Wednesday, 31 August 2011

Psychotropic drugs and the cult of AA

Perhaps the only good thing about being a depressed alcoholic is that I get to take a lot of psychotropic drugs without fear of prosecution. My daily cocktail currently includes Venlafaxine (a serotonin-norepinephrine reuptake inhibitor that acts on two separate neurotransmitter groups), Mirtazipine (a noradrenergic and seratonergic antidepressant), Zopiclone (a non-benzodiazepine hypnotic agent), Chlordiazepoxide (an anxiolytic benzodiazepine derivative with anticonvulsant, sedative, and amnesic properties) and a line of coke with my cornflakes. I also take strong vitamin B complex tablets, pills to control my hayfever and Diclofenac for the gout that plagues me from time-to-time, but I don't think they count as psychotropic. Floating on the mild high induced by the soup of pharmaceuticals bathing my few remaining neruons, I could have strolled through the recent riots in Tottenham without a flutter of anxiety troubling my chemically lobotomised brain. Until very recently I was also drinking between two and three bottles of red wine a night (that's about 205 units a week, rather more than is generally recommended).

It's a minor fucking miracle that anything resembling Tom Mitchell materialises from the pharmaceutical fog when he wakes up each morning and stumbles downstairs to make a mug of tea. Ask any honest psychiatrist how and why each of the drugs listed above works and the answer will involve an expressive shrug and some stuff about molecules binding to receptors. In truth, contemporary psychiatrists work a bit like a monkey pressing buttons on a keyboard, a few sequences of which release treats if pressed in the correct order. They know that the sequences have certain effects; they understand that pressing the keys sends certain signals to the computer's processor but beyond that you may as well ask the monkey what's going on for all the coherence of the answer you'll get. It is not much of an exaggeration to say that mediaeval apothecaries operating using Paracelsus's doctrine of similars were as well informed.

It grieves me to report that I have drunk my last alcoholic drink. The final sip of the liquid that has been my lover, trusted friend, confidante and unfailing source of uncomplicated pleasure for 23 years passed my lips on Tuesday 23 August 2011, at about 11pm, when I was barely conscious and certainly unable to appreciate the poignancy of the moment. The following day I went to see a new psychiatrist (my psychiatrists have a half life of about 18 months) to discuss options for detox and rehab. For a variety of reasons this man's approach clicked with something in me and, when he asked when I'd like to start detox, I replied 'tonight'. The course of Chlordiazepoxide, which prevents seizures during withdrawal, that he prescribed expires tomorrow morning, after which I'm on my own, chemically speaking (except for the other psychotropic drugs, of course, but they have ceased to count, or work).

I have been dithering about this decision for a couple of months. My hesitation stemmed not just from the fact that I really, really didn't want to make it (true) but also because it is astonishingly difficult in the UK to get help quitting any addiction unless you are prepared to join a cult.

When I asked my psychiatrist (the one before the current one) for advice, she recommended admission to the Priory's 28 day 'Addiction Treatment Program' (ATP). For about £18,500 you get a supervised detox, a private room, three barely edible institutional meals a day and the opportunity to participate in an Alcoholics Anonymous (AA) 'fellowship' group. AA's approach is based in the so-called 12 step method, which is a truly terrifying set of instructions for brainwashing highly vulnerable and often desperate addicts.

See for yourself:

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Allow me to paraphrase.

1. Take a vulnerable subject and persuade him that he is worthless, dirty and spiritually dead.
2. Into the void you have created slip a convenient substitute - God (our God).
3. Hit the poor bastard with the sucker punch - he can never leave because, if he does, he will immediately go to hell (aka step 1).
4. Go forth and spread the word.

Now I knew some of this at the time my psychiatrist suggested the Priory and I said that I didn't really think that an approach that required me to relinquish control over my fate to a higher power was destined to work with me, a monist, a materialist and an atheist.

Did she immediately see that I was right and suggest other approaches? Did she hell. She asked me to keep an open mind (see my earlier post on the real meaning of such a request) and suggested I talk to one of the 'experts' on the ATP. This I agreed to do (psychiatrists wield tremendous authority). The lady I met was lovely. Inarticulate and severely screwed up but sincere and lovely. She told me that yes, there is a lot of talk about God and a lot of evangelising but 'many' participants think of the fellowship as their 'higher power' and wouldn't I consider just taking the bits of the program I wanted and ditching the rest? She even knew an atheist (only the one but who's counting?) who was still 'with the program' after a decade. How could I dismiss it without having so much as attended a meeting, she enquired? I swear, this woman could have taught the Reverend Moon a thing or two.

AA should be banned. Is most respects I am a believer in the motto caveat emptor. If I offer you a bottle of snake oil for £100 (or £18,500) and you are stupid enough to hand over the wedge, that is not a matter in which the government should intervene. In this case, however, the victims of the scam are particularly vulnerable to exploitation and their resistance to BS is likely to be at an all time low at precisely the moment they are targeted by the AA cult.

'Hang on', I hear you say, '"victims", "scam", "BS", "cult"? Surely AA helps people, doesn't it?'

No. It doesn't. About 70% of the individuals who embark on a 12 step based ATP relapse. According to the government's own mental health guidelines (see here) 12 step methods do not have significantly different outcomes than other approaches to addiction treatment. The other approaches were CBT, couples therapy, psychoeducational intervention (whatever that may be) and 'coping skills'. Let me ram the point home. Going on a 'coping skills' course is statistically neither more nor less likely to help you successfully give up alcohol than AA.

Lest you think that I am making this up I have quoted verbatim the wording in a footnote (1).

I wouldn't be so worked up about all this if AA were not so all-pervasive in the addiction treatment industry. Out of curiosity, I checked out every residential rehab unit within 50 miles of my postcode. Every single one of them either uses a 12 step approach or is run by the Salvation Army.

Faced with the option of checking into a rehab clinic that requires you to leave your brain at the door or going it alone, I decided to go it alone. My beloved, wise and inspired sister had tracked down a psychiatrist at a Private Hospital in London. He specialises in addiction and had successfully treated a friend of my brother-in-law. Dear friends, let me tell you how much it costs to detox safely and without added institutional meals and charlatanry. £9 (sic). That's what the oh-so-aptly named 'Bliss Pharmacy' at Marble Arch charged me for the 52 Chlordiazepoxide tablets that Dr S prescribed. I'll admit that the one and a half hours I spent with Dr S set me back £380 but boy was it worth it.

Amy Winehouse recently became more famous than she could ever have dreamed of being in life by the simple if drastic expedient of dying. A friend sent me the link to her song 'Rehab', in which she explains her refusal to acquiesce to pleas that she should go there. If someone had had the wit and the wisdom to tell Amy that she didn't need to go to rehab, she might not have felt the need to rebel with such fierce and suicidal determination and she might still be alive today.

'Rehab' by Amy Winehouse

So what next? I'm detoxed. I've said 'no, no, no' to rehab. I'm not going to be in the 70%. I am semi-resigned to a life of sensory deprivation (the friend who advised me not to worry about this - 'masturbation is an art form' he said - is evidently better versed in this field than me). For the moment I'm working very, very hard and thinking as little as possible. One step at a time.

The explorer Benedict Allen became infamous for killing and eating his faithful pet dog Cashew, while lost in the Amazon rain forest. Cashew had become separated from Allen some days earlier when his canoe capsized but the dog had somehow tracked his master and was reunited with him. Several days later, delirious with malaria and hunger, Allen chopped the poor dog's head off and ate its flesh. I think I have an inkling how Allen must have felt, when he regained his sanity. He had killed his best and most faithful friend in the belief that it was absolutely necessary if he was to survive himself. Cashew's story has a sad denouement. A few minutes after eating him, Allen vomited up the dog's remains. Cashew died for nothing but Allen lived to tell the tale (in fact I heard the story from the man himself, when I was an undergraduate). Will the murder I have recently committed have a similarly pathetic ending?

By the way, I don't really do coke with my cornflakes. Just wanted to know who was paying attention.

(1) 'The clinical evidence revealed no significant difference between TSF [twelve step facilitation] and other active interventions in maintaining abstinence, reducing heavy drinking episodes when assessed post-treatment and at various follow-up points up to 12 months. TSF was significantly better than other active interventions in reducing the amount of alcohol consumed when assessed at 6-month follow-up. However, the effect size was small...and no significant difference between groups was observed for any other follow-up points.

No significant difference in attrition rates was observed between TSF and other active interventions in attrition post-treatment and up to 6-month follow-up. However, those receiving TSF were more likely to be retained at 9-month follow-up, although his difference was not observed at 12- and 15-month follow-up.

The quality of this evidence is high, therefore further research is unlikely to change confidence in the estimate of the effect.'

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