text:
March 24, 2010
Addicts have a choice.
93 comments:
- Class factotum said...
Alcoholism. The disease you get from empty bottles.
- TosaGuy said...
In today's new health care world, we need to impose a tax on the addicts to cover the increased cost of their health care.
- TosaGuy said...
Some liberals may think it would be cruel to tax addicts, but many of you should be able to rationalize doing so by simply dreaming of taxing Rush Limbaugh.
- Robert Cook said...
I have a close friend who has fallen into an abyss of alcoholism in the last couple of years, and it's a terrible and pitiful thing to see and experience. She's lost just about everything as a result of her addiction. However, I still have hope that at some point she will decide that she wants to regain her life badly enough to make the choice to pursue sobriety, and will stick to it, hard as it will be. Many addicts have made this recovery and more are doing so every day.
So, yes, addicts do have a choice.
- bagoh20 said...
I've been arguing this with my addict friends for years. It's not just the professionals who cling to the disease idea. Like most self-described victims, addicts cling to that idea like a race card holder.
Good post John. I was caught by this:
"But having good intentions behind your account of reality hardly ensures that your account will be accurate."
I'm pretty sure John is a liberal and that piece of wisdom explains the problem with that addiction as well.
- Hoosier Daddy said...
Some liberals may think it would be cruel to tax addicts, but many of you should be able to rationalize doing so by simply dreaming of taxing Rush Limbaugh.
Am I the only one that differentiates between someone who gets hooked on prescription drugs as a result of a dibilitating disease or chronic pain and a meth or coke addict? Getting high to escape reality as opposed to getting high to make the pain go away I find to be two different things.
But that's just the logic in me.
- bagoh20 said...
I've known and buried many addicted friends. I do believe it is a choice, but the problem I see is that the addict simply loses the ability to appreciate the benefits of sobriety fully and consistently enough to make the right choice. The drug always looks like the better pick sooner or later and back on the ride they go. That and the natural bent of some people to just never say: "That's enough, I'm satisfied."
- Skyler said...
Old but nonetheless welcome news.
I wonder why one shrink is called a "Harvard psychiatrist" and the other simply a "psychiatrist" as though being from Harvard makes someone so superior. There are plenty of smart people from other schools. I tire of this pro-Harvard bigotry.
- Class factotum said...
In today's new health care world, we need to impose a tax on the addicts to cover the increased cost of their health care.
Are we going to charge extra to sex addicts, too? I think we should.
- Hoosier Daddy said...
"Harvard psychiatrist" and the other simply a "psychiatrist" as though being from Harvard makes someone so superior.
Louis Winthorpe III: He was wearing my Harvard tie. Can you believe it? My Harvard tie. Like oh, sure he went to Harvard.
Trading Places, 1983
I've long been bemused by how easily impressed people are by brain scans. That every state of mind is paired with something going on physically in the brain was known in principle long before anyone was able to capture pretty pictures of it. Excellent post, JAC.
- Michael said...
I stopped drinking 20 years ago because I am/was addicted to alcohol. I doubt seriously that alcoholism is a "disease" but I do not doubt that if you quit drinking the desire to drink will go away. Give a monkey a number of drinks every day and the monkey will become addicted to alcohol. Not because he didn't get enough bananas when a baby and not because he had a bad home life but because he drank too much alcohol with too much regularity. Our therapeutic culture has transformed a fairly simple solution (quit drinking) into a very complicated solution(quite drinking after you find out why you drink). I commend to all Theodore Dalrymple's book "Romancing Opiates: Pharmacological Lies and the Addiction Bureaucracy" which supports the view that the industry built around "recovery" is very invested in the notion that addictions to drugs and alcohol are nearly impossible to overcome without the help of therapy, medical supervision, etc. The point about addiction to pain killers versus "recreational drugs" is well taken. If the underlying physical pain has gone, however, continuing to take pain killers would be in my opinion a clear choice.
- Greg Hlatky said...
I wonder why one shrink is called a "Harvard psychiatrist" and the other simply a "psychiatrist" as though being from Harvard makes someone so superior.
People from Harvard always let you know they're from Harvard.
- k*thy said...
Getting high to escape reality as opposed to getting high to make the pain go away I find to be two different things.
That's really only the difference between psychic pain and physical pain. Both are very real.
I had a brother-in-law who was caught up in addiction and died because of it. I know he tried to break away from it, tried to make a different choice, but in the end, couldn't. I also have friends who have made the choice and been able to make recovery work. Recognizing and putting weight in consequences is the key.
To paint it as all-or-nothing choice vs. disease I think is incorrect. From my own experiences, I'd contend that there are elements of both.
- themightypuck said...
How does this philosophical pearl affect the practice of medicine? Is it to simply say that addiction can't be treated by doctors? I don't know the numbers and given the way the State picks winners in the addiction game (like AA) it seems conceivable that it is all a scam. Still, I'd like to see some more evidence.
- The Drill SGT said...
People from Harvard always let you know they're from Harvard.
early and often in my experience
- Scott said...
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- mesquito said...
I have no doubt that I'm hard-wired to be an alcoholic. However, I don't get any sort of pass on being a destructive, obnoxious asshole for 15 years.
- themightypuck said...
@Hoosier Daddy,
Aren't you really just using morality to underpin the cold hard calculus of who is really worth saving? The fact of the matter is that people who become addicted because they have unbearable lives don't really have much incentive to get better, whereas people whose addictions have made their lives terrible are probably worth saving and are far more likely to make the effort to save themselves.
- Scott said...
- This comment has been removed by the author.
- Michael said...
K*thy: You wrote about your brother-in-law: "I had a brother-in-law who was caught up in addiction and died because of it. I know he tried to break away from it, tried to make a different choice, but in the end, couldn't" As hard as it is to say, the man "wouldn't" or "didn't" give up alcohol, not that he "couldn't." My personal experience with the problem and direct knowledge of hundreds of people with addiction tells me that we do indeed have a choice, the addict knows he has that choice and the addict makes the choice in favor of the drug. He knows it is going to kill him but he does it anyway. He perceives the other choice as too hard or he has been told it is too hard or the people around him provide him with substance in the form of pity that makes the romance of addiction more attractive than the boring, the sober.
- Scott said...
"It's easy to keep believing in a dogma if you don't look at any of the evidence that goes against it."
So true. But sometimes reality catches up. Like the bumper sticker says, "My karma ran over my dogma."
The interesting anecdote John relates about incentivizing good behavior in Vietnam vets is old news. Today, most big companies require successful job applicants to undergo a pre-employment drug screening. That must be very effective in suppressing overall drug use in the USA (although I've never seen a study on that phenomenon).
In addiction, the fuzzy philosophy looks like this:
a. Addiction is characterized by people making choices that a person with "self control" would not make.
b. The tendency to be an addict is influenced by a neurological component.
c. Therefore, altering the neurology of an addict will cause them to make the choices that someone with "self control" would make.
I would argue that the self-control-influenced choice is not about using drugs. It's a choice about whether or not to be an addict.
"Being an addict" is a state of identity that is chosen of free will. If one becomes aware of one's addiction and chooses to shed that identity, then choosing to not pick up the bottle or the joint or the cigarette becomes more attractive.
Altering the neurology of the addict may be one way to change the attraction of addict identity, but it's not the only way, and it may have unintended consequences. People who can identify with the culture of the 12 Step programs (which can be difficult to do) generally do stop using.
(arrgh, I can't type today)
- John Althouse Cohen said...
I wonder why one shrink is called a "Harvard psychiatrist" and the other simply a "psychiatrist" as though being from Harvard makes someone so superior. There are plenty of smart people from other schools. I tire of this pro-Harvard bigotry.
There's no Harvard psychiatrist. Heyman is a Harvard psychologist. In the context of the review, the fact that he's a psychologist rather than a psychiatrist or neuroscientist is very significant. As a psychiatrist, the reviewer might be more attuned than Heyman to brain chemistry -- and in fact, the review mildly criticizes Heyman for this in the fourth-to-last-paragraph.
I was more specific about Heyman because as the author of the book being reviewed, his credentials are more important than those of Satel, the reviewer. I considered being parallel and referring to Satel as "an American Enterprise Institute psychiatrist," but I thought this would be too wordy and less informative than "Harvard psychologist."
- Hoosier Daddy said...
Aren't you really just using morality to underpin the cold hard calculus of who is really worth saving?
Maybe I haven't had enough coffee yet but I honestly have no idea what you're saying.
My point is that I differentiate between someone who got hooked on Vicadin because of chronic pain and someone who spent their 20s smoking pot, doing shrooms and following the Grateful Dead. It's not an issue of who is worth saving but not all addicts are equal in my eyes.
- David said...
I learned about alcoholism up close and personal through by beloved but alcoholic second wife.
The argument about whether it's a disease is all semantics. If it's a disease, it's a treatable disease. The treatment is to stop drinking. There are lots of ways the treatment can fail, but unlike in other diseases, the treatment is ultimately in the hands of the patient.
RIP Sally.
- madawaskan said...
Well ya coulda just dropped Haaaavaaard.
But, there's hope for you yet kid, because even though you "believe" in redistribution after much brooding on the subject you've decided to "tip" according to performance.
Imagine that.
Your own personal capitalism.
- Scott said...
David, I'm so sorry for your loss.
My partner died of AIDS in 1994; but since his death, his father and two of his brothers had their deaths hastened by alcohol addiction. (It's hard to stay sober on the rez.)
HIV and alcohol have taken so many of the people I have loved. Sometimes I feel like I've survived a war.
- c3 said...
We tend to have dichotomous and/or moralistic viewpoints of behavioral conditions. By dichotomous I mean either "Its a disease; I'm powerless. I need treatment." versus "Its a choice. Choose wisely."
Clearly biochemistry is involved in behavior. That doesn't eliminate choice and volition. At a minimum I need to choose to take my medicine (i.e. naltrexone)
My clinical experience tells me that some folks have a much harder time overcoming their ?biochemistry. And some folks would rather be high.
A little personal anecdote. When I worked on the reservation we had many alcoholics. Sometimes an individual would plead powerlessness because he/she had a "disease". My standard response was to point out that diabetes (also prevalent on that reservation) is also a disease and that doesn't mean the diabetic doesn't have to take his meds and follow a diet.
- Scott said...
c3, that's a disingenuous bifrucation. :)
You are powerless over your diabetes. You can choose to eat properly, monitor your blood sugar, and take your medications.
You are powerless over alcohol. You can choose not to pick up the first drink, and to get mutual support from other alcoholics in not drinking.
Last trip to San Francisco, I saw a panhandling bum (er, homeless person, sorry for being judgmental) on the street holding a sign, "I ADMIT IT, I'M AN ALCOHOLIC, GIVE ME MONEY TO DRINK!" And I was tempted to do so! I love honesty.
- themightypuck said...
@Hoosier Daddy,
I'm short on coffee as well so I'll just concede that if you didn't understand me it was probably me. It seemed like a good idea at the time.
- Kirby Olson said...
British doctor Theodore Dalrymple claims in his books that it's like a case of flu, and lasts about as long, to get off of heroin.
One of the funny things to think about though is -- we now have gay rights parades. How long will it be until we have heroin users' parades! Addicts pride marches.
Maybe it's something to be proud of, really, but our consciousness just hasn't been raised as of yet?
Perhaps addiction is a choice we should all consider when we're thinking about the optimum lifestyle. Now that the state is going to expand healthcare to be more like the British system, this will mean that heroin is now free, too, right?
- Scott said...
"One of the funny things to think about though is -- we now have gay rights parades. How long will it be until we have heroin users' parades! Addicts pride marches."
The whole Alcoholics Anonymous - 12 Step culture would frown on such parades. Anonymity is considered not only a practical necessity to preserve the effectiveness of the program, but also a spiritual component that leads one to a "genuine humility". (Program heads, see the "long form" of the 12th Tradition in the appendix of the 12x12.)
- Dust Bunny Queen said...
In today's new health care world, we need to impose a tax on the addicts to cover the increased cost of their health care.
It would be considered a pre-existing condition.
We can't charge extra for people who smoke themselves into illness, eat themselves into obesity and self infliced diabetes, heart condidtions, neuropathy or drink themselves into liver failure.
We can't charge extra for ANYTHING. The concept of insurance as covering a risk that you pay premiums that are proportional to the level of the risk is DEAD as a doorknob.
We are ALL equal now Comrades.
Well....except for those at the top of the Politburo and official members of the Party/aka Union Members..... who are exempt from Obamacare.
- traditionalguy said...
Welcome to the Nanny State. A basic under-pinning of settled science is being propagated so that only deniers are the spokes people for truth. The hateful effect of a nanny state is the denial of moral choice by a "man's" free will. The messsage to be put into science speak is that there are no more men, only collections of cells walking. That is also a DEATH SENTENCE. Beware of pretend scientists bearing gifts that are killers.
- themightypuck said...
I've gotten off heroin and pain meds and it was never a problem. The hardest drug for me to quit was crystal meth but I got off that as well. The most painful drug for me to quit was xanax which I had taken daily for 8 years as prescribed by a doctor for a legitimate health reason. That was hell for 3 days and dysfunction for 3 months. The only drug I have been unable to quit is alcohol and for the most part I don't abuse it (although I bet I'd live longer if it were illegal).
- caseym54 said...
Define "addict."
AA defines "alcoholic" as one who has lost control over alcohol. They suggest that, first, a person with an alcohol problem attempt to regain control. The AA solution presumes that self-control is unlikely, and it is not at all based upon choice, will-power or self-knowledge, all of which concepts are more of a hindrance to the AA solution than a help.
- Joe said...
I hate to agree with Rob't Cook, but yeah addicts have a choice...part of Recovery is realizing that I DID have a choice, where previously I didn't see the choice....much less choose wisely.
My choices is/was to drink or not, snort or not, date the obsessive-compulsive or not, a host of things...when you're in the world of AA/NA/ACA you often don't realize you had choices. AFTER you get into Recovery you begin to see you do and did...they may not be palatable choices, or easy choices, but I do and did have them
Sometimes they are to not numb myself with drugs or shopping or gambling or guilt and actually confront the painful things in my life. And sometimes that choice is so difficult I'd rather drink or smoke or shop or be a self-destructive, guilt-wracked person...but sooner or later the choice(s) will re-occur and I'll have the chance to choose CORRECTLY this time.
- Skyler said...
Puck wrote: (although I bet I'd live longer if it were illegal).
There has been no evidence I can see that either during Prohibition or now with drugs that making them illegal stops the addicts from getting them. All prohibition does is make crime more likely for them to get their illegal fix. I've not even seen any evidence that it even slows anyone down.
- TosaGuy said...
It would be considered a pre-existing condition."
Sorry, DBQ, they can because health care policy is now a political issue, not a medical one. All it takes is a vote by Congress to render addiction a non-prexisting condition. They could even tax different rates for different drugs. Liberals may wish to tax Oxy at confiscatory rate because they perceive it as a rich person's drug, while give those addicted to weed a subsidy. I am exaggerating a bit, but its to make a point that such decisions can be made whenever Congress feels like it.
The same thing could happen with fat people or those who smoke or those who engage in high-risk sports. The guy who pays the bills gets to make the rules.
My initial point was dripping with sarcasm, but every single issue like this is now open to exploitation and will be decided in the political arena as much as it will be the medical one.
- jamboree said...
It's a choice although just like overeating it becomes a harder choice as you go down the spiral.
It's one thing choosing to not enjoy more food because you want to look hot. It's another if you will have to make that choice over and over - possibly for years if you are obese - to enjoy the same outcome.
If you've tried everything to make whatever in your life better and nothing is working you might try say champagne and get the immediate relief. It's a choice. If you keep making the drugs/alcohol choice over and over, the results of the non-escapist, productive choices will be so far out on the horizon that you won't be able to see them making it feel completely pointless.
Less of a choice then from your perspective.
But do I think they are compelled by anything but momentum? No.
- themightypuck said...
@JAC Sounds like you were thinking that the probative value of links to the AEI would be substantially outweighed by the danger of unfair prejudice.
- Scott said...
@themightypuck: What tools did you find useful in ending your relationship with these chemicals? Do tell.
AA as an institution and a movement does not define alcoholism. Some speculation is thrown around in the literature (a physical disease combined with a mental obsession, etc.) but none is considered to be a definition. The first tradition of AA is, "The only requirement for membership is a desire to stop drinking." That alone is the common bond. There is no definition of alcoholism there, or in any of the twelve traditions, or twelve steps, or twelve concepts for world service..
Your statement...
"The AA solution presumes that self-control is unlikely, and it is not at all based upon choice, will-power or self-knowledge, all of which concepts are more of a hindrance to the AA solution than a help."
...is not entirely true. Any member of AA will tell you that to stay sober, you have to choose not to pick up the first drink; that in fact you do have choices, and that you have a better chance of making the right choices generally if you work the program. But it is true, AAs will generally tell you that using raw willpower alone is like "trying to pull yourself up with your own bootstraps."
- themightypuck said...
@Skyler. I'll admit to being a bit glib. Still, I really liked opiates and I bet if I could get them at the corner store I'd probably use them more often (no guarantee I'd get hooked). Right now, I know I can find junk somewhere in downtown LA but there isn't a snowball in hells chance I'll go down there to buy it.
- AllenS said...
I'm neither a psychiatrist nor a psychologist. I have made some clinical observations over the years. A lot of people like to get fucked up.
- Scott said...
On self knowledge: Steps 4 through 9 are all about gaining awareness of the dynamic of one's active alcoholism; and about moving beyond it. If that isn't self knowledge, then what is?
- Scott said...
generally :)
- themightypuck said...
@ Scott, For getting off opiates the tools were having shit I needed to get done. I never had a chance to go too far down into the bunny hole. For speed it was tougher because you can really be functional on that if you don't go overboard. Wellbutrin helped me bridge the gap. Xanax was really hard. I basically lay in bed for a week in the fetal position listening to books "on tape". Alcohol I have no solution for. The conventional wisdom is that submission to a higher power and relentless confrontation of the sources of your addiction will help.
- Scott said...
Damn, themightypuck, you're awesome! Major-league self awareness, and I'm saying that without being glib. Live long and prosper!
- k*thy said...
Michael, I also had a desire quit and chose to make moves in that direction. I know how hard that is. Being on the other side of my choice, I can see that there is a choice. When I was in the middle of the addiction, I wasn't able to see that I had an option. As my gas ran out, I began to question whether I would or could make that choice. From that, I'd say that whether you're deep in it or on the outside makes the difference in if you see a choice.
True enough - he wouldn't give up alcohol. I know that he tried, but in the end, I see that his fear eventually killed him. I'll always wonder if he gave up and just thought he couldn't.
- Joan said...
British doctor Theodore Dalrymple claims in his books that it's like a case of flu, and lasts about as long, to get off of heroin.
I know a young man, currently finishing a jail term, who is a heroin addict. He has been through "rehab" countless times. He has always relapsed, although before his last (worst) relapse, he stayed straight for well over a year, because his son was born and he wanted to be there for him. Eventually, though, his son wasn't a strong enough motivator to keep him clean.
The "rehab" referenced above is a very short-term thing. In that sense, Dalrymple's statement matches current medical practice: it doesn't take that long to clear the drug from your system. This guy's problem is much deeper than the physical dependence aspect, and it does have to do with his neurology.
Your ability to deal with addiction -- and adult life in general -- is greatly determined by your experiences during adolescence. Brain development during this time occurs at about the same rate as it does during the few years after birth -- just tremendous growth in the connections being formed, and the speed at which we're able to retrieve information and make decisions. Decision making ability develops last of all. That's why current secondary teaching education now stresses explicitly teaching junior high and high school students responsibility, learning strategies and organizational skills.
If you don't learn how to make good decisions as an adolescent, it will be harder (but not impossible) to make good decisions as an adult. If you start smoking pot at 13 and spend your teen years stoned, as the young man I know did, your brain development will literally be stunted. In many ways this guy still thinks like a kid because he never learned how to think like an adult. He tuned out at exactly the wrong time.
None of that removes the idea of agency from his behavior, though. It just means that it's harder for him to discern what he should he do, because his brain isn't wire to think that way.
- themightypuck said...
Thanks, but I doubt I am that self aware. It is really easy for a person to fool oneself about such things and way easier to fool others. I think this is why most 12-step programs require a kind of blind submission. One caveat: I've never been in a 12 step program but I have read the blue book.
- edutcher said...
My old man was a drunk. From the time I was born until just a few years before he died.
Though it's not anything original, it's still true: until you've hit what you see as rock bottom (and you have to see it that way), you won't quit. Once you do, then you'll quit.
So, yes, you have a choice, but you have to stop lying to yourself - and there's always at least one lie.
themightypuck said...
@Hoosier Daddy,
Aren't you really just using morality to underpin the cold hard calculus of who is really worth saving? The fact of the matter is that people who become addicted because they have unbearable lives don't really have much incentive to get better, whereas people whose addictions have made their lives terrible are probably worth saving and are far more likely to make the effort to save themselves
My bolding. The first part is the lie and the second is the reality. Addiction will make any addict's life Hell and they all have an excuse. The issue is that somebody somewhere went through the same ordeal and didn't get addicted, so you have that choice. Once addicted, something has to come along to make them stop lying to themselves. For some, it never comes.
And, yes, after a half century of how it's cool to get high and how we must understand the addicted, I can't wait to see how the death panels handle this one.
Truth in advertising: for about ten years I was on Zoloft and Xanax (both prescribed) for severe depression. I decided to get off them because I had gotten some perspective and wanted to tackle my problems rationally. I've since been told Xanax is addictive. I do remember some withdrawl, but I didn't have that much trouble. Make of it what you will.
- Joe said...
12-step programs have an extremely high failure rate, approaching 90%. On the flip side, the success rate for people doing it on their own is in excess of 80%.
One thing that has struck me watching various rehab programs on TV is how cult-like they are.
Cults don't work by causing genuine self-motivated change, but a phony change in behavior in order to appease the leader or someone else. (And they can cause huge guilt when a person tries to reconcile their natural behaviors with the artificial ones pushed on them by the leaders [to an extent I've been there with the religion of my birth.])
I've also been struck that for the vast majority of the subject on these shows, it's blindingly obvious that the addiction is a symptom and that many (most?) of the subjects suffer from depression.
Thus, changing the behavior has nothing whatsoever do to with actually helping the person. Worse, having the subject change simply to appease the show's charismatic star is simply substituting one high for another. Relapse is inevitable once the cult environment is removed and/or the subject fails to respond to the social stimuli.
- c3 said...
c3, that's a disingenuous bifrucation. :)
You lost me. I think we're saying the same thing. Its both biology and choice.
another anecdote. Had a patient who was a poly-substance abuse. He succeeded in getting off the meth and the opiates. He just couldn't kick his smoking habit. He thought that was the hardest
- Scott said...
"12-step programs have an extremely high failure rate, approaching 90%. On the flip side, the success rate for people doing it on their own is in excess of 80%."
This is the internet. Numbers are easy to throw out. If you can't link your presumed statistics to the source documents, then your words are just so much blah-blah.
AA is not a treatment program.
Here is what AA calls its Preamble. It's AA's declaration of what it is:
"Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership; we are self-supporting through our own contributions. A.A. is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy; neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety."
If a person who goes to AA stays sober three years, is it a success? If they get drunk in the fourth year, is AA a failure? That's what makes statistics regarding recidivism so bogus. People in AA go to meetings because they find it useful. Those who don't, don't go.
If you're afraid of AA, please stay away. If you want to try it, go ahead. If you like it, stay as long as you want. If you want to leave, go ahead, nobody is going to run after you or send you a bill. If you don't think it works, cool, try something else.
As for AA being a cult: If it is, then it has to be the cheapest, most benign cult around. If you don't think so, then try Scientology. Or the Catholic Church. Or Islam.
- Scott said...
@c3: Yeah, I agree, we're on the same page.
- Joe said...
Scott, I clearly said that 12-step programs use cult-like techniques. Moreover, I've heard these statistics for over thirty years and there are several well done studies to back it up.
Even that aside, I'm sure we would agree that forcing someone into a treatment program of any type isn't going to be very successful. On the other hand, a person who really wants to change will likely be successful in any program, even one that is self-directed.
- Kirby Olson said...
Food addictions are probably similar. People shove their faces full to get a feeling of contentment, one which of course can never come from food.
Michelle Obama ought to team up with drug addiction counselors to get the lard off, the needles out of the eyeballs, and the show on the road.
- Joe said...
(One Who Used(s) 12 Step Work)
Joe has "studies" that show 90% of AA-type work fails...well I have seen studies that show AA-type programs at least as successful as Group or Individual Therapy.
My thinking on his stat's are as follows, the 80% number is for folks who wanted to quit drinking, or smoking or just decided Pot wasn't for them. IF, you're not an addict, quitting is not a struggle....
As to the 90% number, IF true, I'd submit that is the result from this population being ADDICTS, not just casual users. If you're an Alcoholic, or Dependent on Pot, or Shopping, or a Drug Addict, to be distinguished from someone who has tied one on, or got high, or likes to shop....IF you can't just have ONE DRINK, then yes, you will have a high failure rate.
Because quitting is tough....It's easier to stay in the pit than climb out, or at least it seems that way. And all the folks around you want you to STAY in that Pit.
Quitting alcohol, drugs, Pot, shopping, or gambling means changing your life, pretty much top to bottom, changing friends, alienating family, and confronting some things about yourself that most of us would rather not confront.
So, it is not surprising that there is a high failure rate in 12 Step Work...just like quitting smoking is easy. I did it three times.
Bottom-Line: Joe may or may not be right with his numbers, and they may not mean as much as he thinks they do.
- Joe said...
As to 12 Step work being "cult-like." I'd say it's more like a CHURCH...it's very Catholic if you ask me.
I'd say Catholicism is cult-like or Islam...I mean they want you at their place of worship/indoctrination pretty much all the time. They constantly hit you up for money, use guilt, and have a Party-Line on a host of issues.
And this is from someone who's Catholic AND been in 12 Step work...I see a lot of similarities, so if AA is a cult so is my church...or neither is, which is my bet.
Never understood why people have a case of the @rse with 12 Step work. It's not for everyone, but then neither is macramé or Veganism. If it isn't your cup of tea, I say just leave it well enough alone. In my 12 Step group we didn't care if you stayed or went, only that you got help and got better....we were just one way of doing so, and freely acknowledged it.
- Julie said...
I think it's because to you physical pain and psychological pain are different. I infer that to you one is real and the other is not, and so one is a more or less acceptable reason to use drugs and then allow yourself to become addicted to them (because at some point, for most of the people addicted to pain killers or other meds, the physical pain has gone away but they still use the drugs. It might be a different case for people with chronic pain, although I'm really skeptical about this alleged epidemic of chronic pain). Addicts are not college-aged pseudohippies smoking pot and following the Grateful Dead; almost none of them are addicts in any sense of the word. And certainly not all addicts, of either variety, use drugs initially out of a need to relieve any kind of pain. Some of them just do it for fun, I guess. But a constant and persistent desire to escape reality, physically and/or mentally, often does speak to some kind of pain, whether physical or mental, and to me they are equally real. In some cases I have personally seen, I would argue that mental pain was more debilitating than physical pain.
That does not mean that I believe that addiction is not a choice. I think it is. I just don't think there is any moral difference between someone who allows themselves to become addicted to pain meds and those who allow themselves to become addicted to alcohol or meth or coke.
- Penny said...
It seems implausible to me that there isn't a pharmaceutical company out there that couldn't come up with drug "x" that would make you feel "high" for "y" period of time, without becoming physically addicted, or having serious health consequences.
But it wouldn't be "right" to make such a drug. Would it?
- Joan said...
I'd say Catholicism is cult-like or Islam...I mean they want you at their place of worship/indoctrination pretty much all the time. They constantly hit you up for money, use guilt, and have a Party-Line on a host of issues.
Joe, unfortunately you sound like a too-typical poorly catechized Catholic. You don't know what you're talking about.
You are obligated to attend Mass on Sundays -- that's an hour a week -- plus the occasional holy day of obligation, and there are scarcely half a dozen of those scattered throughout the year. You are always welcome to attend Mass or simply be present to the Lord, but there is no requirement to do so. Additionally, you are only required to take Communion during Easter time, so if you choose, you can simply receive reconciliation and Communion all within the same week and be done with your yearly obligation. Many Catholics do.
As for "constantly hit[ting] you up for money," no Catholic church has membership fees or dues the way some other religious organizations do. Anyone, Catholic or not, can walk into a Catholic church and participate in the rite (although only those in a state of grace and in communion with the Church's beliefs may take the Eucharist). Sure, we pass the plate, and we collect money for various charitable works supported by the parish and the local St. Vincent de Paul Society, and a host of other worthy causes. There is no requirement that you donate to these organizations. If you have children you wish to have educated by the church and you cannot afford to pay for their religious education, the fees will be waived.
As to having a "Party Line": yes, we have our dogma. But the faith also requires you to form your own conscience, not be an unthinking mindless robot. Unlike a cult, there are no "hidden mysteries" in the Church -- all of our mysteries are out there in the open, and we talk about them all the time: virgin birth, God made man, Jesus risen from the dead, redemption. These are lively topics of discussion.
God - and we - know that the Church has done some horrible, horrible things over its history. The Church is made up of men, after all. But please don't trash the religion by lumping it in with the likes of cults and Islam, which ignore natural law and despise freedom.
- Joe said...
Let me repeat myself one more time "cult-like techniques".
A major feature of a cult is that it tears you down and makes you dependent on the group; your sense of self becomes linked to the cult and mostly to the cult's leader.
Some religions do this, though all have the potential to do this since religions and cults depend on the same psychology. One important distinction is that cults insist and depend on this, while religions allow a person to be a casual member. Thus, all religions are not cults, but all religions can become cult-like (and can cause individual leaders to create sub-cults within the religion. Some Catholic orders definitely fall into this category.)
At one point in my life I took the religion of my birth very seriously. Leaving it in my thirties proved easier than I expected, but looking back, I'm astonished, chagrined and embarrassed at how much of my free will I turned over to others (and, mind you, this is a religion that preaches that free will is one of the most important things around.)
Another interesting thing cults and religions can do is to simply redirect an obsession from one thing to another. So an alcoholic may join a religion and become a devoted volunteer. Yes, that's good, but what happens if their faith slips or the leader they put their trust in betrays them in some, perhaps even otherwise benign, way?
(Now we get into the philosophical territory of whether people in general really can change that much at a deep level or whether much of our changes are merely redirecting our impulses and desires.
Regardless, I do think it could be shown that people who change to the extent they can out of deep self-motivation are more likely to stick with that change than people who change in order to please others. I think it could also be shown that for some people, it really doesn't matter WHY they changed their behaviors, the change sticks.)
- pst314 said...
"...I commend to all Theodore Dalrymple's book 'Romancing Opiates: Pharmacological Lies and the Addiction Bureaucracy'..."
I second that. Just finished reading it a few days ago. Excellent book. Dalrymple's book is based on his many years of experience treating addicts.
- Joe said...
Yeah Joan...whatever.
I'm perfectly happy being Catholic. I'm a convert. But please lay off...I find I could be at the parish pretty 3 or more nights a week, mayhap more, Scouts, RCIA, Bible Study, Dave Ramsey, Knights of Columbus, Church Fair planning, Prep, and on and on....
We have a position on health Care, Illegal Immigration, Womyn in Priesthood, Womyn in the Deaconate, pornography, War, Poverty, again on and on...
There's the first collection, the second collection, the Bishops' Annual Appeal, our Capital Campaign, Flowers for Easter, a chance to play poker, a chance to play casino games, a chance on the 50-50 Raffle...and on and on.
Bottom-line: LIGHTEN UP FRANCIS. It was a joke, but if you want to get all Prissy about it, yeah, the Church wants you there pretty much as a part-time job, wants you to conform to a whole raft of positions that are "Catholic" and hits you up for cash multiple times a week.
All of which I don't mind, but I don't deny them either.
- Scott said...
"I've heard these statistics for over thirty years and there are several well done studies to back it up."
But then, as Mr Althouse Cohen noted,
"It's easy to keep believing in a dogma if you don't look at any of the evidence that goes against it."
So until someone can actually link to one of these studies "proving" that 12 Step programs are not efficacious, then I'll just assume that it's garden variety bullshit. This is the internet. You can do that.
In any case, talking about efficacy and AA in the same breath is sort of stupid. AA isn't treatment. The people who go to meetings find them useful. The people who don't probably don't.
One of my pet peeves, though, is when courts send people convicted of DUIs to go to a certain number of AA meetings. Although some people do get sober under these circumstances, there are a lot who don't, and who end up resenting being sent there. This is understandable. AA is for people who have a desire to stop drinking. If there is no such desire, then there is no reason to go.
wv: retab :)
- Joan said...
Bottom-line: LIGHTEN UP FRANCIS. It was a joke.
No, it wasn't, as evidenced by the fact that you responded the way you did. All that stuff you listed? Doesn't contradict a word I wrote. Yes, your parish church asks for your participation, both in time and money. But you can't deny that if you don't participate in any of that, they'll still welcome you whenever you decide to show up, however infrequently that may be.
That is not cult-like.
You want to slag on the church, that's your right -- but I don't have to let it go uncontested.
- Joan said...
Joe -- I mean, c'mon -- look at my profile picture. It's there for a reason.
- Joe said...
That is not cult-like.
And had you read my post closely you would have discovered that was my VERY POINT, thank you.
I was pointing out that IF, AA was a cult or cult-like, then how much more so my parish or mosque...the for the reasons I enumerated. I concluded by stating that I believed that NEITHER was cult-like….so LIGHTEN UP FRANCIS.
I can point out the foibles of being Catholic and NOT be anti-Catholic….just like I can point out that my life partner snores and doesn't like doing the dishes. That doesn't mean I want a new life partner, merely that I am cognizant that my life partner is not perfect, far from it. Parenthetically, let me state that I am even further from perfect than my life partner and that truly I have "married up" to the extent it is possible to do so in this life. So too, my parish…I derive IMMENSE joy from it, but I still notice when my parish "snores, burps, or farts." Now if a discussion of the "cult-like" nature of my parish disturbs you, please move on….because we are simply going to have to agree to disagree on this issue.
My view of the Church is the view of TS Eliot in his THE HIPPOPOTAMUS…as I read it, Eliot acknowledges the foibles of the Church and the person, mired in the swamp, but does not deny their Divinity and Salvation, for all that.
- Greg Hlatky said...
God - and we - know that the Church has done some horrible, horrible things over its history.
It is said that the Church truly is a divine organization: how else could it have survived 2000 years under such incompetent management?
- Michael said...
As I said earlier I stopped drinking twenty years ago. I used AA extensively in the first couple of years to get me through the early days but haven't been in years. The percentages being thrown around are, of course, meaningless. I would guess that there are many people who have successfully used AA to stop drinking and then have gone on with their lives free of alcohol and AA. The guys active in AA have to conclude, for their own reasons, that people that leave AA do so to resume their drinking lives. Thus the wacky statistics.
If one thinks of AA as a cult then I would avoid it. There is clearly a lot of nonsense spouted in AA but it is a club that is full of losers and drunks so what would you expect? In general if you are just sober you might question whether something you have heard is BS or the truth. Generally you should go with your instincts and accept it as what it probably is, BS. But the overriding theme is "don't drink." If you carve out all the other stuff, all the stuff you don't like but adhere to this one principal you will succeed at ending your dependence on alcohol. And after a year or so, it will probably never cross your mind to have a drink.
Finally, AA proves without a doubt that the stresses of an investment banker, housewife, plumber, biker, petty thief, insurance salesman and house painter are identical.
- Joe said...
God - and we - know that the Church has done some horrible, horrible things over its history.
And how much more so the "State." Torquemada NEVER killed as many, either in absolute or proportional terms, than did Yezhov, Yagoda, Beria, Himmler, Pol Pot or Mao...Last century over 100 million folks killed as "undesirables" by the "State", makes the "intolerance" of the religious pale into insignificance, doesn't it?
- Joan said...
I can point out the foibles of being Catholic and NOT be anti-Catholic
I think what we have here is a tone issue. I read your posts with a dismissive tone, you're insisting they're light-hearted, just noting the "foibles" of a dearly loved organization.
My problem is that there's a lot of Catholic bashing around, and I am conditioned to read anti-Catholic statements, however kindly they may intended, in a negative tone. I apologize for over-reacting to you, personally, but I still believe that what I wrote has a lot of value for other readers who may come to your posts from a perspective similar to mine. Were you and I having this conversation face-to-face, I can assure you I wouldn't have given you the lecture.
I ask you to please think carefully before making such comparisons in the future. There are a lot of people out there who do think that the RCC is a cult, and giving them any fodder whatsoever is unfortunate.
FWIW, I don't believe AA is cult either, but I have no experience with the organization. People in any group can be unduly swayed by a charismatic leader, and if corruption is revealed later, devastation results. I submit that's much less likely to happen in the RCC, where the focus is - rightly - on Jesus Christ, and not on any earthly leader.
- Joe said...
Finally, AA proves without a doubt that the stresses of an investment banker, housewife, plumber, biker, petty thief, insurance salesman and house painter are identical.
Oh yeah...it's why I liked Rush Limbaugh's problems. People making hundreds of millions of dollars can be addicts...they all aren't on Skid Row, and just because you're "functional" doesn't mean you're NOT an addict.
- Joe said...
And Joe talks about AA as cult-like and one of the things he points out is cults have charismatic leaders...AA has NO leaders, charismatic or otherwise. Groups, at least the ones I attended, have no leaders...they have "old timers" but no leaders. To the extent that there was leadership; it was by example and 'suasion. Each person took it in turn to lead meetings, and the decisions of the group were based on CONSENSUS, we all agreed or not...the very antithesis of a "cult."
Sorry, I kept hearing "Dennis the Peasant" in my head as I wrote that...."We're an Anarcho-Syndicalist Collective"......
- Joe said...
Any way I've talked too much...you all have fun.
- Scott said...
"Finally, AA proves without a doubt that the stresses of an investment banker, housewife, plumber, biker, petty thief, insurance salesman and house painter are identical."
It's like church was back in the day when just about everybody went to church. You learned that you had a kinship with people in your neighborhood who were different from you.
- Alex said...
A lot of people like to get fucked up.
I think this might be the real secret to it all. I know why I drink, it's to get a buzz.
- Alex said...
And how much more so the "State." Torquemada NEVER killed as many, either in absolute or proportional terms, than did Yezhov, Yagoda, Beria, Himmler, Pol Pot or Mao...Last century over 100 million folks killed as "undesirables" by the "State", makes the "intolerance" of the religious pale into insignificance, doesn't it?
Except back in the middle ages, the Church was the state so you just proved the other guy's point.
- Joe said...
Except back in the middle ages, the Church was the state so you just proved the other guy's point.
Reading for understanding is NOT your forte is it....
Torquemada NEVER got 100 million folks, or the same percentage of populace that those 100 million represent.
So, NO, I did NOT make the other guy's point. But please don't hesitate to contribute when the Spirit so moves you.
- Joe said...
Joe (the other Joe) will you please read what I fucking wrote. This just pisses me off. I DID NOT say AA was a cult. I said 12-step programs use "cult-like techniques". That phrase is important.
Step three of AA, specifically, is "3 - Made a decision to turn our will and our lives over to the care of God as we understood Him."
Surrendering your will to someone else is one of the defining factors of a cult. The word like, modifies that (surely you understand the concept of simile. If someone takes a car to a mechanic and says "my engine makes a sound like that of a dog barking" the mechanic wouldn't say, "are you saying your engine is a dog?")
- Penny said...
"But then, as Mr Althouse Cohen noted,
"It's easy to keep believing in a dogma if you don't look at any of the evidence that goes against it.""
It's also easy to "frame a problem" to come up with the answer you want, AND the answer that society can accept.
- Joe said...
Step three of AA, specifically, is "3 - Made a decision to turn our will and our lives over to the care of God as we understood Him."
Surrendering your will to someone else is one of the defining factors of a cult.
I would not consider turning my will and my life over to God, or some other Higher Power as You/We/I choose to understand it/Him/Her is actually turning one's will over to SOMEONE. Certainly not in the same sense that the people of Jonestown turned their will and their lives over to Jim Jones or the Davidians turned their will and their lives over to Koresh.
So NO, AA really isn't "cult-like" is it...or if it IS, then EVERY church, synagogue and mosque is also a "cult-like" following.
Sorry your "evidence" is pretty weak so far...By your definition the RC Church, and the United States Marine Corps are also "cult-like"...when pretty much anything is "cult-like" the term loses precision and utility.
- Alex said...
Joe - from the standpoint of militant atheists ANY religion/church is a cult.
- Joe said...
Joe - from the standpoint of militant atheists ANY religion/church is a cult.
as could be said of militant atheists......and still your term lacks precision and seems to fail in its understanding of AA, as well. It's not jsut AA or churches, but also sports teams, military units and militant atheist organizations or the NAACP or Operation PUSh that now could be considered "cult-like." Agian when anything can be cult-like what value is the term?
- Michael said...
Joe: Why don't you just go have a drink and relax?
- k*thy said...
Joe at 4:08, I'd agree. I think the phrase "as we understood Him" covers this. It's up to each of us to define for ourselves. There is no singular God, here.
- Joe said...
Joe: Why don't you just go have a drink and relax?, mayhap I can...mayhap I can't go to the track...or just smoke a little marijuana..who knows.
But if someone's going to use "cult-like" they're going to have to do a better job than the other Joe did.
- bagoh20 said...
"If you start smoking pot at 13 and spend your teen years stoned, as the young man I know did, your brain development will literally be stunted."
I'm screwed.
- Eric said...
Sure, addicts have a choice. Even if you're the most easily addicted person on the face of the earth you don't need to take that first dose of whatever it is.
I'm the kind of person who can sit down in front of the television with a two pound bag of Doritos and eat the entire thing without even realizing it.
But knowing that, when people offered me various drugs in college I turned them down.
- Joan said...
bagoh20: I'm screwed.
Depends. If you were stoned but managed to finish high school, go to college, or get and hang onto a job, you'll probably be fine.
If you got high every day, flunked out of high school, never held a job a day in your life, got sent to juvie and then prison for various petty offenses, moved up to H from pot, and turned to drug dealing to support your habit... you've screwed yourself.
By which I mean, you've made it a lot harder to play it straight, because you don't know the rules, or, more importantly, the thought patterns behind the rules. You can still learn them, but it's going to take a lot of work, and you're going to have put in years before knowing what's good and what's bad, what's right and what's wrong, are things you really don't have to think about, because you just know.
For you, I'm hopeful. I love your screen name. It is - bag o' H2O, isn't it? That's what we all are, bags of water...
wv: being (deep! LOL)
- Jaz said...
Without attending a drug alcohol treatment program under the care of medical professionals, you cannot hope to achieve complete recovery.


text:
Researchers will determine whether a specific molecule governs immune T cells' "intolerance" to the body's own tissues (as occurs in autoimmune diseases) and, conversely, "tolerance" to brain tumors that invade and take over brain cells.
Ironically, activation of immune T cells in autoimmune diseases results in destruction of the body's own tissues, while therapies aimed at promoting attacks by T cells against aggressive brain tumors fail. T cells fail to attack brain tumors, in part because the tumors create an environment that suppresses initiation of these immune responses. Ordinarily, T cell responses are initiated through the cells' interactions with "antigen-presenting cells" (APCs). These include immune macrophages and microglial and dendritic cells. APCs ordinarily capture, process, and present a specific invader to immune T cells. When this process goes awry in autoimmune diseases, somehow the body's own tissues are misidentified as invaders. Conversely, the process fails to initiate an immune attack against brain tumors. The investigators, therefore, are studying how APCs either activate or turn-off immune T cells.
Whether or not APCs effectively initiate immune T cell attacks may depend on a molecule called "LR8." The researchers hypothesize that this molecule is absent when T cells attack the body's own tissues in autoimmune diseases, but present when T cells appropriately attack invaders. By studying T cell-APC interactions in tissue cultures in the lab and in a mouse model of autoimmune MS, the investigators will see whether manipulating the levels of LR8 alters the abilities of APCs to capture, process, and present a defined agent to immune T cells. The answer should help determine whether LR8 causes T cells' destructive or protective actions, or is simply associated with those actions.
Significance: If this molecule is found to directly regulate T cells-APC interactions, the research may eventually lead to development of therapies that prevent T cell attacks in autoimmune diseases and transplantation and therapies that strengthen T cell attacks on brain tumors.
Inflammation and T cell responses promote both wound healing and provide pathogen defense. However, many CNS disorders result from inappropriate direction of autoimmune responses against essential CNS elements (for example, multiple sclerosis). In addition, the ability to treat many chronic CNS degenerative disorders (for example, Parkinson's disease) with transplant therapies of healthy cells or even stem cells is limited by their propensity of partially matched transplant tissue to elicit destructive T cell responses, ultimately leading to transplant rejection. Our lab uses bone marrow chimeric methodologies coupled with gene expression profiling to define the molecular features associated with destructive versus protective/benign autoimmunity. Our goal is to define events that regulate the "tipping point" between destructive and protective/benign autoimmunity. In our ongoing studies, we have identified a novel target for the modulation of microglial function and CNS autoimmunity: clast1/LR8. LR8 is a tetraspan CD20-related molecule. We find that its expression is absent during the initiation of destructive auto-reactive T cell responses (for example, during EAE), but present during induction of protective T cell responses (for example, following facial axotomy).
We therefore, hypothesize that Clast1/LR8 expression is causative in inducing a neuroprotective and/or partly tolerogenic antigen-presenting cell (APC) phenotype. Here we propose to generate lentiviral reagents to modulate LR8 expression (up and down) in the antigen-presenting cells that are likely to contribute to the promotion of destructive anti-CNS T cell responses. We will utilize in vitro and in vivo assays to test whether and to what extent LR8 expression is causative in regulating the APC function of microglia, macrophages and dendritic cells. We will also examine whether modulating of LR8 expression can alter the incidence, severity, or kinetics of experimentally induced autoimmune encephalomyelitis (EAE).
Sensory difficulties, like hearing loss or vision problems, are not just about those senses but also the extra cognitive effort it takes to understand them. Dana Foundation grantee Jonathan Peelle talks about the cognitive challenges involved with hearing issues, how even slight deficits in "normal" hearing levels can lead to changes in how sound is processed, and why this work may offer us new insights into how hearing may be linked to the development of dementias.

subset: commoncrawl


text:
Now in its fifth generation, the BMW 7 Series offers all the power of a twelve-cylinder petrol engine in its top-of-the-range model, the BMW 760Li. The BMW TwinPower Turbo V12 accelerates the sedan from 0 to 100 km/h in 4.6 seconds. You'll hardly notice the gear changes, thanks to the eight-speed automatic transmission with electronic gear selector and Steptronic. Even at high speeds, the revs are reassuringly low.
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text:
Robotic-Assisted Gynecologic Surgery FAQs
What is robotic-assisted surgery?
How does robotic-assisted surgery work?
What are the benefits to a patient?
Why is there less blood loss with robotic-assisted surgery?
What are the risks of robotic-assisted surgery?
What are the patient criteria for robotic-assisted procedures?
What about long-term follow-up from robotic-assisted procedures?
Since 2006, UC Davis' gynecologic oncology surgeons have been performing minimally invasive procedures using a robotic surgical system. The device enables surgeons to safely treat several types of gynecologic cancers and other conditions. The surgical robot, with its precision-guided arms and video camera, is completely controlled by a trained surgeon who manipulates the mechanical arms from an operating-room console near the patient's bed. Robotic-assisted surgery requires several small incisions rather than the larger opening of traditional "open" procedures, which can help reduce blood loss and postoperative recovery times.
Similar to laparoscopic surgery in that it is minimally invasive, robotic-assisted procedures use special equipment that includes an operating console for the surgeon, precision-guided robotic arms that are inserted through keyhole-sized incisions, and a small video camera that provides magnified, 3-D images of the gynecological site. The camera enables doctors to see the blood vessels, nerve bundles and organs (such as the bladder, rectum and ureters) adjacent to the operating area. The robotic arms, with full 360-degree rotation capabilities, allow surgical instruments to move with exactitude, flexibility and a range of motion that cannot be accomplished with standard laparoscopy.
Robotic-assisted procedures usually are done under general anesthesia. Most patients experience only a small blood loss and blood transfusions are uncommonly needed. Gynecology oncology patients typically spend one or two nights in the hospital and are usually discharged when they are able to tolerate regular food, walk without assistance, and have pain that is controlled with pain pills.
Patients typically experience significantly less pain and less blood loss than those undergoing conventional "open-incision" procedures. Patients typically enjoy quicker recovery times. Additionally, studies suggest that the robotic-assisted system provides surgeons with a superior tool that allows for the precise removal of lymph nodes during cancer operations, when compared to traditional open or minimally invasive approaches. The robotic system also allows your surgeon better visualization of the anatomy, which is especially critical when working around delicate and confined structures like the bladder, blood vessels and other internal organs. This allows surgeons to perform radical cancer surgeries and help overcome challenges associated with adhesions from previous operations.
The enhanced three-dimensional view with magnification can allow the surgeon to see blood vessels even more easily than is possible with open surgery. This superior visualization along with precise movement of the surgeon-controlled robotic arms improves the ability to expose and control blood vessels adjacent to the surgical field.
Blood loss is also reduced because the pressure generated by the gas used to inflate the abdomen during surgery compresses small blood vessels, which provides surgeons with a better and more expansive view of the operating area.
Robotic-assisted surgery is major surgery performed through small incisions. It has the same kinds of risks that open surgery has including injuries to intra-abdominal organs. There are risks of medical complications such as stroke, heart attacks and blood clots in the legs. General anesthesia is generally very safe, but occasionally there are complications with this as well.
Use of small incisions for laparoscopy usually means less pain and discomfort compared to large abdominal incisions. Therefore, robotic and standard laparoscopic surgery can minimize the risks of wound infections, pneumonia and blood clots in the legs, because only small incisions are required.
The benefits of any surgical procedure cannot be guaranteed. Pre-operative assessment of a patient's overall health is a key element in every surgical decision at UC Davis. Successful outcomes depend on both the patient and the procedure. Patients should always discuss all the treatment options with their physician to understand the risks and benefits.
Not all patients are suitable for robotic surgery. Severe medical problems and/or advanced age may mean that the patient cannot tolerate the special positioning and length of the procedure. Severe obesity is a common limitation, although robotic surgery can sometimes be successful when standard laparoscopy is not feasible. Severe intra-abdominal adhesions due to previous surgery may prevent a minimally invasive approach. UC Davis' surgeons will discuss your treatment options and help you decide the best course of action.
What about long-term follow-up from robotic-assisted procedures?
Follow-up care depends on the condition being treated. Most patients who undergo a robotic-assisted procedure usually have one or two post-operative visits, unless there are complications. If the patient has cancer, follow-up visits to monitor the patient for a possible recurrence is standard care (but is no different than with standard abdominal surgery). Patients may or may not need additional cancer treatments, depending on the pathology report following surgery. Your physician will develop a post-operative action plan for you.


text:
Rip It Energy Fuel is part of the National Beverage family of brands.
National Beverage Corp. (NASDAQ:FIZZ) proudly refreshes America with a distinctive portfolio of Sparkling Waters, Juices, Energy Drinks and Carbonated Soft Drinks. We believe our ingenious product designs, innovative packaging and imaginative flavors, along with our corporate culture and philosophy, make National Beverage unique in the beverage industry.
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Welcome to what was to be our last live match tracker of the year.
Even if today's Leinster club SFC final ends in a draw after extra time, it is unlikely that the replay will be played before the New Year, then again, stranger things have happened.
The Moorefield and St Loman's players will be keen to get out on the pitch having had the disappointment of last weekend's fixture being cancelled due to heavy snow.
O'Moore Park, Portlaoise was the venue for this clash and we were there to bring live updates from the last provincial final of the year.
So to follow our live match tracker at it happened, click here.Tweet


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Clergy sexual abuse and misconduct (including spiritual abuse) is wrong.
It is the pastor's (or any other person in the role of authority)
responsibility to maintain appropriate boundaries. This site is for those
who desire to receive true healing—spiritual, emotional and physical—from
the devastation of clergy sexual abuse. True healing comes from God alone,
through the power of His Word, alone. We take a faith-based, Scriptural
approach to helping victims understand the devastation of clergy sexual
abuse and how they can receive healing and wholeness by God's grace.
It is our mission and prayer that through this web site, you will find
answers and the truth about what's happening to you. The information
in this site is written from a Christian perspective and contains quotes
from both Christian and secular writers (where they align themselves with
the Word of God). We encourage you to please continue
reading this article.


text:
Thanks for the post. Interesting video. I agree that Jordan White is a sleeper. I'm probably just falling in love with his (crazy) numbers at Western Michigan, but you have to have some ability to put up numbers like he did.
Football Outsider runs some sort of Sabermetrics to try an predict which rookie WR will become a playmaker in the NFL. Check out the video.
The WR with the most potential is Stephen Hill (far and away and its not even close). The most interesting thing though is that #3 is Jordan White.
Thanks for the post. Interesting video. I agree that Jordan White is a sleeper. I'm probably just falling in love with his (crazy) numbers at Western Michigan, but you have to have some ability to put up numbers like he did.
I think our scouts do a pretty good job overall
I think we all know Hill is a freak of nature, so these sort of formulas will always work out for him. I tend to believe he will be a special player and his bust potential is very low.
White is a surprise. I didn't expect to see him so high on a list like this. He has average athletic ability for a WR... but the production is undeniable. I wonder what they do with him this year. He could be the #3 or put on IR. It's way to early to tell.
Hill's potential gives me a boner.
White has the potential to be an rock-solid slot guy with average speed and superb route-running/hands. Still very concerned about a guy with two reconstructed knees who broke his foot first week of OTAs.
Hill will be a Top 5 NFL receiver. Minimum
Stephen Hill 660, wow that's over the top. I've been trying to temper my enthusiasm with the pick, but that justifies everything I've been trying to push to the back of my mind.
Hill has yet to catch 1 pass in the NFL, but some Jets fans are already calling him a top 5 WR. Minimum.
Kinda reminds me of Pats fans a few years back when they were saying the same thing about Chad Jackson.
What is interesting to me is that the Jets have drafted of acquired 4 WRs who scored highly on the FBO Playmaker Score:
-Braylon Edwards (traded for)
-Santonio Holmes (traded for then re-signed)
-Stephen Hill (drafted)
-Jordan White (drafted)
This suggests the Jets are using a similar statistical method to evaluate WRs, which is good since the FBO guys are damn smart.
Apparently based on this assumption he has top receiver talent. That's all. It's merely a projection based on his measurables. what they actually do is a different matter.


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Versace VM11 Dining Table
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Animal resources: a research resources directory
U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, 1983 - Animal experimentation - 48 pages
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Animal Diagnostic animal disease problems animal models animal research Animal Resources animals through control available for collaboration Basic Objectives Basic Research Mission behavior Biology Bolivian squirrel breeding colony Cayo Santiago Center and Center Center Director Resource center's services clinical chemistry Collaborating Scientists collaboration in investigating competence in gross Contact Person Core Research Units Current Research diagnosis of diseases Diagnostic resources Diagnostic Services Emphases of Core Emphasis or Application Galago grantee and affiliated hematology hormones immunology infections investigating laboratory animal laboratory animal disease laboratory is Provided lnvestigators Provided Macaca Medical mice microbiology microscopic pathology mulatta Necropsies nemestrina nonhuman primates Papio parasitology pasteurellosis Ph.D primarily to serve Primate Research Center Principal Investigator Program provide general competence Provided staffed provided when available Regional Primate Research Registry reproductive Research Emphasis resources are designed rhesus monkeys rodents Sabana Seca serve the grantee species squids staffed to provide studies Title of Center Veterinary wishing to conduct


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Why They're Unique
"Gearcor has what you need…for the work you do."
People from all professions come into the store every day looking for work footwear, clothing and safety gear. The Gearcor staff takes the time to learn what that customer needs and suggests products that best suit their work environment. For example, if a customer is looking for footwear and works on a construction site, the staff will ask about the job they do and the environment they work in. Then the staff finds out if there are any other special considerations before making style or product recommendations. They also take the time to measure the customer's feet to make sure they get the right size for a comfortable fit.
Gearcor has established a "Gearcor Insider's Club" at the store and are giving away free t-shirts to people who join, while supplies last. Every month they will be giving the club members special gifts, sneak peeks of new products or exclusive discount coupons.
Gearcor Insider's Club Monthly Giveaways
September's giveaway will be a FREE Geacor Work Sock with a $50 minimum purchase
Founded: 2003
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I was going to put an undecided/depends on context option, but have decided that that would be a bad idea; choose which one you think is more correct.
It's clearly log(log x).
As a side note, I believe most people interpret
- sin2(x) as (sin(x))2 and not sin(sin(x))
- sin-1(x) as arcsin(x) and not csc(x).
- log-1(x) as exp(x) = ex and not 1/log x
- fn(x) as f(f(... (f(x)...)) and not (f(x))n.


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Where is this 'way to let go'? In Buddhism we say ''Don't cling to anything.'' We never stop hearing about this ''don't cling to anything!'' This means to hold, but not to cling. Like this flashlight. We think, ''What is this?'' So we pick it up, ''Oh, it's a flashlight,'' then we put it down again. We hold things in this way.
If we didn't hold anything at all, what could we do ? We couldn't walk meditation or do anything, so we must hold things first. It's wanting, yes, that's true, but later on it leads to pāramī (virtue or perfection). Like wanting to come here, for instance... Venerable Jagaro2 came to Wat Pah Pong. He had to want to come first. If he hadn't felt that he wanted to come he wouldn't have come. For anybody it's the same, they come here because of wanting. But when wanting arises don't cling to it! So you come, and then you go back...What is this? We pick it up, look at it and see, ''Oh, it's a flashlight,'' then we put it down. This is called holding but not clinging, we let go. We know and then we let go. To put it simply we say just this, ''Know, then let go.'' Keep looking and letting go. ''This, they say is good; this they say is not good''... know, and then let go. Good and bad, we know it all, but we let it go. We don't foolishly cling to things, but we 'hold' them with wisdom Practising in this 'posture' can be constant. You must be constant like this. Make the mind know in this way, let wisdom arise. When the mind has wisdom, what else is there to look for?
i also recommend 'in the dead of night...', same author
No Abiding
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- Alumni
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Faculty Interdisciplinary Research Project (FIRP)
With the objective of enhancing Interdisciplinary and collaborative research interest in the institute, invitation were sent to all faculty members for submission of project proposals in Sept 2016. It was mentioned that a team of two or more faculty members having expertise in different disciplines working in different departments/centers/schools should come together to submit projects. It is expected that these interdisciplinary research groups will grow in size or merge with other research groups and in the process enhance the level of expertise and scope of research in a specific interdisciplinary theme. Further, these interdisciplinary research groups will attract strong support from external funding agencies and catalyze the synergic 'cross-research activity' between different faculty members across the institute leading to joint research publications, patents and PhD supervisions. These projects are to be considered as one time grant and the success of these projects will be judged based on the external grants the team is able to generate. The projects were evaluated by the external experts in Nov 2016 and FIRP started functioning from Dec 2016 and Jan 2017 depending on availability of manpower with PIs. We sanctioned 38 projects out 90 projects submitted. Selected project is given an initial grant of Rs 10 Lakh. Rs 5 lakh is given as the seed fund for the first year followed by similar fund in the 2nd year. It is expected that the joint research team will submit at least one research project to a funding agency on the completion of the 1st year. Additional funds covering the scholarship of a PhD student for 4 years can also be provided, if required and justified based on the progress of the first year. In this context first evaluation of FIRP were held on Aug 8 in the foyer of Dogra Hall with external experts as evaluator. It was well attended by faculty and students. Prof Ramgopal Rao, Director IIT Delhi, took keen interest and visited all the posters, which is a big encouragement for the community. Evaluation of the FIRP will be done again beginning of next year and a new FIRP call soon will be launched.


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Chapel Hill's Top Karate AcademyAt Karate International of West Raleigh, we're dedicated to building confidence and changing lives. We have been offering martial arts training in the local community since 1974, instructing pre-schoolers, children, teens, adults, and seniors, and whole families. We offer a number of programs for instruction in the martial arts, health and fitness, character development, weapons training, and street smart self-defense. Our goal has always been to produce champions inside and outside of the dojo.
Meet Our InstructorsKarate International is home to some of the most experienced and trusted instructors in the area.
Chester Rowe
Mr. Rowe is the chief instructor at Karate International of West Raleigh. He currently is a 6th Degree Black Belt in Sanshinkai Karate. Some of the other martial arts Mr. Rowe has trained in over the past 30+ years include Judo, Jujitsu, Aikido, Taekwondo, Shotokan, and American Shaolin Wu Shu.
Alex Tsikos
Alex Tsikos is a college student attending NC State. He has received his Associates Degree in Art from Wake Technical Community College in 2013. While attending North Carolina State University, he is currently working on his bachelors in operations management for 2017. At twelve years of age he received his first black belt in Kenpo Karate. At age twenty-one he earned his first degree black belt in Sanshinkai Karate in 2013, and is an assistant instructor and student under the guidance of Mr. Rowe.
Karate ClassesAt Karate International, the habits we TRAIN are the habits we GAIN! We specialize in Sanshinkai Karate. Sanshinkai means the "three power society," the three powers of mind, body and spirit. Sanshinkai is an art that teaches a student balance of self, and the belief that all great techniques contain a balance of mental, physical, and spiritual forces. Our instructors will help you build character, get results, and make new friends. We offer classes for kids, teens, and adults.
My 11 yr. old son, Justin, was diagnosed with autism and ADHD when he was 3. He has battled many self-esteem issues through the years, not to mention his share of bullies in school. We decided to enroll him in karate so he could prove to himself that he can achieve anything he wants with effort and practice. He has not stopped smiling since his first day of class. In a month's time, his level of self-confidence completely transformed! He doesn't look down on himself anymore. He doesn't give up as easily anymore. We have learned that karate teaches more than self-defense and cool moves. It has given us a sense of self-worth and confidence, two things that are impossible to put a price tag on. Jamie S. of Morrisville, NC
Karate International not only teaches all ages of the importance of sport, discipline, and mental awareness, but at the same time, and in a very caring manner brings valuable lessons in Courtesy, Courage, Knowledge, Respect and most importantly perseverance to achieve goals; as they take on the challenges of both achieving the next belt level, and also preparing for whatever challenges life may throw at them. It is with pleasure that we highly recommend Karate International of North Carolina, where both our 2 English children have been attending for the past 18 months, and where both have grown in both maturity, stature, and self confidence daily. Nils H. of Garner, NC
Start your journey by contacting us today!


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Microsoft has continued to update the official Facebook app for Windows Phone, but there's still no convenient way to manage multiple pages that may be tied to an account. This has changed now with FB Pages Manager, which is now available on the Windows Phone Store. This app essentially makes it easy for administrators to manage Facebook pages.
The app is by ImaginationOverflow and was backed by numerous beta testers before being published for the general public to enjoy. As one would imagine, numerous features are included that help make it simple to get information pulled to the Windows Phone, including analytics, notifications, as well as general page management.
The interface is very Facebook-like (get it? Facebook. Like. Bad joke, I know) and fits in nicely with Microsoft's Modern UI. A page status can be updated, deleted and shared, while photos can be uploaded. Messages are synchronised for interacting with fans and / or customers and commenting is fully supported.
The analytical side of Facebook Page management, known as Insights, can be accessed within FB Pages Manager too. This area provides a detailed analysis on how a page is performing. Whether the administrator is interested in the amount of "likes" the page has accumulated or how much reach you're able to achieve, it's all presented in an attractive interface.
Live Tiles are supported and will alert the user when new notifications have been received. Multiple pages can be pinned should you have more than one Facebook page. Finally, the default Facebook theme or the Windows Phone system theme can be configured to provide a more personalised and unique experience.
You can download FB Pages Manager from the Windows Phone Store for $1.99, as well as the free Lite version. The free edition of the app has advertisements and limitations on some features. Strongly recommended if you're looking to manage your Facebook pages while on the move.


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10 best bucket-list U.S. monuments and landmarks
Photographer Blaine Harrington III has worked around the world, but some of his favorite vistas are closer to home. Many of the country's most recognizable monuments and landmarks can be easily visited – and enjoyed without crowds, he says. "If you get out first thing in the morning, it's the most beautiful time of day, and there's almost no one else around." Harrington, who just opened an exhibit at The Wildlife Experience museum in Parker, Colo., shares some of his favorite monuments and landmarks with Larry Bleiberg for USA TODAY.
If it weren't for the brown signs alerting Interstate 90 travelers, it would be easy to drive right by the park, missing the otherworldly landscape of eroded buttes and pinnacles that lies just a few miles away. "You get off the road and very quickly you're into the rock formations," Harrington says. "It's kind of trippy, like being on the moon." He suggests visiting at different times of the day to see how the light transforms the scenery. There are hiking trails, but this is mainly a drive-through park — with an abundance of scenic overlooks.
Bucket list tip: More than most other parks, this is a place to camp, which will allow you to see the formations early in the day, and without traffic. Be sure to stop at Roberts Prairie Dog Town to see the fascinating social mammals.
THE BUCKET LIST: More must-see destinations
Kentucky horse country, Lexington
While the region's famed bluegrass isn't exactly blue, it still makes for unforgettable scenery, Harrington says. "In spring it's very green and you contrast that with the horses in the fields, and the fence lines going hill and dale. It's beautiful country and (has) such a deep heritage." The limestone-rich soil is said to be responsible for the distinctive taste of Kentucky bourbon and for the speed and strength of its thoroughbred racehorses. You can see farms by driving country roads outside the city. Guided tours are also available.
Bucket list tip: Time a spring or fall visit to see thoroughbreds in action at Keeneland Race Course, a National Historic Landmark.
A big part of the appeal of this West Texas park on the Mexico border is its isolation. "It's remarkably far from anywhere, and it's very, very underused," Harrington says. "It's something completely different from what you'll see anywhere else in the U.S." Hiking trails lead to even more remote areas of the Chihuahuan Desert landscape, home to more than 450 species of birds, and 1,200 plants. The Rio Grande forms part of the park's boundary as it passes through Santa Elena Canyon.
Bucket list tip: The scenery is just as stunning at night. "It's one of the darkest places in the U.S. You can see the Milky Way really well out there."
This spot has been sacred to Native Americans for centuries, but it was Steven Spielberg's science fiction film Close Encounters of the Third Kind that put it on the map. (Spoiler alert: The distinctive rock formation proved to be a UFO landing site.) The monument has an undeniable attraction, Harrington says. "You see it in the distance, it's huge." Up close, the appearance changes. "It's all that cragginess in the rock, and you realize it's surrounded by boulder fields."
Bucket list tip: While climbing the tower requires technical skills, it's easy to walk around it on a 1.3-mile, mostly flat, oval path.
Travelers could spend years exploring the windswept shoreline of Maine, or they can go to Acadia, which offers the best of the region's distinctive topography. From popular spots like Thunder Hole and Jordan Pond to the carriage roads that lace through the forest, it's easy to get out and experience the scenery. A shuttle system circulates by the park's top sites. "It's different from the Western national parks and it goes way back," Harrington says.
Bucket list tip: Get up early and watch the sunrise from the top of Cadillac Mountain, the highest point on the north Atlantic Coast.
This is one of the few natural landmarks that can be enjoyed at 50 mph. A carefully-engineered stretch of Interstate 70 twists through the 12 1/2-mile canyon high above the rushing Colorado River. "I'm just stunned every time I drive through it. The combination of the big rock faces, the mountains and the power of the river, and the way they seamlessly put the road in is spectacular," Harrington says. Visitors can hike and bike along the river, and even take an Amtrak train through the passage.
Bucket list tip: After visiting the canyon, stop in the town of Glenwood Springs for a soak in the world's largest hot spring pool, which circulates with 3.5 million gallons of naturally-heated spring water.
Niagara Falls, N.Y. and Ontario
Sure, the area is crowded with tourists, casinos and gift shops, but there's still no denying the power and majesty of the famed falls. "It's a marvel of nature, and man's tackiness can't even ruin it," Harrington says. The falls consist of three sections, Horseshoe, Bridal Veil and American falls. Visitors can don yellow rain slickers to see the cascade from the bottom on the famed Maid of the Mist excursion tour boats.
Bucket list tip: Try the region's famed ice wine, developed from grapes harvested in subzero temperatures.
Goblin Valley State Park, Utah
This desert park, little-known outside the West, is named for its otherworldly hoodoos — toadstool-shaped rock formations. "They're monoliths. It's like being in Alice in Wonderland," Harrington says. The area was in the spotlight last year when three men toppled one of the formations and posted a video online. The remote location makes it an ideal spot for camping, allowing a chance to see the park during the evening and early morning.
Bucket list tip: Don't limit your explorations to the flat rock fields. Climb the buttes overlooking the park for a completely different perspective.
Harrington recommends seeing this glacier-rimmed ocean inlet from a kayak. "It gives me goose bumps just to think about it," he says. "It's just pristine." Visitors can explore fjords by water, or see the sound from the surrounding Chugach National Forest. The area has had a remarkable recovery since the Exxon Valdez oil tanker ran aground here 25 years ago. "This is where the disaster happened. They almost ruined one of the most fabulous places on the planet."
Bucket list tip: Take a boat tour to see Columbia Glacier, which covers 400 square miles, and is the state's largest tidewater ice field.
This Navajo tribal park with its iconic sandstone towers and buttes has been featured in countless films and commercials, but is still an overwhelming sight. "We've all seen it one way or another. It really is the quintessential Old West background," Harrington says. "There's really nothing else like it." The valley, located on Navajo Tribal land, can by visited on self-guided drives, on jeep tours and on guided hikes.
Bucket list tip: Take a spur road to visit John Ford's Point, an overlook displaying the landscape featured in many of the Hollywood director's movies.


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AUSTIN — With as many as 14 spots on Texas' two-deep depth chart still open, Longhorns coach Mack Brown said Friday night's closed intrasquad scrimmage will be "huge" in sorting out the remaining roster issues.
Brown, who said he's not satisfied with any phase of his team just two weeks before the Sept. 3 opener against Rice, said 13 players have earned a spot on the two-deep offense and 17 have done so on the two-deep defense. Performance in the scrimmage — the second of three scheduled for the preseason — will weigh heavily in filling out the rest.
All four of UT's quarterbacks technically remain in the race to start, but they won't split repetitions evenly in the scrimmage. While not giving away who's in the lead, Brown said, "I don't think we've had equal snaps for a while now." Freshman David Ash has received plenty of positive buzz throughout the preseason and could be pushing incumbent starter Garrett Gilbert for playing time. Case McCoy and Connor Wood also are in the mix.
Among the other position notables:
- Brown said he has been impressed with both D.J. Grant and Blaine Irby, two tight ends returning from injury. In the new Bryan Harsin-Major Applewhite offense, Brown said tight end will be one of the most important positions on the field, and a breakthrough from either Grant or Irby would provide a significant boost.
- With safety Christian Scott suspended indefinitely, the Longhorns are moving players around trying to get the most from their secondary. Adrian Phillips is playing all three positions (cornerback, nickel back and safety). Carrington Byndom and Quandre Diggs look like the starters at cornerback, but Brown said A.J. White is "stepping up" at that position as well.
- Former running back Chris Whaley, now a 280-pound defensive lineman, could be an option at either end or tackle, Brown said. UT has enjoyed positive results from past running back-to-defensive line converts, most memorably Henry Melton and Lamarr Houston.
- One season after being hamstrung by their inability to get anything from their return game, the Longhorns are encouraged by their stable of kick- and punt-return candidates. Brown said Diggs, Jaxon Shipley, Darius White and Mike Davis are leading both groups.