Saving Medicare?

Universal health care

Universal Health Care, via Wikipedia

As readers of my blog will know, I had despaired that the Medicare cost problem could be solved by any other way than going to a socialized European/Canadian system. But I just read a plan that just might be a better solution. Written by a member of the paper’s Board of Contributors, Don Campbell, “Ration care with Medicare credits” would retain most of the popular features of Medicare while engaging the hidden hand of the market to hold down prices and foster competition. It contains that missing, essential element that I have so often longed for in my posts, a motive for the patient to care about costs.

Campbell uses a scary word in his title, “ration”. But if you follow the link to his essay you will see that it’s not that bad, and for that matter you will also see the opinion of a doctor that ” . . . we already ration health care, people just don’t understand it.” Now I’m not quite sure what he meant by that, but I suspect he’s referring to the subtle ways of influencing end of life decisions. But one thing comes through clearly: the upwardly accelerating costs of health care in America are unsustainable. (Repetitious, I know, but ever so important.) He offers this argument about that:

A recent study by the Urban Institute found that a typical working couple retiring this year will get about three times as many dollars in Medicare services as they paid in Medicare taxes. What part of that upside-down equation do people not understand?

Campbell likens his plan to the “cap and trade” system proposed for limiting carbon emissions. Here for convenience is his plan as he presents it:

•Assign new Medicare enrollees a credit for total benefits capped at, say, $150,000 that would be adjusted for inflation annually. After the credit’s exhausted, they’d be on their own. (This introduces the dreaded means-testing because some recipients would have paid in more than that in Medicare taxes, but even more would have paid in less, sometimes much less.)
•Permit beneficiaries to buy or sell Medicare credits, at whatever discount that could be negotiated, that could then be redeemed for services at full value. They could also donate them directly to others, or to “credit banks” run by non-profits and religious organizations.
•Limit the percentage of one’s credits that could be sold, so that no beneficiary could fritter away all his or her allotment on flat-screen TVs or Caribbean cruises.

I like it, how about you? I think this might require a little tough love to discourage the present use of ER’s as an alternative. EMTALA needs to be modified. How about establishing a minimum out-of-pocket charge which could be made more amenable to collection than medical bills are now? Charity could be engaged to that end as well, for the truly down and out.

As Campbell alludes near the end of his essay, the plan could make for some very interesting marketing of credits.  I urge you to follow the link above and read his essay – it isn’t very long. The most appealing aspect of the Campbell plan to me is that people would care enough to shop around. Get rid of the red tape, minimize the paperwork, track the credits, watch the market work.  This could even promote more use of “concierge care”, something I have previously touted.  And just think.  If this works, the ACA might be modified along the same lines for people too young for Medicare!

There must be a flaw here and I’m sure someone will tell me what it is. Hurry – I think I’m getting hopeful all over again.

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About Jim Wheeler

U. S. Naval Academy, BS, Engineering, 1959; Naval line officer and submariner, 1959 -1981, Commander, USN; The George Washington U., MSA, Management Eng.; Aerospace Engineer, 1981-1999; Resident Gadfly, 1999 - present. Political affiliation: Independent, tending progressive as the GOP recedes from its Eisenhower roots.
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32 Responses to Saving Medicare?

  1. johncerickson says:

    I’ll have to look this over a little more, but it looks pretty good – with one qualification. What about “quality of life”? I’m not worried about the chronic drunk who wants a new liver every year, or the McDonald’s addict that demands lipo so he can eat Big Macs AND weigh 150 pounds. I’m thinking about people like me, in my current state.My headaches won’t kill me, but they make my life hell. With pain, sleep. and BP meds (all tied to my condition), I burn through a fair amount of money. Nowhere near $150,000, but I’m setting up an example. Now if I hit my $150,000 on, say, a new hip when my gimpy one finally gives out, if that happens in January, I’m dry. What do I do for meds then? (Same thing I do now, but that’s beside the example I’m trying to make.) I’d have to choose being able to walk against having my life for an entire year. And no, I couldn’t afford to buy someone else’s excess. In the same light, you can get a wooden leg for a lot less than $150,000, but it’s hard to use. A carbon-fibre “blade” leg would be great for getting around on, or some fancy lifelike polymer job, but those will blow the $150,000 pretty quick as well. Who decides?
    I’d worry, too, about people in good health selling their credits, then having a health crisis and suddenly needing to buy credits, at a “seller’s” exorbitant price.
    No debate needed yet, just some thoughts – I’ll do some more studying and get back with REAL questions!

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    • Jim Wheeler says:

      An excellent and thoughtful response, John. Thank you. It is comments like yours that keep me going.

      I think your hypothetical question indicates that there must be some provision for infrequent situations such as that you pose. There must be funds set aside for the deserving as opposed to the undeserving, and someone is going to have to make that distinction based on established criteria. Is that impossible? I say it is not. Such things are done even now for the limited supply of transplant organs, are they not? Some will scream “death panels, but if the guidelines are clear and the process transparent, I think it will work, just as organ transplants work now.

      There would also be avenues for appeal to charitable sources. In fact, I can foresee a national foundation for such purposes, endowed by philanthropists. Such solutions would also be leveraged by the nature of the Campbell Plan, which would lower the costs of procedures and treatments. Major issues like the one you pose (major medical) could be mandated for price-negotiation by Medicare with qualified bidders. Yes, I think this would work.

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  2. ansonburlingame says:

    Jim,

    However you choose to “cut” it, what you are suggesting is some form of limiting government funding of health care and making the patient put his own “skin in the game”. In that sense, I am all for it.

    But just consider, how is the idea above much different from the “Ryan approach”, actually the “Ryan Plan” that limits medical costs (purchasing insurance primarily) to $15,000 per year per Medicare beneficiary? The approach seems very similar to me to the one suggested by you and your link.

    There is a BIG difference between purchasing private insurance and a government guaranteed benefit plan where 80% of essentially “everything” becomes a “right”. For example, how much have you paid over your lifetime for house insurance? I bet it is a lot more than you have collected in claims. And at our age if our house was “totaled” I bet the insurance company would come close to either making a profit or at least breaking even today. In other words most people buy insurance for the big loss, and take care of smaller matters out of pocket.

    But what if the government decided that old people cannot afford homeowners insurance. At age 65 a government “plan” would take over from private insurance coverage. Then the “tornado” hits, on one’s home instead of his physical health. The government could not afford such for everyone over 65, for sure.

    Finally, the “replacement cost” of a home is reasonably still predictable today. But try to predict your EOL health care costs say 5-10 years from now. Impossible to do so for the latter in my view. So not only does the future cost of insurance for all folks become an issue, the cost to the insurance company for “dying” becomes unpredictable as well.

    Stopping that spiral is a basic challenge to any healthcare insurance or benefit plan for the future as well. If we do not do so both private insurance and the government will go broke paying for such insurance or benefits.

    The only way I know how to do so is to require EVERYONE to put “skin” in the game and thus control cost through choices in the market.

    In such a situation John above, would be confronted with a hard choice, but still a choice. He could either continue to mitigate the chronic condition OR get a new hip. But he would not be able to do BOTH based on his description. I know what I would do given such alternatives but would NEVER suggest that “my way” should be John’s way.

    I of course would love to see him be able to do BOTH. But…….. I don’t think the government is responsible for anyone to live a pain free life, hard as that sounds “off the top”. Apply that approach to EOL care for example and at some point individuals will choose a low pain and cheaper hospice care instead of a high cost “bet” to extend life for a few….?

    Anson

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  3. Jim Wheeler says:

    The only way I know how to do so is to require EVERYONE to put “skin” in the game and thus control cost through choices in the market.

    I agree with your statement, Anson, but I’m not sure you understood that the Campbell Plan intends to do just that. The idea is that the amount deposited to each citizen’s account would be theirs to manage.

    I do have some misgivings, like yours and John’s, that people would treat their balance of credits irresponsibly, like a credit card. It occurs to me that each patient could be given a healthcare checkbook for their credits, balance established in the register. Then they would write a check for each expenditure, thus insuring their awareness of the declining balance. I think this would work. If like I, you have watched behavior when people purchase things at the store for cash or by check, then you know their awareness of diminishing balance is higher than when they simply swipe plastic.

    And for sure, as in my response to John’s concerns, there needs to be provision for “major medical” issues, but from what I’ve read, that isn’t as infeasible as it sounds, especially if government takes charge and negotiates standard procedures and rates. Yes, I know that moves the system closer to socialized care, but given that the current system is unsustainable, that is acceptable to me. I believe a large part of the waste in our system is not in expensive operations, like hip replacements, but in end-of-life issues and artificially high costs of marginally-beneficial treatments and gadgets.

    Bottom line is just what you said though. Joe Patient has got to have “skin in the game”, and somehow government has got to hold costs down. Medicare has actually been able to do that and I’m hoping we can build on that success.

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  4. Jennifer Lockett says:

    Now, I must say that I respectfully disagree with several of these points. I agree that people do need to have an investment in their medical costs (otherwise, you run into the problems you see in Britain and Canada of people going to the doctor for mundane reasons or even loneliness). However, capping at $150,000k is shockingly low. Just to give you an example, I had a kidney stone at 28. Worst pain of my life. I was on the floor crying and went to the ER. They had no idea what the problem was (I’m not a person statistically at risk for a stone) and so they ran a series of tests – MRI, CT, ultrasound, as well as the manual exams. I got the bill outlined with my insurance info and the pre-insurance bill was $30,000!! That means that one visit to the ER in my twenties would eat up 20% of my lifetime allotment.
    The elderly, especially those in extreme old age, often have very expensive medical expenses – including assisted living. They would run through that $150,000 within a couple of years and lack the ability to earn more money to contribute themselves. My 90 year old grandmother, who is in good health for a 90 year old woman, still has hefty health care bills – and she doesn’t have cancer or diabetes, she’s just very, very old. Heck, one could even credit her ‘healthy lifestyle’ for her long, no very expensive life (non smoker, non-drinker, regular exerciser, healthy eater).
    I also do not like the idea of restricting health care to the ‘deserving.’ I find a moral objection to denying health care to the obese, smokers, alcoholic/addicts (recently categorized as a biological brain disorder, not a character shortfall) in the same way that I would object to firemen allowing ‘meth heads’ to burn if their lab explodes.
    I know that you and I have discussed this issue before. In terms of health care reform, I’m a bigger fan of the models you see in Germany – higher financial buy-in to the system (family of four is $750/month, in the US it’s $1250/month), non-profit insurance, and posted costs in doctor’s offices (not the guessing game we have now). Another good model is Thailand, who in ten years has gone from one of the worst health systems to the world to one of the best (well, pre-2006, after the military coup things are a bit up in the air).
    I do prefer a combination of private funds along with a public tier. No one should be making health care decisions based on financial restrictions.
    Keep in mind that I’m incredibly biased. I just watched my uncle sustain a ‘widow maker’ heart attack (his second). He’s self-employed and due to an atrocious family heart health history (his father dropped dead of a heart-attack at 35) is unable to get an individual plan that will cover anything heart-related. His hospital kicked him out once he became ‘just stable enough’ – they literally turfed him without being seen by a cardiologist for 48 hours, no in-hand medication, no follow-up appointment, and $1,000 in prescriptions. They also refused to answer any follow-up questions as he was ‘no longer a patient.’ They would not let me see him in ICU because I was not ‘immediate family,’ but they allowed the hospital business office to send people several times a day to ask him about payment. So, I guess seeing the dark side I’m a little sensitive.

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    • Jennifer Lockett says:

      Thought I would include this article on addiction as a reference
      http://www.msnbc.msn.com/id/44147493/ns/health-addictions/#.TkmmJGYT9jc

      Addiction is a chronic brain disorder and not simply a behavior problem involving alcohol, drugs, gambling or sex, experts contend in a new definition of addiction, one that is not solely related to problematic substance abuse.

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    • Jim Wheeler says:

      Your real-life experiences are sobering when considering the healthcare problem, Jennifer. You are right-on regarding the amount allocated for a lifetime. As I indicated to John above, there would have to be some separate provision for “major medical” such as heart surgery or hip replacement.

      Your addiction reference is germane because it shows that medical science keeps producing expensive must-have technology. But that’s just the tip of the iceberg of course. With the aging of the population, the shrinking birth rate, diminished immigration and the obesity epidemic we will have fewer and fewer income-earners and care givers to support a burgeoning patient load. I believe the various forms of dementia, already an epidemic, will outnumber addiction problems. How can we afford to treat it all properly? Obviously we can’t under the present system. Whatever solution we settle on, it will have to contain diminished profit for the Medical Industrial Complex and some form of rationing must apply.

      The cost of healthcare in my opinion is society’s biggest problem. We see it coming and no leader seems to have an answer. I hope the press will raise it in the presidential debates, but I’m not holding my breath.

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    • hlgaskins says:

      Jennifer

      “I agree that people do need to have an investment in their medical costs (otherwise, you run into the problems you see in Britain and Canada of people going to the doctor for mundane reasons or even loneliness).”

      I’m not certain where you obtained this information, but it’s not entirely correct, at least as far as Canada is concerned. People don’t go doctors “for mundane reasons” because Canada practices preventative medicine which has the benefit of reducing “later term” illnesses largely responsible for our soaring medical costs. Every Canadian is given a routine physical fitness schedule that is quick, non evasive, and inexpensive. So you can respectfully disagree but your disagreement is not based on fact.

      Here’s a point for you to consider. If Canada and Britain has problems while their longevity exceeds ours, both have lower infant mortality rates then ours, everyone is covered, and their healthcare costs to GDP is almost half of our, then how bad can they be? Certainly not as bad as our system is.

      Otherwise I agree with you totally. In my view human health should never be left to big business monetary considerations, because our health is not a commodity to be traded.

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  5. ansonburlingame says:

    To all,

    First of all, Jennifer, had your Uncle purchased private health insurance as a young man and kept such insurance with regular monthly payments over his life time, he would HAVE today the insurance needed to treat his heart condition. Yes some “regulations” concerning how that insurance is paid when bad things happen and kept current afterwards would have to be made. And those regulations must be constructed to allow private insurance providers to stay whole financially. But in my view that is doable.

    But I bet your uncle simply relied on someone else to pay for his insurance up until he became very ill and now he is really stuck.

    Now for the addiction article, it is very “old hat” to me. At least 40 years ago medical science did brain authopsies on heroin addicts that had died. They found a neurochemical called THIQ (I think) that was present in every one of those addicts. Later the same chemical was found in dead chronic alcoholics as well. So absolutely the addict is “driven” to drink or drug, etc and the “drive” in ones brain is “cunning, baffleing and powerful” as was writen about 70+ years ago.

    There is yet a “cure” for that brain disorder that makes it “go away”. But there is treatment that is very effective. If one does not “feed the beast” with alcohol or drugs, the “bats go back into one’s belfery” and become less compelling over time. And as long as one NEVER “feeds the beast” they stay there for a lifetime.

    I would also point out that DSM IV, the “bible” for mental disorders has long stated that alcoholism and drug addiction is a DISEASE. Even 70+ years ago some doctors knew that, not a lot, but some and they were RIGHT.

    Finally the TREATMENT for the DISEASE of alcoholism does not cost a penny, not a penny. I speak from long experience in that regard as can millions of others that are in “recovery” one day at a time for the rest of their lives.

    Anson

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    • hlgaskins says:

      Anson
      “First of all, Jennifer, had your Uncle purchased private health insurance as a young man and kept such insurance with regular monthly payments over his life time, he would HAVE today the insurance needed to treat his heart condition.”

      That assumes that her uncle could afford the costs in the absence of a collective healthcare plan. Purchasing healthcare insurance as an individual can be prohibitively expensive, especially if one is refused because of family history or a preexisting condition. Many self-employed people make decent wages but how do they provide themselves with benefits that are much higher than those experienced by corporate or state employees?
      “There is yet a “cure” for that brain disorder that makes it “go away”. But there is treatment that is very effective. If one does not “feed the beast” with alcohol or drugs, the “bats go back into one’s belfery” and become less compelling over time. And as long as one NEVER “feeds the beast” they stay there for a lifetime.”

      So why’s that not happening or working? Could it be because it only works for some and not for others, and that the degree dependency and need varies by individual? What happens if that addict has a co-occurring disorder such as depression, and part of the urge to use is to self-medicate? When you’re depressed enough, don’t have anyway to pay for treatment, you’ll do almost anything to numb it from your mind, including suicide. Your simplistic and thoroughly uniformed view of mental health issues, should morally exempt you from making unfounded comments, but you can because your right to free speech doesn’t discriminate knowledge from ignorance.

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  6. ansonburlingame says:

    To all,

    Go to http://ansonburlingame.wordpress.com/?s=THE+ASCENT+PROGRAM.

    That is a blog written about a year or so ago on a local recovery program that really works and supports my comments above.

    anson

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  7. ansonburlingame says:

    HLG,

    Boy did you go off base to call my views on addiction and depression “uniformed” (I suppose you meant uninformed)

    There are two topics that I can debate with the most learned in their respective fields, how to operate a nuclear submarine and how to treat (but not cure) addiction and depression. I know that about which I speak and write in both areas and have the “scars” to prove it.

    As for why it works (recovery from addiction) here are 70+ year old insights: “Rarely have we seen a person fail. Those that do fail are incapable of being honest with themselves……”

    As for Jennifer’s uncle, read my blog on purchasing health insurance at an early age before you leap to conclusions on that point. While you are at it read how Obamacare tries to do the same thing!!!

    Anson

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  8. hlgaskins says:

    “Boy did you go off base to call my views on addiction and depression “uniformed” (I suppose you meant uninformed)”

    Can I then say that you re uniformly uninformed?
    “I know that about which I speak and write in both areas and have the “scars” to prove it.”
    I’ll default to your knowledge of submarines but when it comes to substance abuse you are at best a novice. So in short, you are indeed uninformed. Do are you a psychiatrist, psychologist, or social worker? If not then leave the treatment of substance abuse to those who are trained and licensed to do it.

    “As for Jennifer’s uncle, read my blog on purchasing health insurance at an early age before you leap to conclusions on that point. While you are at it read how Obamacare tries to do the same thing!!!”

    Do you have any clue as to how expensive private health insurance ($500-$600 a month or more) is if you’re not part of a collective? Now you show me how obamacare costs that much!

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    • johncerickson says:

      HLG – I’ll argue with you on only one point – the substance abuse issue. I don’t know what addiction Anson may have fought. I am a recovering alcoholic. I have spent a great deal of time with people who have suffered various abuse problems, and I will vouch for Anson knowing things “from the inside”. Addiction is VERY personal, and there is NO one size fits all answer. Each person has his or her own threshold of resistance – mine was fortunately quite high, and I’ve stayed sober “cold turkey”. Others I’ve known have crashed totally before getting care, and have tried a number of options, including prescription medications and even religious conversion.
      You don’t need letters after your name to know the hell of addiction. And you can be quite knowledgeable if you’ve suffered for a long time – I’ve become very knowledgeable about headaches, as I’ve had a ten-year migraine bout that cost me my home, job, and beloved canine “son”. Please acknowledge that Anson doesn’t have to be an MD, PhD, or DO to have an extensive base of knowledge with addiction and recovery.
      Thank you. We now return you to your blog, already in progress.

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  9. hlgaskins says:

    Johnerickson

    I appreciate the tenacity that gave you the strength to overcome your alcoholism but as you’ve also stated “Others I’ve known have crashed totally before getting care, and have tried a number of options, including prescription medications and even religious conversion.” Unfortunately many of them fail and pay with their lives. If suicide was all that was on their minds then why not end it quickly, instead of prolonging what is obviously an endless agony? Perhaps it’s because there’s just enough hope left to live another day.

    The degree of addiction is like any illness, it varies with the individual. Addictions are most often the result of underlying mental illnesses such as depression and even schizophrenia. A person can only endure so much pain before they begin to seek any available means to ease the hurt, and in many cases if not diagnosed and treated by competent professionals, they will resort to substance abuse. A popular term often used for substance abuse is self-medicating.

    Having personally experienced substance abuse can provide useful anecdotal experience, that when shared with others can be helpful in their treatment, but it can’t replace professional treatment. Therein lies the crux of the matter, and the key phrase here is “professional treatment.” It’s absurd to hear someone untrained state that your 7 years of college is no more than an equivalent solution to their self-idealizations of knowledge. Imagine if you needed surgery, would you except some with anecdotal experience to hold the scalpel? I know I wouldn’t!

    “Please acknowledge that Anson doesn’t have to be an MD, PhD, or DO to have an extensive base of knowledge with addiction and recovery.”

    I will accept that Anson has personal experiences with substance abuse, just as I accept that you do, but a few isolated samples in no way rises to the level of “an extensive base of knowledge with addiction and recovery.” You know about your recovery, and perhaps some of those you’ve encountered while undergoing recovery, and it could make you useful in helping others, but it doesn’t qualify you to assume the role of trained professionals. Anson is bound by his conservative political prejudices, that shutters his every thought within a predefined box of limited ideals. After all, “one mans ceiling is another mans floor.”

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  10. ansonburlingame says:

    HLG,

    And here, right here, is where you are DEAD WRONG. You said, “If not then leave the treatment of substance abuse to those who are trained and licensed to do it.”

    NOW show me those “trained and licensed” people and then show me their success rate in preventing relapse. The professional community either ignores addiction or has hardly a clue how to treat it (other than “go to AA) on a long term basis. And for sure NO ONE has found a CURE for the disease that allows a former addict to lead a “normal life”. ANYONE in recovery for however long (meaning no relapse) must lead a life of self control and discipline that “normal” people are not required to live. Try to shortcut that process and relapse will almost inevitably occur.

    I have observed, first hand, ONE “trained professional” that knew what he was talking about and put it into practice. He was a psychiatrist, with a Fellowship in Addiction AND he was a recovering alcoholic of the “worst sort”. To use the common term in recovery, ” he had personally been through the wringer” and came out clean and sober and has remained that way as far as I know.

    As for depression and alcoholism, yes many addicts are “dual diagnosed” with BOTH diseases though it is very difficult to diagnose both at the same time. Most “trained professionals” will see and attempt to treat depression but fail to see or treat the underlying alcoholism. Why? Because addicts LIE through their teeth to preserve their “right to use”.

    Sure you can throw them into a detox and rehab center for 30 days at taxpayer expense. But it does little long term good as far as treatment goes. I know of one “trained professional” that went through rehab 27, I repeat that, 27 times before he got it right. And you can bet he gave a pretty good lecture series on relapase prevention. He did NOT get those lecture notes out of a book or with titles after his name.

    The professional mental health community is woefully incapable of treating addiction, medically, meaning mentally and physically (other than detox which is “easy”). And the ones on the front lines will admit such if they in fact are honest. Any competent mental health professional will ALWAYS tell the addict to “go to AA (or NA)” as a very necessary and even vital part of their treatment,

    Do that for an addict and THEN (and only then) can the mental health community bring the full force of their profession to treat the depression as well. It is a two step process with sobriety as the first and vital step. Fail that step and watch what happens to the “depressed addict”.

    I assume you know that alcohol is a depressant. So go ahead and take all the “prozac” you like and pour booze on top of it to see what happens. Same with the more severe electric shock therapy.
    Finally, if you want to read of a program that combines trained professionals and recovering addicts all together, go read the like previously provided. If you or a loved one faces the situation of addiction you had best hope to “God” that such a program is available to you or them. And see as well that the program is at LEAST of a year’s duration, just for starters for the really down and out.

    Anson

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  11. hlgaskins says:

    Anson

    No one is suggesting that self help groups shouldn’t be included in helping people with substance abuse problems, but it should always be done under the supervision of mental health professionals. There’s too much that can go wrong when treatment is left to untrained counselors who fail to assess underlying co-occurring mental illnesses. A untrained non professional without supervision can actually make things worse. What would you do if you began counseling someone with a substance addiction and they begin to detox right in front you?

    Treatment for drug abuse and addiction is delivered in many different settings using a variety of behavioral and pharmacological approaches. A medical doctor is always on staff and he/she could also be a psychiatrist, but the most effective treatment team usually consists of a Clinical Psychologist and Clinical Social Worker. Psychologists generally work on assessments and pathologies, while Social Workers develop psychological reports which the assessments are based on, and social histories. Both disciplines are qualified to treat.

    “Along with specialized drug treatment facilities, drug abuse and addiction are treated in physicians’ offices and mental health clinics by a variety of providers, including counselors, physicians, psychiatrists, psychologists, nurses, and social workers. Treatment is delivered in outpatient, inpatient, and residential settings. Although specific treatment approaches often are associated with particular treatment settings, a variety of therapeutic interventions or services can be included in any given setting.”

    “There are many people and organizations in our culture who are trying very hard to make sure that Drug Addiction is NOT seen as a disease or as the result of genetic or biological predisposition. These people have a strong personal and social interest in an entirely nonphysiological model of addictive human behavior. Their perspective of social problems is based primarily on a philosophical orientation with a social perspective, heralding socio-political correctness as its goal.

    Throughout history, a great many people and institutions have tried to help alcoholics and addicts. Currently, there are thousands of different programs in the United States trying to help those people who have a social or personal problem with drugs or alcohol. Yet, the success rate for these programs is extraordinarily low considering the effort and investment made.

    There are countless reasons why these programs are not working, however the main reason is yet to be realized. Existing programs are not working because they’re based on false assumptions of philosophy and human nature. They do not address the motivations and emotions of addictions.

    Today, drug treatment and rehabilitation centers are typically operating on the belief that social or philosophical factors are causing the addictive behavior, and that if we could change an addict’s belief system, or his social support structure we could end his addictive behavior. And yet, the success an individual attains, typically doesn’t last as long as the treatment. This superficial view comes from our governmental and religious orientations which maintain that addiction is the result of bad personal choices, weak character, and anti-social or irreligious behaviors.”

    The answer to your question is that professionals trained in dealing with mental illness that treats it as an illness has the highest success rate in treatment.

    http://drug.addictionblog.org/how-medical-professionals-should-treat-drug-addicts-and-alcoholics/

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  12. ansonburlingame says:

    HLG,

    You said, “but it should always be done under the supervision of mental health professionals.” By that I believe you mean “self help groups” or any “group therapy”. Again, Holy Cow.

    Have you ever been to an AA meeting? The KEY to AA is that the only one that can talk with any conviction or understanding of what goes on with addiction to an addict is another addict. They are NOT “trained professionals” and do not talk like they are. As well no one in AA tries to be a marriage counselor, financial advisor, or attempts to treat any disorder other than simply how to quit drinking and stay quit for a lifetime.

    Any member of AA conducting a “12th step call”, meaning responding in person to an alcoholic asking for “help” or a distressed family member making the call can recognize DT’s based on vast experience. Today they take them to an ER and detox and sit with them to prevent “raising hell in the ER”. Did you ever try to control a “mean drunk”? Doctors do it with thorzine while an AA member can on many occassions “talk them down” with clear understanding of what is going through to mind of someone in DT’s.

    You and many non-addicts seem to believe that “treatment” is some medical phenomena that involves detox and some strong, in house therapy during a 30 day (max) residency in a secure facility. You could not be more mistaken. The relase rate for people leaving such treatment is about 95%. All that is accomplished is to “clean em up and move em out” to God only knows where when they leave such an environment.

    Well I have seen countless times where they “go” and what they “do” when they get there and it is a hopeless morass. If you think the “medical community” can indeed provide the needed “help” to those folks you are simply mistaken and even if they knew how to treat those folks there would not be enough money in the world to do so.

    It is “thinking” (or a lack thereof) such as you express above that contributes to lack of success of recovery from addiction. You really should go to some open AA meeting for about a month or so if you want to learn about this subject directly from people that know what they are talking about based on very direct and personal experience of the “wringer”.

    It might get you out of medical journals and into the real and very tough world of recovery.

    Anson

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  13. hlgaskins says:

    “Have you ever been to an AA meeting? The KEY to AA is that the only one that can talk with any conviction or understanding of what goes on with addiction to an addict is another addict.”

    No, but I’m aware of studies indicating how ineffective AA is. Some people do well with AA but then studies have shown that these same people would do well with a friends or spouses counsel. Your data is as flawed as its source.

    About AA”

    “Nothing could be further from the truth. Even the most ardent true believers who will be honest about it recognize that A.A. and N.A. have at least 90% failure rates. And the real numbers are more like 95% or 98% or 100% failure rates. It depends on who is doing the counting, how they are counting, and what they are counting or measuring.

    “A 5% success rate is nothing more than the rate of spontaneous remission in alcoholics and drug addicts. That is, out of any given group of alcoholics or drug addicts, approximately 5% per year will just wise up, and quit killing themselves.6 They just get sick and tired of being sick and tired, and of watching their friends die. (And something between 1% and 3% of their friends do die annually, so that is a big incentive.) They often quit with little or no official treatment or help. Some actually detox themselves on their own couches, or in their own beds, or locked in their own closets. Often, they don’t go to a lot of meetings. They just quit, all on their own, or with the help of a couple of good friends who keep them locked up for a few days while they go through withdrawal. A.A. and N.A. true believers insist that addicts can’t successfully quit that way, but they do, every day.”

    http://www.orange-papers.org/orange-effectiveness.html

    “AA efficacy rates

    AA’s own analysis was that 50% of all those who try AA leave within 90 days, which they describe as cause for ‘concern’. Their own data shows that is actually optimistic. In the 12-year period shown, 19% remain after 30 days, 10% remain after 90 days, and 5% remain after a year.

    The retention rate of AA is 5% after one year.”

    http://cbtrecovery.org/AAefficacyrates.htm

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  14. ansonburlingame says:

    HLG,

    OK, you admit that you have never attended an AA meeting or I suppose even read the “bible” of AA written and unchanged since 1939, the first 164 pages of the book entitled Alcoholics Anoymous. In part that book established the 12 steps almost universally acknowledged by mental health providers of all sorts as a necessary foundation for long term recover.

    Let me try to make it as simple as I can for you. A common AA “saying” is “if you sober up a drunken horsethief, you still have a horse thief”. Well medical science can “easily” sober up a drunk. Detox him and keep him for 30 days in rehab. But medical science has yet to find a cure for a “horsethief” have they? They rely on law enforcement to protect society against such attitudes using force.

    The 12 steps attack the foundations of the individual that make him a “horsethief”. AA does NOT tell someone how to simply stop drinking. The AA solution for that problem is “put the plug in the jug”.

    What AA and the 12 steps provide is a moral argument (NOT A RELIGIOUS ARGUMENT) about how to STOP thinking like a “thief”. I will almost guarentee you that a sober person that continues to think and act like a very self centered and egotistical “thief” will once again be a drunk if he is an alcoholic.

    The “beauty” of the Ascent program is that it works strictly on the “thief” end of recovery. It requires a way of life that allows no “thieves” to live within the program, much less any “drunk thieves”. NOW here is a statistic for you. Ascent has been around Joplin for about 5 years or so now. The relapse rate, thus far for EVERY person that left the program after COMPLETING the program (about a year) is ZERO. Thus far NO ONE has relapsed after “graduation”.

    Now Ascent is not necessary for many folks in recovery. They achieve recovery and sustain it over a lifetime JUST with AA or some other program that addresses the whole manner in which they live and think, call it their moral foundations. And yes, AA has many that come through the doors as “drunken horsethieves”, stick around for a while to get sober but balk at what it takes to stop being a “horsethief”. But SOME figure out with the help of AA groups how to STOP being a “thief” as well. And when they do so they stay sober in most cases.

    With that perspective in mind, show me any mental health organization that specializes in convincing a person through means other than force to “undo a thief”?

    Finally, statistics are just that, statistics. Recovery is very much a very personal matter. My wife had a medical procedure recently where statistically 0.1% have a stroke. She had a stroke. Forget the statistics in such a very personal trauma which recovery is for anyone trying it.

    Anson

    Like

  15. hlgaskins says:

    “Let me try to make it as simple as I can for you. A common AA “saying” is “if you sober up a drunken horsethief, you still have a horse thief”. Well medical science can “easily” sober up a drunk. Detox him and keep him for 30 days in rehab. But medical science has yet to find a cure for a “horsethief” have they? They rely on law enforcement to protect society against such attitudes using force.”

    I suspect that simple is the best that you can muster. While I haven’t been to an AA meeting, understanding its 12 step philosophy was required study when I was in college.

    The paragraphs conclusion is unqualified and wrong. Medical science or mental health science doesn’t just detox an alcoholic and send them home, although some detox tanks do. Detoxing is only the beginning of treatment. The reason organizations such as AA are largely ineffective is that it operates under the assumption that alcohol is the problem, and by getting rid of alcohol you’ve effectively gotten rid of the problem, which is highly flawed thinking. Even the estimated 5% of those who successfully quit alcohol in AA treatment, or on their own since there’s no statistical difference between them, still suffer from an underlying mental illness. They are often referred to as “Dry Drunks,” or having “Dry Drunk Syndrome.”

    Even though these individuals have shaken loose from the bottle their behavioral patterns remain the same. They are just as angry or just as depressed as they were before they began drinking in the first place. The reason that modern medical and psychological treatment more successful than self-help groups is that it begins with the notion that substance abuse is a psychological/psychiatric disorder. The treatment of course involves a combination of detox, therapy, and depending on co-occurring mental illnesses, some pharmacological treatments as well. For instance if an individual is diagnosed with a depressive illness, then the inclusion of pharmacological treatment such as serotonin reuptake inhibitors could effectively abate the depression enough for the alcoholic to be able to cope with living.

    AA’s only solution is for alcoholics to suffer their way through the process.

    “. The relapse rate, thus far for EVERY person that left the program after COMPLETING the program (about a year) is ZERO. Thus far NO ONE has relapsed after “graduation.”

    The problem with that statistic is that it only includes those who remained with, and completed the program, but those same individuals would’ve successfully completed any program anyway. They are among the 5% that remain sober for more than a year with or without a program. An effective statistic would include everyone who walked through the door to begin with, as well as everyone of those who turned and walked away from it. When a person fails to successfully engage in or complete a program, they are as much a part of its success failure ratio as those who make it through the program. To only count those who made it through the program and then declare a near 100% success ratio is bad science.

    “With that perspective in mind, show me any mental health organization that specializes in convincing a person through means other than force to “undo a thief”?”

    Virtually all of them are there by choice since obtaining treatment is a choice not a requirement, unless of coursed coerced by the courts, and that’s a legal and not a medical problem.

    Like

  16. ansonburlingame says:

    HLG,

    “The reason organizations such as AA are largely ineffective is that it operates under the assumption that alcohol is the problem,…” as you said above.

    As state above, the only suggestion AA has to not drink, basically, is to put the “plug in the jug”. AA deals with the thoughts that lead to “thinking about” pulling that “plug” to return any alcoholic right back down the “drain” and into to sewer of addiction.

    THAT shows your misunderstanding of the whole basis of AA. No where in the 12 steps does it say “do not drink”. The whole concept of the 12 steps is “moral recovery” something that “science”, particularly has not yet a clue how to resolve, en masse so to speak.

    Moral recovery is not religious conversion in AA. In fact I have moved farther away, much farther away for Christianity as a doctrine that before I became involved in recovery some 12 years ago. Some in AA went back to the church in addition to AA as a further effort to recover. But we don’t even allow discussion of religious doctrine in AA. Our only approach is to encourage each individual to seek a “power greater than themselves” or “God as you understand him”.

    I personally don’t even think it is that complicated. I feel as though each of us has a conscience (except for the psychopath) and must learn to “listen” to our deep sense of right and wrong. Almost any “thief” knows it is wrong to be a “thief” but simply ignores that “gut call” and say F… it I need the money or whatever.

    THAT is the KEY to long term, life time recovery for any alcoholic and AA is the best so far to deal with such personal and difficult matters in a very kind and human environment, one drunk to another with each having “been there done that” in being a “thief”. Lawyers, doctors, judges, professionals of all kinds have sought and found great tools to use in recovery from AA, better tools than available to them elsewhere with all their intellects. Same with the bi polar or depressed drunk crawling out from under a bridge applies as well. And those “bridge guys” sit as equals sharing their “experience, strength and hope” with the “high end” drunks every day, for the rest of their lives.

    For those in the general population such as you to disparage or dismiss AA as a vital tool in recovery from addiction is just so wrong that it astounds me. No AA is not the total solution to the vast sea of addicts surrounding us. But it is the best one we have today, in my long and difficult experience dealing with a very big issue facing society.

    Anson

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  17. hlgaskins says:

    “THAT shows your misunderstanding of the whole basis of AA. No where in the 12 steps does it say “do not drink”. The whole concept of the 12 steps is “moral recovery” something that “science”, particularly has not yet a clue how to resolve, en masse so to speak.”

    That’s right Anson, the entire academic community misunderstands AA, but you who has no experience outside of AA knows how professional treatment centers work. Never mind that several independent studies have arrived to the same conclusion. That AA is no more effective in getting people to quit alcohol than the number of people who succeed on their own in the population as a whole. In the meantime you’ll quote some absurd statistic stating a 100% success ratio for all those who’ve completed the program. Do have any idea just how absurd that is? That’s like saying that all of those cured of cancer have a 100% survival rate.

    “Moral recovery is not religious conversion in AA. In fact I have moved farther away, much farther away for Christianity as a doctrine that before I became involved in recovery some 12 years ago.”

    Morality has absolutely nothing to do with mental illness anymore than it has to do with who’s born with high or low IQ’s, or diabetes. And yes AA is a religious based organization.

    “I personally don’t even think it is that complicated. I feel as though each of us has a conscience (except for the psychopath) and must learn to “listen” to our deep sense of right and wrong. Almost any “thief” knows it is wrong to be a “thief” but simply ignores that “gut call” and say F… it I need the money or whatever.”

    People of good conscience and moral character can also suffer from a mental illness. Mental illnesses aren’t necessarily about the effects of having made bad choices. There are so many causes to mental illness that not all are clearly known. This we do know, that serious mental disorders associated with chronic drug abuse include schizophrenia, bipolar disorder, manic depression, attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder, and antisocial personality disorder. Now you tell me just how AA is equipped to treat any of the above mental disorders. The answers is, they aren’t equipped to treat any of the above listed mental disorders.

    The only reason a professional might have to go to AA over a professional treatment center is for anonymity.

    Anson, why don’t you review the science behind the causes of substance abuse, and put a little more trust in the medical and mental health institutions, and then compare.

    Like

  18. ansonburlingame says:

    HLG,

    Obviously we have now reached an impasse, again.

    Do you really think that I have “put all my eggs” in the AA basket without intense scrutiny of other available resources for recovery? Do you think that I have NOT been deeply immersed in what goes on in traditional rehab facilities? Do you think that I have not had extensive discussions with MANY members of the medical community involved in recovery? Do you think that I have NOT read a lot of literature from the professional community related to recovery?

    I have been there done that for over 12 years and the simple reason I have done so is that my LIFE DEPENDS ON IT, literally. This is not an idle discussion arguing over politics or statistics for me. And believe you me if I found a better way to recover, I would do it in a military minute.

    And if you do not believe me, then you should talk to my wife.

    Addiction is a PROFOUND problem in America today. We would all be hard pressed to describe a world in America free of addiction today but for sure it would be one helluva lot better world than we have today. If you really FIXED addiction the number of “poor” would plummet for one thing. They would start “poor” but once really sober the ones that could then improve their condition in life would be remarkable, simply remarkable.

    But if you get nothing else from this exchange PLEASE don’t extend the myth that AA is a religious program. IT IS NOT IN ANY WAY religious. But you would have to immerse yourself in the program to see why I say such with no reservations whatsoever.

    Anson

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  19. hlgaskins says:

    Anson

    “Obviously we have now reached an impasse, again.”

    “Do you really think that I have “put all my eggs” in the AA basket without intense scrutiny of other available resources for recovery? Do you think that I have NOT been deeply immersed in what goes on in traditional rehab facilities?”

    I can’t say what your experiences were, and I have no information as to how effective the local substance rehap institutions are your area. I only know what I’ve studied and experienced in the pursuit of my own profession. I believe that you believe that your choice was the best and perhaps that was enough for you to make it work. I suspect however, that you would’ve been among the 5% that would succeeded on their own without assistance. I have no issue with AA except that I believe professionals should be a part of their efforts. There are many asking as to whether or not AA is a cult organization because it seems to have all the attributes of one. \

    In my thinking AA is to substance abuse treatment what intelligent design is to science. Both are strongly believed in by many and neither are backed by painstaking thorough well organized empirical studies. I never place my trust or make decisions based on leaps of faith alone, because it’s too much like gambling which I also don’t do. At least with science one can make educated decisions derived from studies based the scientific method which supplants the I believe with the I know.
    “Addiction is a PROFOUND problem in America today. ”

    All problems in American are “profound” these days. Addiction has become a crime to be dealt with by law enforcement agencies, when it should be as a medical issue to be dealt with by medical and mental health professions. Our prisons are overcrowded and many dangerous criminals are released to our streets to make way for pot and cocaine users. Our law enforcement agencies war on drugs creates substance rarity which increases its scarcity on the streets and valuable enough to be worth the effort for crime lords to deal in it. The cost of life and tax dollars are being wasted on the most expensive possible solutions when a medical solution would be more effective with little loss of life.

    So no Anson, I will never agree with amateurs as a viable replacement for well trained professionals, and that includes AA.

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  20. ansonburlingame says:

    HLG,

    In your case the word “supercillious” comes to my mind. I suppose for you the word “naive” in my case comes to your mind.

    Thus I give up arguing with you on this point. But there is one phrase from Herbert Spencer in the “Big Book of AA”. It deals with contempt prior to investigation which seems to apply to you in this instance for sure.

    Anson

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  21. hlgaskins says:

    In your case the word “supercillious” comes to my mind. I suppose for you the word “naive” in my case comes to your mind.”

    I suppose, should someone decide to debate an issue with a modicum of knowledge in the debated area, while having an overly self-inflated opinion of that knowledge, could see someone who has it as supercilious. I don’t see you as naive I see you as uninformed.

    “Thus I give up arguing with you on this point. But there is one phrase from Herbert Spencer in the “Big Book of AA”. It deals with contempt prior to investigation which seems to apply to you in this instance for sure.” You would be wrong about me having “contempt prior to investigation” since as I’ve stated previously, study of AA’s 12 steps was required learning while I was working toward my degree. I’ve also reviewed the data of some very excellent studies on the efficacy of AA. You aren’t going to find many mental health professionals (unless they’re right-wing religious flunkies) who currently support AA program.

    Like

  22. ansonburlingame says:

    And right there is the sad fact of trying to deal with recovery in the broadest sense possible.

    “You aren’t going to find many mental health professionals (unless they’re right-wing religious flunkies) who currently support AA program.”

    You seem to be a professional person perhaps with psychology as your field. Being required to read the 12 steps suggests such if it was part of your training. You and many others in such a field have obviously drawn your conclusions based on “science”, statistics, etc. which I readily agree does not explain or even highlight the success of AA.

    AA, as you should know, deals with the “fourth dimension” the spiritual (not religious) dimension of human existance. Science cannot prove such a dimension and sticks to physical, mental and emotional dimensions. In that regard any President that says he prays hard before making a tough decision, life and death decisions, is held in disdain by many Americans.

    Well if all he did was pray, I would hold him in disdain as well. But after he has exhausted working in the other three “dimensions”, to consider and explore the fourth one is consistent with my beliefs, beliefs not held before my beginnings in recovery, but which today give me hope and some degree of strenght to persevere.

    To discount or diminish that effort on my part is dead wrong and wrong to not even acknowledge the possibility of such a dimension available for others as well. The fact that I cannot touch it or measure it does not mean that it does not exist, at least within my psychic. And if that psychic provides real relief from trying to live only in the first three dimensions, then who are you as a professionial to criticize me in that regard. For sure if I use that fourth dimension I do NO HARM to myself or others which is a goal of medical science is it not.

    But when I only lived in the first three dimensions I did great harm to myself and others for damn sure. So again , who are you to critize such efforts on my or anyone else’s part, again as long as we do not harm, which most members of AA that follow the 12 steps at least minimize in a way far different from their past.

    Now go read the “Doctor’s Opinion” in the foreword of the “Big Book of AA”. That guy was open to at least exploring the possibilities of a “new” (1939) approach to recovery and heartedly endorsed such efforts in view of his great failures while practicing medical treatment of alcoholism for his entire professional career. And saddly, medial science has not gone much farther than he did long ago only working in three dimensions in terms of long term treatment (much less a cure) for alcohoism.

    Anson

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  23. hlgaskins says:

    “You seem to be a professional person perhaps with psychology as your field. Being required to read the 12 steps suggests such if it was part of your training.”

    A good guess.

    “To discount or diminish that effort on my part is dead wrong and wrong to not even acknowledge the possibility of such a dimension available for others as well.”

    My point on this is clear. AA’s own statistics have been proven wrong using its own data. It sill to claim 100% success if it only includes those who stuck with the program. Statistics of professional institutions include both successes and failure regardless of the personal involvement of the client.

    “Now go read the “Doctor’s Opinion” in the foreword of the “Big Book of AA”. That guy was open to at least exploring the possibilities of a “new” (1939) approach to recovery and heartedly endorsed such efforts in view of his great failures while practicing medical treatment of alcoholism for his entire professional career.”

    I prefer well organized independent studies using clearly laid out measuring tools to personal and questionable testimonials.

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  24. ansonburlingame says:

    HLG,

    And therein, to ignore or simply discount, the spiritual dimension as a source of great strength and hope of many people is a professional shortcoming of the hightest order in my view.

    You may not know how it works and because you cannot know or understand such a phenomena you thus discount it as “silly” etc. is the height of professional arrogance for something, a disease, that your community has been unable to make any significant inroads for centuries in terms of treatments and cures.

    Frankly HLG, I have encountered many mental health professionals that acknowledge their inability to treat or cure alcoholism and thus defer, with professional advice, to AA. AA does not in any way try to treat or cure diagosable mental illness (other than alcoholism). No sane member of AA will every tell a drunk or recovering drunk how to deal with depression or bipolar disorder, much less the more extreme mental illnesses that I cannot even spell much less understand or try to treat.

    But thus far when dealing with alcoholism alone, AA is the best hope, so far, for most alcoholics to achieve lifetime recovery. You and yours cannot come close to such treatment, again just for alcoholism.

    I will use your economic arguments in this case, wherein you claim that the federal stimulus actually avoided further economic disaster. Well do your best as a mental health professional to treat or cure alcoholism and then consider a world without AA. There are at least 2 million former drunks that would a “lost ball in very high weeds” without AA to rely up for continuing recovery. Now do you think all those folks are “silly”?

    THAT is something you should never discount, even though you cannot understand it scientifically.

    Anson

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  25. hlgaskins says:

    “And therein, to ignore or simply discount, the spiritual dimension as a source of great strength and hope of many people is a professional shortcoming of the hightest order in my view.”

    I was ignoring the “spiritual dimension” because as a placebo he could work. And as far as your view of “professional shortcomings,” you couldn’t be more wrong. The difference is that professionals follow accurately measured data and not some nonsense about 100% success ratios based on those who completed the program.
    “Frankly HLG, I have encountered many mental health professionals that acknowledge their inability to treat or cure alcoholism and thus defer, with professional advice, to AA. AA does not in any way try to treat or cure diagosable mental illness (other than alcoholism).”

    I’ve met some who claim to follow the will of god and base many of their decisions on faith. Once a professional crosses that line they’re no longer professionals.

    “ut thus far when dealing with alcoholism alone, AA is the best hope, so far, for most alcoholics to achieve lifetime recovery. You and yours cannot come close to such treatment, again just for alcoholism.”

    What part of AA’s success ratio of 5%, is no greater than that of a population as a whole don’t you get? Not every alcoholic is religious and an agnostic or atheist wouldn’t even look at a religiously sourced program for treatment. Now wouldn’t that make AA 100% statistically ineffective? It means that as many people successfully self-treat themselves as those with whom AA successfully treats.

    “There are at least 2 million former drunks that would a “lost ball in very high weeds” without AA to rely up for continuing recovery. Now do you think all those folks are “silly”?”

    Unfounded speculation and nothing more.

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