Your comment illustrates a large part of the problem. If society believes addiction is mostly a willpower problem, then effective services to help address it won't exist.

I am an alcoholic sober for several years. It is fundamentally a willpower problem. Even if insurance or the government paid for inpatient rehab, as soon as you walk out the door it’s only willpower that stops you from continuing to drink. The same goes for being given medication that reduces cravings for alcohol or makes you sick if you drink. You can always just not take it.

That said, most people don’t become addicts in a vacuum. Many people become addicts only because a life under the influence beats their life otherwise. Unfortunately it’s a lot harder to fix someone’s life than it is to get them sober. But the poor sober life is, in my opinion, the actual underlying condition which leads to addiction. We don’t really have a framework for treating that as a society nor through the medical system.

Isn't the first step admitting you have a problem and wanting to fix it? There's not much one can do without patient consent (which I don't think is mentioned here).

Even then, the most the hospital can really do is counsel and recommend inpatient treatment at a specialized facility. I really hope the 'pushed out the doors comment was a slight exaggeration. They should have at least talked about the treatment options, given them a brochure/info for a treatment center. It's not much, but that's basically all they can do.

I do wonder if people would be more inclined to address and solve their problem if they felt people around them and society at large cared for them. Most alcoholics I’ve known have struggled with a sense of not mattering, not being cared for, of their problem being inconsequential because they don’t matter, etc. Telling people like that to recognize their problem and want to get better is almost pointless.

It is. But that's making the assumption that step 1 is where most people fail. I suspect that's not the case.

Well, anyone with a problem fails that step for some period of time until they realize it. But sure, once in or trying to be in recovery, that occupies the rest of their life.

This whole thread is making assumptions as it wasn't mentioned if the person would consent to treatment.

That service exists, though. The hospital specifically referred them to AA.

AA is a religious organization. Not everyone wants to be “saved”. Nor should they have to be in order to get treatment for alcoholism.

Not only is it religious, its not founded in any empiricism or medical study. Here's a decent article laying out the critiques, the opening paragraph is what everyone should keep in mind: https://www.theatlantic.com/health/archive/2014/03/the-surpr...

> Say you’ve been diagnosed with a serious, life-altering illness or psychological condition. In lieu of medication, psychotherapy, or a combination thereof, your doctor prescribes nightly meetings with a group of similarly afflicted individuals, and a set of 12 non-medical guidelines for recovery, half of which require direct appeals to God. What would you do?

AFAIK, AA doesn't make you swear on the Bible or profess one's faith in Christ before you're allowed to join a meeting.

You can ignore the religious stuff and still make use of AA's highest-impact features:

- regular meetings, no appointment required

- being open and vulnerable in front of other people who understand the hell of addiction in ways your partner or family won't.

- having an accountability partners to call during moments of temptation, and having that reciprocal commitment is a far stronger deterrent to relapse than calling a crisis hotline offering scripted responses.

You can't ignore the religious stuff. It's baked into the program. Daily prayer is considered a non-optional part of the 12 steps and atheists and constantly derided as being arrogant and unlikely to stay sober. They're a reason why atheists have found it necessary to create separate meetings and why regional intergroups often exclude those meetings from public meeting lists since they consider it to not be "real" AA.

The alternative to AA isn't a crisis hotline, but medical treatment with empirical support for its effectiveness

What medical treatment? 12 step is fundamentally about community and connection (opposite of addiction), there is no pill that can give one that.

IMO it's a cult.

I spent a lot of my childhood at AA meetings with my alcoholic mother. I am also an alcoholic and struggled for years because the only answer I was ever offered was AA/NA. I tried it for myself a few times (usually to please others) but was always instantly turned off by it's cult like attributes. I eventually found help through a few different paths.

disclaimer: my half-sister's mother was in a cult (Alive Polarity Fellowship) for 20 years.

Share what helped, please.

This might sound rough, but don't you think some brainwashing could help your situation?

Well, there was this in my post > "I eventually found help through a few different paths."

So thanks anyway but I don't need any help, especially brainwashing. My mind is too analytical to respond to it anyway ;)

With respect, I believe you have a common misunderstanding of 12-step programs... AA is not an inherently religious organization, nor does it require any religious/supernatural beliefs.

I'm an atheist, and I've been to years of AA meetings. There is no requirement of religious belief for participating. The concept of a "higher power" is an important part of dealing with our narcissistic ego defenses, but it's not necessarily a religious concept. God just happens to be a convenient implementation of a "higher power" that works for a lot of folks.

Now, there are plenty of people in AA, attending and running meetings, who DO have religious beliefs. A lot of AA literature is written by people who have religious beliefs... The people who founded AA had religious beliefs. So I think it's understandable that religion appears a lot in the mix.

Plenty of modern AA groups explicitly address the "God not required" issue... Maybe it helps that I live in a big city, but I've never had a problem with being an atheist and participating in AA.

AA barely works, though.

I know lots of ppl with years of sobriety through AA so I would say it does work for some. It existing as a choice free of charge around the world for ppl suffering is a good thing.

I know lots of people who haven't been attacked by bears since they bought a bear protection talisman so I would say that they work for some.

Yeah except those people don't intrinsically enjoy being attacked by bears despite that it will kill them, and the attacking bears aren't featured as a prominent aspect of the social fabric visible in everyday life, on nearly every corner, tv ad, social event, and otherwise.

Maybe there is something more going on than some person making a conscious decision to keep drinking? I'm not sure what the hospital should do in this exact situation but simply 'pushing someone out of the door' is very likely to have one result and this is the same person coming back through the same door time and time again.

so you don't have any idea what 'they' should do, but clearly it's the hospitals fault.

Maybe the 'they' that should do something is you?, but I guess it's actually easier to blame 'them', because 'they' should do something.

Even AA doesn't want people that won't admit they have a problem. because 'they' can't do anything for them either. The problem lies with the drinker, if they don't want to stop, they have nobody to blame but themselves.

How do you fix a problem that the patient won't admit they have?

What I was trying to say that it would be in the hospital's interest to offer a better solution since it will be that very same hospital that this guy will inevitably return to.

I guess you are in the camp that thinks everyone can help themselves? All I would say to this is that there's lots of evidence around you that proves this idea is wrong.

OK, tell me specifically what a hospital - or anyone else - can do, to 'help' a patient that won't help themselves? Lock them up and dry them out against their will? Should we lock up drug addicts to keep them away from drugs? how about forcing blood pressure meds down the throats of people who are on the verge of a stroke, but won't stay compliant?

My guess is you have never worked in primary care, if you did, you would have a very different opinion about the limits of how much you can help someone that won't help themselves, or even admit they have an issue.

Easiest thing in the world to say is 'someone should do something', and what you usually mean is 'someone else should do something'.

This person is right that hospitals, or health care systems in general should be working on this. It's more complicated than simply not helping people who won't help themselves. The difficulty is that no one knows the best, most effective systems or approaches for doing this, and emergency medicine resources are stretched very thin here in the United States. Emergency departments were designed for the stabilization of life threats, but in our modern collapsing medical system, limiting their scope to this falls short of community needs. There are many people whose only contact with the medical system will be the ED, and finding ways to treat and integrate them into more sustainable programs should be a goal. There are promising advancements being made, however, in initiating standard of care treatments in emergency department settings. On the opioid front, we can start suboxone in the ED, which has proven a pretty effective method of stabilizing people and increasing their participation in treatment down the road. (1)

As someone who is working on this, I don't think it's unfair for people who aren't experts in the field to recognize and call out the fact that something should be done differently. The experts agree, and many of us are trying to figure out a better path forward.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527523/

Referral to psychiatric consultation would be a start. There is a reason why people resort to harmful behaviours and without addressing this you are never going to cure the underlying problem.

I guess the alternative is to do nothing and expect people to cure themselves purely through sheer will, as, more or less, what happens now?

Please explain how this is working?