Sunday, March 15, 2009

More on 12 Step Groups...

At the tail end of an unusually successful week which I hope to allude to more here, I had an e-mail exchange with a relative that was odd, to say the least. This particular relative of mine, a woman, had long had behaviors that most of the rest of my family had considered, ah, unusual, which I won't go into here, but suffice it to say that while her son was growing up, other members of my family, along with myself, concluded that, "He's going to have problems growing up."

He did, exhibited some substance abuse behaviors over a prolonged period of time, got put in rehab, and has been in a 12 Step group for a number of years, and to my knowledge has not re-engaged in those behaviors. Good for him. I hope that he never experiences the downsides of 12 Step programs, which have been well-documented.

Anyway, the other day this relative - the son's mother - sent around to family members an article from Nature, (sorry, no free linky) in which she claimed "studies discussed add new insight into AA and similar programs."

Within this article, despite my relative's claims, no studies' results were actually discussed through the entire article. That I could find. While some papers were listed as footnotes, clearly the publication requirements for Nature do not match the peer review requirements for any of journals in which I've been published.

Now 12 Step programs have never been shown safe and effective for anything (which, when pointed out to my relative she replied that safety and effectiveness for treatments applied only to "drugs and devices," as though things that insurance companies pay for for heath purposes - like 12 Step meeting attendance in rehabs- don't all need to work and it's OK if they hurt you or make you suicidal!) As someone committed to helping all beings transcend suffering, this is appalling, to say the least.

Now I had never read Nature, but as it turns out, it's somewhat less sophisticated than Scientific American, if this article is any judge (the author of the article is a freelance writer, with no scientific, medical, or public health policy background listed in the article). Anyhow, the telltale signs that this was not an article about any of the aforementioned disciplines was here:

Spiritual control
And then there is religion, which has been shown to have a strong inverse association
with drug addiction. Psychologist Michael McCullough, who studies religion and behavior at the University of Miami in Florida, calls this inverse association “one of the most unsung findings in the entire literature on drug and alcohol abuse”. Both adults and children deemed religious by various measures “drink, smoke and do drugs less often”, McCullough says. “If they get into trouble with drinking
and drugs and smoking, they’re more likely to be able to get away from those problems.” McCullough suggests that when a person commits to any cultural system that regulates behavior, the psychological effort to conform strengthens the brain systems that mediate self-monitoring and self-control. “What makes religion unique, I think, is that the code of conduct isn’t just laid down by your parents
or your friends or your principal at school, but ostensibly by the individual who is superintending the Universe, so it has an extra moral

Now, this would make any scientist's alarms go off, because here is an empirically testable claim; it is falsifiable: does religion, specifically a monotheistic religion make one less likely to abuse drugs and alcohol?. We can look at studies of religious people and behaviors.

And the answer is no, it does not. While there is less alcohol consumption amongst sects that prohibit it, we certainly have the experience as a nation with Prohibition (both of alcohol and drugs like marijuana) that shows that prohibiting consumption of substances tends to produce more harmful behaviors than the act itself. The history of alcohol prohibition, for example, was that prohibition produced substantially higher consumption of alcohol (and more unsafe alcohol) than prior to Prohibition. That, plus the explosion in crime, was why it was repealed. This situation has also been observed in teaching sexual abstinence only to youths.

And 12 Step Groups ( links here)?

After several months of indoctrination with A.A. 12-Step dogma, the alcoholics in A.A. were doing five times as much binge drinking as a control group that got no treatment at all, and nine times as much binge drinking as another group that got Rational Behavior Therapy.

It would be unethical to recommend such things, and so it's not surprising that the author of the Nature article is not a member in a profession where such ethical concerns are paramount. We know, at any rate, why these "findings" are "unsung."

It's because they've been found to be false.

Why do people push stuff that's obviously false?

Why did the Bushies push abstinence education? Why does the Catholic Church dissuade people from using condoms for the prevention of many sexually transmitted diseases?

Religious belief. Evidence contrary to one's belief is often discounted.

Let's continue a bit:

Some religious rituals, he says, have been shown to provoke enhanced activity in prefrontal regions. “It’s as if certain forms of prayer and
meditation are pinpointing precisely those [prefrontal] areas of the brain that people rely on to control attention, to control negative emotion and resolve mental conflict.”

There's been studies done on meditation, and it's kind of telling that the author refers to certain forms of prayer and meditation. Which ones? Which ones should someone avoid? I could probably look up studies, but the fact that this is all blurred by the author suggests that this is a point he probably does not want to make.

This blogger became a Zen Buddhist because of the personal efficacy of practicing mindfulness throughout the day. I make no claims regarding the efficacy of my practice on a worldwide scale; and think there was wisdom in dissuading just anyone from joining the temple. While I desire to help all beings transcend suffering, part of the process of skillful means of that is not to proselytize.

However the twelve-step strategies actually work on the brain, “there is now excellent documentation that those who attend AA-type programmes regularly do very well by anyone’s standard”, says Thomas McLellan, director of the Treatment Research
Institute in Philadelphia, Pennsylvania. The problem, McLellan says, is that the
vast majority of people who enter such programmes do not go regularly — they
drop out after a few days or weeks — and are more than likely to relapse.

As long as "anyone's standard" isn't a correlation of attendance with the program and not engaging in abusive behaviors, one might conclude that AA type programs "do very well by anyone's standard."

I could go on. Later on in the article there's a quote about a researcher linking substance abuse issues to "Attention Deficit Hyperactivity Disorder." These two disorders may well be social constructs combined with a great deal of suggestion.

Finally, on this point, it's useful to remember the words of William Blake about 200 years ago: "Prisons are built with the Stones of Law, Brothels with the Bricks of Religion." Prohibition in the form of religion coerced by a monotheistic deity was caught out by the Romantics. No amount of brain jargon will remove that, and such things have the added difficulty that they lack concision and elegance.

How then to deal with substance abuse?

Pay attention. Teach others to pay attention.

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