We're learning more about the craving that fuels self-defeating habits | Hacker News Reader

We're learning more about the craving that fuels self-defeating habits

nationalgeographic.com

263 pointspmcpinto47 comments

The article mentions naltrexone. Dr Eskapa's research of using naltrexone led to The Sinclair Method. His book is called The Cure For Alcoholism. He has made it available for free download here, https://www.dropbox.com/s/60fs7gmvbyzs1kk/Cure%20for%20Alcoh... (please do support him and buy the book if it is of use to you and you have the means)

The Sinclair Method shows that for many people alcoholism is simple chemistry and the addiction can be "unlearned" by taking naltrexone (a cheap patent free drug) an hour before drinking.

If you're interested in finding out more we have a subreddit at https://www.reddit.com/r/alcoholism_medication/.

Honestly, doing something "an hour before" doing something compulsive might be a placebo that trains people to delay doing something destructive. Once that happens, it is much easier to stop doing it completely. I imagine if there was a diet that said "drink a cup of water before eating that cupcake" it might be equally as effective for compulsive eaters.

> I imagine if there was a diet that said "drink a cup of water before eating that cupcake" it might be equally as effective for compulsive eaters.

Having participated in a number of eating disorder groups and also having studied it, I feel sure that is not the case.

Edit: (Assuming that the prior commenters method _is_ effective)

Indeed. And interestingly I believe naltrexone is sometimes used in the same way for eating disorders.

Many alcoholics are already quite adept at delayed gratification, whether it be waiting until they get home for the night before pounding 5-10 drinks, or even waiting for loved ones to go to sleep so they can "hide" their habit.

And heck, "dry drunks" can go the rest of their lives pretending alcoholism isn't having a negative effect on their lives and the lives of those around them.

What the hell is a dry drunk?

A person who quit drinking, but still acts in destructive / dysfunctional ways.

This is the sense in which I used it.

It's an AA term. The narrative is that you are still an "addict" even if you are sober if you haven't dealt with the underlying emotional and psychological issues e.g. worked the steps.

Addiction isn't a soft lack of will but an iron surplus of it despite perennial invectives; it's antifragile. Any cessation/treatment regimen/regime imposed on someone else merely reinforces their drive.

> Addiction isn't a soft lack of will but an iron surplus of it

Relevant: http://existentialcomics.com/comic/13

My my my there is a lot going on there! fun read.

Naltrexone is an opioid receptor antagonist, so it has a very plausible mechanism of action. It disrupts alcohol's effects on the brain when you drink after taking naltrexone. This disruption can cause the alcoholic to quit (or significantly reduce consumption) naturally over time.

Addiction is an "every minute" kind of thing. Sometimes you can put something off for an hour, or know that e.g. dinnertime is the time we open the wine, so you can wait. But then after an hour, it's still there, and another hour, and another, and then you break down and give in when it is late or you are alone. Which then negates/resets any value gotten from the initial delay. So I don't think this is a placebo at all.

Speculating about the drug's performance vs placebo is an argument from imagined evidence -- in this case contrafactual. As with most drugs, placebo is the benchmark naltrexone had to beat to demonstrate efficacy.

Indeed. Some clinical studies are listed here - http://www.c3foundationeurope.org/clinical-trial-evidence/

Also note when researching - many people prescribe naltrexone to be taken every day along with abstinence, and infact when taken this way it's shown to be no better than a placebo. When taken as per The Sinclair Method it has been shown to be over 85% effective.

Interestingly, many prescribe naltrexone along with abstinence, and say the drug should be taken every day. In clinical trials when taken this way it is shown to be no better than a placebo, but in trials when taken as per The Sinclair Method (ie, pill only taken an hour before drinking) it is shown to be far more effective. Here's some links to some studied - http://www.c3foundationeurope.org/clinical-trial-evidence/

People undergoing The Sinclair Method often find there are two parts to their addiction - the chemical part, and the habitual part. Sometimes once the chemical part is extinguished they also have the habitual part to stop.

>In clinical trials when taken this way it is shown to be no better than a placebo //

What levels of effectiveness is that. Placebo's are reported as being pretty strong medicine: no better than placebo is pretty good if your placebo is effective in 40% of cases for example.

The habit/chemistry dichotomy is also part of giving up cigarettes.

There are questionnaires you can take to reveal how much your addiction is chemical led e.g. do you smoke first thing in the morning (when the chemical levels are low) or do you smoke as part of some routine.

From a lot of proximity to this behavior in all of it's forms, there is no one solution and alternative habit forming that creates a mindful pause is one of them.

Unless this drug has a 100% success rate I take the placebo observation as a valid one. But it should not 100% discount the drug efficacy out of hand either.

Would naltrexone also help against browsing habits?

I have no idea. I believe it is used where dopamine is the reward. I know that it is also used for eating disorders and heroin addiction.

In my experience, yes. I previously took it for alcoholism. I found it very broad acting. I stopped drinking compulsively. I also became indifferent overeating, smoking cigarettes, sex, and pretty much everything else compulsive. I've heard of people using it off label to lose weight.

For me it is a very strong & powerful drug, but I also know of others where it did not seem to work. I've heard if you have a family history of alcoholism it is more likely to work.

Were you able to predict when you were going to compulsively have sex, overeat, etc. an hour ahead of time?

I think what he is saying is that when he was taking it for drinking he also noticed it effected his sex drive.

Jeez reddit constantly harasses you to use their mobile app, need to remind myself not to go back.

Try i.reddit.com

tl;dr the thesis is that addiction is a learning process of reinforcing behavior->reward understanding. Targeted magnetic pulses look to be capable of altering the chemistry of the neural pathways where this understanding lives.

The article also notes how increasingly more behaviors are treated as addictions. Korea provides government subsidized gaming addiction treatment, which I think is interesting to consider if we are physically altering destructive behavioral patterns to reprogram people Where will the limits be? Might a workaholic be treated? What about junk food, smart phones? An adolescent with a history of getting kicks out of tormenting others? Fanatical racists or nationalists?

On another note, there are other theories about addiction to supplement this one: https://m.youtube.com/watch?v=ao8L-0nSYzg

Fanatical racists or nationalists?

...Or the insufficiently fanatical...

This line of ethical questioning is behind the plot of Anthony Burgess's 1962 novel "A Clockwork Orange". The main character Alex is subject of an experimental aversion therapy for rehabilitating criminals but the method is flawed and leads to unfair consequences for him.

I'm generally in favor of rehabilitation, but in the case of Alex, I thought that the punishment was fitting.

Well that's the major question, as far as I'm concerned. Does the punishment fit the crime? Are there punishments for which there are no fitting crimes?

Perhaps the line is quite blurry between addiction on one hand, and the general modifications that take place in the brain as part of the processes we call learning or even evolution on the other hand. Perhaps addiction is just those mechanisms gone awry.

Addiction is just one view into impulse control; I don't see any reason to think the average human doesn't commonly have impulse control issues.

Reminds me of the concept of the habit loop in The Power of Habit[0] by Charles Duhigg.

[0]: http://charlesduhigg.com/the-power-of-habit/

From the book, on the habit loop and why we're using toothpaste every day

http://www.slate.com/articles/arts/culturebox/2012/02/an_exc...

The FT (not pay-walled unlike most FT content) recently had an interesting podcast on this topic with a focus on sugar addiction:

https://www.ft.com/content/7af80630-c1a6-4833-9f39-dae093b34...

Google search + incognito usually allows a few peeks.

Thanks for the recommendation. I listened to this episode today and found it absolutely brilliant.

Thanks. This was brilliant! At first I was annoyed by the interviewer, but she made some great analogs with her comments!

I think this is great research, and untangling the loops is something that has a disproportionate positive impact on so much of society.

From an anthropology perspective I'm always curious if there is a selective bias toward a given configuration. And in this case I wonder about what sort of selective bias would select for addictive reinforcement of a behavior over a lack of that reinforcement.

Likely interesting to readers of this thread: https://motherboard.vice.com/en_us/article/bmvdnm/how-psyche...

Reminds me of Baumeister's research on willpower and energy depletion: https://www.youtube.com/watch?v=KfnUicHDNM8

Validity of Baumeister's research has been disputed recently: http://www.slate.com/articles/health_and_science/cover_story...

Related Radiolab episode: The Fix http://www.radiolab.org/story/addiction/

The habits defeat themselves?

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