The Doctor’s Opinion – Dawn Farm Ed Series

silkworthResearch continues to shed light on the neurobiology of alcohol/other drug addiction. Modern research supports much of what was intuitively and experientially believed by the medical specialists who supported the Alcoholics Anonymous program in its earliest days.  This program will describe a physician’s view of alcoholism, as presented in the literature of Alcoholics Anonymous and updated with the modern neurobiology of addictive illness. It will include a discussion of Dr. Silkworth’s explanation of alcoholism as a twofold disease affecting mind and body, how Dr. Silkworth’s opinion relates to the modern neurobiology of addictive illness, identification of therapy for alcoholism as promoted by Alcoholics Anonymous, and the relationship of this therapy to Dr. Silkworth’s opinion.

Handouts and other goodies:

Handouts and slides:

Related reading suggestions:


The Doctor’s Opinion on Alcoholism from Dawn Farm on Vimeo.


View more webinars from Jason Schwartz.

About the presenter

Dr. Herbert MalinoffHerbert Malinoff, MD, FACP, FASAM, is a specialist in chronic pain and addictive illness. He is the Medical Director of Pain Recovery Solutions, PC; and an attending physician at Saint Joseph Mercy Hospital in Ypsilanti, Michigan. Dr. Malinoff is a clinical faculty member of the University of Michigan Medical Center in the Department of Anesthesiology, and a consultant to Michigan Pain Specialists in Ann Arbor, Michigan. He is also a past President of the Michigan Society of Addiction Medicine. Dr. Malinoff received his M.D. degree from the University of Michigan Medical School.

On knowing and piety toward science

WMHlogowebI’ve pushed back before on the limits of research, “rational” policy, evidence-based policies, and the assumption that research is objective, etc.

On Being recently discussed science and the unknown. Here are a few choice bits.

On the limitations of science:

Dr. Gleiser: . . . one of the grand goals of modern physics is to build a Theory of Everything at all. Not a very beautiful name. But a theory of everything that would in principle explain all that we can observe in nature in terms of a single force, so to speak. And it’s a very beautiful idea. It’s very Platonist in its essence, you know, that the essence of nature is mathematical. There is one big symmetry out there and that symmetry is beautiful and beauty is truth. And hence, you know, there has to be that sort of idea in nature as well. And a lot of people, including Einstein — Einstein spent 20 years of his life looking for this Theory of Everything, this unifying theory, and of course he didn’t find it.

I went to grad school trying to find it too, right, and after many years doing this and talking to lots of my colleagues I came to the conclusion that that’s impossible. That the Theory of Everything is an impossibility as a matter of principle. And the problem is this: that the way we understand the world — and interrupt me if I go on for too long.

Ms. Tippett: No, no. It’s good. We’re all — we’re with you.

Dr. Gleiser: The way we understand the world is very much based on what we can see of the world, right? Science is based on measurements and observations. And the notion that we can actually come up and have a theory that explains everything assumes that we can know everything, right? That we can go out and measure everything there is to measure about nature and come up with this beautiful Theory of Everything. And since we cannot measure all there is to measure, since our tools have limitations, we are definitely limited in how much we can know of the world.

So you can even build a theory that would explain everything that we know now. But then two weeks from now, someone else will come and find something new that does not fit in your theory. And that’s not a Theory of Everything anymore because it doesn’t include everything that can be included.

On piety toward science:

Ms. Robinson: . . . we’re pious toward science. It does in fact criticize itself and overturn itself. It deserves that reputation. But this strange little world that we’re presented as being scientific isn’t, you know; it’s some sort of petrified conception that would have been at home in the 19th century.

Ms. Tippett: Do you have any …

Dr. Gleiser: No. I actually — being a scientist I actually agree with Marilynne. You know, I think that once you adopt that there is only one way of understanding the complexity of things you’re just emptying humanity of its value. You know, of the plurality of visions. And so, yes, science is powerful. I love it. I do it. But there are other ways of knowing, you know. And to say that there is only one way of understanding the mind, which is a topic that Marilynne talks so much about in her book, is just silly, to be honest. It’s impoverishing the richness of human culture.

I think all of this is important. Science and research is full of bias and embedded assumptions. For example:

  • Materialism drives faith in the notion that managing brain chemistry is the real path to recovery and suspicion of anything that can’t be measured or have its mechanisms explained.
  • The notion that there’s a direct line between research and policy or practice contains the assumption that what is know is all that is to know or, at least, all that matters.

Recovery vs. Disease Management

hopeThe Hopeworks Community blog has an outstanding post contrasting recovery and disease management.

His focus is on mental illness, but the parallels are clear. One can’t help but reflect on the fact that the addiction recovery movement rose in response to the failure of the mental health system to help addicts recover.

There’s a lot there. It’s worth reading the entire post. Here are a few of my favorite points.

  • Recovery believes that individuals matter.  No degree of impairment or difficulty makes them matter less.
  • Disease management believes that the disease or diagnostic label is the most important thing about anybody.

On recovery vs. symptom management:

  • Recovery  believes the primary thing the  individual recovers is  control over his own life through the acquistion of knowledge, the development of tools that enables him with the support and encouragement of others to begin building the type of life that enables him to be the best and most version of himself possible.  It believes that recovery involves success in activities, connection with other people, in the contetxt of a life of meaning and is important to that individual is important: his thoughts, feelings, goals, aspirations, and interests.  No degree of impairment makes those things matter least.
  • Disease management believes  that symptom management is the best things can be.  And for the most part it believes that those symptoms will be chronic, always in danger of reoccuring.  It largely believes that medication will be a life time need.

On hope:

  • Recovery assumes that hope is a real thing.  Life can and should be a movement towards better things.  The steps may be slow and require much in the way of patience, but no matter how slow or small they are they are real and should be valued and treasured.
  •  Disease managment believes that hope is limited to symptom management.  It assumes that people will need continual treatment and that life will always tend to be disrupted by the “course of the disease.”  Life never really gets better, the hope is that it get less worse.

On the humanity of people with mental illness:

  • Recovery assumes that mental illness does not cause you to lose anything essential to being a human being.  Mental illness may block you.  It may disrupt you.  It may damage you.  It may detour you.  It does not diminish what it means for you to be a human being.
  • Disease management believes that the much of what you do, much of what you think, much of  what you feel, and even much of what you believe is either a symptom of your disease or a reaction to a symptom of your disease.

Personal responsibility:

  • Recovery assumes personal responsibility.  It is not something done to you.  It is not something you are given as much as it is something you get.
  •  Disease management identifies responsibility as following directions given to you by medical personal.

On helping that helps the helper:

  • Recovery assumes that you can support and help others, that often, the greatest help you get is in the help you give.
  •  Disease management believes that your capacity to give to others is not as great as people who are not “mentally ill.”  They do not believe you can be near as helpful as a medical person.

1 in 5 Russian men die of alcohol-related causes

foreignThe scale of the alcohol problem in Russia is stunning:

Today, according to the World Health Organization, one in five men in the Russia Federation die due to alcohol-related causes, compared with 6.2 percent of all men globally. In 2000, in her article “First Steps: AA and Alcoholism in Russia,”Patricia Critchlow estimated that some 20 million Russians are alcoholics in a nation of just 144 million.

They have tried to address it several times, but their efforts have been political pressure to maintain alcohol tax revenues. (Is there a lesson to be learned for advocates of propping up state budgets with marijuana tax revenues?)

The Russian government has repeatedly tried to combat the problem, but to little avail: this includes four reforms prior to 1917, and larger scale measures taken during the Soviet period in 1958, 1972, and 1985. “After each drastically stepped-up anti-alcohol campaign, [Russian] society found itself faced with an even greater spread of drunkenness and alcoholism,” explains G.G. Zaigraev, professor of Sociological Sciences and Head Science Associate of the Institute of Sociology at the Russian Academy of Sciences. The Kremlin’s own addiction to liquor revenues has overturned many efforts to wean Russians from the snifter: Ivan the Terrible encouraged his subjects to drink their last kopecks away in state-owned taverns to help pad the emperor’s purse. Before Mikhail Gorbachev rose to power in the 1980s, Soviet leaders welcomed alcohol sales as a source of state revenue and did not view heavy drinking as a significant social problem. In 2010, Russia’s finance minister, Aleksei L. Kudrin, explained that the best thing Russians can do to help, “the country’s flaccid national economy was to smoke and drink more, thereby paying more in taxes.”

Love and faith

$(KGrHqVHJE!FH,YHy3yhBR8G6+(mnQ~~60_12The field of addiction treatment was flawed in 1973, but not nearly as flawed as some would have you believe.

The following is from Marty Mann in 1973 and I could not do a better job of summarizing Dawn Farm’s approach.

Para-professionals working in the field of alcoholism are overwhelmingly recovered alcoholics. Most of them credit their recovery to AA, some to the facility where they are currently working, an increasing number to a combination of both, and a few to still other forms of therapy. One thing they all share is their attitude toward sick alcoholics, whether those alcoholics are in treatment, approaching treatment, or in and out of treatment with their motivation barely showing. Their attitude even encompasses all those sick alcoholics out there, who have not yet appeared anywhere at all seeking help, some of whom are known to the recovered alcoholics, but who cannot yet be reached. What is this attitude that I call the key to successful treatment? First, it’ is accepting of the other person just as he is, for exactly what he is. Second, it accords him the dignity of his humanity quite apart from his illness which may have buried that humanity deep out of sight. He is regarded as a person, in great trouble to be sure, but not a non-person for all that. Third, it offers him understanding and, as a result of that, compassion, or as many recovered alcoholics flatly put it, love. Finally, and perhaps most important of all, it exhibits faith, a belief that he too, this alcoholic whoever he may be, can and will recover.

There is nothing about this crucial attitude that need be, or is in fact, confined to recovered alcoholics. It is the attitude of many professionals both in and out of this field; it lies within the power of any human being, professional or otherwise, to achieve. But it has been sadly apparent for many years that far too many non-alcoholic professionals!, and other people surrounding the alcoholic, do not have this attitude. They have instead a composite of opposites to the points enumerated above. They are condemning, and therefore often hostile. They are quick to blame the alcoholic for his condition and to see the horrors of the condition as the man. They unwittingly treat him as less ·than human because he is not as they are. They are contemptuous of his weakness, his failure to stand up to life. They are sometimes punitive, believing that what he really needs is to be taught a lesson. They do not understand him and so they do not really like him. And he knows it.

It has been said that alcoholics are like children and dogs; they do not hear what you say, they feel what you feel. Their nerve ends are as if extended out from the body; probing, feeling, responding, often unconsciously seeking the rejection they have become accustomed to getting, testing the counselor.


Sanjay Gupta – I was wrong about pot

English: An ounce of Green Crack bought from a...
English: An ounce of Green Crack bought from a dispensary in California. (Photo credit: Wikipedia)


Worth noting that the guy was almost Surgeon General of the U.S. He’s changed his mind on marijuana. He says he overestimated the harm and looks forward to more research on medical marijuana.


I didn’t read many conclusions in his piece, but I agree with the questions he’s asking.


As far as medical research goes, he didn’t address one issue that I think is very important–the delivery method. Smoking weed bought at a dispensary does not resemble medicine in the least. It seems a very important step is to come up with a good delivery system that delivers a reliable and known dose.



What happened to the “crack babies”?

English: An intubated female premature infant ...
English: An intubated female premature infant born prematurely 26 weeks 6 days gestation, 990 grams. Photo taken at approximately 24 hours after birth. (Photo credit: Wikipedia)



Dirk Hansen reports the good news about “crack babies”:


In a paper authored by Hurt, Laura M Betancourt, and others, the investigators write: “It is now well established that gestational cocaine exposure has not produced the profound deficits anticipated in the 1980s and 1990s, with children described variably as joyless, microcephalic, or unmanageable.” The authors do not rule out “subtle deficits,” but do not find evidence for them in functional outcomes like school or transition to adulthood.


And, the bad news:


As FitzGerald writes: “The years of tracking kids have led Hurt to a conclusion she didn’t see coming. ‘Poverty is a more powerful influence on the outcome of inner-city children than gestational exposure to cocaine,'” Hurt said.


He asks, “How did this urban legend get started?”


In the 1980s, during the Reagan-Bush years, Americans were confronted with yet another drug “epidemic.” The resulting media fixation on crack provided a fascinating look at what has been called “drug education abuse.” This new drug war took off in earnest after Congress and the media discovered that an inexpensive, smokable form of cocaine was appearing in prodigious quantities in some of America’s larger cities. Crack was a refinement to freebasing, and a drug dealer’s dream. The “rush” from smoking crack was more potent, but even more transient, than the short-lived high from nasal ingestion.