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Alcoholism is a Learned Behaviour Disorder

by Sven Triloqvist Sun Jan 2nd, 2011 at 07:32:11 AM EST

Today, a few hours from annual general leglessness of a more complex kind, is as good a time as any to revisit this subject, which I have been following for many years, and which I have frequently tried to elucidate here at ET.

The new drug announced below goes a long way back to the Sinclair Method. Dr Sinclair is a good friend of mine and any discussion with him is inspiring: but on the subject of the treatment of alcoholism he is an expert. I'd like briefly revisit the history, but first read the (partly misinformed) news today...

a discussion for the hung-over - Nomad


Yle: Finnish Remedy for Alcoholism on the Market in 2012

New medication aimed at reducing alcohol dependency could be on the market in just over a year's time. The new medicine is said to lessen the urge to drink excessive amounts of alcohol.

The new drug, called Nalmefene, has been developed by Biotie Therapies in Turku, south western Finland. The Danish Lundbeck company purchased the license for the drug in 2006 and results from its clinical trials will soon be available.

Expectations are high for the new medicine. The previous medicinal remedy for alcoholism was developed well over a decade ago.

Pekka Heinälä, the Chief Physician of the A-Clinic Foundation, says that current such medication can have side-effects for some patients.

"Nalmefene will be a good additional means of therapy," he says.

Nalmefene does not prevent someone from drinking alcohol. Its function is to limit drinking by inhibiting processes in the brain that lead to continuous, uncontrollable alcohol consumption.

Nalmefene is not a new drug, though its action as an opioid blocker (`opioid receptor antagonist' to give it is medical name) is a more recent discovery. Nalmefene replaces a similar blocker called Naltrexone which had the unfortunate (for alcoholics) side effect of being highly toxic to the liver.

The Sinclair Method clinical trials were made using Naltrexone. The wiki goes into the science and history of the method, so I won't repeat it here again.

Nalmafene, as I said, has been around a long time. But the small US pharma that found it and made it, never knew what to do with it. Due, as I recall, to a bankruptcy (it could have been a buy-out) the rights to Nalmafene were offered to the highest bidder. Dr Sinclair and his partners, who had founded both a clinic for treatment and a company to produce an opioid blocker, were keen to acquire those rights. The rest of that story I'll have to leave untold for legal reasons.

My hope is that the `new' drug will be produced and prescribed according to the Sinclair Method. There is good chance it will not.

At the heart of traditional treatments for alcoholism is the idea that you have to stop drinking before you can be treated. Alcoholism has nothing to do with `willpower', it's a Learned Behaviour Disorder, and it is treatable when you know how to cheat the opioidergic system.

Tell me how you feel tomorrow...

Display:
As a confirmed beer bore, I've known more than a few people in my time who became alcoholic. Sadly, most of them had no support network, aside from that of their fellow alcoholics, and descended into their own hell.

It's hard to maintain a relationship with an alcoholic acquaintance; for starters they don't seem to want to know anyone who isn't like them, or at least willing to drink alongside them.

You can do that for a bit, but, their disintegration is hard to watch. A work colleague, who was a lovely woman, simply fell apart and there was nothing anyone, her parents included, could do to help her.

For me, alcohol is fun. I don't drink anything like I used to, but even then, I'd always want a day or two off after a couple of days on. To me, being drunk only makes sense if I've been sober, otherwise it just gets boring. I have no idea what wanting to be drunk all the time feels like and I'm relieved that I'm not wired that way. Anything that can help those who get lost in it is to be welcomed

keep to the Fen Causeway

by Helen (lareinagal at yahoo dot co dot uk) on Fri Dec 31st, 2010 at 09:31:52 AM EST
My late wife worked in addiction therapy for many years.  Alcohol addiction was often more difficult to treat than heroin and she become more and more convinced of the need for holistic methods including family support, peer support, alternative therapies (acupuncture, Reiki, etc.), drug substitution (methadone) together with training and employment programmes designed to build up self-esteem and self-sufficiency. The centre she built up has ended up having a very good success rate, but it often takes years - and yes it does take will-power and the active participation of the client and support of his/her family.  To my knowledge there never was a particularly effective pharmaceutical solution - or at least one which worked in isolation.  I doubt whether Nalmefene is a magic bullet either, but anything which improves on the very limited options currently available has to be a good thing.  When is it likely to become generally available?

Index of Frank's Diaries
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Fri Dec 31st, 2010 at 11:36:10 AM EST
It is available now, but there are still some regulation hurdles. I guess those should be cleared by 2012.

I disagree that willpower plays any part, certainly if a patient is up to a bottle of spirits a day - any more than willpower has anything to do with healing a broken leg.

The treatments carried out by the Sinclair Clinic in Espoo showed 70% of alcoholics who were approved for naltrexone (the toxic one) had got their drinking down to manageable levels within 6 months. As long as they took the blocker before drinking, they continued to recover. And many of these patients were bottle a day types.

The main problem is that for these people, drinking dominated their lives, and when that behaviour starts to be erased, there is a behavioural void for which counselling is needed.

But theoretically, opioid blockers work in such a way that IF every alcoholic drink contained a small does of nalmefene, nobody would become an alcoholic.

You can't be me, I'm taken

by Sven Triloqvist on Fri Dec 31st, 2010 at 12:09:08 PM EST
[ Parent ]
Will power is needed even if only to be self-disciplined enough to keep taking the tablets. Willpower can even help you to recover from a broken leg quicker!

The medicalisation of addiction treatment has been a failure the world over, and better drugs, even if they help that situation will do nothing to address the economic, social, psychological, personal and cultural factors which can also contribute to addiction of various kinds.  Simple counselling doesn't go very far either, although it too is part of the holistic approach used in the Muriel Boothman Centre.

Index of Frank's Diaries

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Fri Dec 31st, 2010 at 12:24:58 PM EST
[ Parent ]
The medicalisation of addiction treatment has been a failure the world over, and better drugs, even if they help that situation will do nothing to address the economic, social, psychological, personal and cultural factors which can also contribute to addiction of various kinds.

Every disease, e.g., alcoholism, has "economic, social, psychological, personal and cultural factors."  Once a person is infected with cholera, say, giving them a job isn't going do a bit of good; neither is a heavy duty dose of "talky-talk" psychological therapy.  Cholera needs to be treated by replacing fluids and salts and a course of antibiotics.

Alcoholism has the special kicker that the person having the disease is the vector of the disease.  Interestingly, there seems to be a population with a neurological predisposition for alcoholism; anecdotal evidence (insert caveats as to the low  quality of such!) informs us some people become alcoholics after one drink, even if they dislike the taste of alcohol.  Other people require a continuous, long term, exposure to alcohol before developing the disease.  This is in-line with other diseases like cholera were some people are quickly overwhelmed by the bacteria while others can resist the bacteria for some time before developing symptoms.

She believed in nothing; only her skepticism kept her from being an atheist. -- Jean-Paul Sartre

by ATinNM on Fri Dec 31st, 2010 at 01:54:18 PM EST
[ Parent ]
ATinNM:
Every disease, e.g., alcoholism, has "economic, social, psychological, personal and cultural factors."  Once a person is infected with cholera, say, giving them a job isn't going do a bit of good; neither is a heavy duty dose of "talky-talk" psychological therapy.

There are differences, and I'm not even sure that alcoholism should be described as a disease.  For instance there are v. effective medical treatments for Cholera and the disease probably wouldn't exist now but for "economic, social, psychological, personal and cultural factors".

The major difference is that there has (up until now in any case) been almost no effective purely medical treatment for alcoholism - the medical model hasn't done a whole lot better than faith healing in that respect.

I don't doubt that there are genetic and other neurological/physical factors which influence the likelihood of addiction, and hopefully effective gene or other therapies will be discovered which will eliminate those.  Many children of alcoholics I know won't drink any alcohol for fear of addiction and having experienced the damage done at first hand.

I don't think we disagree all that much, I just think Sven's total denial of willpower/motivation as a factor is a bit strong and his faith in medical "cures" is not borne out by the evidence to date.  As things stand, the medical profession's attempt to characterise alcoholism as a disease and control its treatment (thus excluding many alternative treatments and professions) is a power play which has been relatively unsuccessful in terms of actual achievement.

The narrative framing of alcoholism as a disease requiring a medically managed cure diminishes both the patient and their prospects of recovery.

If the medical profession DO come up with an effective treatment I am more than happy that they should take control of the therapeutic process, but even successful medical interventions often require a great deal patient advocacy and motivation and my biggest problem with "the conventional medical model" is that it dis-empowers patients and often actually hinders their recovery.

Index of Frank's Diaries

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Fri Dec 31st, 2010 at 03:10:56 PM EST
[ Parent ]
I agree we don't substantially disagree.  

Something may be incurable and still be a disease.  Otherwise you'd have to say bubonic plague only became a disease when antibiotics were discovered.  My point was: alcoholism has a physical component that must be addressed, solved, for the intervention to be better than the "cure" rate of a placebo.

This is not to say the "Mind" side is irrelevant.  It seems to (un-professional me :-) the evidence strongly suggests alcoholism is a Mind/Brain disease and needs to be attacked with psychological as well as physical intervention. At a minimum, as you rightly pointed-out, the patient has to have the Willpower to take the damn pill.  Something, BTW, not limited to alcoholics; in the US people are being forceably hospitalized for tuberculous since it has been proven enough patients don't take the full course of medication, they relapse, and TB is starting to develop resistance to antibiotics because of this.  


She believed in nothing; only her skepticism kept her from being an atheist. -- Jean-Paul Sartre

by ATinNM on Fri Dec 31st, 2010 at 04:29:00 PM EST
[ Parent ]
my reasons for resisting the "alcoholism as disease" framing are not limited to the lack of efficacy of the medical paradigm, although that would be a major reason.

The "learned behaviour disorder" framing emphasises the fact that like all behaviours, learned behaviours can be unlearned and thus behaviour modification techniques, personal motivation, social interactions, institutional supports and alternative exemplars, mentoring and leadership take centre stage. Behaviour is not reducible to biochemistry even though the latter can of course be a major component of it.

Index of Frank's Diaries

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Fri Dec 31st, 2010 at 09:34:36 PM EST
[ Parent ]
Frank Schnittger:
there are v. effective medical treatments for Cholera and the disease probably wouldn't exist now but for "economic, social, psychological, personal and cultural factors".
Smallpox has been eradicated. Does that mean smallpox is not a disease?

Of all the ways of organizing banking, the worst is the one we have today — Mervyn King, 25 October 2010
by Migeru (migeru at eurotrib dot com) on Mon Jan 3rd, 2011 at 05:13:34 AM EST
[ Parent ]
If the clinical trials referenced are phase I or II, then it will take until the middle of this decade. But Sven's comments lead me to believe that they're stage III trials. If so, and assuming the trials demonstrate efficacy and no unexpected complications show up relative to the phase II trial, it should be possible to get it approved for the sort of patients the trial(s) have demonstrated efficacy in before this time next year.

Normally, there will be subsequent clinical trials that seek to expand the drug to more marginal patient groups/disorders. Clinical trials usually start with the most promising uses, on the theory that if you don't get a signal from your most promising trial then you probably won't get a signal at all (and commercially it's better to start with a strong effect and then move to more marginal groups than the other way around).

- Jake

Friends come and go. Enemies accumulate.

by JakeS (JangoSierra 'at' gmail 'dot' com) on Fri Dec 31st, 2010 at 12:17:03 PM EST
[ Parent ]
Way to go Sven. Timing is everything. Couldn't you have waited until we were entering the new year hung over?

(insert serious comment regarding a serious global problem here.)

"Life shrinks or expands in proportion to one's courage." - Anas Nin

by Crazy Horse on Fri Dec 31st, 2010 at 03:17:56 PM EST
When my best friend became a sloppy and belligerent drunk, all of us who were his friends told him, "We love you, we like to be with you but not when you've been drinking."  Turns out, it was the right thing to do.

He became sober through AA and through him I learned about Anne Wilson Schaef and her books When Society Becomes an Addict and The Addictive Organization.  They explain a lot more than alcohol addiction.  They delineate the addictive thought process and thinking system.  It helps explain, for me, the political dysfunction in my own country, the USA, and how power structures maintain control.

All of this brain chemistry as well as psychology and behavioral patterning.  You can make adjustments using any and all of these techniques.  However, I would beware of the "magic bullet" theory:  if you just did x, it would solve your problem.  Problems don't exist outside of systems and x might do wonders for your brain chemistry while leaving your detrimental social network or negative psychological state(s) in place.  Magic bullet thinking is prevalent in our technological world (and a symptom of the addictive system).  Systems thinking is rare indeed.

Solar IS Civil Defense

by gmoke on Fri Dec 31st, 2010 at 05:16:54 PM EST
In the super master of the science meeting of European Neuroscience I tried to make the point that alcoholism is a Learned Behavior Disorder.. obviously I could not make the point to the great masters.. but I could do that with the students.. to get an idea what the masters of Neuroscience think...

Unfortunately, they just do not get it... rat receives alcohol, rat does this and that, I give the rat that and then he does that... no way to point them that the social behavior of rats is slightly different than humans. Fortunately, there seems to be that much money into it, that eventually something can come make which can be useful regarding the physical drive..or not. As far as it goes I guess alcoholics will have to unlearn the behavior the standard way.. with a majority of people visiting people who do no have any idea of anthropology and rarely gets what "Learned behavior" means.. with a little bit of luck they can try someone smart who can help.

A pleasure

I therefore claim to show, not how men think in myths, but how myths operate in men's minds without their being aware of the fact. Levi-Strauss, Claude

by kcurie on Fri Dec 31st, 2010 at 05:33:25 PM EST
All about Long Term Potentiation and the neurology, psychology (writ large,) and the neurology + psychology.

The last, for me, is the most misunderstood.  Using the standard analogy, to get a computer to "do" something the requirements are usually given as:

  1.  hardware

  2.  software

  3.  running the program on the hardware

But that's only true in the grossest sense.

The hardware comprises more than physical objects, e.g., microcode.  The software depends on programming language, compilers, & etc. as well as the exact hardware environment since part of that is user defined, e.g., which port the printer is hooked up to.  Once the program is running how it affects the system depends on how the user uses the program, e.g. computer viruses.    

And, of course, to make things even more fun the hardware is constantly changing in and from subtle to  gross ways.  The software ditto, the hardware plus software ditto, and the current running program can self-modify.

Wheeeeeeeeeeeeeeeeeee!

She believed in nothing; only her skepticism kept her from being an atheist. -- Jean-Paul Sartre

by ATinNM on Sun Jan 2nd, 2011 at 12:26:58 PM EST
[ Parent ]
In a sense the hardware, software analogy is only true at the extremes, that is, basic brain architecture is hardware, and basic structural mythology is software.. but the living reality, as you say, is the messy middle when everything modifies everything.

I am happy enough if they would recall a little the basic sociological aspects of the pshychology-effect in the pattern of learning which modifies the physical driving. Not that most of the people there understand any of it.. most of them fear a computer if it does not use Exce or the statistics universal program (not named here to avoid a publicity stunt).

A pleasure

I therefore claim to show, not how men think in myths, but how myths operate in men's minds without their being aware of the fact. Levi-Strauss, Claude

by kcurie on Sun Jan 2nd, 2011 at 03:39:18 PM EST
[ Parent ]
In a sense the hardware, software analogy is only true at the extremes, that is, basic brain architecture is hardware, and basic structural mythology is software..

I'm not sure what you mean by "structural mythology."  Could you please point me to a definition?

Sapolsky at Stanford seems to get "the basic sociological aspects of the psychology-effect in the pattern of learning which modifies the physical driving."  He's been studying the Forest Troop and has come-up with some interesting findings.

...but the living reality, as you say, is the messy middle when everything modifies everything.

This reminds me of the John Nash response when someone asked him, after his paranoid schizophrenia was overcome, why a man who had accomplished so much intellectually got to a point where he thought "there was an organization chasing him, in which all men wore red ties."  [From the link]  His response was, "That idea came to me in the same way as my previous ideas."

Heh.  Indeed they do.

She believed in nothing; only her skepticism kept her from being an atheist. -- Jean-Paul Sartre

by ATinNM on Sun Jan 2nd, 2011 at 04:33:53 PM EST
[ Parent ]
Reading Sapolski with delight....

Regarding structural mythologies, most antrhopologists just call them myths we live by.. but I do not like to use the word myth in non-scientific enviros given the wrong connotation it has.

A more proper name are structural narratives... I did a diary once.. oh my God I found it.. and it was more than a year ago...

http://www.eurotrib.com/story/2009/8/27/103113/865

there are no links in the diary.. but any symbolic anthropology textbook is full of examples.

A pleasure

I therefore claim to show, not how men think in myths, but how myths operate in men's minds without their being aware of the fact. Levi-Strauss, Claude

by kcurie on Sun Jan 2nd, 2011 at 07:29:55 PM EST
[ Parent ]
thanks for the link


She believed in nothing; only her skepticism kept her from being an atheist. -- Jean-Paul Sartre
by ATinNM on Mon Jan 3rd, 2011 at 11:58:16 AM EST
[ Parent ]
kcurie:
most antrhopologists just call them myths we live by.. but I do not like to use the word myth in non-scientific enviros given the wrong connotation it has
Take a cue from George Lakoff and call them Metaphors We Live By.

Of all the ways of organizing banking, the worst is the one we have today — Mervyn King, 25 October 2010
by Migeru (migeru at eurotrib dot com) on Mon Jan 3rd, 2011 at 12:18:35 PM EST
[ Parent ]
The implications of this are larger than just alcohol.

From the above-cited Wikipedia entry:

Sex, exercise, eating, and risk taking generally result in the release of endorphins

So opoid receptor antagonists could conceivably be used not only in anti-obesity therapy, but also to curb dumbass risk-taking behavior, say, of financial traders.

Wouldn't it be interesting if a financial regulator were to require all persons involved financialization to take Nalmafene twice a day?

The fact is that what we're experiencing right now is a top-down disaster. -Paul Krugman

by dvx (dvx.clt t gmail dotcom) on Sun Jan 2nd, 2011 at 10:37:49 AM EST
That would be highly unethical. As in "we made these rules after the second world war for a reason" unethical.

'Sides, you can probably get the same magnitude of effect if you put 'em all though coke rehab.

- Jake

Friends come and go. Enemies accumulate.

by JakeS (JangoSierra 'at' gmail 'dot' com) on Sun Jan 2nd, 2011 at 10:57:00 AM EST
[ Parent ]
I don't see the ethical problem as all that dramatic, other things being equal (i.e. the side effects of the antagonists are negligible).

Traders who don't want to waive the rush would be free to go into useful work. And individuals who are currently working as traders could be offered backoffice jobs.

I'm not advocating compulsion. But there is a public interest in preventing financial traders from hotdogging.

Besides, Nalmafene would presumably constitute an effective coke rehab therapy in its own right.

The fact is that what we're experiencing right now is a top-down disaster. -Paul Krugman

by dvx (dvx.clt t gmail dotcom) on Sun Jan 2nd, 2011 at 03:52:54 PM EST
[ Parent ]
But isn't the whole point of gambling and trading not the "buzz"?

Index of Frank's Diaries
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Sun Jan 2nd, 2011 at 04:14:59 PM EST
[ Parent ]
The bonuses are also part of the buzz.

If alcohol is a learned behaviour disorder, so is capitalism.

We're being run by monkeys pressing levers for a repeat hit.

And I mean that quite literally.

by ThatBritGuy (thatbritguy (at) googlemail.com) on Sun Jan 2nd, 2011 at 04:40:13 PM EST
[ Parent ]
And the monkeys are looked after by incompetent politicians who think their jobs depend on the number of levers pushed, who are in turn voted for by a majority of people with other levers called remote controls that allow them to almost instantly enter a hypnagogic state in which reality and fiction are impossibly entangled.

Mind you, we are all struggling to unravel.

You can't be me, I'm taken

by Sven Triloqvist on Sun Jan 2nd, 2011 at 05:01:17 PM EST
[ Parent ]
I don't see the ethical problem as all that dramatic, other things being equal (i.e. the side effects of the antagonists are negligible).

Negligible compared to what? Psychoactive drugs always have non-negligible side effects - at a bare minimum, they can cause their intended effect in people who don't need that effect. And a clinical trial that demonstrates that the side effects are less bad than addiction is far cry from demonstrating that it's harmless enough to be added to the general water supply on Manhatten.

I'm not advocating compulsion.

Because "take this drug or you lose your job" isn't compulsion? That is a very scary precedent to set.

But there is a public interest in preventing financial traders from hotdogging.

Of course. That is why we have financial regulators.

But enough public interest to justify violating the principle of informed consent? We don't even do that for the polio vaccine, and wiping out polio is a clear-cut case of public interest if I've ever seen one.

If you want traders to stop gambling with other people's money, you change the rules of operation of the stock exchange so they can't do it. You don't spike their lunch with psychopharmaca. We've been down that road before, and that's a really ugly neighbourhood.

- Jake

Friends come and go. Enemies accumulate.

by JakeS (JangoSierra 'at' gmail 'dot' com) on Sun Jan 2nd, 2011 at 05:10:20 PM EST
[ Parent ]
I'm not sure that nalmefene can be used in treating cocaine abuse. Coke has a dopaminergic effect which modulates neurotransmission, although it is also linked to the opioidergic system.

Nalmefene has a molecular shape that allows it 'block' neuronal endorphin receptors (like a fake key stuck in a lock that can't open the door). If endorphins enter the receptors of firing neurons, they promote new dendritic growth to neighbouring neurons that were also firing at the time of reception. That's how behaviour becomes hardwired - literally.

When neuronal receptors for endorphins are blocked, the process is 'reversed'. i.e. if the stimulation of a neuron by endorphin does not happen because of the blocking, then existing dendritic connections are weakened over time. That is essentially what the nalmefene treatment entails - 'forgetting' behaviour'. Although such behaviour can be quickly 'remembered' again by unblocked stimulation.

Whereas (if I understand it correctly) stimulated dopamine receptors modulate transmission across the synaptic gap. Which is a whole different kettle of students.

I don't know if dopaminergic antagonists have yet been discovered.

You can't be me, I'm taken

by Sven Triloqvist on Sun Jan 2nd, 2011 at 05:33:57 PM EST
[ Parent ]
It is a feature of the Sinclair Method treatment that any endorphin-related activity that you do NOT want to erase, has to be curtailed during treatment, or only allowed on special days; meaning chocs, pornography, gambling, jogging through the pain barrier, chilli, tattooing and piercing - among others.

Nalmefene is also known to work with heroin abuse. Providing, as with alcohol, the blocker is taken before the heroin. The FDA has not approved it for this use yet.

You can't be me, I'm taken

by Sven Triloqvist on Sun Jan 2nd, 2011 at 11:17:03 AM EST
[ Parent ]
heh, this reminds me of a friend, who every time he went on holiday, would religiously pack his 'how to give up smoking' tapes and books right next to his tobacco stash in his suitcase.

so if you're about to go out drinking with your buddies, and if you take the drug, you're going to get a subdued endorphin rush, whether it's from the booze or the company, entertainment etc.?

semi-numb to pleasure, basically?

excuse me if i have missed something, but aren't the only kind of alkies this might work with are the type who unplug the phone, shut the door and get sozzled in lugubrious oblivion, and yet are mature enough to know that they don't want this to be a pattern, so take the drug first too. i guess it will take a drug like this to see how many with this advanced stage of the 'disorder' show up to try it.

this drug sounds like a biochemical feedback machine, a 'lite' aversion therapy, it will be interesting to see how many lives this affects, and if there are long term side effects which are not revealed by the trials.

maybe a simpler way might be biofeedback training, without the chemical in the middle.

thanks for being the resident neurochemistry fan, sven, (and AT)!

there are plenty of teetotallers who already feel like a bishop at an orgy when they go out at a company bender, likewise the designated driver.

what fascinates me is how the drug regulates the drinking back to 'appropriate', ie after a couple of glasses of wine, all of a sudden the next glass doesn't appeal.

perhaps i misunderstood!

anything that helps with the hell that is alcoholism is worth trying.

the discussion about hardware and software modding each other was interesting. kc's point about the myths being the software rung a bell.

taking the analogy further, i suspect one day we will look at many cultural patrimonies as forms of malware installed on the citizen's hard drive before they are of an age to have their own password privileges.

which they then spend their adult lives trying to uninstall, or write macros to limit damage, and using up a lot of energy doing so. personally i feel many people use alcohol to absolve themselves of responsibility, as in 'i did that, really?' musta been the booze, hehe, and everyone hehe's right along because they feel an equal need to 'get out of their heads' too sometimes, so it becomes socially reinforced.

till we address those reasons for wanting to get hammered, removing the alcohol still leaves, as Frank infers also, a whole void to fill with different, less self-destructive activities.

like bungee jumping fr'example, lol.

people are bored, they'll do pretty much anything to change channel, get out of the rut. i have recently heard of the second acquaintance who has taken up hangliding, parasailing. the least likely people i would have ever imagined to fall for (!) something that darwinian, but they are head over heels, ouch, it's the holy grail.

nature has funny ways of thinning out the population, i guess. if they designed a unit that self-ignited spectacularly on its way down, there'd be some salivating consumers rapt in wide-eyed joy lining up to try it.

whatcha gonna do?

'The history of public debt is full of irony. It rarely follows our ideas of order and justice.' Thomas Piketty

by melo (melometa4(at)gmail.com) on Mon Jan 3rd, 2011 at 02:52:25 PM EST
[ Parent ]
There are 2 basic ways to treat Learned Behaviour Disorders: remove all the stimulii that trigger the behaviour (for a time), or prevent reinforcement of the behaviour.

In the case of alcohol, the stimulii are hard to remove because we have learned to drink so many different drinks in so many different places at different times of the day, in different company. It is a very complex behaviour.

But theoretically, if you had only ever drunk one cider a day at 6pm, alone in a red room, wearing a monkey suit, then the unavailability of those stimulii would, over time, erase the behaviour.

Being unable to remove the stimulii, the answer to alcoholism is to prevent reinforcement with, for instance, opioid blockers. For most of us, alcohol is a learned behaviour but not a disorder. It becomes a disorder when it becomes a dominant behaviour that is personally destructive. Before this point, other treatments can be beneficial (except punishment), while alternative behaviours should be encouraged before they are suppressed by the increasingly dominant behaviour of finding and drinking alcohol.

So I agree with Frank that counselling - encouraging and facilitating alternate behaviours - does work. The old behaviours, like an old romance, can sometimes be revived. But beyond a certain point, when the drinking behaviour has become dominant - to the exclusion of all else - the only intervention is the biochemical prevention of reinforcement.

You can't be me, I'm taken

by Sven Triloqvist on Mon Jan 3rd, 2011 at 05:33:24 PM EST
[ Parent ]
I am only posting because it may help someone with this problem.  

The little pill that could cure alcoholism
When an alcoholic doctor began experimenting with Baclofen, he made what could be the medical breakthrough of the century

http://www.guardian.co.uk/society/2010/may/09/alcoholism-health-doctor-addiction-drug?INTCMP=SRCH

Good-bye.

by stevesim on Wed Jan 5th, 2011 at 09:58:33 AM EST
I don't know why you say goodbye
I say hello
hello, hello
I don't know why you say goodbye I say hello
Hello-o-o

Hela, heba helloa
Hela, heba helloa

by afew (afew(a in a circle)eurotrib_dot_com) on Wed Jan 5th, 2011 at 10:39:31 AM EST
[ Parent ]
GABA is very interesting because it powers inhibitory neurons. Sinclair at one time suggested that, as inhibitory neurons must replenish their supplies of GABA as we sleep, and therefore do not function, dreams may be partly the result of uninhibited excitement of neural networks.

You can't be me, I'm taken
by Sven Triloqvist on Wed Jan 5th, 2011 at 10:59:54 AM EST
[ Parent ]
Come back, Steve! Many of us have been through the pain barrier of having our ideas brutally contested. And there's plenty of rewarding endorphins for you on the other side...

You can't be me, I'm taken
by Sven Triloqvist on Wed Jan 5th, 2011 at 11:03:06 AM EST
[ Parent ]
don't be a stranger, steve!

'The history of public debt is full of irony. It rarely follows our ideas of order and justice.' Thomas Piketty
by melo (melometa4(at)gmail.com) on Wed Jan 5th, 2011 at 12:23:30 PM EST
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