Thursday, 10 January 2013

Addiction Therapies

Addiction Therapies and Counselling


I believe that in spite of still having so many questions, I have actually found some of the answers. The most hopeful treatment for all additions (as I write) is a hallucinogen called Ibogaine (see links) and but it is still undergoing medical trials in the USA. There are potentially many other psychiatric conditions for which this therapy could prove effective. It is theorised that depression and addiction are controlled by the same neural mechanisms in the brain's limbic system. Ibogaine or perhaps a derivative could also be useful for other types of depression, post traumatic stress disorder (PTSD) and obsessive compulsive disorders [OCD]. See what David Graham Scott says about his experience: and watch his video Detox Or Die.  

However, in spite of thousands of successfully treated ex-addicts leaving the clinics in Mexico [the only place it is legal to use it] to date there are still no Ibogaine trials planned for the UK. For now British patients would need to go abroad. This treatment was discovered in the 1960s. However, after taking out several patents to prevent others from researching or promoting it, the finder failed to develop it himself while thousands more people continue to die unnecessarily. One problem is safety, on account of the fact that out of hundreds possibly thousands since the 1970s who have taken Ibogaine about 12 who had undiagnosed heart conditions died.

The patents have been expired since 2000, and there have been plans for research in Miami in Florida, for several years. There seems to be one delay after another and it is all moving much too slowly. I believe that the main problem is that in spite of how much addiction (not to mention depression) is costing governments globally, there are too many powerful people making far too much money out of it for research into curing it to be allowed to progress unhindered. Governments also need to consider how many jobs would be lost in pharmaceutical industries combined with the increased demand for jobs if large numbers of psychiatric patients suddenly became fit to work again.

However effective Ibogaine is people still need counselling or therapy to bring them to the point where they are ready to stop. Although in recent years, Cognitive Behavioural Therapy has replaced Gestalt Therapy, there are many reasons why Gestalt Therapy is particularly useful for healing addiction because it can be used to change perceptions about responsibility, and encourages honesty with ourselves and others.

Gestalt therapy is an existential approach that was first presented by Fritz Perls but the majority of modern therapists have switched to CBT, which has been very successful for many psychological conditions.,%202006.pdf

The problem with most therapies is that the patient needs a therapist or counsellor for the therapy to work. The problem is that few addicts seek counselling or even accept it when it is offered, but I have never heard of anyone who regretted their experiences of counselling. A better solution for some might be meditation or self-hypnosis, both of which can be learned relatively easily, although this might require at least one trip to a professional in addition to reading about it. Therapy is especially useful when addiction is combined other conditions like depression, or post traumatic stress disorder (PTSD), which is frequently the case. Addiction is seldom an addicts only psychological problem but it is often the only one acknowledged or treated.

Addiction Survey

Healing Addictions Without Drugs

by Karl Schmidt is now available on Amazon for £25.50 link below
and Waterstones for £21.50 link below

If anyone who has succeeded in recovering from addiction [whether substance or process addictions--even nail-biting] and would like to answer the questions below in complete anonymity you can email me [see profile] or use the Comment Box at the bottom. 

After learning everything that the medical, psychological, sociological and philosophical disciplines could teach me. The 9 most crucial questions that I need to answer to understand addiction as an international problem rather than a personal one are:

1) Why did you decide to take an addictive drug and then keep taking it regardless of risk until you become addicted?

2) Why didn’t you stop before you developed physical withdrawal symptoms to prevent addiction? (It can take from nine months to two years to get addicted to methadone or diamorphine; although street heroin varies because of unknown chemical ingredients.)

3.0) How many times did you attempt to get free?
3.1) Why have you never tried to get free?
3.2) Why did you relapse?
3.3) Why did you succeed in getting free?

After months (sometimes even years) people choose to start taking the same drug or another drug until they get addicted again? (There also appears to be a higher than average potential for ‘recovered’ addicts to become addicted to alcohol or another addictive substance.) However, occasionally addicts just decide to recover and stay recovered.

4) Why don’t people always relapse? Sometimes people suddenly find that they have the strength and determination to stop taking the drug, recover, and stay off long enough to get back into work and apparently never to look back.

5) What made the change possible? Was it something internal or external, (was it something inside them, or was it something about their situation that changed?)     

7) How could treatment agencies, health-care professionals, and society have been more helpful?

8) What directly or indirectly hindered attempts to get drug-free? What else caused difficulties? How did the treatment providers help or hinder prior attempts?

                 9) If for any reason (perhaps constant pain or terminal illness) a long-term drug user cannot stop, what medically safe and socially acceptable options are available to enable the best possible quality of life? (Should social acceptability even be a factor in the treatment of patients?) 

The people I have asked are all from a group of people who [after laboratory rats] have been described as one of the most highly studied populations in science, yet they had never been asked these questions. The nearest was the frequently asked: 'Why do you take drugs?' To which the standard answer was: 'Because I like them.' In at least one case this was simply telling the researcher what they wanted or expected to hear, and this was the quickest way to get on to the next question and the end of the interview. The truth was that I didn't know why I took drugs and didn't know where to begin to explain my need for them. All I did know was that the need preceded  first use thus liking them or not had very little bearing on it.

Friday, 4 January 2013

Is Addiction a Choice or a Mistake?

On the subject of mistakes 

I keep hearing the quote by nineteenth century German Statesman (and who many describe as the true engineer of the First World War) Otto von Bismarck: 'A fool learns from his mistakes, but a truly wise man learns from the mistakes of others'. This suggests the existence of highly intelligent individuals, who throughout their adult lives never make any mistakes. He further implies that only fools learn from their own mistakes. What utter tosh! A fool is someone who keeps making the same mistakes and never learns anything from them. No actually an even bigger fool is someone who believes that he will never make any mistakes. Well news flash! We all make mistakes; trial and error is one of the main ways that people learn. Even some of the world’s cleverest people make some really stupid mistakes.

Off the top of my head, I put ‘Einstein + mistake’ into Google and found an undated paper by Ohanian who has written a book called, Einstein's Mistakes: The Human Failings of Genius.

To read more:

Ohanian described a critical examination of over six proofs that Einstein produced in over forty years working on his theory of relativity. Ohanian found that all six proofs suffered from serious mistakes. They range from unjustified assumptions, errors in logic, and low-speed restrictive approximations. Einstein claimed that he was not born with any special abilities mathematical or otherwise: “All I have is the stubbornness of a mule. No, it is not quite all. I also have a nose.” So unlike some modern scientists Einstein had a great sense of humour. He also had no doubts that the universe was created by God. However, he did question whether the Creation was deliberate or accidental. (This is an incredibly interesting question in spite of Christian doctrine stating that God is invulnerable to error). “What interests me is whether God had any choice in the creation of the world.”  

Of course Einstein was one of a kind so perhaps he is also a one-off in this respect. He was known to be dyslexic and might even have had Asperger’s Syndrome, which could explain the errors. Surely not all genii are so vulnerable to mistakes? I can hear someone say—but yes actually most of them are. I remember reading about a team of psychologists (I will not name them). They designed a study to explore psychiatric in-patient treatment. They booked themselves into different mental facilities as voluntary patients to document the experience, and to discover how long it would take for the staff to detect that they were perfectly sane. The staff never did detect that they were sane (it is not what they are trained to do). The more the researchers tried to convince the staff of their sanity the more insane they appeared.

They had only informed one member of their faculty of their plans in case something went wrong, but a few days later he had an accident driving home. He was hospitalised for several weeks, and was unaware of their difficulties until he eventually returned to work and discovered that they were all missing. If you would like to read more about howling blunders made by really smart, highly educated people click the links below. The first is the famous Stanford Prison Experiment by Zimbardo (1971). Today he is recognised as one of the most brilliant minds in behavioural science. However, when he was a PhD student his career was almost over before it began, when during the running of his unique Prison Experiment things began to go wrong:

When I first read about this I asked my tutor:
“If their treatment was so bad, why didn’t any of the ‘prisoners’ walk out?” He did not know the answer, and most of the discussion and subsequent research has focused on why the ‘guards’ became so brutal. They were not real prisoners they could have requested, nay demanded their release at any time, but apparently none of them did. Perhaps they were reluctant to be the first one to leave; or perhaps they did not want to forfeit the payment that they were due to receive at the end of the study.   

The second was Milgram’s (1961-62) now famous Obedience to Authority Experiment: The subjects were ordered to give what they were led to believe were potentially lethal electric shocks to another person. In spite of the lack consideration for ethics, the findings from these experiments were regarded as being of such scientific importance that (once the dust settled and they were forgiven) the ‘mistakes’ actually enhanced the careers of their creators.

One ethical blunder that not only destroyed the career of its creator but also caused such a backlash of public ill-will against behaviourism that research into changing behaviour through conditioning was stopped, (except for inside secret government facilities). The researchers were John Watson (who said: bring me a dozen infants of average intelligence and I will turn them into scientists, doctors or whatever else you like) and Rosalie Rayner (1920) and the highly successful study with into Conditioned Fear to demonstrate how humans learn fear. Little Albert’s mother had been happy to agree to let him to ‘study’ her eleven-month-old son while she got on with her work as cleaner at the laboratory. He had obtained her consent, but it was obvious that she had no understanding of what the experiment involved or its possible consequences.

As a result of these and many other mistakes, any scientific study using human participants must first be subjected to rigorous questioning by an ethics committee. Then the researchers must also obtain prior ‘informed consent,’ from the participants.        
One reason that all humans make mistakes, especially in judgment and decision-making is because we deceive ourselves on a regular basis. We all have a strong tendency to believe we are right when we are absolutely wrong, but it does not stop there. There is a list of 27 cognitive self-serving biases (which are also self-deceiving biases) and false assumptions to which even the most intelligent and educated people are vulnerable. Even when you know that these exist it is still very hard not succumb; it is goes against thousands of years of evolution to learn how to disregard their influence. If you would like to read about these (or anything else for that matter) put the keywords: cognitive or self-serving biases in Google and click the link to Wikipedia. Nobel Laureates, Kahneman and Tversky (1973) were among the first to observe and report the effects of these biases during their work on cognitive heuristics (rules-of-thumb).

Their availability heuristic said that if you can think about something it must be important. To put this into terms more relevant to addiction, if drugs are not available you cannot take them. In other words, if you had never heard of drugs you would not have gone out to look for them. So where does that leave addiction as a congenital brain disease? The work into the social and environmental influences on decision making also provided some crucial factors in helping to answer some of the questions regarding the addict’s ‘decision’ to take drugs once (and to keep taking them). Kahneman and Tversky were among the first to demonstrate that human beings are not as logical or rational as we used to believe. 

A branch of social psychology explores attribution, (who and what do individuals and society as a whole choose to blame when things go wrong). One of my favourite constructs is ‘fundamental attribution error,’ defined by Lee Ross (1977). This explains how (a part of cognition called working-self), works in the human brain. This convinces us that when we succeed it is because of our own brilliance, determination and other internal qualities. However, if anything goes wrong we blame external factors, the situation rather than us (the train was late, the pavement was uneven, the other player cheated).  

The typical human brain is wired in such a way that it makes us believe that whatever goes wrong it is never our fault. The only problem is that this allows people to avoid acknowledging their mistakes and taking responsibility for their own actions, (or lack of action). This prevents us from learning from our mistakes to improve our chances of future success. But when things go wrong with these defence mechanisms, such as during depression, the effect can go into reverse and the individual believes that everything is her fault. This can result in hyper-sensitivity to guilt, which is one of most damaging emotions; and it is utterly pointless if neuroscience is right and we have no free will. I have found that many people with addictions are also suffering from depression or other psychiatric or psychological conditions. It is sometimes impossible to tell whether this is the cause or the result of drug use, or even a vicious circle.