Bias in the evidence base

evidenceFrom The British Psychological Society’s Research Digest:

In the last few years the social sciences, including psychology, have been taking a good look at themselves. While incidences of fraud hit the headlines, pervasive issues are just as important to address, such as publication bias, the phenomenon where non-significant results never see the light of day thanks to editors rejecting them or savvy researchers recasting their experiments around unexpected results and not reporting the disappointments. Statistical research has shown the extent of this misrepresentation in pockets of social science, such as specific journals, but a new meta-analysis suggests that the problem may infect the entire discipline of psychology.

A team of psychologists based in Salzburg looked at “effect sizes”, which provide a measure of how much experimental variables actually change an outcome. The researchers randomly sampled the PsycINFO database to collect 1000 psychology articles across the discipline published in 2007, and then winnowed the list down to 395 by focusing only on those that used quantitative data to test hypotheses. For each main finding, the researchers extracted or calculated the effect size.

. . .

The authors, led by Anton Kühberger, argue that the literature is thin on modest effect sizes thanks to the non-publication of non-significant findings (rejection by journals would be especially plausible for non-significant smaller studies), and the over-representation of spurious large effects, due to researchers retrospectively constructing their papers around surprising effects that were only stumbled across thanks to inventive statistical methods.

Read the rest here.

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Sublime Recovery vs. Banal Recovery

dialectic3Eve Tushnet offers a really thought provoking discussion of a dialectic involving competing recovery narratives.

First, “sublime” recovery:

In this narrative, addiction and recovery are basically spiritual. Forgive me for drastically oversimplifying a novel I’m loving, but in IJ [Infitite Jest] addiction is often an enslavement of the will or an escape from the self. Recovery is even more insistently spiritual. You recover by giving up and doing as you’re told: Unconditional surrender is the only path to personal peace. If you don’t learn humility through obedience and accept total transformation through surrender to some kind of obscure Higher Power you will destroy yourself and everything you care about.

Then, “banal” recovery:

There’s another narrative, though, which is emerging at sites like The Fix and This is a gradually-coalescing worldview, which typically includes but isn’t limited to “harm reduction” properly understood: ”Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. ”

She contrasts the two narratives in several ways, including their view of authority:

The two narratives have differing views of authority: The 12-Steppy model comes across as authoritarian, and can definitely be used as an excuse for cruelty, but it also has an anarchic respect for the wisdom of ordinary people. It attempts to turn followers into leaders through personal guidance. What I’m (again, super-reductively) calling the harm reduction model is simultaneously much more individualistic, and much more reliant on medical expertise. The expert-layperson hierarchy is in many ways more rigid than the sponsor/sponsee relationship. The harm reduction worldview tries to avoid the problems of class- and education-hierarchies by soliciting as much participation as possible from people on the ground, current drug users. “Nothing about us without us” is a slogan of the harm reduction movement, and one with which I agree… but it’s not a slogan AA ever needed, because AA’s whole genesis and development was by “us,” the alcoholics.

She repeatedly acknowledges that she’s oversimplifying the themes in these narratives, but she does a very interesting job contrasting these narratives and the views within them.

An especially interesting point is around “real” recovery.

The increased prominence of the dramatic 12-step narrative, what I’m calling the narrative of sublime recovery, may make it harder for us to accept that anything else is “real” recovery at all.

Maia Szalavitz, a truly invaluable journalist whose work I’ve recommended here before, recently asked, “Most People With Addiction Simply Grow Out of It–Why Is This Widely Denied?” Part of the answer, I think, is that the growing-out-of-it type of recovery is invisible–and it’s invisible because it’s boring.

I have a couple of reactions. First, that I’m not sure I buy the framing of the the “sublime” narrative as being ascendant.

Second, I’d take a step backward on the this matter. Any addict finding a way out of addiction is something to be celebrated, regardless of the path.

The article she references asks why it’s denied that addicts grow of their addiction. I’ve never heard it disputed that lots of problem users moderate or stop without any professional or informal help. I’ve worked in a fairly traditional treatment program that embraces the “sublime” narrative for more than 20 years and taught social work and chemical dependency classes for more than 10 years and we’ve always discussed the fact that the majority of young people who meet alcohol dependence criteria will “mature out”. We’ve emphasized the importance of careful assessment, looking over an extended period of time for factors like multiple failed attempts to stop or moderate, craving/preoccupation, functional impairment, detoxes with returns problematic use, prior treatment episodes, problems with multiple substances, etc., to try to differentiate between problem use and addiction. This can be especially difficult with young people who have never really tried to quit. The point is that DSM Dependence is not a good proxy for addiction. If you use those criteria for identify addicts you’re going to get A LOT of false positives.

The same problem comes up in recovery advocacy, where we hear the frequent references to 23 million recovering Americans. This number is great for advocacy, but it’s based on surveys that count respondents who report once having “a problem” with drug and alcohol and no longer have a problem. Are these people addicts?

The issue isn’t really about denying their recovery, it’s more about questioning their addiction.

It’s also hard for me to imagine that individuals involved would care much. I get the impression that most of them did not think of themselves as addicts and don’t think of themselves as in recovery.

I don’t deny that there are one-wayers who try to invalidate any path but their own. We see that in all cultures/tribes/organizations. And, I think it’s easy to overstate how much tension actually exists. I don’t hear these conversations among recovering people and I don’t hear much tension around it in professional circles. It’s mostly academics, journalists and activists.

However, where there is tension, I wonder how much of the tension around the “realness” of the growing-out-of-it type of recovery is really about the “realness” of the growing-out-of-it type of addiction.

UPDATE: This isn’t to say I believe that addicts can’t experience “natural remission”. As with any illness, it happens. My question is about the number of addicts who grow out of it.

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Book Review: The Recovering Body

download (3)Jennifer Matesa’s The Recovering Body: Physical and Spiritual Fitness for Living Clean and Sober seeks to provide “a roadmap to creating our own unique approach to physical recovery” and frames “physical fitness as a living amends to self–a transformative gift analogous to the “spiritual fitness” practices worked on in recovery.”

She focuses on five areas, blending her own experiences, other recovering people, empirical research and practical to-do lists. The five areas are:

  • exercise and activity
  • sleep and rest
  • nutrition and fuel
  • sexuality and pleasure
  • meditation and awareness

I see two reasons this book is an important contribution to recovery literature.

First, it’s the first book I’ve seen (not that I’m well read in the area) that places such emphasis on physical wellness and self-care as an important element of recovery within traditional 12 step recovery paths. I’ve seen it addressed as an aside, and I’ve seen it offered as an alternative path, but not as an important element within traditional recovery paths.

As researchers and clinicians search for every tool to give addicts any possible edge as they initiate and maintain their recovery, we’d be wise to take notice. There is a growing body of evidence to support Matesa’s assertions that these are important elements of recovery rather than frivolous and indulgent accessories to treatment and recovery programs.

Second, I am convinced that the future of treatment and recovery programs (All chronic disease management programs, really.) should emphasize a lifestyle medicine as the foundation of care. After all, “recovery as a lifestyle” epitomizes one of the things addiction treatment has gotten really right historically and something the rest of chronic disease care could learn from us.

Despite this, professionally directed treatment that discusses the idea of the “recovery of the whole person” has mostly been lip service. Matesa brings this concept to life and presents holistic recovery as a lifestyle to be cultivated, practiced and maintained. On this front, she’s far ahead of professionals and researchers. The field is not there yet and too often equates recovery with swallowing pills or passively doing what professional helpers direct them to do. Matesa bypasses professionals and speaks directly to recovering people as a peer, calling them to action and offering experiential and empirical truth. That’s radical, in the best sense of the word.

Her writing is very accessible, is not preachy, and unpretentiously conveyed a lot of deep truths that I hadn’t considered but seemed self-evident as soon as I read them.

On a personal note, as someone who only started paying attention to physical fitness after 20 years of sobriety, the book takes a lot of previously disparate pieces of information that I vaguely knew to be true and organizes them into framework that not only deepened my understanding, but offered a concrete path to continue enhancing and securing my own recovery. I highly recommend it.

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A Life Rebuilt

We are very proud and excited to present “A Life Rebuilt” by Adam Wright. Adam is a Dawn Farm alumni and made the film about Amy, another alumni.

We love it and hope you’ll love it to.

We hope this is just the first in a series of Dawn Farm films by Adam.

A Life Rebuilt from Dawn Farm on Vimeo.


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We are all connected

photo credit: davegray

photo credit: davegray

I thought we we done with the Robin Williams commentaries, but Pat Deegan just posted a great one.

There were public displays of affection. There were public memorials. Cries went out imploring the public to seek treatment for depression.

But my reaction was somewhat different. I felt angry that Robin Williams took his life. And I felt scared that, completely sober and without the numbness of narcotics, he killed himself. He finally said, “Enough” and then checked out.

To be honest, I felt threatened by Robin Williams’ decision to take his life. I reflected on that for a long time. Why did I feel threatened by his suicide? Eventually, I realized it was because I could relate to his struggle. Recovery is hard work. Treatment does not cure and is often not totally effective in relieving us of symptoms. Those of us with substance use and/or psychiatric disorders are challenged, each and every day, to make the choice to say “yes”. “Carpe diem”, seize the day, said Robin Williams in the Dead Poets Society.

hopeAs I reflected on my reaction to Robin Williams’ suicide, I realized those of us making the journey of recovery are connected. Without even realizing it, I was depending on Robin Williams keeping his sobriety and recovery, to support my own recovery. When he kept going, it emboldened me to keep going. When he gave up, it opened up the frightening possibility that I, too, could choose to give up.

I do not choose to end my struggle, because my life is more than my struggle. I am moving forward in my recovery despite his choice.

The lesson I have learned through Robin Williams’ suicide is that we are all connected. I depend on each of you who are living your recovery. You give me the hope and strength to say “yes” to today. We are connected. Even though I may never have met you, I rely on you to stay true to your journey of recovery. I will stay true to my journey of recovery. Together we shall forge a life and fulfill our human potential, despite the pain.


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Recovery is good business



I just learned of this upcoming talk in Ann Arbor:

Belief, Hope and Generosity in the Workplace: Hiring Individuals in Recovery
Wednesday October 1, 2014: 7:00 pm to 8:30 pm — Ann Arbor Downtown Library: 4th Floor Meeting Room

Ari Weinzweig believes that a key aspect of managing ourselves is acknowledging the power of belief – and how much, whether we realize it or not, our beliefs impact our lives and our futures.

In this talk, the CEO and co-founding partner of Zingerman’s Community of Businesses will take a look at how our beliefs play out in our day to day workplace experiences and how we and our workplaces are impacted by our beliefs. Ari will discuss how what we believe about ourselves, our organization, our coworkers, our boss, the work that we do and our ability to do it will significantly alter the outcomes we get in what we do, and how, wittingly or unwittingly, we go to great lengths to reinforce our beliefs.

zingermans_wisdom_4Zingerman’s has been very good to the recovering community and Dawn Farm. They’ve made Ann Arbor and the recovering community stronger by giving lots of recovering people (often with spotty employment histories) a chance, paying them fairly and providing a growth-fostering workplace. Not surprisingly, small groups of recovering people have developed within their businesses. These groups end up recruiting new employees from withing the recovering community, they support each other, push each other and work together to fulfill Zingerman’s mission:

We share the Zingerman’s Experience
Selling food that makes you happy
Giving service that makes you smile
In passionate pursuit of our mission
Showing love and care in all our actions
To enrich as many lives as we possibly can.

So, recovery is good for business. We’re grateful for Zingerman’s, and I’m pretty sure Zingerman’s is grateful for the recovering community.

Here’s a story we included in a mailing several years back.


Recovery is good business

Or good deli, to be more specific.

The photo above is a collection of men and women who share two great things. They all work for the nationally-known Zingerman’s Delicatessan (that’s co-owner Paul Saginaw on the far left). And all of their lives changed as a result of the programs of Dawn Farm.

Nancy had an addiction that eventually incapacited her. Vince smoked cocaine and injected heroin-and was released from jail to enter Dawn Farm. Betty was a chronic alcoholic, as was Mark, who washed out of school due to his drinking. Jeff and Frank were longtime crack addicts. Pat used a variety of narcotic drugs-that devastated his life. Terry had lost her two children due to her alcoholism.

The stories go from bad to worse. But all of these addicts and alcoholics found a way off the streets through Dawn Farm. These stories all resulted in a miracle-because these men and women are sober and drug-free today. And working at a really great place!

Each of them works full-time. They pay taxes. They rent videos and go grocery shopping. In addition, they all work for a wonderful local employer.

Paul Saginaw and his partners have been hiring Farm graduates for many years. “They really are terrific employees, and I’ve had great success with them over the years.”

Zingerman’s knows that “farmers” know how to work- and they have had a history of good experiences hiring young men and women who’ve been associated with Dawn Farm. “Zingerman’s is great,” offers Betty, “they really make you feel like you’re a part of a family.”

Zingerman’s and Dawn Farm have a unique collaborative relationship in helping these men and women find a way into normal life. The positive culture at Zingerman’s is one that works well with the community of recovery.

The group assembled above have these words for the struggling alcoholic or addict: “You can get better-like we did. You don’t have to live that way anymore. Get some help! Call the Farm, and stay there.”

Paul Saginaw offers his own advice: “When you get out of treatment, come and see me. We’re hiring.”

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Michigan Senate passes 3 bills to make overdose drug more accessible

NARCAN-KITThis is very good news for Michigan:

The state Senate gave final passage today to three bills that will make access to drugs like Narcan, which can successfully reverse the deadly effects of a heroin overdose, more readily available and require emergency medical personnel to carry the drug with them.

The bills would:

  • Allow Narcan to be prescribed to friends and family of heroin addicts, so it’s readily available in the event of an overdose.
  • Protect a person administering Narcan in good faith to be immune from criminal prosecution or professional sanctions.
  • Require emergency medical personnel to carry the drug in their vehicles and be trained in how to administer it.
  • Require the state Department of Community Health to complete annual reports of opioid-related overdose deaths.

It still needs to go to conference and the governor’s desk.

What’s prompting this?

While heroin deaths are down in Oakland and Wayne counties in recent years, they’re up overall in the state, jumping from 271 deaths in 1999-2002 to 728 in 2010-12, according to statistics compiled by the Michigan Department of Community Health.

Admissions to heroin treatment programs also is on the rise, with 12,753 people seeking help for heroin addiction in 2012, compared to 6,500 in 2000.

Now, the big question is, What comes after the overdose rescue? Are these people going to have real access to high quality treatment of adequate duration and intensity?


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