Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Recovery. Show all posts
Showing posts with label Recovery. Show all posts

Friday, March 8, 2024

What Does Being Sober Mean Today? For Many, Not Full Abstinence

Ernesto Londono
The New York Times
Originally posted 4 Feb 24

Here are two excerpts:

Notions of what constitutes sobriety and problematic substance use have grown more flexible in recent years as younger Americans have shunned alcohol in increasing numbers while embracing cannabis and psychedelics - a phenomenon that alarms some addiction experts.

Not long ago, sobriety was broadly understood to mean abstaining from all intoxicating substances, and the term was often associated with people who had overcome severe forms of addiction. These days, it is used more expansively, including by people who have quit drinking alcohol but consume what they deem moderate amounts of other substances, including marijuana and mushrooms.

(cut)

As some drugs come to be viewed as wellness boosters by those who use them, adherence to the full abstinence model favored by organizations like Alcoholics Anonymous is shifting. Some people call themselves "California sober," a term popularized in a 2021 song by the pop star Demi Lovato, who later disavowed the idea, saying on social media that "sober sober is the only way to be."

Approaches that might have once seemed ludicrous-like treating opioid addiction with psychedelics - have gained broader enthusiasm among doctors as drug overdoses kill tens of thousands of Americans each year.

"The abstinence-only model is very restrictive," said Dr. Peter Grinspoon, a primary care physician at Massachusetts General Hospital who specializes in medical cannabis and is a recovering opioid addict. "We really have to meet people where they are and have a broader recovery tent."

It is impossible to know how many Americans consider themselves part of an increasingly malleable concept of sobriety, but there are indications of shifting views of acceptable substance use. Since 2000, alcohol use among younger Americans has declined significantly, according to a Gallup poll.

At the same time, the use of cannabis and psychedelics has risen as state laws and attitudes grow more permissive, even as both remain illegal under federal law.

A survey found that 44 percent of adults aged 19 to 30 said in 2022 that they had used cannabis in the past year, a record high. That year, 8 percent of adults in the same age range said they had used psychedelics, an increase from the 3 percent a decade earlier.

Tuesday, June 12, 2018

Is it Too Soon? The Ethics of Recovery from Grief

John Danaher
Philosophical Disquisitions
Originally published May 11, 2106

Here is an excerpt:

This raises an obvious and important question in the ethics of grief recovery. Is there a certain mourning period that should be observed following the death of a loved one? If you get back on your feet too quickly, does that say something negative about the relationship you had with the person who died (or about you)? To be more pointed: if I can re-immerse myself in my work a mere three weeks after my sister’s death, does that mean there is something wrong with me or something deficient in the relationship I had with her?

There is a philosophical literature offering answers to these questions, but from what I have read the majority of it does not deal with the ethics of recovering from a sibling’s death. Indeed, I haven’t found anything that deals directly with this issue. Instead, the majority of the literature deals with the ethics of recovery from the death of a spouse or intimate partner. What’s more, when they discuss that topic, they seem to have one scenario in mind: how soon is too soon when it comes to starting an intimate relationship with another person?

Analysing the ethical norms that should apply to that scenario is certainly of value, but it is hardly the only scenario worthy of consideration, and it is obviously somewhat distinct from the scenario that I am facing. I suspect that different norms apply to different relationships and this is likely to affect the ethics of recovery across those different relationship types.

The information is here.

Tuesday, March 6, 2018

Don't Blame PPC, Blame Poor Ethics

Kyle Infante
Forbes.com
Originally posted on February 2, 2018

Here is an excerpt:

To sum up the entire debacle in a nutshell: Marketing entities would create referral ads and websites to bid on highly sought after addiction keywords, drive traffic to their call centers and send people to facilities-based purely on profit. There was no clinical or medical prescreening being conducted, no thought put into placing that individual with the appropriate level of care. Suffering addicts and alcoholics were being misled by strategic digital marketing tactics and pushed to the highest bidder. Often, these high bidders had a slew of ethical issues. This drove the cost per click for each ad through the roof, and soon enough only the Goliaths could compete on PPC (pay per click). Unless you had the money to hire an advertising agency or had an in-house marketer with extensive digital experience, there was no way to survive.

Recently, Google stepped in and placed restrictions on these ads to curb the gross abuse of the market. In September 2017, Google began to limit the kinds of ads facilities could create and just this year placed a temporary ban on all recovery ads to audit the entire industry.

The article is here.

Monday, March 6, 2017

Cultivating Moral Resilience

Cynda Rushton
American Journal of Nursing:
February 2017 - Volume 117 - Issue 2 - p S11–S15
doi: 10.1097/01.NAJ.0000512205.93596.00

Here is an excerpt:

To derive meaning from moral distress, one must first change the relationship with the suffering that it causes. Human beings have the potential to consciously decide what mindset they will bring to a given situation; they have the option to choose a path of mindful awareness and inquiry over one of helplessness and frustration. When people are mired in the “judger pit,” the tone of their conversation is punctuated by negativity, closed thinking, and judgment of themselves and others.40 Alternatively, when in an inquiring mindset, they are more inclined to remain positive—despite their distress—and are able to ask questions that may help reveal unknown or overlooked possibilities.

Shifting the focus from helplessness to resilience offers promising possibilities in designing interventions to help mitigate the effects of moral distress. Resilience—an umbrella concept that has been applied in diverse fields of study—can be psychological, physiologic, genetic, sociologic, organizational or communal, or moral. Although there is no unifying definition, resilience generally refers to the ability to recover from or healthfully adapt to challenges, stress, adversity, or trauma. One definition characterizes it as “the process of harnessing biological, psychosocial, structural, and cultural resources to sustain wellbeing.”

Psychological resilience, for example, “involves the creation of meaning in life, even life that is sometimes painful or absurd, and having the courage to live life fully despite its inherent pain and futility.”

The article is here.

Saturday, December 5, 2015

Implanting and Erasing Memories: Life-Changing, or Taking Science Too Far?

By Jordan Gaines Lewis
Gaines, on the Brain
Originally published November 9, 2015

Here is an excerpt:

But what if doctors and researchers could attack PTSD at the source: actually implanting or erasing specific memories in a person's brain?

It may sound like science fiction — not unlike Lord Voldemort luring Harry Potter to the Ministry of Magic by creating false images in Harry's mind, or the entire premise of the movie Inception — but science is actually getting close. In mice, neuroscientists have found ways to not only identify the location of certain memories, but to actually manipulate those memories.

But can we do this in humans — in patients with PTSD? And perhaps the bigger question: should we?

The entire blog post is here.

Thursday, November 19, 2015

With Sobering Science, Doctor Debunks 12-Step Recovery

Interview with Lance Dodes
NPR
Originally posted March 23, 2014

Here is an excerpt:

There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent. Most people don't seem to know that because it's not widely publicized. ... There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine.

It's not only that AA has a 5 to 10 percent success rate; if it was successful and was neutral the rest of the time, we'd say OK. But it's harmful to the 90 percent who don't do well. And it's harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. AA is never wrong, according to AA. If you fail in AA, it's you that's failed.

Wednesday, April 10, 2013

Viewpoint: We Need to Rethink Rehab

By David Sheff
Time
Originally published April 3, 2013

Here are some excerpts:

I’ve already written about my experience with Nic, but for my new book, Clean, I wanted to understand why so many suffer and die. So I undertook an investigation of the treatment system that so often fails. I learned that no one actually knows how often treatment works, but an oft-quoted number of those who abstain from using for a year after rehab is 30%. Even that figure is probably high. “The therapeutic community claims a 30% success rate, but they only count people who complete the program,” according to Joseph A. Califano Jr., the founder of the National Center on Addiction and Substance Abuse and former U.S. Secretary of Health, Education, and Welfare. “Seventy to eighty percent drop out in three to six months.” Over the course of my research, I did hear one statistic that I trusted. Father John Hardin, chair of board of trustees at St Anthony’s, a social services foundation with an addiction recovery program in San Francisco, told me, “Success for us is that a person hasn’t died.”

The treatment system fails because it’s rooted in an entrenched but inaccurate view that addicts are morally bereft and weak. If they weren’t, the belief goes, they’d stop using when drugs begin to negatively impact their lives. Most treatment centers in America are based on an archaic philosophy that’s rooted in the Twelve-Step model of recovery. Twelve-Step programs have saved countless lives, but they don’t work for a majority of people who try them. It’s not a fault in the program itself. Its founder, Bill Wilson, wrote, “These are but suggestions.” But many rehabs require them. This is particularly problematic for teenagers and young adults, the very people most susceptible to addiction. Twelve-Step programs require people to accept their powerlessness and turn their lives over to God or another higher power. Many adolescents question religion and in general teenagers aren’t going to turn their lives over to anyone.

In many of these Twelve-Step-based programs, patients are berated and yelled at if they don’t “surrender” and practice the steps. They’re warned — in some cases, threatened — that if they don’t they’ll relapse and die. It can become a self-fulfilling prophecy.

The entire story is here.

Saturday, February 9, 2013

Successful and Schizophrenic

By ELYN R. SAKS
The New York Times - Opinion
Published: January 25, 2013

THIRTY years ago, I was given a diagnosis of schizophrenia. My prognosis was “grave”: I would never live independently, hold a job, find a loving partner, get married. My home would be a board-and-care facility, my days spent watching TV in a day room with other people debilitated by mental illness. I would work at menial jobs when my symptoms were quiet. Following my last psychiatric hospitalization at the age of 28, I was encouraged by a doctor to work as a cashier making change. If I could handle that, I was told, we would reassess my ability to hold a more demanding position, perhaps even something full-time.

Then I made a decision. I would write the narrative of my life. Today I am a chaired professor at the University of Southern California Gould School of Law. I have an adjunct appointment in the department of psychiatry at the medical school of the University of California, San Diego, and am on the faculty of the New Center for Psychoanalysis. The MacArthur Foundation gave me a genius grant.

Although I fought my diagnosis for many years, I came to accept that I have schizophrenia and will be in treatment the rest of my life. Indeed, excellent psychoanalytic treatment and medication have been critical to my success. What I refused to accept was my prognosis.

The entire article is here.

Wednesday, January 30, 2013

Recovery from autism spectrum disorder (ASD) and the science of hope

Editorial in The Journal of Child Psychology and Psychiatry
Sally Ozonoff JCPP Joint Editor
Originally published January 16, 2013
DOI: 10.1111/jcpp.12045


The Journal of Child Psychology and Psychiatry, and the field of developmental psychopathology in general, is keenly interested in stability and change, continuities and discontinuities, and prediction of outcome. This issue of the journal presents several articles that examine influences and predictors of child difficulties, such as avoidant behavior (Aktar et al., 2012†) and antisocial behavior (Rhee et al., 2012). The effects of maternal depression and parental anxiety on child outcomes are also explored in this issue (Aktar et al., 2012; Hughes et al., 2012), as are the stability of symptoms in autism spectrum disorders (Corsello et al., 2012; Simonoff et al., 2012). All add to our understanding of the basic mechanisms and developmental pathways that underlie atypical child development. I call your attention to one article in particular that explores these concepts from a different angle and brings solid science to an understudied topic with a very controversial and contentious history, namely recovery from autism spectrum disorder (ASD).

Fein et al. (2012) recruited 34 children with clearly documented early histories of ASD who no longer met criteria for any autism spectrum diagnosis and, even further, had lost all symptoms of ASD. They compared these children to a group of typically developing participants and found no differences on multiple measures independent of the group classification process. They conclude, rather modestly, that these results “substantiate the possibility of optimal outcome,” demonstrating that some children with a clear early history and accurate diagnosis of ASD do indeed move into the entirely normal range of social and communication development later in childhood. Fein et al. use the word “recovery” only once in their paper, in reference to the findings and claims of another study. Their avoidance of the word is likely intentional. In fact, scientific papers have largely steered clear of this word, although it is alive and well on the Web. Why has recovery been such a provocative concept?

Lovaas (1987) was the first to use the term “recovery” in relation to ASD, describing the outcomes of children he had treated using the methods of applied behavior analysis. He did not provide an explicit definition of recovery, but described this group of children as having normal educational and intellectual functioning. His interpretation of this outcome as “recovery” was embraced wholeheartedly by some and scrutinized skeptically by others. It was pointed out that many children who meet criteria for ASD attain this level of functioning, but continue to display significant symptoms. Whether they had achieved “recovery” that fit with the Merriam-Webster definition of “regaining or returning to a normal or healthy state” was disputed. Researchers have generally avoided the term for fear of being viewed as naïve, idealistic, political, or simply just not good scientists. But recovery has remained a very powerful construct, one that many parents talk about and that has been the subject of much media and internet attention.

The entire article and issue can be found here.