October 23rd, 2016

_The Anatomy of Addiction_, Akikur Mohammad

I did NOT finish this book. I hit the chapter on pregnancy and the number of false assertions just Got To Me.

The first assertion that caught my attention was the claim that there isn't any good reason to smoke marijuana. What, chemo nausea doesn't count any more? He thinks you should take marinol in pill form, instead, when all the research I've seen over the last few years suggests that the desirable compounds in marijuana for most purposes are NOT THC -- that's just the part that makes you high. Worse, of course, if you've got bad enough nausea, you aren't gonna be able to swallow, much less keep a pill down. But you know, he is in favor of recreational marijuana as a harm reduction strategy, so I was prepared to allow his bigotry and ignorance pass.

The first one that made me do research was the claim about MET. I'd never heard of MET.

https://en.wikipedia.org/wiki/Motivational_enhancement_therapy

Mohammad makes a variety of claims for MET, none of which seemed all that plausible to me. From page 99 in the hardcover:

"Motivation enhancement therapy (MET) has been thoroughly researched in the field of substance misuse and has been proven to be exceptionally effective at enhancing an individual's motivation to make positive changes in behavior."

Assuming that actually means something, let's focus on "thoroughly researched" and "proven to be exceptionally effective".

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2148493/

Effects are small, highly variable, especially by program site. This does _not_ sound like "thoroughly researched" or "proven to be exceptionally effective". MET probably does help, and in fact, if you wanted to claim it worked better than other forms of beginning counseling for substance misuse, I wouldn't even argue with you. But he is overselling it here.

While I absolutely support the use (and think it should be much more widespread) of Suboxone, I think there are points in this book where he oversells that, as well (altho I'm having trouble finding the one I remember right now).

The chapter on teens and drinking/drugs has a tight focus on harm reduction, rather than abstinence, and I completely agree with the argument there. However, it is immediately followed by the chapter on pregnancy that caused me to completely abandon the book (apparently, a non-pregnant teen gets harm reduction strategies because, you know, they work. But a _pregnant_ teen or non-teen gets hard core judgement.

In fact, the author is advocating for nothing less than insisting that _all_ women of reproductive age stop drinking entirely (at this point, I kicked myself. It's not like I couldn't have seen this coming, right?).

"All of this diagnostic and treatment services would be unnecessary if women would simply not drink while pregnant, if they plan on becoming pregnant, or run the possibility of becoming pregnant."

Basically, if you are pre-menopausal and haven't been sterilized, he thinks you shouldn't drink. He may be thinking, well, you can drink if you aren't having sex. But then he has clearly ignored the possibility of rape and sexual assault. As far as he is concerned, if a woman who could possibly become pregnant still drinks despite knowing the risks of FAS:

"the mother, despite understanding the danger, has the medical illness of alcohol addiction known as alcoholism". That sentence is framed as once she's pregnant, but just a paragraph earlier is any woman who might become pregnant. Given that as many as half of all pregnancies aren't planned, and given that he doesn't seem to think that abortion is an option, he figures adult women who drink are, per se, alcoholics.

Honestly, he's a fool and tool. And worse. Don't read this book. I am _so_ glad I got it from the library because at least this way he doesn't get any money for it.

Also, as bad as these detailed complaints are, they are just the tip of the iceberg with the problems in this book. I knew that there was developing resistance to evidence based medicine, but since I mostly read stuff by H. Gillbert Welch and his associates, I was a little puzzled about why. Well, this guy answered that question. If he thinks he is doing evidence based medicine, then I would resist it, too.

Sunday's Activities Include: Applebee's, horse, play date, halloween decorations, decluttering

T. and I went to lunch at Applebee's followed by the horse. I had a nice conversation with my friend M. (at the horse, not my walking partner). Then it was back home to have a snack with M. (my walking partner, not my friend at the horse), which was disrupted by arriving to discover that the kitchen table was completely covered with ... stuff.

Poor M. Well, I didn't scream or yell or anything, but I was firm. Everything went into a bin and upstairs to A.'s room (it was all hers except a couple items, and T.'s item went into the trash after consultation with him). Once there, I said it all had to be put away and since there was no space to do that we had to create space by getting rid of things. We now have a full bag of stuffies, a full bag of Minnies (the snap on dress up ones and various paraphernalia), a half full bag of Doc McStuffins toys and a partially full bin with a bunch of my clothes, and a few other odds and ends that came out of A.'s room. In the course of packing up the Minnies, I found the Minnie music player that I found the book for in the playroom a few days earlier. A. and I moved from her room to the upstairs hall, and decluttered many stuffies there as well. She was a completely good sport. I didn't pressure her about anything and she got rid of a ton of stuff. The "keep" criteria seems to be: is it pink? And/or a Ty toy? There are other things she is keeping, but that accounts for a shocking amount of it. We got everything from the kitchen table put away and the room still looks much emptier than it did before, and the hall is amazingly better. M. and her dog P. departed fairly early on in this process (as we were packing up the bin to clear the table out to make space for snack).

When playdate arrived, R. got out the sewing machine, because R. (A.'s friend) and A. wanted wings attached to some of their Ty unicorns. A. and R. (husband) had gone to Michael's earlier in the week for supplies. I served coleslaw to R.'s parents (my friend D. and her husband I. also my friend of course!), and then he returned home to monitor a roast chicken and coach other child through the week's homework. D. and I had manhattans and I ate the chicken that R. had cooked on the grill before settling in to make wings. (In answer to your question, it was not wings and wings, it was drumsticks for the chicken. I know, would have been funny, right?)

Partway through our manhattans, D. brought up the topic of Halloween decorations, so I went down to the basement, pulled out that bin, and deployed the decorations. So that's done.

R. (husband) has a dehumidifier (or possibly a humidifier) filter that goes to an appliance we no longer own. Anyone got any ideas? It is NIB -- I'm thinking we may be approaching that moment where I set up a freecycle account. Ugh.

ETA: I also noticed a line of dust bunnies along the wall in the master. R. says that when he made the bed today with fresh sheets, he may have done so quite "vigorously". Dunno. I vacuumed the room, tho, because it clearly needed it. A. is having a blast with toys that she has been recently reminded of by decluttering everything else.