Like almost every other writer on the topic of addiction, you write as if we are living in a free country as far as scientific research is concerned and that we can therefore draw adequate generalizations from the status quo. To the contrary, we live under a drug-war Sharia that strictly outlaws almost all research of psychoactive drugs, many of which could work wonders with alcoholics and other addicts. Although you don't mention this, Bill Wilson himself had great initial success in treating alcoholics with LSD. It was not science that stopped such treatment, but rather politics, when Richard Nixon decided to launch a war on Timothy Leary and hippies by outlawing their drugs of choice, namely psychedelics. And US-inspired drug law remains as anti-patient as ever, as therapist Gabor Mate was recently forced to stop his promising treatment of Canadian alcoholics with the entheogenic concoction known as ayahuasca.
So if AA is ineffective -- as I would definitely agree - it is as much the Drug War's fault as it is that of Bill Wilson and his theories.
Given the existence of the unscientifically motivated Drug War, it may well be true that Naltrexone is a relative godsend for alcoholics. That said, this is a huge "given." We should remember that we are choosing from a starkly limited pharmacopeia when we make that choice. There are thousands of potential psychoactive godsends out there that we are forbidden from studying, notwithstanding our pretensions at being a scientific country. By failing to acknowledge this outrage, we may be giving far more kudos to Naltrexone than it deserves. How good is it, you ask? How can we know until we compare it to the thousands of other potential therapies that we have chosen to ignore? It may well be the best thing currently "going" for alcoholics, and for that I yield to the experts - while yet pointing out that there really are no experts on addiction treatment per se since the Drug War has essentially placed all the potentially valuable therapeutic substances off-limits, not merely to individuals but to addiction researchers as well. No surprise there. We'd have just as few aviation experts today if the only legally available planes were gliders.
Also there is a real irony in the use of Naltrexone to block the action of opiates, at least when used in a Drug Warrior country such as the USA. By waging drug-war colonialism, we have sent our military abroad to destroy opium crops that have been used in moderation in the east for millennia, forcing other countries to turn to the western drug called alcohol to achieve, in general, a far uglier form of self-transcendence and relaxation than that supplied by the judicious poppy user. Not content to destroy the poppy in the East (always against the will of the local people, who have no say in the matter), we now seek out a drug that will obviate the poppy's effects, thus ensuring the prosperity of American Big Liquor for centuries to come. This is fundamentally a racist and anti-scientific war on the poppy, one which dogmatically recognizes only evil in the plant, failing to acknowledge its role in providing human transcendence over the ages - a viewpoint that keeps Anheuser Busch heirs smiling on their way to the bank (just as they were no doubt smiling when the DEA stomped onto Monticello in 1987 to steal Thomas Jefferson's poppy plants).
This brings me to the other problem with the Naltrexone approach, namely that is all stick and no carrot. Yes, the substance helps to destroy the addiction but it also gets rid of the transcendence which the addict was seeking in the first place. Psychedelics, on the other hand, work by actually providing the sought-after transcendent experience and it is that very transcendent experience from which the psychedelic user often emerges with new insights into their earthly condition and a new mental flexibility in dealing with their drinking problem.
One other bone to pick: I would ask you to question your apparently strong faith in science, at least as practiced in the States.
It is the alleged "scientific" approach to psychiatry that has led to the great but unacknowledged addiction of the American people, in which 1 in 8 Americans are now chemically dependent on antidepressants, all under the discredited theory (promulgated by a full-court media press by academic talking heads under the pay of Big Pharma) that these substances fix a chemical imbalance. As Robert Whitaker demonstrates, however (in "Anatomy of an Epidemic"), this is pseudoscience, not science. These antidepressants (SSRIs and SNRIs) have been shown to CAUSE the imbalances that they purport to fix. They certainly don't work for me after decades of use, and I am now forced to take Effexor the rest of my life against my will - Effexor, a drug that has a relapse rate just as high as heroin.
But I've yet to hear of one single addiction "specialist" wringing their hands on my behalf, or on behalf of the tens of thousands of unacknowledged antidepressant addicts actively cursing modern psychiatry online even as I speak - cursing it for one's loss of empowerment, one's unsought-for life-time role as an "eternal patient," having to apply to a doctor for their monthly fixes. (Part of the professional silence is based on the convenient myth that there's a meaningful difference between addiction and chemical dependency. Tell that to an Effexor addict after he or she has gone cold turkey for three days.)
Since psychiatry has no problem with thus addicting users like myself -- and to ineffective medicines at that - they have no leg to stand on in warning me that I might become chemically dependent upon, say, opium, should I be given the same legal access to that drug that I would have had in 1913, and they have even less standing in remonstrating against my use of totally non-addictive psychedelics. If such drugs are not even considered for treating alcoholism it is thus merely for political reasons, not scientific ones. So let's not write so as to imply that these therapies have somehow been tried and found wanting, when in reality such therapies remain unthinkable to Western researchers under the thrall of Drug War propaganda.
CONCLUSION: I believe we have no right to opine on the relative insolubility of addiction problems until we have re-legalized Mother Nature's medicines. Until then, any conclusions we reach on this topic should be followed by a huge footnote, both for the patient's benefit and by way of protest, stating that the addiction problem, for aught we know, could turn out to be far more soluble than we currently suppose, once the United States finally renounces its anti-patient Drug War, along with its efforts to enforce that war worldwide by way of the financial blackmail of its friends and foes alike.
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