Letters, We Get Mail, CDXI
by Orange



BLOG NOTE: 2014.08.16:

An open letter to The FIX web site, a comment on an article about using mental techniques to replace pain medications in Veterans:

A VA Clinic Tries a New Course

New England vets will be treated with a process called "ACT."
Veterans and others seeking relief from chronic pain could be spared joining the millions unwillingly addicted to narcotic pain pills. So what is "Acceptance Community Therapy?"

http://www.thefix.com/content/VA-Clinic-Tries-New-Course-No-Addictive-Painkillers-Neville-Elder2024

I am a Veteran who is appalled by the sound of this article.

This "ACT" was sounding a lot like Alcoholics Anonymous even before I read Dr. Amanda Adcock's ignorant statement that "I mean its like AA or any other treatment program," says Adcock. "People who are one step ahead and looking back explaining how to get there to the new guy."

All of the talk about "acceptance" was the dead giveaway. Acceptance is considered one of the holy virtues in Alcoholics Anonymous:

"And acceptance is the answer to all my problems today. When I am disturbed, it is because I find some person, place, thing, or situation — some fact of my life — unacceptable to me, and I can find no serenity until I accept that person, place, thing, or situation as being exactly the way it is supposed to be at this moment. Nothing, absolutely nothing happens in God's world by mistake."
== The A.A. "Big Book", Alcoholics Anonymous, 3rd Edition, "Doctor, Alcoholic, Addict", page 449.

Now this new "treatment" is going to be just like A.A.?

But A.A. is not treatment, and they will tell you so. They start off by talking about how great the A.A. treatment is, and how it has saved millions of lives, but when you press them for the specifics, like what is the actual cure rate per thousand newcomers, and what medical studies prove the success rate, they switch tunes and declare that A.A. is not treatment and they do not keep records. It's just a "spiritual fellowship". Yes, it's a bait-and-switch trick. A.A. is full of them. And the actual A.A. cure rate is unbelievably low. It is the same success rate as you get by doing nothing — it is the normal rate of spontaneous remission in alcohol abuse and alcohol addiction — just leave the alcoholics to their own devices, and let a few of the alcoholics sober themselves up because they decided not to die that way, and that is just as successful as Alcoholics Anonymous "treatment".

Then this article went on to give us a hexagonal diagram with seven fluffy buzz-words. That is also typical A.A. propaganda, the propaganda trick of the Glittering Generality. It's easy to grandly bandy about wonderful words like "love, fellowship, community, acceptance, hope, salvation, serenity, happiness, God, country, Mom, apple pie, values, eureka, mindfulness, committed, full and meaningful life," and on and on and on, but it is quite another thing to deliver treatment that actually works and produces good outcomes.

Has this ACT ever been proven to work in several valid, properly-conducted, Randomized Longitudinal Controlled Studies? There was no mention of such tests. That is very suspicious. A program that somebody thinks might work in several patients is not a good treatment program for Veterans — especially not when the proponent of such treatment wants to take medications away from Veterans. Likewise, the author of this article faults the VA doctors for being conservative and reluctant to accept ACT. I should hope so. They are also reluctant to embrace witchcraft, voodoo, and demonology for the same reasons.

Then this article used another propaganda trick: Proof By Anecdote. We get the story of one Veteran who found happiness, and that is supposed to show that this "treatment" works: The happy Veteran said, "Now I know that when I experience the pain, the pain makes me feel alive." Spoken like a real masochistic leather-and-whips sex freak.

And Dr. Amanda Adcock explained, "I've worked with several vets who have come completely off narcotic pain meds and are maybe using some other nerve medication..."
Excuse me, but "several" does not prove that the treatment works. I can show you "several" A.A. members who swear that reading the scribblings of the pathological liar William Griffith Wilson (founder of A.A.) keeps them sober. And several Scientologists often swear that reading the "brilliant" writings of the paranoid schizophrenic Lafayette Ronald Hubbard (founder of Scientology) makes them "clear". That is not proof of efficacy. Proof by anecdote is fraud. The plural of "anecdote" is not "evidence".

The idea that Veterans should just tough it out and do without medications is also an old Alcoholics Anonymous idea. A.A. is notorious for telling people not to take their medications — any kind of medications — and to just trust the 12 Steps and God to heal them. A.A. has killed a lot of people that way, causing everything from strokes and heart attacks to suicides in depressed people. This ACT program sounds like more of the same superstitious faith-healing nonsense. Now the Veterans are supposed to just get a new attitude and live without pain medications? That is quackery again.

The Alcoholics Anonymous idea is that we should discard several hundred years of medical progress and just go back to medieval faith healing — just pray to God or Saint Somebody Or Other and demand a miracle, and He or she will give you a miracle on demand and heal you. No medical treatment is required. This ACT idea is similar: just get a new mental attitude and hey presto! you don't need to take any medications. That is faith healing by another name.

Now if the Veterans who are in pain had spent the last 40 years in a Buddhist monastery in the Himalayan Mountains, meditating and learning sophisticated mind control techniques, then it might be possible for them to think their way out of pain. But that is not what they did, and that is not where we are.

A veteran friend of mine went to the San Jose VA Medical Center and asked what drug and alcohol treatment was available, and they told him: "Bible studies, or A.A." In other words, fanatical cult religion quackery or fanatical cult religion quackery. We Veterans deserve better than that. And now this ACT promises to deliver more of the same quackery under another guise. Disgusting.

== Terrance Hodgins, also known as "Orange", author of "The Orange Papers", http://www.orange-papers.org/





August 17, 2014, Sunday, the Fernhill Wetlands at Forest Grove:

Fluffy seeds
Fluffy seeds

Pondscape with Greylag Goose
Gus sees me, and is coming to get some munchies.

Pondscape with Greylag Goose
Gus approaching

Canada Geese
The flock on the pond

[More bird photos below, here.]





[ Link here = http://www.orange-papers.org/orange-letters411.html#MonaLisa ]

Excerpts from the debate on The Fix

MonaLisa1998

Orange, I love you to death, but you're off base on this one.

OrangePapers

Hello Mona, thanks for the love. That is unclear. What is off-base? Which of my statements is incorrect?

By the way, there is even more that I didn't say, like the implicit assumption that using painkillers equals addiction to them. That is the propaganda and debating trick of conflation.

use == misuse

use == addiction

Not even half-true.

Then I noticed the sub-headlne: "Veterans and others seeking relief from chronic pain could be spared joining the millions unwillingly addicted to narcotic pain pills." Millions? That sounds like a made-up statistic. What government agency ever said that "millions" of people (presumably in the USA) are addicted to painkillers?

Is there really a problem with millions of Veterans being addicted to pain-killers, like the headline implies?

Henry Steinberger

Here is where we might agree somewhat. I don't know the actual statistics (and I'll bet neither do you), but I do work with vets, and some do get addicted, using way more narcotics than is needed to control pain, with the side effect that they are too sedated to enjoy life, to interact with family and friends, to pursue what they define as a meaningful and fulfilling life. They come for help. The cost of buying ever greater amounts of narcotics sucks money and life away. To save money some turn to street Heroin which is cheaper, but sometimes tainted, of unknown potency and so downright dangerous, not to mention all those damn needles. If one needs to continuously receive medication a shunt is usually installed so as not to continuously assault the skin and other tissues. I don't know if it's millions or thousands, but they are out there. And many are suffering unnecessarily. And I find that many are not using narcotics for physical pain, but rather to control emotional pain for which there are better approaches (mindfulness and acceptance come to mind, but there are many). And controlling emotional pain this way often, nay usually, leads to problems from the side effects. Narcotics stop pain (all kinds) and cause heavy sedation. Without pain I can do myself harm. If I didn't feel back pain after hours working in my garden, I could actually harm my back. Pain is a warning to stop and protect oneself. So are many of our emotions, even though we don't like them. It's like taking the battery out of the smoke alarm — yes it will be quiet, but you won't know when the house is on fire. Sometime sedation is needed, but daily heavy sedation is not much of a life, and it impacts the people we love. (Sorry, daddy is too sedated to play, work, love or anything else.) Enough.

MonaLisa

News flash guys. The fact that a therapeutic technique happens to have an AA buzzword in it does not make it AA. ACT is a legitimate, evidence based protocol. It's fine to complain, but please, before you do so, know what you are talking about.

http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=191

OrangePapers

Evidence-based? Watch out. I'm just starting to check out all of those tests, and what I am seeing is not encouraging, and it is not "evidence" that ACT does anything for pain. Just any old test does not necessarily prove effectiveness.

The very first test listed on that page says, "A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder."

That is not a Randomized Longitudinal Controlled Study to test whether ACT replaces pain medications or reduces pain. In fact, there was no control group. That test simply compared ACT with "progressive relaxation training". And the test subjects were suffering from obsessive-compulsive disorder, not pain.

Darrel Huff, the author of "How to Lie with Statistics", said, ""If you can't prove what you want to prove, demonstrate something else and pretend that they are the same thing."

Study 2 asked whether ACT would reduce rehospitalization of psychotic patients. That has nothing to do with veterans in pain. There was no control group. They simply compared ACT results with results from "treatment as usual (TAU)".

Study 3 says "Mediators of change in emotion-focused and problem-focused worksite stress management interventions." Work-site stress has nothing to do with Veterans in pain.

You see, simply tossing around some tests results does not make something "evidence-based". And it sure does not prove that ACT can replace pain medications.

The "supplementary materials" section of that page lists more tests that have nothing to do with pain management:

Gaudiano: Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: pilot results.

Goodman: The Yale-Brown Obsessive Compulsive Scale.

Hayes, Acceptance and Commitment Therapy: Model, processes and outcomes.

Twohig, Increasing willingness to experience obsessions: Acceptance and Commitment Therapy as a treatment for obsessive-compulsive disorder.

So far, I'm seeing zero evidence that ACT reduces pain.

OrangePapers

By the way, Mona, that SAMHSA page that you referred to contained a great line about "Quality of Testing." They didn't really pursue that idea at length, but should. There is great variation in the quality and validity of tests.

For example, suppose I was to do a test of ACT versus peanut butter as a cure for pain. After doing the test, I could report, "Eighty percent of the Veterans agreed that ACT was just as good as, or better than, peanut butter for reducing their pain." Obviously, the results are meaningless because peanut butter is not good treatment for pain.

I suspect the same logical fallacy in the first test on the SAMHSA page where researchers compared ACT to "progressive relaxation training" for treating patients with Obsessive-Compulsive Disorder. But when was relaxation training ever found to be valid treatment for OCD? (Now I can believe that telling frantic patients to calm down and relax, and teaching them relaxation and meditation techniques could sometimes help a few of them, but that isn't a cure or real treatment for OCD.)

The way to do valid testing is to have a control group — a group of patients who get no treatment — so you can see how much they improve over time with no treatment at all. Thus you are recognizing the natural healing process — "spontaneous remission" — and accounting for it. (Several eminent psychiatrists have noticed that it didn't seem to matter what therapy or treatment the patients got, most of them got better over time anyway.) If a group of patients who get the experiment treatment gets the same improvement as the control group, then the treatment is doing nothing and is worthless. If the treated group does worse, then the treatment is poison, and is harming the patients. Toss it in the toxic waste dump. Only if the treated group does significantly better than the untreated group does the treatment get rated as successful.

I described proper Randomized Longitudinal Controlled Studies (RLCS) at greater length in this letter:
http://www.orange-papers.org/orange-letters26.html#RLCS

About the term "evidence-based": Suppose I was a doctor who had a patient with a bad streptococcus infection. I say, "I'll treat the patient with penicillin. That is good evidence-based treatment. Voodoo is not evidence-based, and magical charms and spells are not, and prayer is not, but penicillin is, so I'll use penicillin." And lo and behold, the penicillin works well, and the patient recovers. Now suppose I have a patient with cancer. I say, "I'll treat the patient with penicillin. That is good evidence-based treatment." WRONG! No it isn't. There is zero evidence that penicillin cures cancer, and a lot of evidence that it doesn't work on cancer at all.

Similarly, talk therapy is not evidence-based treatment for pain. This ACT sounds a lot like a Dutch Uncle session where the "therapist" says, "Grow up. Tough it out. Accept that you are sick. Commit yourself to doing better." That may help with a few psychological conditions, but it is not a cure-all.

The fields of psychiatry and psychology are plagued with fraud and quackery. I blame Sigmund Freud, who started it with the assertion that laying on your backside on a couch and staring at the ceiling and talking about fantasies of sex with your mother was good psychotherapy that could cure all kinds of mental illnesses. Since then, we have had an endless series of hoaxes and fads and frauds like Rebirthing Therapy and Recovered Memories Therapy that have caused more harm than good. The biggest improvements in psychiatry in the last century have come from medications, not talk therapy. Anti-psychotic medications have released a lot of patients from straight jackets and insane assylums, and made it possible for them to live semi-normal lives.

When someone advocates going in the other direction, and substituting talk therapy for medications, I am very, very suspicious of quackery and fraud.

Henry Steinberger

I love Huff and have re-read it over the years. If you can't prove something, change the subject and prove something else. OK — perhaps this research doesn't study what's reported in this article in FIX — that reflects bad journalism, not bad science. Perhaps the author of the article needs to re-read the study. The media is looking for stuff about pain (if it bleeds, it leads), and OCD just doesn't sound painful enough (for a journalist — though for OCD sufferers it can be debilitating — and ACT is a great approach to OCD. Secular Mindfulness (as studied by Jon Kabat-Zinn) has a proven track record for helping (not curing) with chronic pain. ACT incorporates mindfulness training and likely gets similar results, plus the focus on a valued life and commitment to one's values. But like I said previously, go to the ACBS website and check out the research on ACT (go beyond one [expletive avoided] magazine article written for a more general audience, and you will see (if you are open to seeing) what really is there. NOW I have to read the {blankitty} article and see where this PAIN was inserted, if at all.

OrangePapers

Hello Henry,

Thanks for all of the letters. I wrote a long answer to you, but left it in the other computer at home. I've been having computer problems and had to reinstall the entire operating system here and things still are not right, and this is the first time I've even been able to connect. I'll send you the letter on Monday. In the mean time, all that I can say is that I agree with what you have said, and it's a real shame that you aren't the one who is running the program for the V.A. Have a good weekend now.

MonaLisa1998

They aren't using it for pain treatment though, Orange, or using it to reduce pain! It is being used as a psychological treatment alongside medication. As the article notes:

"This therapy isn't replacement for medication at all:

"We have a broad perspective, a common language, to think about how to use any pain treatment for the purposes of getting back into life rather than simply the elimination of pain."

This approach allows PCPs to use meds more effectively.

"Sometimes I have people I work with who use meds constantly and chronically and perhaps have a problem with medication. What we do is help someone to use meds more functionally. [For example,] if I know I react poorly to a medication perhaps I can I adjust when I take my doses, in order to be more able to engage with my family."

I think your objection to this has entirely to do with the fact that the author mentioned the dreaded "AA" words in the article and that the word "acceptance" is used in the title of the approach. A bit of a knee-jerk, if you ask me.

OrangePapers:

Hi MonaLisa,

Knee-jerk reaction? Yes, I reacted to the line that her program is "just like A.A., or any other treatment program..." But I believe that I have good reason to react. The VA has a long history of shoving A.A. on Veterans. Over in California, for many years, the Moos and Humphreys team has been using the Palo Alto VA Medical Center and VA funding to conduct faked tests and studies that supposedly proved that A.A. works great. The International Journal of Mental Health and Addiction totally discredited the faked Humphries-Moos study that supposedly showed that A.A. works better than Cognitive Behavioral Therapy. They criticized the "test" for many failings like bad mathematics in calculating the A.A. success rate, no control group, mixed teachings (teaching 12-Step superstitions in CBT courses), cherry picking, self-reporting, unrealistic environments, and no actual valid follow-up. The Moos-Humphreys team has been using VA facilities to shove such A.A. quackery on Veterans for many years. See:
http://www.orange-papers.org/orange-letters247.html#Clark_M

So when another "authority" comes along and says that she is running a program for the V.A. that is just like A.A., I believe her.

I have received several letters where people complained that the treatment center salesman told them that the program was based on Cognitive Behavioral Therapy, but it turned out that it was just another 12-Step program. Then the "counselors" rationalized that A.A. helps people to straighten out their thinking just like CBT, so they are just the same. No they aren't. See:
http://www.orange-papers.org/orange-letters325.html#Ilse3

And of course there is also the content of the whole rest of the article, with her star pupils raving about the joys of pain — "the pain makes me feel alive" — and all of her "success stories" were people who had totally stopped taking pain medications. There were no stories about the guys who simply cut down on their consumption of pain pills. Apparently they weren't "success stories".

And see the drift of the language: "All along they've being doing all these things (avoidance, denial, substance abuse, etc.) in the service of pain instead of the service of well-being or their family and the things they care about." That sounds exactly like A.A. put-downs. You selfish creep. You disgusting addict.

And then we get the double-talk: "Addictive behavior is no more stigmatized than any other behaviors." She says that right after she shames the Veterans for denial and selfishness and not considering the feelings of the family, etc... That is also A.A. behavior, first declaring that alcoholics are selfish and self-centered and in denial and morally deficient, and then declaring that "We want to remove the stigma of alcoholism." (No they don't; they do everything in their power to increase the stigma by stereotyping alcoholics as bad people who are weak and selfish and immoral and don't know God and are only an arm's-length away from relapse, so you can't trust one at all.)

And again, the article says that "This therapy isn't replacement for medication at all...", but the success stories are all people who have totally quit taking pain medications. So apparently she thinks that her program really is a replacement for pain pills. At least sometimes. "I've worked with several vets who have come completely off narcotic pain meds..." She said little about teaching Vets to be more careful and responsible in their use of medications. (Admittedly, maybe the writer just forgot to include that in the story.)

We got this:

This approach allows PCPs to use meds more effectively.

"Sometimes I have people I work with who use meds constantly and chronically and perhaps have a problem with medication. What we do is help someone to use meds more functionally. [For example,] if I know I react poorly to a medication perhaps I can I adjust when I take my doses, in order to be more able to engage with my family."

Sometimes it does mean getting off of painkillers altogether.

"I've worked with several vets who have come completely off narcotic pain meds and are maybe using some other nerve medication and they say things to me like: "Now I know that when I experience the pain, the pain makes me feel alive."

First, she talked about using "meds" more effectively, but then switched to "quit narcotic painkillers completely." It's a complete about-face, a bait-and-switch trick in five sentences. That sounds just like another A.A. bait-and-switch trick: First, it's "See a doctor, because we only know a little," but then it's: "Meds still the small quiet voice of God. We know more about addictions than doctors."

Now it is possible that this is simply a very badly written article that doesn't do justice to Dr. Amanda Adcock. Perhaps the writer just left out all of the stuff about teaching the Veterans how to just use fewer pills, and stave off addiction.

But I don't think so. Dr. Amanda's final answer was: "Acceptance of chronic pain as something's that's always going to be there. Something that hijacks the brain and takes over but it's something we can learn to live with."

So just accept your pain. Learn to live with it. You are going to be in pain until you die. (Or commit suicide to end the pain.)

Oh well, have a good day anyway.

== Orange

*             orange@orange-papers.org        *
*         AA and Recovery Cult Debunking      *
*          http://www.Orange-Papers.org/      *
*       http://www.orange-papers.org/forum/   *
**     "There shall be no *poofing* in science"
**       ==  Paul C. Anagnostopoulos





August 17, 2014, Sunday, the Fernhill Wetlands at Forest Grove:

Pondscape
Pondscape

Pondscape
Pondscape

Canada Goose family with goslings
A family of Canada Geese is coming over to get some bread

Canada Goose family with goslings
Bread on the Water

[The story of the birds continues here.]





[ Link here = http://www.orange-papers.org/orange-letters411.html#Henry_S ]

Date: Thu, 21 Aug 2014 21:23:42 -0000     (answered 27 August 2014)
From: "Disqus"
To: orange@orange-papers.org
Subject: Re: New comment posted on Changing of the Guard

Henry Steinberger wrote, in response to OrangePapers:

Dear Orange, My Fellow Supporter of Science-based & Secular Options,

You know me and what I support is science and secularism. So let me start out by pointing out that everything and everyone who uses the term 'acceptance' is not necessarily of the same stripe. Even if AA and some (certainly not all) religions promote acceptance, that does not mean that accepting oneself, others and the world as they are is an AA or some sort of spiritual adventure. NO! Albert Ellis, of Rational Emotive Behavior Therapy (REBT) fame, made Unconditional Self Acceptance a major tool of REBT (and it has been also used in SMART Recovery). You don't need a higher power, just Al's rational logical thought to find that accepting one's self is far more workable than tearing one's self apart. Even Sam Harris suggests that we can find useful humane values without religion and Ellis found this one, and he was clearly an atheist (though he didn't like the absolutism of atheism and was heard to say: I'm agnostic, but pretty damn sure that it ain't so and I'll find out for sure when I'm dead." Hope he was right — he hated harp music and heavenly choirs.

Now let me clear up what ACT is and isn't and point you towards the facts. Acceptance & Commitment Therapy is a third wave behavioral/cognitive approach to helping people with a great deal of science based empirical support. It is listed as such by the American Psychological Association (do you need the references?) and you can check it out further at the website of the Association for Contextual Behavioral Science (ACBS) at www.contextualscience.org — and I hope you will. BUT I think I know another place where one might have found an AA connection (which I've been trying to get past too). The first book on using ACT in dealing with substance abuse — a workbook called "The Wisdom to Know the Difference" by Kelly Wilson — reflects his own personal recovery and bias, hence the title — which like 'acceptance' takes on a different sense in ACT.

Allow me to explain. In ACT we are not the calling on some lord, god or higher power, however one might obfuscate religion, to remove defects of character or to give us strength to acceptance, courage to change or wisdom to know the difference BETWEEN WHAT YOU CAN AND CAN'T CHANGE. Now I'm an ACT therapist, psychologist and member of ACBS (more on that later) In ACT we note that we can't very well change our thoughts and feelings [except perhaps by the use of unworkable or harmful strategies including the misuse of drugs] so we had best 'accept' them without getting into a futile or harmful attempt to control them [as with drugs], but we can, to a greater extent, control our behavior — and Kelly is delivering the wisdom to know THAT difference. It's being used to capture the Serenity Prayer audience, but it's not a prayer, but rather a formula for getting free from the struggle humans have with mind stuff, and focusing on our human strength to control our behaviors and pursue a life based on (Humanistic if we choose) values — hence wisdom that does not require any 'spiritual awakening' or other faith-based stuff (I say stuff, but you know what I mean).

OK — Kelly's book has lots apologia in his attempt to make ACT fit with AA — damn sidebars explaining how these two seemingly incompatible approaches could be compatible, while he apologizes for a lot of the AA nonsense — for instance saying that wading through the AA dogma can be seen as an exercise in acceptance as there will be lots of people in life who snow you with their dogma ... and so forth. But that's just Kelly. Perhaps AA did save his life and he will be forever grateful (though I've never heard him go on about a higher power or insist that one must bend their will to 'his' etc.) — but please let that go. A better explanation of ACT and its empirical support, besides that found at the ACBS website, can be found in the book for clinicians:

Turner, Nick, Welches, Phil & Conti, Sandra Mindfulness-Based Sobriety: A Clinician's treatment Guide for Addiction Recovery Using Relapse Prevention Therapy, Acceptance & Commitment Therapy, & Motivational Interviewing. New Harbinger Publications, 2013. This book ends with a brief bibliography supporting ACT that you might want to check out before making further comments. And please note that 'mindfulness' can be purely secular without any Buddhist dogma, though it has its roots in that tradition.

So, if I have not yet convinced you, please, let's discuss it. I believe you are a very influential person and I want us to stay on the same side of this issue. You know my mission has been to offer people, my clients and all people, science-based secular options for dealing with addictions — and I see ACT as just such an approach (along with Motivational Interviewing and Alan Marlatt's Mindfulness-based Relapse Prevention Therapy. ACT is science-based and not AA, even if the word acceptance has many meanings (just ask Alice in Wonderland's caterpillar — the word means just what I want it to mean, nothing more and nothing less).

Henry Steinberger, SMART Recovery® Advisor

Link to comment: http://redirect.disqus.com/url?impression=6c438574-2979-11e4-9c5f-002590f3bbfa&experiment=default&behavior=click&url=http%3A%2F%2Fwww.thefix.com%2Fcontent%2Fchanging-guard%23comment-1553550268%3AV6EwbruEhtcRMJsatdH1c1XHIXQ&type=notification.post.registered&variant=control&event=email


From: "Disqus" To: orange@orange-papers.org Subject: Re: New comment posted on Changing of the Guard Date: Thu, 21 Aug 2014 21:48:22 -0000

Henry Steinberger wrote, in response to OrangePapers:

I love Huff and have re-read it over the years. If you can't prove something, change the subject and prove something else. OK — perhaps this research doesn't study what's reported in this article in FIX — that reflects bad journalism, not bad science. Perhaps the author of the article needs to re-read the study. The media is looking for stuff about pain (if it bleeds, it leads), and OCD just doesn't sound painful enough (for a journalist — though for OCD sufferers it can be debilitating — and ACT is a great approach to OCD. Mindfulness (as studied by Jon Kabat-Zinn

Link to comment: http://redirect.disqus.com/url?impression=de9efec0-297c-11e4-8ee0-002590f0f6c8&experiment=default&behavior=click&url=http%3A%2F%2Fwww.thefix.com%2Fcontent%2Fchanging-guard%23comment-1553581541%3AE03F4dSucpPSoMcYahOPuuPgJwI&type=notification.post.registered&variant=control&event=email

Hello Henry,

It's good to hear from you. I have the greatest respect for your work, and defer to your opinion on what ACT is and how it works. If you say that ACT is good stuff, I'll accept that. And I shall go to the library and put a hold on the book that you recommended. Education just never ends, does it?

Alas, it sounds like Dr. Amanda Adcock is doing something other than the ACT that you describe. She says that it is "just like A.A. or any other treatment program." I see only two logical possibilities: either 1) She doesn't know what A.A. really is, or 2) her program really is just like A.A.

The "ACT" program that she is describing doesn't sound much like the ACT program that you described.

I read with alarm her bragging that her star pupils rave about the joys of pain like an S&M pervert: "...the pain makes me feel alive." And her chorus line of poster-child success stories is all guys who take no painkillers at all. There was not one word about teaching rational thinking. (Getting people to repeat buzz-words like "mindfulness", "acceptance", and "values" is not teaching rational thinking.) There was not one word about hints and kinks and techniques to reduce their consumption of painkillers. Nothing about how to stop taking them every so often, when the pain isn't so bad, to detox for three days or so, and test whether they are becoming addicted, and if so, stay off of them until the withdrawal symptoms end. (Many people can accept the idea of being in pain for several days in order to get clean and avoid addiction, while the idea of being in agony for the rest of their lives is unacceptable.) The only end goal that was stated in the article is to make the Veterans stop taking pain pills. That is not good treatment for chronic pain. And I can't see such a program appealing to many Veterans who are in pain.

Now I saw that line that says, "This approach allows PCPs to use meds more effectively." (PCPs was never defined. I guess it means something like Patients with Chronic Pain.) And, "Sometimes I have people I work with who use meds constantly and chronically and perhaps have a problem with medication. What we do is help someone to use meds more functionally." If she is really doing that, then good. But her suggested treatment was just to tell them to take the meds at other times of the day?

Then the author followed that with, "Sometimes it does mean getting off of painkillers altogether." And Dr. Adcock said, 'I've worked with several vets who have come completely off narcotic pain meds and are maybe using some other nerve medication and they say things to me like: "Now I know that when I experience the pain, the pain makes me feel alive."'

So she keeps coming back to the goal of getting the vets to take no powerful narcotic painkillers that actually work. That seems to be the real objective.

I also saw the shaming. The Veterans who are consuming a lot of pain pills are accused of "avoidance, denial, substance abuse", and not caring about the well-being of their family. That is just like A.A. Dr. Margaret Thaler Singer stated that one of the essential elements of a brainwashing program was to create a sense of powerlessness, covert fear, guilt, and dependency. That's the 12-Step program. That doesn't help to improve mental health. Are shaming and guilt induction really a part of ACT?

Shaming and guilt induction are a big part of the 12-Step program. And they can produce very bad results. They can drive depressed people to suicide. I blame the Hazelden routine of repeatedly making Robin Williams do Steps 4 and 5 for his death. Steps 4 and 5, I'm sure you know, are where the "client" lists and confesses all of his sins, moral shortcomings, wrongs, and defects of character. After 28 days of that routine in a previous stay in Hazelden, Robin Williams confessed to Guardian newspaper reporters that it was so hard to live down all of the things that he had done, "You know, I was shameful, and you do stuff that causes disgust, and that's hard to recover from. You can say, 'I forgive you' and all that stuff, but it's not the same as recovering from it. It's not coming back." See:
http://www.theguardian.com/film/2010/sep/20/robin-williams-worlds-greatest-dad-alcohol-drugs

One more trip through Hazelden, and one more repetition of Steps 4 and 5, and he committed suicide. I sincerely hope that Dr. Adcock's program isn't like that. So yes, when Dr. Adcock says that her program for Veterans is just like A.A., that sets off alarm bells.

I quite agree that many Veterans have severe emotional problems. I know some of them. And some of them use drugs to kill their mental pain. One is a Vietnam Vet who is a junky/speed freak who lives on the streets, and the odds of him ever getting clean and sober before he dies are approximately zero. He has been through many programs, including 12-Step ones, and won't even consider going into another one now. When I talk to him about all of the benefits that he could get if he gets into a program, his reaction is, "Oh no. They will start imposing their rules on me (and testing for drugs)", and he won't even consider it. I don't know what to do to help a guy like that. When I give him money, he immediately spends it on drugs. When I buy him a guitar, he disassembles it and loses the pieces. So what to do?

Undoubtedly, part of the problem here is the writer of the article. The article is loaded with biased words and propaganda tricks. He uses slanted language like "millions unwittingly addicted." Yes, those Veterans sure are stupid, aren't they? They are qualified to handle nuclear weapons, but not smart enought to handle pain pills.

And the author used propaganda tricks like conflation and proof by anecdote, which does not inspire confidence. If the program works so well, why don't we get even one statistic for the success rate, or even a measurement of how many of the treated Veterans were able to reduce their consumption of painkillers, and by how much? Just bragging about six or seven guys who no longer take pain pills does not show that the program helps Veterans.

And yes, you are right that I don't know what percentage of Veterans are addicted. I believe that information is protected by doctor/patient confidentiality, so the VA won't be releasing that information.

Oh well, upwards and onwards. And thanks for all that you do.

== Orange

*             orange@orange-papers.org        *
*         AA and Recovery Cult Debunking      *
*          http://www.Orange-Papers.org/      *
*       http://www.orange-papers.org/forum/   *
*
**     Robin Williams: 'I was shameful, did stuff that caused disgust —
**      that's hard to recover from'
**     == The Guardian Newspaper, "The G2 interview",
**     http://www.theguardian.com/lifeandstyle/series/the-g2-interview





August 17, 2014, Sunday, the Fernhill Wetlands at Forest Grove:

Pondscape with Canada Geese
Pondscape with Canada Geese
Do you think there are a few geese?

Canada Goose flock coming
The flock is coming to get something to eat.

Pond dug up
By way of contrast, this is the main pond, drained and dug up with bulldozers.

Canada Goose goslings
Pondscape with bulldozers

[The story of the birds continues here.]





[ Link here = http://www.orange-papers.org/orange-letters411.html#WillieMakeIt ]

Date: Fri, 15 Aug 2014 16:52:43     (answered 1 September 2014)
From: WillieMakeIt
To: "orange@orange-papers.org" <orange@orange-papers.org>
Subject: Let me in

Looking for forum approval. User name WillieMakeIt

A question to group from old timer: "We're all equals here right?"
I replied: "Some more equal than others"
The dude went off on me, thought he was going to have a heart attack!

Thanks
WillieMakeIt

Hi WillieMakeIt,

Thanks for the laugh. Ah yes, good old Orwell.

Have a good day now.

== Orange

*             orange@orange-papers.org        *
*         AA and Recovery Cult Debunking      *
*          http://www.Orange-Papers.org/      *
*       http://www.orange-papers.org/forum/   *
*
**     "Don't you see that the whole aim of Newspeak is to narrow the range
**     of thought? Has it ever occurred to you, Winston, that by the year
**     2050, at the very latest, not a single human being will be alive who
**     could understand such a conversation as we are having now? The whole
**     climate of thought will be different. In fact, there will be no
**     thought, as we understand it now. Orthodoxy means not thinking —
**     not needing to think. Orthodoxy is unconsciousness."
**       ==  George Orwell's 1984, Syme, pages 46-47
*
**     "When you live in a world of universal deceit, telling
**     the truth becomes a revolutionary act"
**       ==  George Orwell
*
**     "To see what is in front of one's nose needs a
**     constant struggle."
**       ==  George Orwell





[ Link here = http://www.orange-papers.org/orange-letters411.html#Bob_O ]

Date: Sat, 16 Aug 2014 11:52:46 -0400 (EDT)     (answered 1 September 2014)
From: Bob O.
To: orange@orange-papers.org
Subject: A description of xa

Terrance,

I understand XA is dangerous but it is difficult for me to explain the dangers. People start asking me questions and I am unable to respond. I tell them to read the Orange-papers but many do not have access or are unwilling to invest the time to read. They will say aa saved their life. I am considering responding with xa is nonsense and say no more. I have noticed some of the people I have talked to I have not seen again but I do not know if they abandoned the cult. I think nonsense is a word everyone can understand and is obvious at meetings.

Thank you for all you do.
Long Island Bob O.

Hi again, Bob,

Thanks for the note. I also have trouble debating face-to-face. I'm much better on paper (that is, really, typing on a computer,) where I can think about my answers for a while — even for days. I think that being quick on your feet (either physically or mentally) is a gift that some people have and some don't.

The best thing that I know of to answer Steppers is information, the truth, and more truth and more truth. Truth is their enemy. That's why they don't allow "non-Conference-approved literature" in their meetings. Something that hasn't gone through their filter of censorship is dangerous because if the members learn the truth, most of them will leave. So I just keep on collecting facts.

I also reread the web page on Propaganda and Debating Techniques and Logical Fallacies every so often, just to refresh my memory of those things and to be able to recall them quickly and easily. And recognize them when someone is pulling them on me.

And they get used a lot in cult religions, both A.A. and other nuts like Pentacostals. They will really hustle you with all kinds of logical fallacies and propaganda tricks. I was just remembering that 45 years ago, I had a Pentacostal arguing with me, "What is your God going to give you? My God gives me...." as if believing in God is a business deal, and you should choose the God who will give you the biggest payoff. That is Assuming the Major Premise, assuming that God gives big rewards to those people who declare that they are His most loyal followers. (Actually, they sound like a bunch of selfish opportunists to me. If I was God, I would not be impressed with such selfish schemers who only love me because they think I will give them money and immortality.) Alas, at that time, I wasn't quite aware of what a hustle such religious diatribes are. But now I know.

And A.A. uses exactly the same logical fallacy in Tradition One, where it says, "A.A. must continue to live or most of us will surely die." That assumes that A.A. is keeping its members alive. No it isn't. They keep themselves alive.

So anyway, it helps a lot to be able to spot the logical fallacies and propaganda tricks, so that you can respond to them and reject them. And it also helps a lot to be able to recognize the outright lies that are repeated so often that people believe them without question. Like in the next letter.

Have a good day now.

== Orange

*             orange@orange-papers.org        *
*         AA and Recovery Cult Debunking      *
*          http://www.Orange-Papers.org/      *
*       http://www.orange-papers.org/forum/   *
**     "A great deal of time and intellectual force are lost in the world,
**     because the false seems great and the truth so small and insignificant."
**       ==  Maria Montessori





[ Link here = http://www.orange-papers.org/orange-letters411.html#Lorraine_S ]

Date: Sat, 16 Aug 2014 23:40:36 -0400     (answered 1 September 2014)
From: Lorraine S.
To: "orange@orange-papers.org" <orange@orange-papers.org>

Do you think that millions is Alcoholics who are sober today is a mistake or a great big lie ?

Sent from my iPhone

Hello Lorraine,

Thanks for the question. That is a Big Lie. That is of course the propaganda trick that Adolf Hitler popularized with all of his lies about how inferior the Jews are, and they caused all of Germany's problems, and that if Hitler just killed all of them, Germany would enjoy a thousand years of power and prosperity. Those lies were repeated so often, for so long, that many Germans, possibly most of them, believed them, at least partly, at least for a while.

Now I know that many of the people in A.A. who repeat the jabber about millions saved are not deliberately lying. They actually believe what they are saying. Somebody said that stuff to them and they believed it, and now they just repeat it without having ever checked the facts.

A.A. has been lying about their numbers since the very beginning. Bill Wilson started it, bragging about the "First 100" when there were only 40 sober A.A. members in the whole world. (And those 40 didn't stay sober, either).

Even Nell Wing, Bill Wilson's personal secretary for many years, wrote in her book,

      Many members recall Bill's tendency to exaggerate. Ruth Hock, Bill's secretary and office manager, remembers that when talking before a meeting he was prone to be overgenerous in quoting the latest membership count or convention attendance. He might say, for example, "Well, folks, I'm glad to say there are now 150 members." Ruth, who like me could be quite literal-minded, would lean over and whisper, "No, Bill, it's only 95" or whatever the figure was. Afterward, Bill would complain good-naturedly, "Oh, Ruth, you're spoiling my fun." Bill always claimed the attendance at the 1955 International Convention was 5,000. Dennis, who handled the registrations, told me the true number was about 3,100, plus possibly a few hundred walk-ins. I recall myself that the crowd nowhere near filled Kiel Auditorium.
Grateful To Have Been There, Nell Wing, page 61.

Lying and fudging the numbers in the critical life-or-death matter of recovery from alcohol addiction is fun?
Bill Wilson was really something else.

Oh well, have a good day anyway.

== Orange

*             orange@orange-papers.org        *
*         AA and Recovery Cult Debunking      *
*          http://www.Orange-Papers.org/      *
*       http://www.orange-papers.org/forum/   *
**      A big lie is more plausible than truth.
**          ==  Ernest Hemingway





[ Link here = http://www.orange-papers.org/orange-letters411.html#Henry_S2 ]

Date: Fri, 22 Aug 2014 16:36:07 -0500     (answered 12 September 2014)
From: "Dr. Henry Steinberger"
To: "'Orange'" <orange@orange-papers.org>
Subject: comment from another reader

Dear Orange,

Mona Lisa wrote me and said:

"Orange is an ally but it's important to keep in mind that he's on the "get rid of AA" side of things, not the "make sure that options are available" side of things.. AA has twisted the meaning of so many words that when we try to use them in their correct sense, it freaks people out."

So, as I said before and on too many replies, please give ACT a bit more exploration and don't judge it by that one word.

I'm still hoping to hear from you more directly (I can't spend another moment on replies regarding FIX — they mess up lots of stuff, but then again there's only so much coverage for SMART Recovery, Moderation Management and my other pets help organizations and therapeutic methods (MI, CBT, DBT, REBT, ACT etc.).

Henry

Henry Steinberger, Ph.D., APA-CPP (Substance Use Disorders)

Hello again, Henry,

Apparently our messages have sort-of crossed in the mail. That is, you have not seen the responses to you and Mona that I posted to The FIX. I haven't been able to respond further, or even see any more comments, because I have been fighting with reinstalling and rebuilding my operating system for three weeks now, and haven't been able to email you directly. I finally got most everything fixed and functional just yesterday, and was able to download 10,000 backlogged emails, including yours. (Yes, I get a lot of spam and bogus forum registrations from spammers.)

So attached are two more files, my first response to you and also my response to Mona Lisa. These files are also posted on the Orange Papers website, here:
http://www.orange-papers.org/orange-letters411.html#MonaLisa
and
http://www.orange-papers.org/orange-letters411.html#Henry_S

Mona Lisa is quite incorrect when she says that I am merely responding to one word in a knee-jerk reaction. As I already explained in the response to Mona, I was responding to everything from Dr. Amanda Adcock's statement that her version of ACT is "just like A.A. or any other treatment program," (thus recommending mentors and sponsors), and propaganda tricks like conflation (use of painkillers == misuse == unwitting addiction), the excluded middle ("you must totally abstain from taking painkillers or else you will be unwittingly addicted"), the bait-and-switch tricks in the article, the shaming and guilt induction, the proof-by-anecdote and chorus line of poster children, the use of inaccurate inflamatory language, and the hidden agenda of getting Veterans totally off of pain pills.

Mona is also totally wrong when she says that I'm only interesting in attacking A.A., and do not care to provide alternatives to sick people. I have been recommending SMART, SOS, Lifering, RR and WFS for 13 years now and cannot count how many people I've referred there. And when people complained that there was no SMART in their area, I recommended that they start their own SMART meetings, and some did, like in England.

Here is my standard list of better methods, organizations, and forums:

  • Sensible Evidence-based Recovery and Support Groups.

  • And here is my list of What works?

    And something that I have never bragged about is the fact that I facilitated SMART meetings in Portland for a while, so that court-ordered people would have someplace else to go, other than A.A. (But now my health is unreliable and that is out of the question.) I am very much interested in getting sick people good treatment.

    Have a good day now, and thanks for all that you do.

    == Orange (really, Terrance Hodgins)

    *             orange@orange-papers.org        *
    *         AA and Recovery Cult Debunking      *
    *          http://www.Orange-Papers.org/      *
    *       http://www.orange-papers.org/forum/   *
    *
    **     Confucious say:
    **     He who take pundit at his word
    **     Have the brains of little bird.
    **       ==  Klytus (Salon forum, 22 Oct 2008) 
    





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