What Science Says to Do If Your Loved One Has an Opioid Addiction
fivethirtyeight.com
fivethirtyeight.com
An interesting takeaway I had was the importance of community. Does anyone know any non-profits or startups working to increase people's sense of community at a mass scale? It seems this is missing from large parts of the western world and has many consequences.
You're describing most religions that I'm aware of. Say what you will about their beliefs, but most of them (definitely not all) work hard to have an inclusive and supportive community.
With the condition that you abide by the rules. It's the assurance that everyone adheres to more-or-less the same values that glues the community together.
Also, if I may venture slightly off-topic, the modern western definition of "inclusive" seems to imply "without requiring people to adhere to anything", which is the opposite of what you need to build a community.
No shared set of values ("do whatever you want" does not really count as a value) means less trust and more suspicion.
Simplest example: group A values sexual restraint and have a philosophical framework that justifies why this value is necessary for the preservation of society, group B values sexual freedom and is dismissive of the philosophical framework of group A.
Members of group A will be extremely weary of members of group B, and will be concerned about how they might start influencing their children, for example. So they will avoid them. Vice versa, members of group B will be suspicious of group A members, because when you see people being suspicious and avoidant towards you, you tend to become suspicious of them as well.
The rules are generally in place to protect the community from sociopaths and serve as the communities immune system.
People who have problems with the religious community usually are for their arbitrary rules rather than they'd much rather be sociopaths.
(I'd make the argument they aren't particularly good about keeping sociopaths out anyways but that's another topic)
This isn't failproof of course. Sociopathic cult leaders are very dedicated.
I read it to. The thesis is basically that - societal norms are designed to make it easy for normal people to notice psychopaths and avoid them. The book is pretty convincing, I'd give it a look. I didn't notice too many numbers or studies quoted in it, though.
Presented without evidence though, parent commenter's statement may be hard to believe.
Not only has that sometimes caused harm to harmless people "not in the tribe", but sometimes legitimate sociopaths have actually exploited "the rules and norms" to their end. (A particularly notorious example of the later that I can think of is Ted Bundy.)
Agreed with the idea that religion does foster a sense of community. If you can get that without the nasty tribalism side effects you sometimes see from it, it would work.
If their lack of sexual rules is part of a bigger 'no rules or values needed' system, then I would really doubt that they can develop a pepper sense of community.
There aren't instituting "reverse" sexual morality either - straight people will be found among their membership rosters and friend groups - but they do create spaces that are particularly welcoming to non-straight people, and have large concentrations of them.
Wait what? Because she brought up abortion? https://www.nobelprize.org/nobel_prizes/peace/laureates/1979...
She failed to realize that money might not buy happiness but it sure buys the kind of misery we all like.
I'm not saying the KKK is a good community group, but I will say there are a lot of people with less community than they offer.
Of course, this means reading their posts which is not for the faint of heart. It's like most of them are missing something and are trying to find something to belong to. In a way, I feel more sorrow than anger towards them.
http://www.imdb.com/title/tt4848130/
I don't think I've seen anything quite so darkly comic as their fire safety class before their cross burning ceremony, as their artificial-fiber robes are highly flammable.
This is non-profit territory, absolutely not startup territory. You can only build a classic VC-funded startup by promising that eventually you're going to extract value (usually monopoly profits!) from the community.
"Sense of community" is one of those things that's traditionally ranked well below profits and been destroyed in the search for profit.
Hell, I think you could convincingly argue that opening a new pub counts as founding a startup aimed at increasing people's sense of community. It doesn't have the unlimited scale of a tech startup, but it is a company that profits from offering a 'third place'. For that matter, plenty of churches have been run more like businesses than non-profits while still creating strong communities.
As long as the sense of community is profitable, it might do well with startups. That just hasn't been a common state of affairs lately.
Much of the loss of community in America is small businesses getting destroyed in the market by successful startups (i.e. large corporations).
Namely:
1. artificial social heirarchy
2. magical thinking
3. group think
4. rules without reason
When you take apart any given religion, and inspect individual parts, and place those parts within the context of a small, insular village, dispossessed of plumbing, medicine or indoor heating, any single part starts to make sense. But many are far, far away from that, and need not invest in superstition.
Morality is great, but in some cases morality without purpose translates to overbearing fear imposed with motive.
Mythology and folklore are good for illustrating practical principles and relationships between ideas, but some people refuse to consider whether the ant and the grasshopper never actually happened.
All this taken together, often tips the scales toward cognitive dissonance for some who think too deeply about bald facts. I don't have a solution to fix this, but I've seen what happens when smart people try to reimagine a modern religion that might fit current scenarios, and it's usually equally terrible.
Someone will eventually figure this modern community rationale problem out, but it's not something you can just fake or make up for its own sake. It's something that needs to (seem to) happen organically, on its own, and remain authentic. Sounds pretty difficult if you ask me.
Unitarian Universalist churches are good for community and avoid most of these negatives in my experience.
Campfire is not therapy or a replacement for therapy. But peer support can be powerful + inexpensive. And being part of a true peer group can provide a kind of value that professional mental health can't. You can't be friends with you therapist, and their job is not to truly empathize with you.
Would love any thoughts / feedback!
What's the main challenge for you as it relates to the product? i.e. are you limited on needing more customers / stronger product market fit, do you have insane product market fit and limited on hiring, etc?
Is this a for profit thing?
Our main goal is to help as many people as cost-effectively as we can. After thinking a lot about it, I think there's more evidence we can scale better as a for profit.
The most exciting approach is to level up our members to lead groups with their challenge. They truly empathize and care about the group, which can make them more effective than a whole bunch of training. Plus, it reinforces that this is not a case where you are being treated for a mental health problem. This is a tight-knit community helping each other.
This is one area that's crying out for some kind of reform.
If we can alter our culture and separate a person's purpose from their employment, then we might be able to get to a Star Trek future. If I can get anything I want from a replicator in the wall, what are my incentives to still better myself and work towards something?
I don't think so. I think people can find a purpose without us imposing one on them.
> If I can get anything I want from a replicator in the wall, what are my incentives to still better myself and work towards something?
Why do people get really good at chess when there is little extrinsic motivation in it? If some people just want to hang around, is that really a "problem" we need to address?
I didn't mean to say a purpose should be imposed. Today it kind of is. A purpose is often closely tied to a job and a job is pretty much required to survive.
I was trying to convey that we should look for more ways to help people find a purpose or whatever you want to call some activity that is meaningful and fulfilling to that individual and socially healthy.
> If some people just want to hang around, is that really a "problem" we need to address?
Maybe, maybe not. If they are hanging around because it's what they want to do and they are happy and healthy doing so, then I don't see a problem.
Purpose might not be the right word. I think people need meaningful lives.
But yeah, in the next decade it's burger flippers and delivery drivers.
It comes down to whether you want to stop people using drugs because you don't like that they get happy so easy, or whether you want people to stop using drugs of their own accord and have happy lives. If it's the second - help.
"To that point, pain treatment is not the most significant risk factor for addiction. Far greater risk comes from simply being young and from using alcohol and other recreational drugs heavily. Ninety percent of all drug addictions start in the teens — and 75 percent of prescription opioid misuse begins when (mainly young) people get pills from friends, family or dealers — not doctors. Opioids are rarely the first drug people misuse."
Filling voids and seeking happiness aren't mentioned in TFA.
Now you put it on me and my happiness? Not helpful either.
https://en.wikipedia.org/wiki/Rat_Park
Also, downvoted for needlessly confrontational pedantry.
I sincerely believe that anyone that thinks pointing out the obvious to an addict will help has not actually done it. And I consider "It's something in your environment" to be obvious, true, and totally not actionable.
Furthermore, the idea that addiction is necessarily filling a void is, to be blunt, bullshit.
peace out :)
Our improved understanding recognizes the need for human-to-human connection. We're realizing that substances are serving as substitutes for people who are lacking that genuine connection in their lives. Just removing the substance will create a void that will quickly get refilled, either by a relapse, another substance or something else that isn't productive.
And it's a mistake to think of this as solely a substance abuse problem. There are many other ways that people self-medicate. Television, the Internet and smartphones are all "relationships" that we lean on when we're not getting enough of the genuine kind that we crave. We like to blame this opioid epidemic on overprescription of these drugs, but we're making a huge mistake if we ignore everything about our society that has created so many human beings who are so detached from each other that they become addicted to these things.
"Chances are" he's identified a vague cause? I'm not saying he's wrong, but that it doesn't help an addict to point that out. And again, the article is all about effectively helping the addict.
I don't think we disagree except for in the intent of my original comment.
For instance this sentence "More than 13 percent of its participants died after treatment,1 mainly of overdoses that could potentially have been prevented with evidence-based care." The argument is that they "could" have been prevented but how do they really know that? How many people in general die of an overdose after X number of stays in a rehab? Through my own experiences going to rehab, I have known of many people who die. The fact is you can't predict which people will "get" it any better than you can predict if it will rain next month.
I also disagree with this notion that being on suboxone or methadone indefinitely is a legitimate solution. Like what? You're advocating to stay on a drug the rest of your life? That isn't recovery at all, it's a band-aid that will likely lead to relapse and promotes a perpetual notion of being sick.
I also disagree that their supposed evidence that CRAFT gets twice as many people into rehab has much relevance. How many of those people relapsed? How many of the people that didn't go to rehab ended up overdosing OR recovering? We don't get the whole picture so the "evidence" is mute.
They knock 12-step which is fine but it turns out that it works for millions of people.
There is no silver bullet here.
While I have mixed feeling about the "tough love" approach, I can tell you from personal experience that the only reason I'm not buried right now is because at a certain point the floor dropped out too low, my family and friends abandoned me, I lost everything for a moment, and the pain and horror reached a level that finally I had a change of psyche on my OWN and realized I wanted to get better.
In my own humble opinion the only "science" that matters on this subject are the opinions of those whom have lived it and recovered. Go survey the opiate addicts that didn't end up dead and find out what worked for them.
As I said in another comment, alcohol is an odd drug. It's mechanisms work very differently from opioids and needs very different behaviors and strategies to combat.
Okay, so now we've established that alcohol and opiates do different things in the brain.
So, at this point, I'm going to ask you: "Why should you assume similarity rather than assuming difference?"
Just because viruses and bacteria are both harmful does not mean we should use antibiotics for both.
But getting rest and good nutrition will help the body fight both. So they work differently but some treatment is the same. Not unlike what gp was pointing out.
Going cold turkey from alcohol can be fatal.
That's some pretty scary data. Half the death rate... that's a very significant number.
> You're advocating to stay on a drug the rest of your life?
Why not? It saves lives (hello insulin). And here's a telling bit from the article:
> When patients take a stable, regular and appropriate dose, maintenance medications don’t cause impairment, and the patient can work, love and drive. In essence, what maintenance does is replace addiction — which, remember, is defined as compulsive use despite consequences — with physiological dependence, which, as noted above, is not harmful in and of itself.
Here's the link with much more info about buprenorphine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293937/
Certainly it would be nice to have an effective solution that didn't require daily use... but we don't. What we have is a safe drug that cuts the death rate by half.
Not to mention, that seems like a pretty horrible and bleak outlook to make people believe they can't make a full recovery without being medicated for the rest of their life.
Again, I've known many people who have taken these drugs and a large number of them relapse bad. In fact, from what I hear the withdrawl from suboxone is 10x worse than from heroin.
[1] Xanax has a lot of problems with long term use though, so Xanax, specifically, would likely not be a good candidate.
My MIL replaced alcohol and cocaine addictions with a coffee addiction. It's been over a decade and she doesn't seem to have any significant negative outcomes with the coffee and coffee is cheap and readily available almost everywhere. From what I see, I believe the coffee is more of a psychological crutch for her - but it's not harming her.
"Detoxifications and drug free modalities, although appealing to an understandable desire for recovery without medications, produces only 5-10% success rate. Methadone maintenance is associated with success rates ranging from 60 - 90%. The longer the people are in this modality the greater their chances are of achieving stable long-term abstinence."
The answer is: never.
Only if they get into a program that guarantees they will be detoxified in 6 months(or so). This is rare unfortunately because it needs the addict's consent, which is rarely given. They usually choose the "open-ended" program because it's easier.
They only use methadone because it's a legal(but controlled) drug. It's not that much better than heroin.
But I am just stating facts.
> at some point methadone might get de-prioritised
But that is wishful thinking, not reality. Open-ended programs do not work. Period.
By far most people in such programs relapse multiple times. You can't expect from the addict to kick the drug off out of sheer will and good intentions.
> took intelligent pro-active steps to move their lives forward
You don't understand addiction and how it works. It has nothing to with intelligence or logic. When someone chooses an open-ended program is because the people around them force them to take some action and they choose the easiest one.
Again, no one is judging and no one said those people do not need love, quite the opposite. But open-ended programs destroy their lives.
"For opioid addiction itself, however, the best treatment is indefinite, possibly lifelong maintenance with either methadone or buprenorphine (Suboxone). That is the conclusion of every expert panel and systematic review that has considered the question — including the World Health Organization, the Institute of Medicine, the National Institute on Drug Abuse and the Office of National Drug Control Policy."
https://fivethirtyeight.com/features/what-science-says-to-do...
One has to wonder why would we not choose a treatment(3-12 months, depending on the person/situation) since it can demonstrably help people recover completely from opioids and instead choose life-long dependence on particular drugs.
Are these the same scientists that think prescribing Vicodin, as if it's aspirin, is a good thing?
Who cares? Nobody talks this way about a person who has to take heart medicine every day to survive, and not that many talk this way about me when I take Lexapro every day to not get depressed. What makes methadone so different?
You can survive without it for starters. Not the case with heart medicine I guess?
If you saw people, with the same condition as yours, having a good quality of life without medicine wouldn't you not wonder if that could apply to you too?
In the case of drug addiction, I've seen many people successfully kicking off the habit in months and living a perfectly healthy life, as if almost nothing happened.
Life-long methadone users? Not so much. I can tell that people really think it's different from heroin but it's not really. It's just regulated. Think about it ;)
Experience is valuable but for driving systematic changes, unreliable. Its too easy to color personal experience with bias of many kinds. That's the entire point of science, to eliminate those biases and document the underlying evidence to support a claim like: "Methadone does not work."
Challenge accepted :D
Scientific fact 1: methadone doesn't alleviate the addiction. It actually feeds it to the point that it increases the patient's tolerance at which point you have to increase the dosage.
Scientific fact 2: methadone doesn't provide the "high". Totally true. That's why the vast majority of patients seek it elsewhere(alcohol, cannabis, etc).
Scientific fact 3: Life-long methadone users have relapses more than once. Most clinics/doctors supporting methadone brush it off as "it's quite normal and logical".
Scientific fact 4: innumerable people have been able to kick off opioid addiction by following long-term(but not life-long) therapies.
General fact: You'd be hard pressed to find a drug, other than methadone, that has been so controversial in its usage.
More facts: these panels of "experts" don't provide evidence that long-term recovery doesn't work, but they opine that "hey, methadone is the best, true story.". Show me data, show me science ;)
Isn't it way too convenient for the drug industry? Has it ever happened before, I wonder?
Isn't it weird that heroin addiction in US has increased because of the gratuitous opioid prescriptions?
https://www.theguardian.com/society/2017/mar/29/us-heroin-us...
This is not what a solution should look like.
I'm not necessarily a supporter of suboxone / methadone / whatever , but this NIMBY rhetoric isn't helpful, either.
It's rare for the down-turn of an area to have one extraordinary cause.
I guess that the suggestion is that methadone clinics create crime where there otherwise wasn't -- but I don't see it that way in my community.
What I see these clinics provide is a centralization of potentially bad actors for authorities to keep tabs on while they seek guidance or pay court-ordered time to the system otherwise.
What's the alternative here? Cease these communal style clinics? If one believes in these treatment options whatsoever then it must be realized that cessation of these clinics would take that care option away from many people who may find legitimate use.
I don't have alternatives to the clinics , but I do have insight into what one should pay attention to when an area begins to struggle:
Income, education, and general upward mobility within society.
no it's not. he's talking about a single store. in my town it's the homeless shelter and halfway house that causes a 5 block radius around it to be a terrible place to live.
we're not talking about building more housing, or zoning for high density commercial/residential mixes, or building public transit, or eliminating cars from downtown cores, or building more bus routes, or bikeshares, or uber, or any number of things that people actually want. we're talking about methadone clinics and halfway houses next to where affluent people live.
if you pretend like it's hard to understand why people don't want those things in their residential/shopping neighborhoods, you're just going to alienate everyone you communicate with. you can't just invoke the magic 'nimby' and get people to change their minds. __they don't want these things next to where they live__.
Which is the precise definition of Not In My Back Yard...
here's another turn of phrase you might find handy: choose your battles.
the junkers have basically turned the nearest subway into hamsterdam.
Man On Stoop: Got to. This America, man
From my work with injecting drug users about a decade ago: None prefers methadone, they only take it because, when in a treatment program, they get it for free and unadulterated. When it comes to actually ceasing consumption, at least on the mindvox drug users list, the consensus seemed to be, that is is easier when first switching back to heroin.
Ask your friends whether it is the methadone as a substance that helped them or the decriminalization and steady supply they don't have to worry about. From experience, I bet on the latter.
I would like to make a small, and perhaps somewhat pedantic comment regarding your last statement:
>In my own humble opinion the only "science" that matters on this subject are the opinions of those whom have lived it and recovered. Go survey the opiate addicts that didn't end up dead and find out what worked for them.
There is a problem of silent evidence and survivor bias here. What is important is not what they did that led to their recovery, but what they did differently (or, more generally, what was different in their circumstances) from those that tried to recover, but didn't.
So, IMHO, what is needed is not _just_ the opinions of those that recovered, but a longitudinal study to identify which, out the many factors that were involved in the recovery process, have been the most instrumental.
On survivorship bias: the B 17:s in 2nd world war that generally are used as the practical example of this principle had bullet holes exactly in those parts of the plane that were fine. The parts that had not taken a beating in the survived planes were the ones that needed more armourplating.
So, where are the psychological bullet holes in those who've not beaten addiction?
That's assuming they did anything different at all. It could just be that there is not a one size fits all treatment for this problem, and part of the solution is to match the right treatment for each particular addict.
For opioid addiction itself, however, the best treatment is indefinite, possibly lifelong maintenance with either methadone or buprenorphine (Suboxone). That is the conclusion of every expert panel and systematic review that has considered the question — including the World Health Organization, the Institute of Medicine, the National Institute on Drug Abuse and the Office of National Drug Control Policy.
With four links in that last sentence.
12 Step programs for instance... well, they really don't have a great success rate. It seems like the success rate is around 5 to 10 percent for AA. (http://www.npr.org/2014/03/23/291405829/with-sobering-scienc...).
But for me, I think that the issue is less the program than it is the default option, often ordered by the courts. 12 step therapy probably does work with certain personalities. For others, it will do nothing, or maybe even make things worse.
This is probably the same for "tough love" type rehab programs. Some people would be okay with this. Others would react better with other options (your CBTs, BCTs, etc.)
I will say this from a "non-expert" perspective: suboxone honestly is what you want to do from a chemical perspective for opioids. Suboxone is a combination of a mild opiate (buprenorphine) and naloxone, a μ-opioid antagonist that's there mainly to prevent abuse.
For an addiction, chemically, moving to something milder seems like a great intermediate step, akin to some methods of getting off of nicotine (eg, slowly decreasing mg of patches etc). The nicotine patches don't work too well -- it seems like the effectiveness rate is only about 17% (http://www.mdedge.com/jfponline/article/60156/addiction-medi...). But this is a significant increase from placebo (another study -- https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010505/ -- says 50-70% more likely).
Agree that there is no silver bullet; probably the best route out is a combination of something to handle the chemical side with some form of therapy to handle the other end. The type of therapy would probably have to heavily depend on the person, given that the therapy must be something the person is willing to commit to in order to work.
I hate how tinfoil hat-y this sounds, and I'm certainly no expert, so feel free to offer alternatives
I don't think that count's as "highly" privatized. I personally think the incentives involved in the private prison system present major ethical issues, but I think we need to look at the incentives involved with the our legal system and governmental prisons, also.
Things like that may be what they are referring to.
I could only agree more if you removed probably.
"Psychedelics Help Reduce Opioid Addiction, According to New Study"
Contrast to the crack epidemic in the 80s: fuck'em, throw them all in prison.
Edit to add: I wish the best of luck to those who have been caught up in this crisis: I'm rooting for you, and I hope every last one of you find the treatment you need. For those of us who aren't affected, it's time for some deep introspection about what we allow our politicians and (yes) our neighbors to get away with.
i think the real issue is opiates seem to be heavily affecting affluent suburban and urban people, who are predominantly white, and make up a huge amount of the tax base.
If something is scary, you show the thing. You don't make up metaphors. Trainspotting and Requiem for a Dream most likely prevented more people from ever trying heroin than any government-sponsored PSA ever did.
https://m.youtube.com/watch?v=AKXN6Vdr3g0
Spoiler: same actress.
I don't know much about the subject but when I try to do a bunch of cursory searches, most of what I find are histories on alcoholism and the variety of treatment methods. As far as I know, before the crack cocaine epidemic, I don't think people really understood just how pernicious the problem of opiate addiction was. Doesn't excuse mass incarceration of black people, but I'm not sure people had any idea on how to actually approach the problem back then. I'm not sure we have a good approach even now.
It's also worth noting how small the problem with cocaine and other opiates was in the past. The crack cocaine epidemic was probably the first time the nation as a whole had to learn what this stuff actually was.
And alcohol is a very strange drug. It doesn't quite work like others. For example, if you block the high, most people quit wanting opioids. That doesn't seem to be true of alcohol. In addition, drying you out from alcohol seems to actually damage the impulse control centers in your brain, so avoiding relapse is much more important. etc.
> It's also worth noting how small the problem with cocaine and other opiates was in the past. The crack cocaine epidemic was probably the first time the nation as a whole had to learn what this stuff actually was.
I think the real issue is that modern production methods at that point started making far more potent drugs.
That doesn't mean I'm not allowed to feel regret for society's past (and indeed ongoing) failures.
Agreed. And there is no reconciliation for the damage that has been done (and continues to be done). Politicians don't take this seriously enough. It won't be enough just to reform drug policy. It won't be enough just to free people who were wronged by the system. It's going to take society changing heart and supporting people who have been hurt for years. And the people who were hurt trusting a society that threw them and their family away...
I don't really buy that though. Honestly, I think the problem is simply being on opioids for a week due to post surgery pain or similar is enough to hook people.
My write in ballot would include various forms of legalization and treatment. I've heard DMT can make people quit heroin over night. While a little radical, that's better than the alternatives.
You're going through this thread and blaming victims for their misfortune. It is, to say the least, unedifying.
Situation: Crack use climbs in black communities leading to major social problems.
Option A: Create tough laws to stop crack use. WRONG, YOU ARE RACIST (for singling out the black community).
Option B: Don't create tough laws. WRONG, YOU ARE RACIST (for not caring about the black community).
Your breakdown of this situation makes it sound like you think it doesn't matter what you do, because someone will call you a racist no matter what. In other words, that accusations of racism are totally arbitrary. That's not true.
That's overly reductive to the point of being wrong. There was never a particularly strong feeling that crack addicts should be thrown in prison any more than other types of addicts. People were strongly in favor of throwing crack dealers in prison because they were turning neighborhoods into war zones as they fought for lucrative turf.
And it wasn't just white people, either. The strongest advocates you'll find of drug criminalization are black people who lived through the crack epidemic in the '80s.
Obama got a whole law passed in 2010 to address it!
Edit: for the uninformed down voters: https://www.google.com/amp/amp.slate.com/articles/news_and_p...
Your bias is showing. Crack arrest spree is more accurate. I was politically active while it was happening, so no, this isn't a recent observation.
Can I just add how incredibly rude "slurped up some recent liberal political journalism" is? You should be ashamed of the way you talk to strangers on the Internet.
May be there is racism that is institutional, but the point is most people even those who are against harsher sentences today thought it was a remedy. We will be failing ourselves if we cannot examine that fact and simply hitch and re-assign every "fucked up" decision to racism.
I didn't. I thought it was racist back then. Many black leaders thought it was racist back then too
That's exactly the irony of institutional racism: it's so rarely _consciously_ racist. It is often "colorblind".
But, I still think that it would be wrong to assume that there was universal (or even majority) support among the black community. One confounder would be the media; studies have shown that public opinion about drug use and drug crime were/are directly related to media coverage [2]. With Reagan publicly saying drugs "are as much a threat to the United States as enemy planes and missiles", I think it's difficult to disentangle anyone's true personal feelings about the law from the sociopolitical influences that were present at the time.
The view of policing at the time was simply different. Some might have viewed the ADAA as a much more honest form of policing black communities, as opposed to the efforts undertaken in the 1960s and 1970s: stifling civil rights-related protests and other actions, along with actions by high-powered militarized SWAT teams being concentrated in poor black communities [3].
Even in retrospect, the issues are complex and unclear. Is it really difficult to believe that most people at the time, policymakers or not, were simply incapable of fathoming the results of the ADAA? It's clear that the imbalance in policing, partially as a result of the ADAA, has decimated the black community. Most of the damage, I would argue, is due to an ugly amalgamation of the rise of the prison industrial complex and the transparent willingness of policymakers to look past the needs of poor and minority communities in writing criminal law over the last 30 years.
[1] https://en.wikipedia.org/wiki/Anti-Drug_Abuse_Act_of_1986 [2] https://academic.oup.com/socpro/article/41/3/425/1671880/Set... [3] https://www.washingtonpost.com/news/wonk/wp/2016/05/02/ameri...
It's true that there was mainstream black support for anti-crime legislation, but that support wasn't distinctive. Blacks weren't leading the charge; they were just another part of it.
John Pfaff has been on a lot of podcasts, he is the most insightful person on criminal justice that I have found. Surprisingly Vox has a good summary of his book.
https://www.vox.com/policy-and-politics/2017/5/30/15591700/m...
> Pfaff tries his hand at some of the messaging that will be needed here: He argues that incarceration is simply an ineffective way to combat crime, while it imposes all sorts of costs on individuals and society that likely outweigh its benefits.
And yes, Obama got a law passed based on a lie. That happens all the time.
EDIT: Most people really don't care what you put into your body until you make them care, and that's what happened. You'd open up the paper and see another eight-year-old on the way to school got shot in the head because crack dealers were spraying bullets at each other again. That happens often enough and the public decides Something Must Be Done.
Personally, I thought a better solution would be to teach the crack dealers how to shoot, but nobody liked my idea.
I'll take this opportunity to point out that, right or wrong (obviously: I think you're wrong), you've contradicted your comment rooting this subthread. You began by saying there was never strong feeling that black crack users should be imprisoned, and find yourself here arguing that imprisoned black crack users somehow deserved it.
I don't have access to the actual study, but the abstract very much reads like a study that came to the conclusion the authors wanted.
>You began by saying there was never strong feeling that black crack users should be imprisoned, and find yourself here arguing that imprisoned black crack users somehow deserved it.
Eh... no, I never said that second part. You might want to read through the thread again.
That wasn't happening with powdered cocaine.
I found his appearance on Joe Rogan's podcast (most recently #698) compelling
Oh, wait. I can.
Because it's well-known that stereotyping works on everyone. And yes, black people can be racist against whites, or also against other blacks.
But that doesn't justify anything. In the particular case of the US, it also ignores that white (men) overwhelmingly control the levers of power, answering your question with a resounding "nothing bad".
Would you agree that white men have lost at least some of their control over the levers of power as you call them since the founding of this country when they had total control? Would you agree that it's perfectly possible for white men to lose even more of that power, perhaps even to the point where they are no longer the dominant political force, especially given the changes in demographics in the United States, and especially if white men display a low level of preference for members of their own race? Do you agree that is an outcome which many people consider to be extremely desirable and which many people are working toward achieving?
Assuming that other racial groups also show some preference for members of their own group, what do you expect would be the consequence to white people of this choice to show a low level of preference for other members of their own racial group?
We've heard that before. There is a twist there though. A lot of that "tougher on drugs" legislation was pushed by the poor black community leaders because they saw what crack was doing to their children, young adults, whole families. Normally we'd all want to say it's the white man abusing their privilege in a sadistic manner but sometimes there are some subtleties involved.
http://www.slate.com/articles/news_and_politics/crime/2016/0...
Another interesting thing there is that CIA was probably involved:
https://en.wikipedia.org/wiki/CIA_involvement_in_Contra_coca...
Now on paper they "weren't" but given the article from Gary Webb and reading between the lines about what their own Inspector General said "...agency officers were not required to report allegations of drug trafficking involving non-employees, defined as paid and non-paid "assets"—pilots who ferried supplies to the contras, as well as contra officials and others.[49][50]..."
Saying "X is X" does not mean you are "making it X". If you think he's making it a racial issue, you might want to consider that it just might be actually a racial issue.
What? I made one comment. Not only was parent's comment only loosely relevant to the article itself, but they provided no evidence to support their position, all with an undertone of maliciousness. I'm willing to accept it's a racial issue if you present evidence that reasonably eliminates confounding factors like the ones I brought up. As for the opioid epidemic: I care about as much as I care about the crack epidemic, which is about as much as I can care without having anyone close to me be affected.
> Saying "X is X" does not mean you are "making it X". If you think he's making it a racial issue, you might want to consider that it just might be actually a racial issue.
They are "making it a racial issue" because the article is about how to best help someone with an opioid addiction, not why people write so many articles about opioid addiction, or why so many people care about opioid addiction, or why the method of dealing with the opioid epidemic seems different than that of the crack epidemic. Parent's comment is, again, only marginally relevant to the content of the article.
I'll let you fill in the blanks: If the 80s epidemic and the current opioid crisis are experiments and the sentencing scheme remains identical, what is the independent variable?
a lot more people die from opiods than crack. most crack users are white.
Race was and is a key factor in American politics, and in politics everywhere. (I don't know anything about politics in, say, Cambodia, but I can tell you race is a key factor.) The civil rights movement, 20 years before crack was a political issue, faced such powerful opposition that it reversed the polarity of US political parties (causing the former Confederate states to flip to R from D).
In this light, sibling responses to the tune of "why do you have to make it about race" or "seems like it was more about X" read as worse than ignorant. You'd have to be willful to be this ignorant about politics.
My 2c: Parent comment is so obvious it is inane. But apparently I'm in the wrong here.
While the description talks about taking a pill to solve your addiction problems (some very interesting insights into the latest research at that time 2015 and also many absurd regulatory hurdles), it's the interviews with researchers and addicts that are truly eye opening - and address many of the issues you mention. After listening to it I personally will never reduce someone who has an addiction to failure of character.
Addiction is multi-faceted.
Thx for the radiolab link.
As someone who has had a loved one go through addiction, and ultimately die from that addiction, I find the binary nature of a lot of this self-described "evidence based guide" dangerously black and white. Proclaiming that abstinence based programs "have not been found to be effective" is total nonsense. What the study found in GB was that psychological only based treatment is less effective at preventing death than replacement therapy, on average. For many, replacement therapy may very well be the best option. For other, abstinence programs may give them an opportunity to fully reclaim their life. How about we empower medical professionals with the ability to treat the disease with a number of weapons, rather than creating this false dichotomy, which is not represented in the data. This guide would potentially discourage someone, or a family member, from choosing a very viable option for treatment, by overstating results.
While I'm not a medical professional, the best example I can think of is with how we treat depression. For some people, active psychotherapy is the best treatment option. For others, a regime of anti-depressants is sufficient treatment. For others, a combination of both is the optimum treatment option. What we don't do, as scientists, is say, "Option 2 has a 30% better outcome, thus we only will treat depression with option 2." That's just absolute junk. What it means is that we will look at what cohorts tend to respond best to option 1, 2, and 3, and understand why, so we can choose a treatment option that makes sense for that individual, without having to try 1, 2, and 3. It doesn't mean that we just toss out the other options wholesale.
The 538 politics podcast does a, "Good use of polling" and "bad use of polling" intro during many of their podcasts. This article would clearly fall under the category of "bad use of polling". I hope to see better out of 538 in the future on these topics.
Actual drug users are likely to recommend using kratom to alleviate withdrawal symptoms and ibogaine (or another powerful hallucinogen) to permanently remove the addiction.
"Science" does not recommend this, because politics has made the hallucinogens--and research into their therapeutic uses--at least as illegal as the opioids that cause all the problems. As someone with an opioid addiction is likely already routinely breaking some rather serious laws, and frequently courting sudden death by overdoses or adulterants, it may be worth trying the single dose of ibogaine before choosing the lifelong maintenance therapy.
Withdrawal is hard. Yes. But at least the person is in the right mindset to go through it once they are off the compulsory addiction, even if it takes a year to get to that point.
As kchoudhu points out and many have pointed out to me before this article, certainly once a bunch of white kids have this problem, suddenly they are "victims" not "criminals". Yet we have destroyed so many lives between the 80s and now, especially with the mandatory minimums and such.
I do agree with you, however. People become addicts due to how our society has criminalized and deregulated drug manufacture and sale and made it extremely hard to teach people how to do properly.
At some point Britain thought that wealthy highly-educated people were incapable of being criminals, until time proved them wrong. Science is always evolving.
The war on drugs weighs particularly heavily on black defendants. The police target their neighborhoods, herding people into a court system where judges are demonstrably harder on black offenders. The report found that nearly half of the counties in Florida sentenced African-Americans convicted of felony drug possession to more than double the jail time of whites — even when their backgrounds were the same.
This may just be a Florida problem, but I doubt it.
https://www.nytimes.com/2016/12/17/opinion/sunday/unequal-se...
300 is a small statistic.
10% of 300 is even smaller.
Science is hard.
From someone I know with personal experience, after they were charged with possession with intent to distribute due to growing pot, they had 3 choices. Go to jail, spend $X on an attorney who would get them probation, or spend 10 * $X on an attorney who would get them off. Both attorneys had perfect records, n>100, at their respective objective.
So, then, why would black people spend less money on legal defense?
Anyway, there doesn't appear to be consensus on whether coffee/tea drinking in moderate amounts is good or bad, but I've seen more suggestions that it's beneficial than otherwise. Any input to that?
Just to emphasize that:
Before my SO started working in a hospital, I had no idea that people going through alcohol withdrawal can end up in the ICU. They're ending up in an ICU because of the withdrawal, not the alcohol... That was really surprising to me.
Also interesting that, in the very wealthy area we're in, outside of infants and the elderly, middle-aged white men going through alcohol withdrawal are the most common ICU patients.
(sorry for derailing discussion away from opioid addiction)
> but in the end the person still
> needs to go through withdrawal
2. For myself, going on generic bupenorpine, and tapering off was not that bad. I took a year to taper off. I probally could have tapeed off the opioids if I was given a chance. The problem is most Doctors just cut you off. Completely ridiculous, especially if the patient is a serious individual. (I got lucky to find a doctor to prescribe bupenorpine without driving me crazy with endless office visits. I also just happened to be given the drug for another disorder.)
3. The generic bupenopine is still pricey. I don't quite get it, other than most Dr's don't trust their patients to not abuse opioids, so there isn't a huge demand for generic Subutex? There are still some sensible people who just want to stop the original addiction. On the other hand, I wouldn't be schocked if the price of generic Subutex is the result of some shenanigans.
4. Most people will be given Suboxone, that has Naloxone in it. It makes doctors feel safe, and that's what was taught in the course they had to take in order to prescribe/treat. Crazy again. (I felt Nalaxone just raised the price of the drug, but some of you will need an opoid antagonist in your treatment, especially if street drugs are easily available, or you don't have not much self control.)
4. My point is if you Taper off, all the drama is spared. My story will never be on Lifetime.
5. It's still a pain in the ass with the Dr. visits, and getting scripts though.
6. I can offer this, if you want to stop, Taper off. Yes--I know it's just not that easy. The system we currently have makes getting off difficult. Again crazy?
7. Stay away from all the support group sites. They just scared the hell out of me, especially the ones on the internet.
8. If you are addicted to anything, most of you can successfully taper off yourself. Very few of you need the drama, and expense of a rehab. Again--the system is so rediculious, we are forced into going to the rehabs, just to get the opportunity to taper off. Again crazy.
9. We have a crisis. It's not giving addicted people the easy/cheap way to Taper off the most controlled substances. It's no wonder people turn to the streets to feed their cravings.
It is legal in most of the US (I believe there are 1 or 2 states which have banned it, it has a long history by now in US law. A year or so ago the DEA announced to Congress the intention to schedule it (ban it) under their 'emergency' powers (which is bullshit since there are no deaths from it, and it remains mostly unknown, those 'emergency' powers are simply abused). After that announcement, they were required to consult research and doctors, along with opening a public comment period. Afterward they withdrew their intent to schedule it. So, for now, it remains legal.
Its effect upon a person with no opioid dependence is at low doses similar to caffeine without the 'jittery' part and without the crash afterward. In larger doses it has mild analgesic and sedative properties. I've taken Vicodin after I had my wisdom teeth removed, and have also tried kratom, and not even in large amounts have I ever experienced it giving any sort of similar 'high'. It is mildly habit-forming of itself, but very mildly compared to opiates. Withdrawal after extensive use might consist of having the sniffles and feeling a bit restless for a day or two. With tapering dosages down rather than sudden cessation, nothing is likely to be noticed.
Reportedly, kratom ameliorates most, if not all, withdrawal symptoms from things like Oxycontin, heroin, etc. Expecting people to go through withdrawal is inhumane and stupid. We can deal with it without the suffering. Kratom can be gotten online from multitudes of vendors. Please steer clear of the "legal high" and 'weed shop' variety of places. In addition to being radically overpriced, their association does active harm to the community of people who use kratom reasonably. Stay away from extracts and concentrated forms (although those seem to have mostly gone away from most outlets, they were big for awhile and were bordering on dangerous) and just get simple crushed leaves. If you or a loved one wants to quit, kratom will let you do so without ruining your life.
If your loved one does not want to quit, because doing so would expose them to the full pain (emotional, physical, OR psychological) of a life they hate and which they feel traps them... your problem and theirs is not the drug.
I often do not mention kratom in public forums intentionally. It's odd. I do not hold my tongue about hardly anything, I am very talkative. But I am always afraid that one message about kratom will get read by a busybody with an axe to grind and they'll spearhead a movement to have it banned. I am glad to have seen the multiple places around the country where states tried to ban it but were met with both doctors and police stepping up and telling them "this is not a problem. Stop trying to make it one for your own aggrandizement."
But when I come across someone who deals with addicts, I always try to explain it as best I can.
It should go without stating that I very much support keeping it legal and available, especially to people who are addicted to opiates.
The only way to continue to get the effect you experience, is by following your protocol and taking months in between uses to reset.
It’s not a wonder-drug, and it needs to be respected and taken in moderation because it is habit-forming. But I believe that it’s one of the best underused tools we have for helping victims of addiction.
non-evidence based medicine that uses the made-up-on-the-spot holistic approach is upheld by the idea that there is no scientific method available because it is about the body as a whole.
I think that rebuttal is reductionist and that there could be a method that is applicable to that form of treatment.
does anybody have thoughts on that?
PS I'm not an advocate of treatment because they also employ shortcuts to "recovery".
AA and NA are not only wholly unscientific, being invented of whole cloth by a layperson in the early 20th century (for context, lobotomy was a totally accepted psychological treatment for decades after 1935). There was no science whatsoever involved in AA, and indeed Alcoholics Anonymous actively resists any data collection about the efficacy of its techniques whatsoever.
It's main advantages from a US perspective are a) it's free. The costs are borne mostly in the form of churches providing basements and meeting rooms. and b) it's super churchy. We love churchy stuff around here.
So basically we kicked addiction under the rug for the entire 20th century in favor of religious hokum that refuses any objective evaluation of its efficacy, or changing its methods.
I should say, for the record, that there's a lot of people that have been helped by AA and NA, and there's indisputably good work being done there. But it's not perfect and categorically refuses to get better, and its longevity is IMHO more a result of our collective refusal to take the problem of addiction seriously in the US than anything else.
There are a ton of articles out there, most seem like clickbait, but there are studies that have been done such as this one [1] which say that LSD has had a positive impact on alcohol abuse. I'm not saying this is the cure, but I do think further studies could prove beneficial.
Edit: Added pdf of paper [2].
[1] http://journals.sagepub.com/doi/abs/10.1177/0269881112439253
[2] https://www.ntnu.edu/documents/139226/8932977/JOP439253.pdf
Point of fact, addiction is a disease and must be treated like a disease. This is pretty mainstream and not really all that controversial. The issue we're working through, glacially, is that in the US healthcare is for-profit and junkies are not profitable. So we just.... throw those people in the garbage. I think that's both immoral and economically wasteful. I know former junkies. Personally. And they're not garbage-- they have value and if you can get them well, they want to live a productive life.
The plain fact of the matter is that there's no business case for treating these folks-- the government is going to do it or nobody is going to do it. And the status quo is "Fuck it, send them to church. I'm not paying for a bunch of crackheads to get clean. They need to find jesus." Which is another way of saying "Let them eat thoughts and prayers."
What an overly dramatic way to restate that these orgs are anonymous.
collective refusal to take the problem of addiction seriously
Incorrect. The church, particularly Jesus, does take it seriously. Addictive and destructive behavior patterns are called sin, but because this "progressive" society continues to water down right vs. wrong and tread down a path of moral relativism (that's just like your opinion, man!), it has reaped exactly what it has sown - a lukewarm and ineffectual stance towards active repentance from sin, including the desire to help others in that process.
What have you personally been doing to take things more seriously?
Evaluating the performance of our current approach is very much "taking it seriously". This is what the OP is suggesting.
There is good and there is evil. The attempt to deny it, as you correctly say, causes huge problems. Like how we tell school children that they are no more than evolved animals, then wonder about why they go shooting people then take their own life.
There’s also the fact that it’s objectively destructive, simultaneously to society, personal relationships, and the addict. No need to even invoke philosophical good and evil there.
And I say this as a religious person myself.
The reason AA works is it refuses to change. It refuses to follow fads. It makes it imperfect but also makes it very resistant to politics.
> actively resists any data collection about the efficacy of its techniques whatsoever.
Because it's Anonymous. This is part of what it is. Sucks, but that's what it is. It's an important part.
> it's super churchy.
True, it's full of atheists though, I'd be interested to see if it has more atheists than the general population. But true it does use a cult model for positive change.
> There was no science whatsoever involved in AA
But there is solid science that backs AA. Even if it was started without a scientific underlying idea.
People love to bag out AA, but as your last line says it is working for some people, studies back this.
In a future utopia where healthcare is free and drug abuse is treated appropriately there might be better but we can't toss out one of the best treatments while we wait.
The article is about family (Nar-Anon) and opioids (NA) so my comment is all a bit OT.
But let's take CRAFT from the article, without the culty bit of Al-Anon/Nar-Anon, which CRAFT removes, can it be self sustainable across the world? If not, then is it really a better cure.
Dude, there is no reason you can't collect medical data responsibly and with respect to privacy. Cmon man. We do a whole lot of this, all over the place. They can, they just won't.
> But there is solid science that backs AA. Even if it was started without a scientific underlying idea. > People love to bag out AA, but as your last line says it is working for some people, studies back this.
It would be untrue and unfair to say that there's nothing to AA. It's been successful, but how successful? Compared to what? IMHO, the greatest aspect of its success is its ability to let people off the hook. This is just a way for politicians to throw some 'thoughts and prayers' at a hard problem and call it good.
It's not good. It's not all bad, but you start digging into the social science research and there's a lot of progress that's been made since the 30's that AA just won't touch. AA isn't working for a whole lot of people.
But it's cheap and it doesn't trigger certain populations within our democratic society, so it's gone on and on. I think we're running out of road here, but... well, we'll have to see.
OK, if someone wants to be an opioid addict, why not just let them? The "driving heedlessly into the abyss" aspect seems mainly due to opioids being illegal and expensive. I mean, do we use such language about diabetics? Do we expect them to manage their diabetes through diet alone?
I'm not aware of solid evidence for health risks associated with chronic opioid use alone. Excluding opioid addiction, I mean. But please do share.
https://www.asam.org/docs/default-source/advocacy/opioid-add...