.

So, you can't do this solely with taxation. You need some regulation with the tax. But tripling the tax would add something like $17 billion a year in new revenue. When we were debating how to pay for Obamacare we talked about taxing soft drinks, about taxing tanning beds, taxing plastic surgery, and we actually tax medical devices. Taxing alcohol was never on the list.
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