Friday, 2 September 2011

High and dry

Another week, another mind-altering substance. This one is called Baclofen, an anti-spasticity agent that has been around for years and has been used primarily to control the symptoms of MS and cerebral palsy. A cardiologist, Olivier Amiesen wrote Le Dernier Verre, published in English as The End Of My Addiction, about how Baclofen 'cured' his alcoholism.

Baclofen is a GABA (gamma aminobutyric acid) receptor agonist, that works by binding with GABA receptors in the cell membranes of neurons, opening potassium channels via a series of intermediate metabolic steps and thereby inhibiting the release of certain neurotransmitters. Why that in turn reduces alcohol cravings remains in the realms of speculation.

I've finished my course of Chlordiazepozide, so the number of psychotropic substances I ingest each day is stable at four. Since three of these have anxiolytic properties, a pot-toking jellyfish probably suffers more anxiety in the course of a bad day in the plankton than I do in an average week. My new psychiatrist cheerfully told me that he is using me as 'a sort of a guinea pig' because the Medical Research Council has recently declined to fund a full scale clinical trial into the efficacy of Baclofen in addiction treatment so, for the moment, he must rely on anecdotal evidence from his patients.

Clutching his prescription in my sweaty hand, I paid another visit to Bliss (the pharmacy, not the state of mind), handed over £12 and swallowed my first dose. At this rate of expenditure on pharmaceuticals it will take me 32 years to spend as much as the Priory would have charged me for a month's stay. I may not be a financial analyst of the first water but I know a bargain when I see one and Baclofen is definitely up there with Sainsbury's own-label Chianti and the flame-haired masseuse at the Hotel Lipka in Montenegro.

Speaking of the Priory, a friend(1) has alerted me to the entertaining factoid that 'the Priory chain was sold to a bunch of US private equity sharks, Advent International, which specialize in “mid-cap growth companies” (addiction is a fine growth business, of course)'. I worked for a few years in the leveraged buyout group at JP Morgan and became accustomed to going on site visits, during the course of which we observed soon-to-be-made-redundant wage slaves going about their futile working lives. This activity was referred to as 'kicking the tyres'. Presumably Advent's executives got to kick the retards before they handed over the wonga to the Priory's previous owners...wait for it...RBS.

Boarding the train back to Chippenham my new drug was immediately put to a stern test by the bloke who sat next to me, sipping beer from a can all the way. I was trying to read a book by the wonderfully euphonious philosophical quartet Bennett, Dennett, Hacker and Searle, the first and third of whom argue that qualia (the 'what it is like' of sensations) do not exist. I can assure them that the beer quale not only exists, it has real effects in the brains of addicts like me.

But this blog is meant to be about alphatuosity, so let me present you with a fine example, taken from the Priory's leaflet on alcohol dependency, on display in the waiting room above the machine dispensing free coffee (an addictive substance on which, according to John Walsh of The Independent, the average Brit now spends more per annum than on utility bills - see here). 

Is alcohol dependency a disease?

It has a cause, a symptom and is treatable - so it has all the characteristics of a progressive disease. People who are dependent on alcohol lose control of how much and how often they drink. The only effective remedy to is to stop drinking completely. 

Alcohol dependency is described in medicine as a 'morbid process'. Put simply, it may kill you if it is left untreated.

Let's briefly but critically appraise this lovely example of complete horse shit.

It has a cause, a symptom and is treatable - so it has all the characteristics of a progressive disease.

Right. So love is a disease, is it? It has a cause (meeting someone with whom you experience mutual sexual attraction), a symptom (several actually, all mind-altering) and is treatable (by marriage). The non-sequitur (see this splendid cartoon series for daily illustrations of the concept) is an essential weapon in the armoury of alphatuists. The method involves making simple, inarguable claims, then drawing invalid but superficially plausible conclusions. I believe in God. I needed a parking space. I prayed that one would be available. There was a parking space just where I needed it. Therefore God exists.

People who are dependent on alcohol lose control of how much and how often they drink.

True but then people who are dependent on oxygen lose control of how much and how often they inhale. The true-by-definition statement is another hallmark of alphatuosity. The point of treatment for alcohol addiction ought to be to enable an addict to regain control. Telling an alcoholic that he cannot control his drinking is like telling an explorer he cannot head east from the North Pole. It is true but useless. The alcoholic, like the explorer, needs to know something that is true but not trivial. 

The only effective remedy to is to stop drinking completely. 

The argument from authority is very powerful. The above sentence is untrue. Many heavy drinkers and some (but very few - see here - alcoholics) learn to moderate their consumption without stopping completely. Presented to suggestible individuals, in a leaflet published by a respected psychiatric hospital, however, it is treated my most readers as being the gospel truth. Ordinary people will do truly appalling things if instructed to do them by an authority figure (see here for a description of a classic series of experiments by Stanley Milligram in which volunteers complied with instructions to administer fictitious electric shocks to a 'subject', who was in fact an associate of Milligram). Alphatuists know this and will often abuse positions of authority by asserting useful falsehoods as undeniable. The key to the gates of heaven are to be found beneath that bulge in my cassock, little boy.

Put simply, it may kill you if it is left untreated. 

Life is a morbid process. Metabolism leads inexorably to death. The point is not that alcoholism 'may' kill you if it is not treated. The point is whether or not the small quota of life each of us experiences is enhanced or diminished by alcohol. It's a moot point and one on which the Priory's leaflet is silent.

Because the Evening Standard is now free I picked up a copy at Marble Arch tube station yesterday, which is why I know that 'shopping mall bosses are shocked at staff who cannot read or write' (see here, if you must - the article is journalism at its most tawdry). Why the bosses are shocked is not explained but one sometimes wonders whether the illiterate are not the lucky ones.

No doubt Advent International will meet its IRR target for the Priory acquisition. My friend is right. Addiction treatment is a growth industry, one driven more by credulity than greed.

(1) It's odd but true that 95% of the interesting factoids I know have been vouchsafed to me by, at most, 5% of my acquaintances. I am not blowing smoke up the arse of this guy (although I suspect he'd enjoy it if I did) when I say that he is responsible for a clear majority of the 95%.

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