Medical Immunity (to addiction)....

[Gooddoctordoc]

I am a 72 year Caucasian male who quit drinking at 50 after having been an alcoholic for 36 years. Many is the time that I have awakened the next day with an empty liter bottle of VO or Cutty Sark close at hand. I suppose that if I had not been 90 lbs overweight, it would have killed me. When I quit, naturally I thought that I would need the services of a treatment center. I had my family doctor check me into a dry out place in Waco. To make a long story short, my psychiatrist at the facility released me on the fourth day. I never thought about a drink, I never wanted a drink, and I had no withdrawal. It's the same to this day. I asked my doctor how this was possible, and he said that he did not know. There must be a certain percentage of the population that cannot become addicted to alcohol, and I must be one of them. What say you?

 

[Fervent Freyja]

I am a 72 year Caucasian male who quit drinking at 50 after having been an alcoholic for 36 years.

There must be a certain percentage of the population that cannot become addicted to alcohol, and I must be one of them. What say you?

I say, that you have contradicted yourself...

 

[jim hardy]

There must be a certain percentage of the population that cannot become addicted to alcohol, and I must be one of them. What say you?

Sounds plausible.

Addiction can be psychological or physical or both.
Not everybody metabolizes alcohol the same.
If you had no physical craving my guess is you have the "lucky" gene for alcohol metabolism so don't get a very high acetaldehyde peak.
Did you have blackouts ?Here's an excerpt from a decent article
http://pubs.niaaa.nih.gov/publications/arh294/245-255.htm

Genetic Variation in ADH and ALDH
Class I ADH and ALDH2 play a central role in alcohol metabolism. Variations in the genes encoding ADH and ALDH produce alcohol- and acetaldehyde-metabolizing enzymes that vary in activity. This genetic variability influences a person’s susceptibility to developing alcoholism and alcohol-related tissue damage.

ADH. The ADH gene family encodes enzymes that metabolize various substances, including ethanol. The activity of these enzymes varies across different organs (see Table 1). When ethanol is present, the metabolism of the other substances that ADH acts on may be inhibited, which may contribute to ethanol-induced tissue damage.

.

old jim

 

[Student100]

This is normal, there are always segments of the population that don't become addictied to a substance after regular use.

Some substances are more addictive.

The majority who smoke become addictied, but there are those who can remain longterm casual smokers who experience no withdraw or cravings during periods of abstinence.

I'm not one of them. : (

The majority who drink alcohol don't become addicted, but some do.Simply because you don't have a physiological addiction doesn't mean you aren't addicted. In your case it sounds like the alcohol dependence was a result of environmental/psychological factors.

 

[Fervent Freyja]

Simply because you don't have a physiological addiction doesn't mean you aren't addicted. In your case it sounds like the alcohol dependence was a result of environmental/psychological factors.

Still, all people addicted to alcohol should take precaution during withdrawal! We should assume that it's dangerous for all people, even if there is a small minority that don't have the same withdrawal risks and somehow aren't physiologically addicted (whatever that means). Until a person can be tested and proven to safety recover without healthcare assistance, then they should take it seriously! And don't you know, how many people have made the claim to be so unaffected by alcohol that they can still safely drive and function normally while drinking? It wouldn't surprise me to read that they also believe they aren't subject to withdrawal symptoms or even addiction.

From: http://pubs.niaaa.nih.gov/publications/arh22-1/61-66.pdf

Acute Alcohol Withdrawal Syndrome Alcohol withdrawal is a distinctive clinical syndrome with potentially serious consequences (see table) (American Psychiatric Association 1994). Symptoms begin as early as 6 hours after the initial decline from peak intoxication. Initial symptoms include tremor, anxiety, insomnia, restlessness, and nausea. Particularly in mildly alcohol-dependent persons, these symptoms may comprise the entire syndrome and may subside without treatment after a few days. More serious withdrawal symptoms occur in approximately 10 percent of patients. These symptoms include a low-grade fever, rapid breathing, tremor, and profuse sweating. The time course of withdrawal is outlined in the figure on p. 63. Seizures may occur in more than 5 percent of untreated patients in acute alcohol withdrawal. Another severe complication is delirium tremens (DT’s), which is characterized by hallucinations, mental confusion, and disorientation. The mortality rate among patients exhibiting DT’s is 5 to 25 percent.

 

[Ygggdrasil]

There is evidence that genetics can influence individuals' susceptibility to addictive behavior: http://learn.genetics.utah.edu/content/addiction/genes/

However, the are considerable environmental factors as well (e.g. ones upbringing, access to treatment, social pressures, etc.).

 

[jim hardy]

The early part of this book has a not-too-technical explanation of the variations in body chemistry that make some people more vulnerable than others.

http://www.barnesandnoble.com/w/under-the-influence-james-r-milam/1102541472

 

[Student100]

Still, all people addicted to alcohol should take precaution during withdrawal! We should assume that it's dangerous for all people, even if there is a small minority that don't have the same withdrawal risks and somehow aren't physiologically addicted (whatever that means).

It means what it sounds like, most peoples bodies don't develop a dependence on alcohol and they experience no withdraw symptoms.

until a person can be tested and proven to safety recover without healthcare assistance, then they should take it seriously!

Of course, any long time drinker who experiences symptoms of withdraw should go to the ER for monitoring. The seriousness of withdraw is overblown though, very few require in-patient monitoring. That said, only a doctor can make that determination.

And don't you know, how many people have made the claim to be so unaffected by alcohol that they can still safely drive and function normally while drinking? It wouldn't surprise me to read that they also believe they aren't subject to withdrawal symptoms or even addiction.

From: http://pubs.niaaa.nih.gov/publications/arh22-1/61-66.pdf

I don't see the correlation between thinking you can function on alcohol and thinking you won't have withdraw symptoms. Even mild symptoms are readily apparent.

 

[Fervent Freyja]

I don't see the correlation between thinking you can function on alcohol and thinking you won't have withdraw symptoms. Even mild symptoms are readily apparent.

Because, people tend to believe that they have superpowers when intoxicated.

I'm already aware that some are more susceptible to alcoholism, this was linked back when I was in high school- I don't drink much myself primarily on account of that. I'm talking about after-the-fact, when someone is already physiologically addicted for a long period of time.

Old men are supposed to be nice, not grumpy or drama-seeking. You are probably decreasing your life span by being so argumentative. Grumpy Old Men Don't Live Long: Study

 

[Student100]

Because, people tend to believe that they have superpowers when intoxicated.

But you need to not be drinking to experience withdraw.

I'm already aware that some are more susceptible to alcoholism, this was linked back when I was in high school- I don't drink much myself primarily on account of that. I'm talking about after-the-fact, when someone is already physiologically addicted for a long period of time.

It doesn't matter if those predisposed to become alcoholics drink a little or a lot, they will become addicted. If you're an alcoholic, there is no such thing as drinking in moderation.

Old men are supposed to be nice, not grumpy or drama-seeking. You are probably decreasing your life span by being so argumentative. Grumpy Old Men Don't Live Long: Study

Not being argumentative, unless you consider a friendly discussion argumentative.

 

[davenn]

Not being argumentative, unless you consider a friendly discussion argumentative.

I agree totally

FF really needs to lighten up with her attitude

 

[jim hardy]

Old men are supposed to be nice, not grumpy...

??
I thought you pretty girls liked us that way.

 

[Laroxe]

I think that most addictions are related to a persons vulnerability at particular periods in their lives, even with drugs like heroin, the use of which was endemic in US soldiers in Vietnam, on return to the USA the rate of addiction quickly fell back to the normal background rate. There has been some work with rats (referred to as Rat Park) that also demonstrated the importance of the environment rather than the nature of the rat or the drug. If you were willing to forget long periods, waking up with a bottle, it suggests it must have served a function for you at the time and when it no longer served that function you stopped. Whether someone is addicted or not, or even the drug used is not a great predictor of the physical harm that might be done with continued use at high dose. The most significant harm caused by alcohol is to the liver, which luckily has an amazing capacity to repair itself, the big problem in acute with-drawl is it can increase the chances of an epilepic type fit, so short term monitoring is usually a good idea. The belief that an alcoholic is alcoholic for life is part of the philosophy of groups like the AA and becomes part of a self fulfilling prophecy which is probably unhelpful, there are increasing numbers of therapists that aim to teach people to control their drinking.

 

[jim hardy]

The belief that an alcoholic is alcoholic for life is part of the philosophy of groups like the AA and becomes part of a self fulfilling prophecy which is probably unhelpful, there are increasing numbers of therapists that aim to teach people to control their drinking.

It's the unpredictability that marks an alcoholic. Alcoholics lose control , they might do fine for some time but will experience that oblivion where they do not remember the end of an evening or a week.

Anyone able to control it is not an alcoholic they're just a heavy drinker.

“Big Daddy: What makes you so restless, have you got ants in your britches?
Brick: Yes, sir...
Big Daddy: Why?
Brick: - Something - Hasn't - Happened...
Big Daddy: Yeah? What is that?
Brick [sadly]: - the click...
Big Daddy: Did you say the click?
Brick: Yes, click.
Big Daddy: What click?
Brick: A click that I get in my head that makes me peaceful
Big Daddy: I sure in hell don't know what you're talking about, but it disturbs me.
Brick: It's just a mechanical thing.
Big Daddy: What is a mechanical thing?
Brick: This click that I get in my head that makes me peaceful. I got to drink till I get it.”
― Tennessee Williams, Cat on a Hot Tin Roof

escapism.

"...my disease grew upon me--for what disease is like Alcohol!--and at length even Pluto, who was now becoming old, and consequently somewhat peevish--even Pluto began to experience the effects of my ill temper.""I knew myself no longer. My original soul seemed, at once, to take its flight from my body; and a more than fiendish malevolence, gin-nurtured, thrilled every fiber of my frame.""When reason returned with the morning --when I had slept off the fumes of the night's debauch--I experienced a sentiment half of horror, half of remorse, for the crime of which I had been guilty; but it was, at best, a feeble and equivocal feeling, and the soul remained untouched. I again plunged into excess, and soon drowned in wine all memory of the deed."

"And now was I indeed wretched beyond the wretchedness of mere Humanity."

- Edgar Allan Poe, "The Black Cat"

Loss of control, declining emotional condition

An alcoholic might get that "click" and drink to oblivion after just a couple beers on some nights and on other nights not at all.
'Blackouts' are something not everybody experiences .
http://www.aa.org/assets/en_US/en_bigbook_chapt3.pdf

Success of 12 step treatment baffles the scientific community.
http://www.scientificamerican.com/article/does-alcoholics-anonymous-work/

In 2006 psychologist Rudolf H. Moos of the Department of Veterans Affairs and Stanford University and Bernice S. Moos published results from a 16-year study of problem drinkers who had tried to quit on their own or who had sought help from AA, professional therapists or, in some cases, both. Of those who attended at least 27 weeks of AA meetings during the first year, 67 percent were abstinent at the 16-year follow-up, compared with 34 percent of those who did not participate in AA. Of the subjects who got therapy for the same time period, 56 percent were abstinent versus 39 percent of those who did not see a therapist—an indication that seeing a professional is also beneficial.

If you don't like how your life is going you need to change your behavior.
It's that simple.

A therapist who hasn't experienced "that click" is in no position to give advice.

old jim

 

[Laroxe]

There is an interesting discussion about this based on the data from National Epidemiologic Survey on Alcohol and Related Conditions which shows that the majority of people do improve, especially if they avoid treatment. If you think about it there is something very strange about the belief that people have to hit rock bottom, effectively loosing everything in life they value before they can be helped, when we know how important social support systems are. Then they have to acknowledge that they have no control over their own behaviour and never will have, before expecting them to control their own behaviour. The outcomes generally for AA/12 step style approaches is not significantly different from the spontaneous recovery levels. This has acted as an impetus to develop alternative approaches, particularly in CBT with more realistic goals.
http://www.thecleanslate.org/self-c...ce-recovery-rates-with-and-without-treatment/

 

[jim hardy]

If you think about it there is something very strange about the belief that people have to hit rock bottom, effectively loosing everything in life they value before they can be helped,

What's strange about that ? It is a factual observation of behavior from the 1930's .
Human nature hasn't changed but general public awareness has. It's 70 years later now and we talk about problems, it's almost a status symbol to have a therapist . Look in any bookstore at how big is the Self Help section. Yes, people are self-treating.

From the study that author links:
http://www.thecleanslate.org/wp-content/uploads/2012/07/Recovery-Rates-In-General-Population.pdf

To be classified with PPY alcohol dependence, respondents had to report that one or more symptoms of at least three of the following criteria occurred before 12 months ago:
(1) tolerance,
(2) withdrawal (2+ symptoms or drinking to relieve or avoid withdrawal),
(3) persistent desire or attempts to reduce or stop drinking,
(4) much time spent drinking or recovering from drinking,
(5) reduction/cessation of important
activities in favor of drinking,
(6)impaired control over drinking, and
(7) continued use despite physical or psychological problems caused by drinking.

That level of awareness indicates those people were well on the way to recovery when they entered the study.

Here's the telling line from that report

3 Recovery rates are likely to be higher (and less often associated with alcohol treatment) if the baseline population comprises less severely affected individuals—for example, those with abuse, or “problem drinkers,” rather than just individuals with alcohol dependence.

I don't know anything about Steven Slate's experience with St Jude Retreats , for whom he apparently works
http://www.thecleanslate.org/about-2/
but they seem to be an upscale treatment center
https://www.thefix.com/content/saint-jude-retreats-non-12-step-rehab00222
selling the same thing that AA promotes, namely behavior modification.
Bless his heart, if it worked for him he should spread the word.

Many people are put off by the mild religious allusions in 12 step programs and need an alternative .

It is my goal someday to open up my own center of intensive treatment that teaches people to believe in themselves and take back the power to face their problems, suffer through their pain and move on. If you let the trauma live on inside you and surrender to its destructiveness, you essentially just throw a blanket on a fire…it mahttp://http://www.thecleanslate.org/self-change/substance-dependence-recovery-rates-with-and-without-treatment/y go out, but it may set the blanket ablaze and consume you. The real goal of treatment should be to seek out why you use in the first place and then fix those issues. I believe that most people would discontinue their self destructive behaviors if the root of those behaviors were dealt with. I’m not saying I know the answers, I’m just saying there has to be a better way.

.
That's what the 12 steps are for.

The outcomes generally for AA/12 step style approaches is not significantly different from the spontaneous recovery levels.

Which outcomes ? 12 step programs promote abstinence and for that outcome the numbers speak, see red rectangles :

Better than 2::1 everywhere.old jim

 

[Laroxe]

That level of awareness indicates those people were well on the way to recovery when they entered the study.

I think all studies have to use fixed criteria as to what constitutes an alcohol problem and the DSM IV or 5 criteria are the most widely used, you can't really just make up your own.

Which outcomes ? 12 step programs promote abstinence and for that outcome the numbers speak,

again, you can't just choose an outcome to suit your beliefs, if your treating alcohol dependence it makes sense that this should be reflected in the primary outcomes.
The fact is that AA is the only thing offered to most people, it allows providers to pretend they are doing something while spending very little.
This is a evidence review that goes into some detail about the methods used and looks at specific interventions. The reality once again, is that none are brilliant. I have no real problem with AA and recognise its place but I also believe that some of their teachings are inconsistent with current theories about behaviour change.

 

[jim hardy]

if your treating alcohol dependence it makes sense that this should be reflected in the primary outcomes.

What put me off about the article was Slate's crowing about what he offers up as debunking of AA. I'd say he's still in denial or perhaps still grinding an axe..

I also believe anybody who can control their drinking does not have the "unlucky " metabolism

Alcohol is eliminated from the body by various metabolic mechanisms. The primary enzymes involved are aldehyde dehydrogenase (ALDH), alcohol dehydrogenase (ADH), cytochrome P450 (CYP2E1), and catalase. Variations in the genes for these enzymes have been found to influence alcohol consumption, alcohol-related tissue damage, and alcohol dependence.

That genetic predisposition toward unlucky metabolism is ethnic. For old Mediterranean societies that have had wine around for all of recorded history it's in 5-10% of the population, North Eurpoean 20%-ish; American Indians 80% ish . (Source- that "Under the Influence" book i linked above. )

If i combine "Still Dependent" and "Partial Remission" together the difference virtually disappears.

What that table tells me is people with "unlucky metabolism" for whom abstinence is necessary tend to get steered into treatment,
hence
the greater numbers of "low risk" and "asymptomatic" drinkers in the untreated group , people who are able to control it after they deal with their demons,
and the greater numbers of "abstainers" in the treated group .

Maybe somebody will do some DNA screening and publish.

Meantime i'll remain circumspect of anybody selling $30,000 treatment programs be they 12-step or CBT based..

Slate's article does support Gooddoctordoc's premise in post 1 , though.