Medicine is an Important Part of Addiction Recovery

See update below.

Alcoholics Anonymous (AA) is such a part of American culture that even those of us untouched by alcoholism [1] know some of the basic principles of the AA approach. In fact AA is popular enough that the Church has modeled its Addiction Recovery Program (ARP) after it, as stated in the ARP guide. So The Atlantic got my attention when I saw the title of a new article, The Irrationality of Alcoholics Anonymous, and I was a little surprised by what I read. Here are a few excerpts that, together, summarize the article.

The problem is that nothing about the 12-step approach draws on modern science: not the character building, not the tough love, not even the standard 28-day rehab stay.

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The 12 steps are so deeply ingrained in the United States that many people, including doctors and therapists, believe attending meetings, earning one’s sobriety chips, and never taking another sip of alcohol is the only way to get better. Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment. But although few people seem to realize it, there are alternatives, including prescription drugs and therapies that aim to help patients learn to drink in moderation. Unlike Alcoholics Anonymous, these methods are based on modern science and have been proved, in randomized, controlled studies, to work.

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Bill Wilson, AA’s founding father, was right when he insisted, 80 years ago, that alcohol dependence is an illness, not a moral failing. Why, then, do we so rarely treat it medically? It’s a question I’ve heard many times from researchers and clinicians. “Alcohol- and substance-use disorders are the realm of medicine,” McLellan says. “This is not the realm of priests.”

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Although AA claims a success rate of 75%, another estimate suggests it is closer to 5 - 8%.

We’ve grown so accustomed to testimonials from those who say AA saved their life that we take the program’s efficacy as an article of faith. Rarely do we hear from those for whom 12-step treatment doesn’t work. But think about it: How many celebrities can you name who bounced in and out of rehab without ever getting better? Why do we assume they failed the program, rather than that the program failed them?

In the October 1989 General Conference, Elder Boyd K. Packer said the following:

It is my conviction, and my constant prayer, that there will come through research, through inspiration to scientists if need be, the power to conquer narcotic addiction through the same means which cause it. I plead with all of you to earnestly pray that somewhere, somehow, the way will be discovered to erase addiction in the human body.

As discussed by the article, there are several medical drugs available that can help relieve the urge to drink--or to drink heavily--although they are not effective for everyone. Unfortunately, however, I am unable to find any encouragement in the Church's ARP guide for afflicted persons to seek medical treatment. That seems to me like an important omission. Tackling addiction issues using Gospel principles is great, but as Elder Dallin H. Oaks has reminded us,

Latter-day Saints believe in applying the best available scientific knowledge and techniques. We use nutrition, exercise, and other practices to preserve health, and we enlist the help of healing practitioners, such as physicians and surgeons, to restore health. The use of medical science is not at odds with our prayers of faith and our reliance on priesthood blessings.

I'm not qualified to render judgment on 12-step programs; they obviously do help some people. For its part, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (part of the National Institutes of Health (NIH)) recommends social support, including joining AA or a similar program, as a part of recovery efforts.

I guess the bottom line is this: People with substance addictions should, by all means, join support groups like AA or the Church's ARP program. But chances for improvement are best if medical help is also sought. Chemistry caused the problem; it can also be part of the solution.

[3/21/15] Update: For some push-back on the Atlantic article, see Why Alcoholics Anonymous Works.

Notes:
1. Disclaimer: To my knowledge, nobody close to me has (or has had) a substance addiction, so I have little personal experience with these issues.

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In the Universe, But Not Of the Universe?

I have a hard time rejecting causal determinism [1], which is essentially the idea that every result (including our choices and actions) depends on a chain-reaction of cause-and-effect relationships stretching back to the origin of the universe. And throwing a spirit into the equation doesn't seem to help because in Mormonism "all spirit is matter." So whatever that matter consists of, it will have laws that govern it. This leaves us with the prospect that our personalities, decisions, etc. are the combined chain of cause-and-effect relationships of physical and spiritual matter. This shouldn't be all that shocking in as much as our very existence is dependent on the existence of the universe (or multiverse, or whatever) and its laws and properties. If we have no right to exist apart from the universe, should we be shocked that everything we think and do is an extension of the universe?

But what people really seem to care about are issues of agency and responsibility. If we aren't truly making free choices (i.e. choices that are somehow not dependent on the configuration of matter in the universe--I guess), can we be held responsible for anything? And in a Mormon setting, what is the point of the plan of salvation if we are all simply acting out the consequences of the laws of the universe?

I have two responses to this [2]. First, as long as there are conscious beings with subjective experience, they will have a stake in regulating the behavior of other conscious beings. I don't want people stealing my stuff, for example, so laws and punishments are useful for deterring poor behavior and encouraging good. Second, if free will (i.e. the type that somehow makes decisions independent of the state of matter in the universe) does not exist, then we are all in the same boat--presumably including God [3]. There's no need to worry about Laplace's demon; he doesn't exist.

It seems to me that if causal-determinism is true, existence in the universe remains an unpredictable adventure [4], and we go right along on our merry way.

Notes:

1. ...which is different than saying I'm confident it is true.

2. I don't claim to have thought this through all the way. Whether by free will or determinism, I don't find the wrangling over definitions and thought experiments inherent in free will discussions to be worth my time and interest. I'm just giving you my two cents.

3. In Rational Theology, John A. Widtsoe wrote: "There can be no rational discussion of the details of God's life or nature. To him we give the most complete devotion, for to us he is in all respects infinite and perfect. His Godhood, however, was attained by the use of his power in simple obedience to the laws he discovered as he grew in experience." Maybe the universe favors the development of gods because they have a Darwinian advantage (i.e. scum bags are self-destructive).

4. Well, some things are predictable even now. I just mean that nobody can predict every detail of the course of the universe.

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Updating Sexual Development

One of the things I have always liked about biology is the propensity of nature to violate rules that people think are inviolable. This week's example comes from a news article, Sex Redefined, in the journal Nature. It covers current understanding of sexual development in humans--something most of us thought we understood by the time we finished high school biology. But it turns out that there are multiple stages to it, each of which can produce a variety of results. The basic outline is as follows:

That the two sexes are physically different is obvious, but at the start of life, it is not. Five weeks into development, a human embryo has the potential to form both male and female anatomy. Next to the developing kidneys, two bulges known as the gonadal ridges emerge alongside two pairs of ducts, one of which can form the uterus and Fallopian tubes, and the other the male internal genital plumbing: the epididymes, vas deferentia and seminal vesicles. At six weeks, the gonad switches on the developmental pathway to become an ovary or a testis. If a testis develops, it secretes testosterone, which supports the development of the male ducts. It also makes other hormones that force the presumptive uterus and Fallopian tubes to shrink away. If the gonad becomes an ovary, it makes oestrogen, and the lack of testosterone causes the male plumbing to wither. The sex hormones also dictate the development of the external genitalia, and they come into play once more at puberty, triggering the development of secondary sexual characteristics such as breasts or facial hair.

Not having a developmental biology background, I found that my understanding was a little out of date in that I was still under the impression that female development is the default track. That the developmental process can be altered and lead to surprising results isn't particularly new, but some of the examples given in the article are still impressive (e.g. womb discovered in 70 year old man).

As for how any of this fits (or doesn't) with Church doctrine, I previously laid out a few thoughts here. As a side note, I've only ever heard vague hearsay that special gender cases have gone to the First Presidency. Given the statistics involved (at least 1 in 4500 people), I would imagine that disorders of sex development are not uncommonly considered by Church leadership, but that's just my guess. I would also guess they are handled on a case-by-case basis, but if anyone out there has insight into that aspect, please chime in.


Notes:
For more, see Duane Jeffery's article, "Intersexes in Humans," for a nice LDS-oriented discussion of this topic. It seems to have held up well since it's publication in 1979. See also Jeffrey Keller, "Is Sexual Gender Eternal?"

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A Paranormal Plug in the Deseret News

Oh, for heaven's sake. Daniel Peterson's latest column in the Deseret News, Defending the Faith: Rethinking materialism in science, advertises a new home for cranks and loons. As a casual observer (and an overall fan) of Peterson, this isn't terribly surprising. He has expressed affinity for Intelligent Design on several occasions, and he seems to relish taking on 'the establishment' as he perceives it. Simply by the title of the column you know it's going to take an aggrieved stance toward mainstream science, but he does one better by telling everyone about a group of open-minded scientists who are calling for revolution, and spreading their questionable (at best) assertions.

When I looked around the Open Sciences site, it didn't take long to find that it's a collection of people pushing all kinds of fringe ideas (parapsychology and psychic phenomena, mysteries of water, etc.) At least a few of them have a long history of, shall we say, original thinking. After this group of revolutionaries met a year ago, they issued a manifesto which serves as the foundation of Peterson's column. It's written in the classic style of minority scientists who think they don't get enough respect [1]. It notes that they are "internationally known [2]," vents their grievance at all the dogmatism, and collects names of people with PhD's in order to appear important.

Before presenting their unorthodox ideas, the manifesto prepares the way with this statement.

Science is first and foremost a non-dogmatic, open-minded method of acquiring knowledge about nature through the observation, experimental investigation, and theoretical explanation of phenomena. Its methodology is not synonymous with materialism and should not be committed to any particular beliefs, dogmas, or ideologies.

Ah, classic. We all know that scientists should follow the evidence wherever it leads, and that dogmatism runs against the spirit of science. This kind of statement serves two purposes. First, to disarm critical scientists by appealing to their scientific values, and second, to help cultivate the appearance of unfair treatment by critics in the eyes of the public. It's not that the statement is wrong, per se, it's just incomplete. It's missing notions of skepticism, reproducibility, criticism, and so on.

Moving on, there are a variety of claims: we've got quantum mechanics (QM) and consciousness, near-death experiences, mediums who contact the dead, telekinesis, etc. Let me pause here to give you my rule of thumb on QM: you can dismiss out of hand anyone that uses QM to support new-age-type claims. I know that sounds dogmatic, but QM is strange stuff and is difficult to understand because it is heavily mathematical and contradicts our intuitions. Given the fact that new-age claims are not part of standard physics courses, it is much more likely that someone connecting QM to consciousness either doesn't understand QM, or has hijacked it in a way that is difficult to discern for non-physicists (of which I am one).

The manifesto continues:

Moreover, materialist theories fail to elucidate how brain could generate the mind, and they are unable to account for the empirical evidence alluded to in this manifesto. This failure tells us that it is now time to free ourselves from the shackles and blinders of the old materialist ideology, to enlarge our concept of the natural world, and to embrace a post-materialist paradigm.

Now it is certainly the case that we don't fully understand how consciousness works under currently understood physical principles (which is different than to say it CANNOT be understood eventually), but here is what our revolutionaries assert as a better view:

15. According to the post-materialist paradigm:

a) Mind represents an aspect of reality as primordial as the physical world. Mind is fundamental in the universe, i.e. it cannot be derived from matter and reduced to anything more basic.

b) There is a deep interconnectedness between mind and the physical world.

c) Mind (will/intention) can influence the state of the physical world, and operate in a nonlocal (or extended) fashion, i.e. it is not confined to specific points in space, such as brains and bodies, nor to specific points in time, such as the present. Since the mind may nonlocally influence the physical world, the intentions, emotions, and desires of an experimenter may not be completely isolated from experimental outcomes, even in controlled and blinded experimental designs.

d) Minds are apparently unbounded, and may unite in ways suggesting a unitary, One Mind that includes all individual, single minds.

There you go, folks! Materialism has failed to give a good explanation, so we can now say that mind is basically magic unmoored from the known laws of the universe.

I know there are still a lot of questions remaining within science, but I fail to see how positing that "mind is fundamental to the universe"--whatever that means--helps anything. I know that some of these statements bear a superficial resemblance to certain scriptures, but that doesn't guarantee that they really correspond to one another. And I know that to be a Mormon entails a certain amount of belief in things not borne out by science (yet?), but that doesn't mean we should run into the arms of the scientific fringe.


Notes:
1. Compare the manifesto with Dissent from Darwinism and the Global Warming Petition Project.
2. So am I, and I'm a nobody.

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BYU Fact-Checks Joseph Smith on Zacharias: How an Apocryphal Story Became Revealed Knowledge

As we are studying the New Testament in Sunday School this year, I was interested to see that Lesson 4 contains the following tidbit about John the Baptist and Herod's 'slaughter of the innocents'. After describing Joseph and Mary's flight to Egypt, as recorded in Matthew, the manual quotes Joseph Smith:

To protect John, “Zacharias caused [Elisabeth] to take him into the mountains, where he was raised on locusts and wild honey” (Teachings of the Prophet Joseph Smith, sel. Joseph Fielding Smith [1976], 261).

A more full quotation is as follows:

When Herod’s edict went forth to destroy the young children, John was about six months older than Jesus, and came under this hellish edict, and Zacharias caused his mother to take him into the mountains, where he was raised on locusts and wild honey. When his father refused to disclose his hiding place, and being the officiating high priest at the Temple that year, was slain by Herod’s order, between the porch and the altar, as Jesus said.

In 2013 the Religious Studies Center at BYU published an interesting article, "The Confusing Case of Zacharias," by Lynne Hilton Wilson, which shows this story to be a spurious tradition from the second century A.D. You should read the whole thing, but the story can be told in a few steps.

1. Zechariah, son of Jehoiada, was a high priest serving in Solomon's temple and was stoned to death (2 Chronicles 24:21).

2. Zechariah, the son of Berechiah, was the minor prophet after whom the Old Testament book is named.

3. In Matthew 23:35, Jesus told the Pharisees that they were guilty of killing the prophets, including "Zacharias son of Barachias, whom ye slew between the temple and the altar." Luke 11:51 records the same condemnation, but simply referred to "Zacharias, which perished between the altar and the temple."

4. Matthew seems to have mixed up which Zacharias was referenced.

5. The early-Christian document, "Protevangelium of James" embellished on the nativity narratives and connected the Zacharias referred to by Jesus with the father of John the Baptist by having him killed by the altar [1]. (In the process, the document transformed the father of John into the high priest. Also his blood turned to stone.)

6. In spite of its dubious origins, the story continued to circulate down through the centuries and was published multiple times in a variety of venues in the nineteenth century, including the Times and Seasons in Nauvoo. It was then incorporated into Teachings of the Prophet Joseph Smith by Joseph Fielding Smith.

7. Here we have a twist in the plot. It turns out that there is no evidence that Joseph actually wrote the statement quoted above. After laying out the evidence, Wilson writes:

Although we know of no evidence that Joseph Smith wrote, delegated, or approved the publication of this article referencing Zacharias, it still found its way into Joseph Fielding Smith’s compilation, Teachings of the Prophet Joseph Smith, in 1938. The pertinent problem lies in the fact that these teachings became interpreted by many as instructions to the Church from the Prophet. As a result, several Latter-day Saint books have spread the story as if it were a restored truth—including Sunday School and institute manuals.

Indeed, her footnote #2 lists its use by a number of LDS authors--some of whom are big names (e.g. McConkie, Millet, Matthews, Skousen), and it does appear in several Church publications. In the January 1995 Ensign, for example, it was listed as one of the insights about the Bible given to us as revealed knowledge through Joseph Smith.

This all makes my title tongue-in-cheek, since it turns out that Joseph Smith probably had nothing to do with the teaching. How ironic, though, that a centuries-old apocryphal story became 'revealed' knowledge. Given its widespread and authoritative distribution, it probably has a lot of years to live still.

Notes:
1. Translations available here. The murder of Zacharias happens toward the end.

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NASA: 2014 Hottest Year on Record

NASA and NOAA have officially declared 2014 as the warmest year on record. This in spite of parts of the United States being colder than usual, and the lack of El Niño. Here is the NASA temperature record with El Niño-La Niña cycles shown:

And here is the difference from average for 2014. Did you know that part of the U.S. can be cool while most of the rest of the planet is warmer than usual? I know it sounds crazy, but it's true!

Think about this for a second and let it sink in. That blue spot over the eastern U.S. is what makes people say, "What ever happened to global warming?" It's like residents of Detroit wondering what happened to global population growth.

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BYU Studies: Science as Storytelling, and the Atomization of Knowledge

While looking for something to read during my Christmas vacation, I discovered that the last 2014 issue of BYU Studies contains an article by Barry Bickmore and David Grandy titled, "Science as Storytelling." The article is nicely summarized as follows:

Much [o]f our modern world revolves around something called "science." But what is science? Interestingly, this turns out to be a very difficult question to answer because every definition seems to include something we don't consider science or seems to exclude something we do consider science. In this essay, the authors present their own definition: Science is the modern art of creating stories that explain observations of the natural world and that could be useful for predicting, and possibly even controlling, nature. They then refine this definition by offering seven rules that scientific storytelling must follow to distinguish it from other genres. These rules fall under the following general topics: reproducibility, predictive power, prospects for improvement, naturalism, uniformitarianism, simplicity, and harmony.

Bickmore and Grandy explain that their article originated as part of an introductory science course in order to address simplistic views of science and the corresponding tendency to reject scientific findings that clash with personal, religious, or political views. Theirs is a time-honored attempt to define what makes science unique from other human endeavors.

Their use of storytelling as the central concept of science made me nervous at first because it is easy to dismiss scientists as making up stories. They address this concern and explain their reason of word choice.

[W]e chose the word “stories” to emphasize the idea that the explanations scientists come up with are not themselves facts. Scientific explanations are always subject to change, since any new observations we make might contradict previously established explanations. The universe is a very complicated place, and it is likely that any explanation that humans come up with will be, at best, an approximation of the truth.

I think use the word "story" is fine as long as it is used loosely. For example, if you were to ask how water gets to the faucets in my house, I would tell you a story beginning with the entrance of the main water pipe into my basement, and how the water is distributed to various places by various pipes. Plumbers count on building codes to help ensure that the story is consistent from house to house. However, occasionally they will find deviations or expansions on the basic story. As they attempt to understand these variations, they are basically refining the story of that building's flow of water and acting accordingly in order to control the flow. When pipes are hidden by walls, floors, or ceilings, there will always be a little uncertainty in the story. But with enough probing of the system, the remaining uncertainties become negligible or practically irrelevant.

Unfortunately, the attempt to separate facts from stories (or hypotheses, theories, etc) can also be a source of mischief. It can lead to what I call the atomization of knowledge, where knowledge is broken down into the smallest possible pieces and loses its force because the formation of context and relationships between facts is prevented. Take, for example, the following quote of Hugh Nibley provided by R. Gary in the comments to my last post.

The fossil or potsherd or photograph that I hold in my hand may be called a fact—it is direct evidence, an immediate experience; but my interpretation of it is not a fact, it is entirely a picture of my own construction. I cannot experience ten thousand or forty million years—I can only imagine, and the fact that my picture is based on facts does not make it a fact, even when I think the evidence is so clear and unequivocal as to allow no other interpretation. (The Collected Works of Hugh Nibley, vol. 1, ch. 2, 25-27.)

That's all well and good, but a dedicated skeptic might question whether a fossil is actually a fact, and assert that only pixels are fact--pictures are interpretation. Actually, Bickmore and Grandy hint as much when they write:

Consider fossils. They look like the remains of living things. Is it not reasonable to suppose that they were once living things that were covered and preserved in sediment, just as dead organisms can be covered and preserved in sediment nowadays?

That's quite an underselling of fossils; the evidence is better than that. I'm not criticizing the authors--they were just making a point about the consistency of cause and effect--but it helps to illustrate the problem. It took me about 10 seconds to Google up some creationists arguing that when it comes to fossils, the only facts are their physical properties (dimensions, weight, etc). Scientific troublemakers excel at this kind of game--keeping attention on the most basic indisputable facts so that higher-ordered interpretations appear to be mere guesses.

This all goes to my view that, just as it is impossible to entirely separate science from non-science, it is impossible to entirely separate fact from interpretation, and the judgment of fact vs interpretation will differ based on knowledge-base. That carbon has 6 protons is a statement of fact to chemists because it is so well tested. A non-chemist might consider it merely an interpretation. Maybe I could formalize this as a rule of thumb: if someone seems keen to separate fact from interpretation, there is a good chance that they are selling scientific garbage. This is because specialists will tend to have an appreciation of where accepted facts end and interpretations begin in their field, so they don't need to bang on about it. Further, they will tend to dispute interpretations with additional observations or facts, rather than by getting pedantic about the demarcation between the two.

From the discussion thus far you would be forgiven for wondering how scientists make any progress at all. The rules outlined by Bickmore and Grandy are key here. I list them as they appear in the article.

Rule 1: Scientific stories are crafted to explain observations, but the observations that are used as a basis for these stories must be reproducible.

Rule 2: Scientists prefer stories that can predict things that were not included in the observations used to create those explanations in the first place.

Rule 3: Scientific stories should be subject to an infinitely repeating process of evaluation meant to generate more and more useful stories.

Rule 4: Scientific explanations do not appeal to the supernatural. Only naturalistic explanations are allowed.

Rule 5: Any scientific explanation involving events in the past must square with the principle of “uniformitarianism”—the assumption that past events can be explained in terms of the “natural laws” that apply today.

Rule 6: Scientists assume that nature is simple enough for human minds to understand.

Rule 7: Scientific explanations should not contradict other established scientific explanations, unless absolutely necessary.

Although they are all important, I think rules 1, 2, 3, and 7 are particularly important. I would argue that the remaining rules are simply extensions of those four rules working together.

Well, I've gone on long enough and I don't have a good way to wrap up. So I'll just say go read the article and see what you think.

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Facts and Authority

The Crucible of Doubt, by Terryl and Fiona Givens, contains this quote from Austin Farrer that I liked and thought I would pass along:

Facts are not determined by authority. Authority can make law to be law; authority cannot make facts to be facts.

This would seem to be obvious, but you don't have to look too far to find facts disputed on the basis of authority (i.e. position within the Church). By virtue of their authority leaders of (and within) the Church are entitled to establish law, and I strive to obey the law. But when it comes to facts, authority is not a guarantee of accuracy.

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