Talk:Alcoholism/Archive 4

message: Manual of style, a guide not a policy suggests:
In general, specialized terminology should be avoided in an introduction. Where uncommon terms are essential to describing the subject, they should be placed in context, briefly defined, and linked.
Thought this might help. You all are making real progress.  Keep up the good work. --FloNight talk 15:40, 6 July 2006 (UTC)
thread_title: Manual of style: lead section

message: I think we'll be more effective in the tactical discussion (what words do we use to explain alcoholism) if we have a clear set of objectives for the remaining definition first.  So rather than talk about what to write in this section, let's talk about what our objective is for the remaining definition section.  If we first have an objective then I think finding the words will come much more naturally.  It would be worth reviewing what we have agreed upon to give us an idea of how to approach finishing the definition.  I'll have some thoughts on the subject but I plan on not being here much over the weekend.  I'm not saying wait for me, only that I might not be around much.   Anyhow, it's something to think about and what we have agreed upon I think is very respectful to the reader and non-confrontational.  I think the reader would so far say "Ok, they're not trying to sell me anything and what they're saying makes sense" and want to continue reading.  So far the introductory definition seems quite credible to me.  06:14, 8 July 2006 (UTC)
replies: text: I agree that we've made some real good progress and have a "credible" definition. I'm also open to anything that will help us move forward. Unfortunately, I'm going to be out of town for about a week so I'll have to leave it to the rest of you. And I can just see you all breathing a big sigh of relief at my upcoming vacation: Finally, some peace and quite around here, they say. Seriously, keep up the good work, all of you. :) --Doc Tropics Message in a bottle 06:52, 8 July 2006 (UTC)
thread_title: Comments on Developing a Strategy

message: I've made several minor edits, mostly for the sake of formatting, and I think I see a need for many, many more. I really don't anticipate these will be "controversial" since the changes are largely cosmetic in order to Wikify the article, but if I accidently turn something into nonsense feel free to revert it and mention it here. --Doc Tropics Message in a bottle 21:12, 20 July 2006 (UTC)
replies: text: ND, I'm afraid the majority of our cites, links, and refs need a major overhaul. Your work in formatting and streamlining has been excellent, and I was hoping you could help in this area as well. I've tried but I lack any subject-matter expertise, and usually just end up with a headache. I'm beginning to wonder if we need to just "burn" all three sections and start over? That sounds like a potential headache as well, so I'm somewhat at a loss. --Doc Tropics Message in a bottle 19:07, 26 July 2006 (UTC)
thread_title:  Formatting 

message: Do the superscript numbers in this section mean anything anymore? I assume they were references to footnotes either in the article they came from or an earlier version of this wiki article. Any ideas? Nunquam Dormio 18:48, 26 July 2006 (UTC)
replies: text: ND, I'm afraid the majority of our cites, links, and refs need a major overhaul. Your work in formatting and streamlining has been excellent, and I was hoping you could help in this area as well. I've tried but I lack any subject-matter expertise, and usually just end up with a headache. I'm beginning to wonder if we need to just "burn" all three sections and start over? That sounds like a potential headache as well, so I'm somewhat at a loss. --Doc Tropics Message in a bottle 19:07, 26 July 2006 (UTC)
thread_title:  Blood tests 

message: In reviewing the cites in our first paragraph, both of the remaining cites are to other encyclopedias (Medline Plus Medical and Britanica).  I think that it's a very poor showing that, for our first paragraph, we have to point to another encyclopedia and say "See, they think so, too!"  After some consideration, I think it would be a better policy to back up our opening section with the rest of the article, and if we need to back up individual statements in the rest of the article, then we should find more authoritative sources than other encyclopedias.  Unless someone protests, I'm going to remove those two references. Robert Rapplean 17:15, 23 July 2006 (UTC)
replies: text: I agree (although I thought Medline was a Journal rather than an Encyclopedia). It really bothers me to see refs to EB anywhere; I'm sure we can do better. Once you've taken care of those two, would you like to sort through 3 - 9? I tried to reduce and reposition those more appropriately; maybe you'll have better luck :) --Doc Tropics Message in a bottle 17:21, 23 July 2006 (UTC)
replies: text: I realized that Medline self-identifies as an encyclopedia so I went ahead and removed the first two cites. They're still available in the history of course, so if anyone really wants to replace them it's easy enough. I couldn't find a specific WP:POLICY against citing other encyclopdias, but I strongly agree that our intro should stand on its own and we should think carefully about citing other encyclopedias anywhere, ever. --Doc Tropics Message in a bottle 01:21, 24 July 2006 (UTC)

text: I also removed a broken link from the next section. --Doc Tropics Message in a bottle 01:53, 24 July 2006 (UTC)
thread_title: Do we really need to be Citing another encyclopedia?

message: who came up with a stupid definition that omits the word dependency / Palx 14:13, 4 August 2006 (UTC)
replies: text: The big reason, Palx, is that dependence itself can mean many things. To some, dependence is synonymous with addiction; to others, dependence refers to a physiologic state. Psychiatrists use the term dependence the way other physicians use the term addiction. Dependence to some is a disease state while to others it represents a natural mammalian response to specific groups of drugs. Because of the many standards (and resulting confusion) around this term, we elected not to incorporate it within the definition of alcoholism itself. That way, we can be clear about what alcoholism means without using other terms which, while clear to some, might not be clear to all readers. Drgitlow 02:12, 5 August 2006 (UTC)
thread_title: Why we don't use the word "dependency" in our primary definition

message: I took a stab at the definition of Addiction.  It's a simplification of what the article has to say, and I think that's what we need here.  Please let me know if you find a problem with it.
I'd like to revisit our definitions of 'abuse' and 'dependence'.  Right now the page currently reads:
Abuse and Dependence have standard medical diagnosis definitions in the DSM-IV-TR, but this terminology is now under discussion for change as DSM-V is being prepared.
What this translates to is that "abuse and dependence have definitions, but these definitions might change".  I think we'd be better off if we actually provided the readers with a definition that's currently accurate.  I do have to say, though, that most politicians have never opened a DSM, and they have more influence over the commonly understood definition of abuse than any doctor does. Robert Rapplean 18:19, 30 July 2006 (UTC)
replies: text: See what you think of the changes I implemented just now. I'm trying to avoid actually putting the full working definition of 'abuse' and 'dependence' as defined in DSM-IV, but we could present an overview of this in a sidebar. I figured that would be covered in the entries for abuse and dependence, but now that I've just looked those up, there really isn't much there. Think it belongs here? Drgitlow 03:16, 5 August 2006 (UTC)

text: Got it. In part, I've been avoiding a more detailed approach because the precise definition has a copyright issue. Give me a couple of days to find out the extent to which I can simply summarize and that will get us around the Billy Joe Bob issue. Drgitlow 03:33, 7 August 2006 (UTC)
thread_title: Terminology Section

message: Hey, Dr. Gitlow.  I noticed that you adjusted the aforementioned section to say:
A psychiatrist would probably quote the DSM-IV and state that the presence of abuse is based upon the definition provided there.
I was hoping to give the reader a better perspective on the considerations a medical professional would have for labelling something as abuse.  This kind of says that "if you're not smart enough to read the DSM that I'm not going to tell you."  Could you elaborate a little for our audience? Robert Rapplean 00:01, 4 August 2006 (UTC)
replies: text: See what you think of the changes I implemented just now. I'm trying to avoid actually putting the full working definition of 'abuse' and 'dependence' as defined in DSM-IV, but we could present an overview of this in a sidebar. I figured that would be covered in the entries for abuse and dependence, but now that I've just looked those up, there really isn't much there. Think it belongs here? Drgitlow 03:16, 5 August 2006 (UTC)

text: Got it. In part, I've been avoiding a more detailed approach because the precise definition has a copyright issue. Give me a couple of days to find out the extent to which I can simply summarize and that will get us around the Billy Joe Bob issue. Drgitlow 03:33, 7 August 2006 (UTC)
thread_title: A Psychiatrist's definition of abuse

message: I created a straw model for a definition of dependence in the terminology section.  I belive that it's reasonably accurate and more informative than what it replaced, but feel free to pick it apart. Robert Rapplean 16:26, 15 August 2006 (UTC)
thread_title: Taking a stab at ''dependence''

message: I've moved all of the diagnosis information into one place.  I'd like to change this heading to something less technical, preferably something like "Identification", specifically to avoid controversy over whether this is a medical, behavioral, or spiritual problem.  Also, many of the entries here refer to concepts that aren't discussed in this article, and we need to fix that.
Could we have a bit of brainstorming about the various ways of identifying an alcoholic?  I'd like to put each major method under its own subheading.  Obviously the DSM and CAGE models belong there.
I'd also like to expand on my first paragraph that describes the difficulties involved in diagnosis.  Can we put a section in previous to it that describes the various addiction factors that contribute to alcoholism?  I think that would properly belong in the "extended definition" section of the article. Robert Rapplean 22:39, 20 July 2006 (UTC)
replies: text: I'll leave the technical end of things to our panel of experts, but the changes you've made so far look good to me; it's a better format for the info I think. I also agree that "addiction factors" does belong in the extended definition (unless it gets so long that it deserves its own section). It seems we've re-established enough goodwill that you could go ahead and edit, just be prepared to discuss if anyone objects. Happy editing! --Doc Tropics Message in a bottle 02:15, 21 July 2006 (UTC)
replies: text: The CAGE isn't a diagnostic test. It is simply a screening test used to identify those individuals likely to have alcoholism. As an analogy, to diagnose primary hypertension, one might conduct a screening test of measuring blood pressure. A single result of an elevated blood pressure may have many causes, one of which is primary hypertension. The DSM definition of alcohol dependence is a diagnostic definition for the disease of alcohol dependence (DSM's term for alcoholism). The 1992 JAMA article's definition of alcoholism is another diagnostic definition for the disease. From a medical standpoint, a physician will ask a series of questions designed to determine whether an individual's intake of alcohol has led to adverse outcomes in a repetitive manner. If the answer is 'yes,' then the individual is alcoholic. If 'no,' then intake of alcohol may be either nonpathologic or causing something other than alcoholism. For instance, let's say an individual comes in to see me complaining of significant anxiety, but has NO other problems. And let's say that individual honestly reports drinking 2-3 beers each day. That patient possibly has an alcohol-induced anxiety disorder. I then tell the patient that their anxiety, which is causing significant discomfort, may be a result of alcohol intake. I recommend cessation of alcohol use and a re-examination in 1 month. If in one month the patient has not stopped drinking despite the possible adverse reaction, now I must consider alcoholism as one possible diagnosis. Drgitlow 02:30, 21 July 2006 (UTC)
replies: text: An interesting example Dr. G, and well written. Keeping in mind our Hypothetical Reader (who is still working towards a high school diploma), is it possible to clarify the difference between screening and diagnosis within the article a bit? It seems that the different techniques could probably stay in the same section since, to a layman, the difference appears to be a rather minor one? I think this actually sums up a challenge facing the article overall: We really need to bring the overall level down a bit to make it more accessible to our HR, but without dumbing it down so much it turns into nonsense. --Doc Tropics Message in a bottle 02:48, 21 July 2006 (UTC)

text: OK, who forgot to log in? :) I went waaay out on a limb and unilaterally changed the section header to "Identification and Diagnosis", although "Screening and Diagnosis" might also be appropriate. --Doc Tropics Message in a bottle 03:27, 21 July 2006 (UTC)

text: Rewording might be appropriate, if handled with care.  I just read through that section again and it seems to be refering to "borderline" cases, but that isn't clearly stated. If you can clarify that without delving too deep into "specialist stuff" it would be perfect :) --Doc Tropics Message in a bottle 18:24, 23 July 2006 (UTC)
replies: text: I believe that this can be fixed by changing the leading word "diagnosis" to "identification".  I agree that diagnosis isn't terribly hard.  If a person tells you that they have trouble not drinking then that pretty well settles it (oversimplification, I know).  The difficult part comes in when other people are trying to decide if their loved ones are alcoholics.  This usually involves attempting to apply the observer's priorities on the drinker, which is more often than not a mis-match.  This is where the difficulty comes in.  Again, trying to keep the non-medical-professional audience in mind.  Does that make sense?  Robert Rapplean 04:40, 25 July 2006 (UTC)
thread_title: Identification and Diagnosis section

message: The current diagnosis section opens with a sentence that reads that diagnosis of alcoholism is difficult. I'm not sure what that statement is, whether it's an opinion or a value judgment in and of itself, but it's certainly not true for an addiction medicine specialist. Alcoholism is our bread & butter -- making the diagnosis is about as easy as pulling weeds. Can we reword that? Drgitlow 18:16, 23 July 2006 (UTC)
replies: text: Rewording might be appropriate, if handled with care.  I just read through that section again and it seems to be refering to "borderline" cases, but that isn't clearly stated. If you can clarify that without delving too deep into "specialist stuff" it would be perfect :) --Doc Tropics Message in a bottle 18:24, 23 July 2006 (UTC)
replies: text: I believe that this can be fixed by changing the leading word "diagnosis" to "identification".  I agree that diagnosis isn't terribly hard.  If a person tells you that they have trouble not drinking then that pretty well settles it (oversimplification, I know).  The difficult part comes in when other people are trying to decide if their loved ones are alcoholics.  This usually involves attempting to apply the observer's priorities on the drinker, which is more often than not a mis-match.  This is where the difficulty comes in.  Again, trying to keep the non-medical-professional audience in mind.  Does that make sense?  Robert Rapplean 04:40, 25 July 2006 (UTC)
thread_title:  Diagnosis 

message: I have removed the following chunk from the page because it was in the identification and diagnosis section.  It doesn't really seem to fit, but I've archived it here in case we want to use it later for something.  Regardless, it's a rather large quote that should probably be broken up and explained, or paraphrased. Robert Rapplean 18:17, 16 August 2006 (UTC)
thread_title: A removal

message: There is reason that healthcare professionals have a tough time accepting any treatment that involves continued drinking. The Pendery article in Science in 1982 (Science. 1982 Jul 9;217(4555):169-75.) essentially blew the moderation movement out of the water by demonstrating that over the long-term, patients who truly had alcoholism and who tried to drink in moderation either a) died of alcohol-related disease, b) ended up with significant morbidity due to alcohol-related disease, or c) had successfully entered abstinence. One method of diagnosing the disease is to simply see whether a patient tries to control their alcohol intake; if they do, they probably have alcoholism (noone tries to control their orange juice intake -- if they did, one would think there's something wrong). Drgitlow 16:53, 3 July 2006 (UTC)
thread_title:  Curing by moderation (Reposted comment from archive) 

message: Hi, Doc.  Thanks for making the correction on the detox section.  I was finding it tough to believe that any alcohol center actually administers alcohol as part of in-patient detoxification.  It's terribly contrary to their philosophy.  I'll remove the chunks of the previous paragraphs that conflict with it. Robert Rapplean 21:00, 10 August 2006 (UTC)
replies: text: Until at least the late 80s, some VAs were still using alcohol on a tapering dose schedule, but I don't think that's done anymore. When you get right down to it, as far as the brain is concerned, there's no real difference between alcohol and the other sedatives, so the conflict to using alcohol for the taper is psychologic or philosophic rather than biologic. Drgitlow 18:26, 11 August 2006 (UTC)
thread_title: Edits on Detox section

message: Hey, folks.  The references section has gotten out of control as an unreadable mishmash of cites that may or may not actually be pertinant to something that is still in the article.  Could you help me out here?  I'd like to maintain a permanent section in the talk page that specifically lists the significance of each reference to the article at large.  Many of these articles are not readily accessible, so I'd like to create a guide to their significance so the reader doesn't have to go digging into a bunch of medical journals to figure out what the purpose of the cite is.  I'm going to use this site from Dr. Sinclair as an example of how I'd like to see the cites explained.  In the article I'd like to see them ordered based on the position of the text in the article that they support. Robert Rapplean 16:42, 22 July 2006 (UTC)
replies: text: I think this is an excellent idea, and without question, something needs to be done. It appears that many of the cites are redundant in the sense that they point to articles which say essentially the same thing. I'd like to suggest a couple of ideas, but I'll wait for input from others before taking any actions:
# Eliminate some of the redundant cites.
# Try to avoid referencing the websites of individuals, even if they are MDs. I think these don't have as much credibilty as the numerous journals we can link to.
# If any sentence actually needs more than a single cite, that might indicate that we need to rewrite the sentence for clarity.
--Doc Tropics Message in a bottle 17:30, 22 July 2006 (UTC)
thread_title: References Section

message: I'm not sure how to handle the APA's in this article. I've made reference to the American Psychiatric Association in my entries. MedicalMan has made reference to the American Psychological Association in his. Both organizations use the abbreviation APA and some of our current paragraphs use the APA abbreviation as well. Readers won't know which APA we refer to. It's annoying, but I suggest we spell out each such reference to be certain readers (and we) know whom is being cited. Drgitlow 04:17, 1 July 2006 (UTC)
replies: text: Likely that American Psychological Association is the more commonly recognized use of APA. Agree that writing out each one is necessary in this case. FloNight talk 15:39, 1 July 2006 (UTC)
thread_title:  APA vs APA 

message: I'm going to attempt to rearrange the talk page so that it has major sections which reflect the major sections of the article itself, in the same order.  I archived the discussion about moving the Disease topic, but need to put a placeholder at the top telling people that all discussion about that topic should be addressed there.  I'd like to suggest that we have effectively resolved the differences that required us to go into mediation, and comments pertaining to that can also go into the archive. Robert Rapplean 15:44, 22 July 2006 (UTC)
thread_title: Regarding recent edits

message: drgitlow, please be more careful in honoring Chris with edits I made. Because you chose to highlight Dr. Benjamin Rush's view that alcoholism is a disease, I think it essential to point out his view that Negroidism is also a disease because this helps the reader understand his conception of disease.Medical Man 01:46, 3 July 2006 (UTC)
replies: text: I didn't highlight Dr. Benjamin Rush's view. I never wrote a sentence about Dr. Rush. I thought that was there before I ever got here, but I can check back in the history. Drgitlow 03:54, 3 July 2006 (UTC)

text: Yup...it was added on April 9 by someone without a user signature. After I started working on this, but not me. Drgitlow 04:09, 3 July 2006 (UTC)
thread_title: Please be more careful

message: At this point, I think what is happening is that the editors are working together to build consensus and to discover directions for the article with which all can agree and/or compromise about. After the serious disagreements that we had originally, we've come a long way. I admire the fact that we've all stepped back, are taking a breather, and are simply discussing perspectives for now without fighting about the article. And though the new template at the top of the page is correct, a couple of more days of discussion prior to getting back to the work at hand seems reasonable to me. Other thoughts? Drgitlow 22:00, 11 July 2006 (UTC)
thread_title:  Talk Page Discussion 

message: I was looking for a definition of alcohol toxemia and found this instead [].  A quick look at the article and the associated talkpage [] indicates that it's very up to date. I assume it's a "mirror", but the website appears to be at least semi-commercial (note the HUGE ads?). Can anyone shed some light on this? --Doc Tropics Message in a bottle 18:16, 25 July 2006 (UTC)
replies: text: This is a spam link.  The first link randomly fails to actually go to the alcoholism article and displayes a page full of advertisements for bible software instead.  Nice spotting.  How do we report such things?  Oh, I fixed the alcohol toxemia to link to Effects of alcohol on the body, which is redirected from Alcohol poisoning.  Robert Rapplean 20:26, 25 July 2006 (UTC)

text: Actually, it's worse than that.  It isn't even a mirror.  I made a change and accessed their site, and it immediately had the change in its version.  They're directly querying Wikipedia and re-presenting the information as their own.  That's really underhanded. Robert Rapplean 20:40, 25 July 2006 (UTC)
replies: text: I thought it seemed really strange; I'll ask someone to take a look. Thanks for fixing the link, I got distracted and forgot :) --Doc Tropics Message in a bottle 21:02, 25 July 2006 (UTC)

text: I sent a message to the dev team, and they blocked the offending IP address.  Brion sends his thanks for catching this. Robert Rapplean 21:24, 25 July 2006 (UTC)
replies: text: Quick work! And I did something useful! :) --Doc Tropics Message in a bottle 21:42, 25 July 2006 (UTC)
thread_title:  Mirror site? 

message: Our generalization in the second paragraph that "Those with alcoholism tend to start drinking alcohol at an earlier age than those without alcoholism" may have only limited applicability. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) says that early onset of drinking is later associated with certain  alcohol-related problems in "some Western countries" 
The NIAAA also notes that "It is not clear whether starting to drink at an early age actually causes alcoholism or whether it simply indicates an existing vulnerability to alcohol use disorders (26). For example, both early drinking and alcoholism have been linked to personality characteristics such as strong tendencies to act impulsively and to seek out new experiences and sensations (27). Some evidence indicates that genetic factors may contribute to the relationship between early drinking and subsequent alcoholism (28,29)." (National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol Alert, #59, April, 2003.)
Unless we research the applicability of the statement globally and also address the highly controversial issue of causality, I think we should delete the assertion.Medical Man 02:15, 29 July 2006 (UTC)
replies: text: Medical Man makes a good point, and I agree with him since the statement is very easily misinterpreted. Here's the issue as I see it - there has been some early research demonstrating that those who have alcoholism started drinking at an earlier age, in general, than those who don't. Some people interpret that as meaning that if you take a given individual and don't allow that individual to start drinking until age 21, you have reduced that individual's chances of being alcoholic. There is no evidence that this is the explanation to the research finding. There are nearly half a dozen other possible explanations of the research finding, but at the moment I concur that unless we want to go into a detailed discussion of this, we should simply exclude the material. Drgitlow 15:40, 30 July 2006 (UTC)
replies: text: I'll second-second this decision.  We'd have to get into a discussion about causal and casual relationships for people to understand this.  Also, the fact that there's no evidence to support the idea of alcohol at an early age resulting in alcoholism states pretty clearly that there's no evidence to suggest that including this statement would benefit the reader. Robert Rapplean 17:56, 30 July 2006 (UTC)
thread_title: Our assertion about early onset of drinking

message: It's been a while since I dropped by this article, and I must say, this has been some damn fine work. Discussion, concensus building, rewording... you guys have been brilliant in fixing this thing up. Ronabop 05:31, 31 July 2006 (UTC)
replies: text: I heartily agree. This is great. —Centrx→talk • 12:10, 14 August 2006 (UTC)
thread_title: Holy Snifters, Batman!

message: "This is generally accomplished in a majority of patients entering treatment through a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. The treatment community for alcoholism therefore supports an abstinence-based approach, unlike the harm-reduction approach that is supported for opioid dependence."
The above doesn't make sense... how does the "therefore" get put in there? (I added "usually therefore", to bridge HR treatment and abs treatment (most folks in HR hope it's a bridge for the worst cases) but it's still somewhat nonsensical).. "entering treatment through a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms"... That says nothing about abstinence, unless the reader is supposed to *infer* that therapy requires abstinence (nope), self-help groups require abstinence (nope), or development of coping mechanisms require abstinence (no, but it sure *helps*). 
Does Gabbard go into better detail on the theory that treatment = abstinence, or does he start from a theory that all non-abstinence treatment is not to be counted as treatment? I'm even wondering if he's working with since-discredited models that it is reasonable, healthy, or even *possible* to have a 100% ethanol free diet. (There's a sticky line here.. most fruit juice contains ethanol, but it is not intentional ethanol use, or abuse(?), to drink orange juice. OTOH, chugging mouthwash is not the same thing at all). Ronabop 05:52, 31 July 2006 (UTC)
replies: text: I rewrote the paragraph to address your quite appropriate criticism. I think this does the trick, but if not, we can wordsmith further here in the discussion area, then repost to the article afterward. I'm curious about your statement regarding fruit juice and ethanol content. I don't believe there is any ethanol in fruit juice - in fact, disulfiram (Antabuse) can be administered to patients when dissolved in fruit juice. Were there any ethanol in fruit juice, that would be a recipe for an immediate reaction. Drgitlow 18:06, 31 July 2006 (UTC)
replies: text: It's a matter of concentration levels.   and  are some starting points. The quick talk-page summary is that it's just about impossible to eat a healthy diet without consuming *some* alcohol on a regular basis, but if the ppm is low enough, it's diluted to trace amounts. Some background on raising the issue: I work in a field where "five nines" is a normal term for the field (that's 99.999%), and "nine nines" (99.999999999%, or .000000001%) is considered an optimal target. Contrast this with some interesting(?) brochures I once saw at an AA meeting, which recommended against eating homemade Ice Cream(!), because vanilla extract often contained alcohol, and people were worried that it might lead to relapse. *sigh*. I could write a really big essay here on how people in early stages of recovery tend to think in absolute terms (I will consume lots of alcohol, or I will not consume *any* alcohol), but to summarize the screed/rant/essay, Antabuse can be taken with alcohol, as long as the amount of alcohol is fairly minor, because there is no such thing as a 100% free alcohol diet, if a person consumes anything capable of fermentation. Like bread. Or fruit. Ronabop 04:24, 1 August 2006 (UTC)
thread_title: Gabbard

message: I changed the wording at the very start of the section from Substance Abuse Disorders to Substance Use Disorders, the currently preferred term. The reason the term was changed is that Substance Abuse Disorders refers to the entities such as Alcohol Abuse, Opioid Abuse, etc., but not necessarily to the dependencies/addictions such as Alcoholism. Substance Use Disorders includes all the conditions related to pathologic use of substances. This terminology change is taking place gradually, and you'll see many references out there to "substance abuse disorders." However, that term is no longer in favor due to the confusion it causes.Drgitlow 23:36, 1 August 2006 (UTC)
replies: text: Works for me.  My experience with the usage of "substance abuse" definitely makes me want to avoid the term abuse entirely, except to define it and explain why the article avoids it (which I think is valid). Robert Rapplean 05:00, 2 August 2006 (UTC)
replies: text: I agree with both; the term "abuse" should be avoided except to explain why it's not currently used. --Doc Tropics Message in a bottle 13:20, 2 August 2006 (UTC)

text: Wheeeeee, I went on an anti-abuse rampage.  I also removed the bit about early drinking at the beginning.  I hope you like the new wording. Robert Rapplean 22:51, 2 August 2006 (UTC)
thread_title:  Terminology in epidemiology section 

message: Ashmoo asked for citations on two statements.  The first one was for the idea that many studies have been done demonstrating naltrexone to be of questionable value in supporting abstinance.  Since the statement says "many" I assume he wants more than one.  How many would you like?  Here's a quick list:
*Renault, P. F. (1978) Treatment of heroin-dependent persons with antagonists: Current status. Bulletin on Narcotics 30: 21-29 ¶ Renault, P. F. (1980) Treatment of heroin dependent persons with antagonists: Current status. In:  Naltrexone: Research Monograph 28, Willett, R. E., and Barnett, G., (eds.), Washington, DC: National Institute of Drug Abuse, 11 22. 
*O'Malley, S.S., Jaffe, A.J., Rode, S., and Rounsaville, B.J. (1996) Experience of a “slip among alcoholics treated with Naltrexone or placebo. American Journal of Psychiatry, 153(2): 281-283. 
*Maxwell, S., and Shinderman, M. S. (1997) Naltrexone in the treatment of dually-diagnosed patients. Journal of Addictive Diseases 16: A27, 125, 1997 ¶ Maxwell, S., and Shinderman M. S. (2000) Use of Naltrexone in the treatment of alcohol use disorders in patients with concomitant severe mental illness. Journal of Addictive Diseases, 19:61-69.
*Oslin, D., Liberto, J., O’Brien, C.P., Krois, S., and Norbeck J. (1997) Naltrexone as an adjunct treatment for older patients with alcohol dependence.  American Journal of Geriatric Psychiatry 5: 324-332.
*Kranzler, H. R., Tennen, H., Penta, C., and Bohn, M. J. (1997). Targeted Naltrexone treatment of early problem drinkers. Addictive Behaviors 22: 431-436. ¶ Kranzler, H. R., Tennen, H., Blomqvist et al.. (2001) Targeted naltrexone treatment for early problem drinkers. Alcohol: Clinical and Experimental Research 25 (Suppl. 5) 144A.
*Balldin, J., Berglund, M., Borg, S., Månsson, M., Berndtsen, P., Franck, J., Gustafsson, L., Halldin, J., Hollstedt, C., Nilsson, L-H., and Stolt, G.  (1997) A randomized 6 month double-blind placebo-controlled study of Naltrexone and coping skills education programme.  Alcohol and Alcoholism 32: 325; ¶ Månsson, M., Balldin, J., Berglund, M., and Borg, S. (1999) Six-month follow-up of interaction effect between Naltrexone and coping skills therapy in outpatient alcoholism treatment. Alcohol and Alcoholism 34:  454; ¶ Månsson, M., Balldin, J., Berglund, M., and Borg, S. (1999) Interaction effect between Naltrexone and coping skills.  Treatment and follow-up data. Abstract to “Evidence Based Medicine of Naltrexone in Alcoholism”, satellite symposium to the 7th Congress of the European Society for Biomedical Research on Alcoholism. Barcelona, Spain, June 16-19, 1999. 
I could probably provide about a dozen more. How many do you feel is sufficient?
Also, he requested citation for "For those who don't understand the mechanism involved, these results have been assumed to reflect the effectiveness of the two treatments in combination.".  I'm not sure what he's asking for on this.  Maybe a physician's opinion survey performed by someone like Reuters?  This information was gathered in an unofficial manner, having discussed the issue with a couple dozen or so medical professionals regarding their and their professional associate's thoughts on the matter.  Do you feel that this needs rephrasing?  Does someone have better information on this?
I also noticed that he had a problem with "This logic is faulty because it assumes that the two treatments are merely complementary, like two people pushing a car, as opposed to sequential, like turning a doorknob and then pulling on it.", stating that it is "POV demagogic unsourced comment".  You're big on making sure that nobody uses words in an original manner, aren't you?  I'll accept that the statement may be "leading", the same way that a description of addition leads people to believe that things can be summed.  I don't believe, however, that it in any way takes advantage of people's prejudices, fears, or suspicions.  Please support this statement and/or provide a better way to describe this phenomena to the reader. Robert Rapplean 23:50, 19 September 2006 (UTC)
thread_title:  Request for clarificiation on recent edits 

message: Twintone, do you have any more information on the testing that you mentioned in the "testing" section?  "A1" sounds a bit vague.  I'd like to put something in that describes what evidence exists that this allele is linked with alcoholism and addiction, and more specifically what KINDS of addiction.  For instance, does this apply to tobacco addiction as well as narcotics and alcohol?  Please cite references if you can.  Thanks. Robert Rapplean 17:40, 20 September 2006 (UTC)
replies: text: Robert, I'll look up some more stuff when I can.  I heard Dr. Drew talk about this on his Discovery Health show and then it took me awhile to find it online.  What he said, however, was that tobacco addiction is different so it won't test for that.  This test will only help doctor's forsee risks for patients that might get hooked on alcohol or opiates.  The A1 does sound vague and not having a medical degree I'm not exactly sure what that means except it's the type of allele linked with that genetic coding.  The test is fairly new, and I don't know if it's even officially out on the market so hopefully there will be more information available about it soon!--Twintone 20:38, 20 September 2006 (UTC)
thread_title:  Looking for more information on Allele testing 

message: I find this sentence a bit strange: "the majority of the population can drink alcoholic beverages with no danger of suffering from it". How about replacing it with "for most people, moderate alcohol consumption poses little danger of addiction"? grendelsmother 21:28, 26 September 2006 (UTC)
thread_title:  Rephrasing 

message: This statement was placed under the Diagnosis section.  It makes a valid point, although the grammar and sentence structure needs some help.  I'm placing it here for consideration of where it belongs in the article and how to state it within the context of the section it gets put in. Robert Rapplean 21:14, 27 September 2006 (UTC)
thread_title:  Point that needs work 

message: i found these two images over in the wikimedia commons :
 
...and this article could use a little imagery. the top was given from a german contributor, and the bottom from an icelandic (here is a site for its explaination, hope someone speaks the language ). either way, i hate to see an article go without images but i also don't know the context of these two pictures too well as they are in a foriegn tounge. anyone game to try and incorporate one or both? JoeSmack Talk(p-review!) 20:43, 29 September 2006 (UTC)
replies: text: I agree strongly that the article needs images.  Where would you put these and to illustrate what?--Twintone 21:03, 29 September 2006 (UTC)
replies: text: There in lies the problem; a simple sentence about the era these images are from in the description of the thumb would do, but both sources are in languages other than english. Anyone know someone who speaks German or Icelandic? Actually, thats a dumb question, i'll look around the Babel categories, unless someone beats me to it. JoeSmack Talk(p-review!) 22:19, 29 September 2006 (UTC)
replies: text: I'm going out for the night, but in case anyone wants to beat me to it before tomorrow, here ya go ! :) JoeSmack Talk(p-review!) 00:49, 30 September 2006 (UTC)
replies: text: Look what I foooooound: . JoeSmack Talk(p-review!) 18:39, 30 September 2006 (UTC)

text: Tah-rue. Some info graphs on statistics would be excellent. I'll see what I can do too. JoeSmack Talk(p-review!) 23:16, 1 October 2006 (UTC)
thread_title:  images 

message: This is largely addressed to Dr. Gitlow because of his contributions of information regarding barbituates' value in the detox process. It's also addressed to PointlessForest, whose addition looks an aweful lot like an advertisement.  Because of criticism from the recent peer review we are currently attempting to decrease the total length of the article.  Creating lists of specific drugs and going into detail about their prevalance and comparative benefits is not condusive to this goal, and is kind of tangential to the general topic.  Unless you're looking for a primer on how to drug someone who is going through detox, it's not very useful.  I'd like to find a way of summarizing that entire section. Robert Rapplean 19:30, 12 November 2006 (UTC)
replies: text: I read through this section, and I'm somewhat on the fence. There is some good info there, but from a layman's point of view I'm not sure that all the specific references add much to the article itself. Perhaps a general summary, rather than detailing the individual drugs in such depth? As Robert points out, some of them sound rather like advertising blurbs. --Doc  Tropics Message in a bottle 19:40, 13 November 2006 (UTC)
replies: text: There's no question that it's all too easy for an encyclopedia article about a subject to expand, especially when the topic is covered by textbooks, each hundreds of pages long. When I've made entries, I've tried to incorporate answers to questions that patients most frequently ask. Patients often ask about detox...is it safe or dangerous to do on one's own...is it painful or painless...what process is followed...and so on. There are quite a number of protocols out there, but they can be boiled down to two drug classes (barbiturates and benzodiazepines) and two intervention methods (drug challenge followed by taper; CIWA, which is a screen for withdrawal symptoms that will be repeatedly processed with the patient). Treatment is comfortable when correctly carried out and takes a few days. It is not safe to do this alone, though it is safe in an outpatient setting with proper oversight. Obviously, this brief explanation might lead to other questions: what do I mean by drug challenge, for instance, or what are the differences encountered between barbs and benzos. This is where the line might be drawn regarding the scope of the article. Drgitlow 02:08, 25 November 2006 (UTC)
replies: text: Given the technical nature of the subject, a certain level of precision is required, and this further implies a certan level of necessary detail. Something that might help keep the article clean would be to write the entry as sparely as possible, while liberally linking to the important related concepts. For example, drug challenge might be an important concept, but explaining it within the article itself is sub-optimum. However, a very reasonable stub article for drug challenge could be created; it need be no more than 2 or 3 paragraphs to start.  If Dr. G, or anyone else, would enter a block of relevant text, I would be happy to wikify it and add appropriate links. We could do the same for Treatment diffs of barbs and benzos, or any other important facts/concepts. This would not only streeamline the article, it would improve coverage in the med/sci articles and provide room for future expansion. I'll do the grunt-work if someone will give me the raw material to start with. Just let me know. Doc  Tropics 23:38, 29 November 2006 (UTC)

text: It sounds reasonable to me, but as always, I would defer to the consensus of our local experts : ) Doc  Tropics 18:47, 12 December 2006 (UTC)
thread_title:  Blossoming list of detox drugs