Author Topic: Safe Injection Sites in Ontario and the Idea of 'Evidence'  (Read 623 times)

0 Members and 0 Guests are viewing this topic.

Offline cybercoma

  • Hero Member
  • *****
  • Posts: 2730
I think spoon-feeding might help.  Why not just provide a link to an article about the study ?
Because then you'll ask why a link to the study wasn't provided and there are numerous studies. Here's one systematic review for you: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685449/


Offline TimG

  • Hero Member
  • *****
  • Posts: 2616
Nonsense? It directly refutes your claim that chasing funding in order to have job security is the reason they're biased.
Except I a never made such a claim. Try reading what I write instead of making stuff up.

guest4

  • Guest
AA/NA is the most widespread addiction treatment program largely because it is free and ubiquitous. It has lasted 80+ years and if it did not help people it would not exist. That is evidence that is far superior to any so called study. There is also are almost no professionals who work with addicts that does not see the value of AA/NA although they will likely see as a supplement to go a long with other treatments. You will get a few professionals who have a hate on for it but they are a small minority.

Happen to have watched a documentary on addiction treatment some time ago.  AA was, for a long time, the only game in town  and it became very familiar; that is the secret of its longevity, not effectiveness.   It does work for some people, clearly, but the evidence suggests it's one of the least effective methods.  Here's an article that covers many of the same points made in the documentary.

https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/

Offline TimG

  • Hero Member
  • *****
  • Posts: 2616
It does work for some people, clearly, but the evidence suggests it's one of the least effective methods.
Your article mentioned that it is impossible to study AA properly because it is "anonymous" so any comparisons to other treatments have to be taken with a grain of salt. More importantly, you can't judge addiction treatment like a black box where addicts are fed in one side and count the number of sober people that come out the other. It just does not work that way. Relapse is a part of recovery so measuring effectiveness requires a longer term outlook (i.e. number of sober days after 1, 3, 5 and 10 years). The author's clear bias against AA was shown by her dismissal of the need to actually "try the program" before it can help. No other medical intervention is judged based on the number of people that refuse to follow the treatment plan. Why should AA be judged by that metric?

More importantly, addiction is a multi-faceted problem and trying to find a single one size fits all solution is wrong headed. i.e. AA cannot help with detox or dual diagnoses (people who are addicts with other conditions such as bipolar disorder). It is a means to deliver cognitive therapy and support to a large number of people cheaply. If naltrexone helps with cravings then it should be used but after 1 year physical cravings are gone and relapse occurs because of a failure to deal with the psychological issues that led to substance abuse in the first place. That is where peer support is invaluable. Who do you really think has a better chance of helping a addict through a crisis: a therapist charging 100/hour who is available 9/5 workdays or a fellow addict that has 20 years of recovery that can be called any time of the day?

Lastly, an abstinence based program is essential to recovery. Telling addicts that they can consume their drug of choice in moderation will generally lead to failure because once under the influence of the drug the addict is no longer going make rational decisions and is much less likely to control consumption. That does not mean that some individuals can make moderation work - it just means that the primary objective of any useful treatment has to be abstinence.

« Last Edit: August 16, 2018, 06:56:01 am by TimG »

Offline ?Impact

  • Hero Member
  • *****
  • Posts: 2941
Your article mentioned that it is impossible to study AA properly because it is "anonymous" so any comparisons to other treatments have to be taken with a grain of salt.

Yes, AA is anonymous so we don't have complete data on it. Generally people quote between 8-15% success rates, compared to 20-45% rates for more modern clinics. The numbers I gave the other day however are based on a study completed about 5 years ago from a sample size of 6,000 people who agreed to long-term monitoring. Again, they were based on people attending for alcohol treatment, not narcotics:

40% of people drop out after a few meetings
27% remain sober for a year
24% remain sober for 1-5 years
13% remain sober for 5-10 years

Offline TimG

  • Hero Member
  • *****
  • Posts: 2616
40% of people drop out after a few meetings
You don't judge a treatment based on the number of people that refuse to follow the treatment plan. So based on your stats 23% of people who actually try the program are sober after 5 years which is pretty good. But even then such stats are misleading because someone may relapse 3 times after 1 year before "getting it" and achieving long term sobriety. How would those kinds of examples fit into the data you quoted?

I also question 20-45% for modern clinics if these numbers are provided by clinics that seek to be paid for treatment. There is a strong incentive to define success in ways that make the clinics look as good as possible while minimizing the benefit of free programs.

More importantly, I don't believe there is any 'magic bullet' out there are all treatment programs have poor success rates but I doubt any can come close to competing with AA/NA on % success/dollar spent.


« Last Edit: August 16, 2018, 07:25:18 am by TimG »

Offline ?Impact

  • Hero Member
  • *****
  • Posts: 2941
You don't judge a treatment based on the number of people that refuse to follow the treatment plan.

Perhaps the reason AA has such a high initial dropout rate is that people realize that it is just a front for the Bible thumpers.

Like Like x 1 View List

Offline TimG

  • Hero Member
  • *****
  • Posts: 2616
Perhaps the reason AA has such a high initial dropout rate is that people realize that it is just a front for the Bible thumpers.
Except it isn't. People who make AA/NA work for them understand the need to move beyond the literal imagery of the steps and find a way to look at them that helps them - even if it means replacing references to "god" with some other image that works for them.

I realize you have a big hate on for anything that smells like religion but you should not let your irrational prejudices cloud your judgement. Remember that addiction is a fundamentally an irrational problem and if using god/spirituality allows an addict to manage their obsessions then why is that a concern?

 As far as the drop rate goes: what is the drop out rate for your unnamed "modern treatments"? My bet is they have manipulated their stats to avoid counting drop outs.
« Last Edit: August 16, 2018, 07:42:22 am by TimG »

Offline ?Impact

  • Hero Member
  • *****
  • Posts: 2941
My bet is they have manipulated their stats to avoid counting drop outs.

More likely they "manipulate" the methods to build on what works and drop that which doesn't. Unlike the Bible thumpers that havn't changed their 12 steps since they were founded 80 years ago, because they are used to following scripture.

Offline TimG

  • Hero Member
  • *****
  • Posts: 2616
More likely they "manipulate" the methods to build on what works and drop that which doesn't.
IOW, you have no clue. You throw around stats without understanding how they were calculated because they give you an excuse to criticize a program that you don't like because of the "god" thing.

The bottom line is AA/NA does work for many people and it is unlikely that its success rate is much less than other treatments once you make sure you are comparing apples to apples. And even if its success rate is lower it helps more people because it is low cost. So the question becomes: what exactly is the problem with AA/NA?
« Last Edit: August 16, 2018, 09:09:02 am by TimG »

Offline ?Impact

  • Hero Member
  • *****
  • Posts: 2941
IOW, you have no clue. You throw around stats without understanding how they were calculated because they give you an excuse to criticize a program that you don't like because of the "god" thing.

The bottom line is AA/NA does work for many people and it is unlikely that its success rate is much less than other treatments if once you make sure you are comparing apples to apples. And even if its success rate is lower it helps more people because it is low cost. So the question becomes: what exactly is the problem with AA/NA?

If you go back to my first comment on the matter, I clearly said that AA does some good work. I am not knocking them, just putting them in their place. It seems very clear that success rates of other programs are better, and yes I do have a clue. I am not saying to get rid of AA, just be realistic. Don't allow people to die of overdoses or infections, just because AA gives them a faint hope of curing their addiction therefore if they don't follow it they deserve to die as you seem to think.

Offline TimG

  • Hero Member
  • *****
  • Posts: 2616
Don't allow people to die of overdoses or infections, just because AA gives them a faint hope of curing their addiction therefore if they don't follow it they deserve to die as you seem to think.
This tangent started because you rejected my argument that SIS prolong addiction because they enable addicts because it was a 'AA thing' and therefore not real. You later seemed to accept that the risk of enabling an addicts is real but felt it is worth the trade off if lives can be saved. The latter is a reasonable argument that I don't necessarily agree with.

My primary concern about SIS is they suck limited resources away from the programs that are really needed such as detox beds and recovery support services. If detox and support services were fully funded then I could see the value of SIS but as long as these services are underfunded SIS are a distraction that allow politicians to get away with under-funding recovery supports services because they are seen to be "doing something" even if that "something" is making the problem worse.

Offline ?Impact

  • Hero Member
  • *****
  • Posts: 2941
My primary concern about SIS is they suck limited resources away from the programs that are really needed such as detox beds and recovery support services.

It is right wing politicians that suck resources away from programs. The money spent on SISs is very minimal compared to the number of lives they save. Yes lets have more and better detox facilities, but you will still have better return from an SIS. Most significant is the money saved in the health care system due to fewer infections is far more than what is spent on SISs.

Offline TimG

  • Hero Member
  • *****
  • Posts: 2616
Yes lets have more and better detox facilities, but you will still have better return from an SIS.
Not if addiction is prolonged because addicts are more comfortable continuing in their addiction. A shortage of detox beds will make this outcome more likely.

Most significant is the money saved in the health care system due to fewer infections is far more than what is spent on SISs.
This argument I agree with but I am more concerned with saving lives by getting addicts clean.

Offline ?Impact

  • Hero Member
  • *****
  • Posts: 2941
Not if addiction is prolonged because addicts are more comfortable continuing in their addiction.

You know very little about addiction if you think fear of infection or death is an effective motivation factor.

If we followed your wasting resource logic, then we should get rid of ambulances and spend that money on more hospital beds.