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Comment by WhompingWindows | Hacker News Reader

"Drug overdoses were the leading cause of increased mortality in midlife in each population, but mortality also increased for alcohol related conditions, suicides, and organ diseases involving multiple body systems."

Perhaps we can start treating addiction like a disease and not a moral failing?

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I don't think addiction is a disease or a moral failing, it's more a product of the environment of the addict.

Case in point: up to 20% of soldiers in Vietnam were addicted to heroin during the war, and up to 40% had tried it, but when they came home only about 5% remained addicted. See: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1521-0391....

There are many factors in a person's life that lead to addiction, and while I'm not an expert, I think there needs to be a formalized system of getting people out of the environments in which they became addicted as part of the treatment.

> formalized system of getting people out of the environments in which they became addicted as part of the treatment.

Isn't that what going to rehab is about? For those who can afford it atleast...

I guess I mean, changing environments after rehab.

The problem many recovering addicts face, is that even if they get to go to rehab, they return to the same stressful home life/enabling friends/underemployment that pushed them into addiction in the first place.

I guess what I'm saying is that rehab without job training/support and relocation assistance of some kind is doomed to high recidivism. (If the word recidivism applies to rehab, not sure if that's proper usage here)

> I don't think addiction is a disease or a moral failing, it's more a product of the environment of the addict.

Diseases are very often products of the environment.

That's very true. I guess I'm referring to "disease" in a too-narrow pathological sense.

We're all complex open systems so of course disease and environment are intertwined, I just find that when lay-people like me refer to addiction as disease, they typically mean a narrow definition of "let's find a problem with your brain that we can fix," and not much else.

Maybe I was addressing an imaginary counter-argument!

This is the kind of snide remark that drives me crazy.

Treating addiction as a disease will not fix anything except put more money in the drug companies pockets (which is why they push this narrative). Treating diseases is amazingly more ineffective than preventing the disease.

Preventing addiction is not something we like to talk about. Our drug companies and government have been amazingly complicity in pushing pain standards that have killed hundreds of thousands. Similarly we have so called "treatments" for depression, ADHD, and other newly-popular diseases that may in fact be making things worse long term, but the government has done nothing to make sure that long term outcomes are better but has been run by Big Pharma for a long time.

That is a very good point. When you talk about preventing addiction, are you referring to the war on drugs or providing quality of life improvements that might steer people away from drugs in the first place?

> When you talk about preventing addiction, are you referring to the war on drugs

When you talk about preventing systematic racism against blacks, are you talking about the Atlantic slave trade? Because the the relation between the latter pair is about the same as that between the former.

treating addiction as a disease has brought us drugs like chantix (varenicline), among others. it is very profitable for them to first create an addiction, then offer the solution.

i agree that the drug companies will continue to profit from pitching addiction as a medical problem, and it is very true that preventing addiction is far easier than treating it.

regrettably, preventing addiction is not something our society is geared up for. if anything, we are in the mode of causing addictions for the purpose of profit -- whether by social media or by opiates. our society inflicts enormous pains on people and drives them to escapism via drugs as a result. the rat park experiment is very enlightening in this regard: https://en.wikipedia.org/wiki/Rat_Park

the treatments for depression are, unfortunately, a way of compensating for the deprived and stressful environment in which we live. it is this environment that i suspect is the root cause of the widespread prevalence of depression, though there is probably a sizable population of people who develop depression regardless of their environment. antidepressants are intended to help the latter group, but are used for both the former and the latter.

as we know, the antidepressants don't definitively solve any underlying neurobiological problem, though they may save a few lives and empower some people to change their life's circumstances and ultimately recover. is it better for someone to be reducing their pain using antidepressants rather than street drugs? certainly.

you mention ADHD, but i think your angle on it isn't exactly in the same bucket as depression. people with ADHD are at extremely high risk of addiction. i imagine that if we could reliably treat ADHD and increase awareness regarding the disorder's attendant comorbidities, we would be preventing many addictions before they could develop.

I would just like to see more education about addiction. Society definitely doesn't handle addiction properly, but it's not a disease and it's not a clear cut moral failing (though it takes strong morals to overcome). The roots of addiction go deep and many people don't properly understand that the roots have to treated lest the addiction sprout again in some form.

> but it's not a disease

In what precise way is it not?

Disease generally implies the damage or malfunction of a system of the body. Whereas addiction is a malfunction of behavior.

My comment likely didn’t translate my thoughts clearly enough. I would not argue against “mental disease”. The distinction between physical and mental disease is important (because treatment is so different) and under common definition physical disease is implied. That was the miscommunication in my and many other comments in this thread.

Addiction is a disease. And I also think it can be a moral failing to play around with addictive substances. I say this as one who has a long family history of addiction and who has struggled with his own addictions: I was wrong to get involved with certain things.

When I reached out to my parents my (normally quiet and ultra-supportive) mom’s first words were, “I thought you were smarter than that.” And her next sentence was, “How can we help you?”

Once someone is trapped preaching ceases to be helpful. But preaching the morality of good decision making to avoid the pitfalls of vice can help prevent people from entering the funnel.

My view is unlikely to be popular on this board, but I think your point is a classic example of the either-or fallacy.

“Playing around with biohazards is bad. Oh, the bottle broke and you’re sick? Well... let’s get you to the hospital.”

“Drugs and alcohol have the potential to absolutely destroy your life and the lives of people you love. You’re an alcoholic? Let’s get you the help you need.”

Your description is very different from treating it as something to punish people for, which is what usually is meant with "moral failing" in this context.

Even that I'm on the fence about. It can be perfectly appropriate to punish people for making poor choices while at the same time helping them overcome some of the natural consequences of those choices.

I don't know where I stand on the issue of incarcerating people for drug use. But on its face I am not opposed to putting people in jail for selling highly addictive substances to young kids. This is one issue I have with the pro-legalization theory. Alcohol absolutely destroys lives (my grandmother drank herself to death when my mom was 13 in order to have some mental escape from the physical abuse of my alcoholic grandfather). Prohibition didn't seem to work very well, but general acceptance also seems to be failing.

It's a complicated issue, and I don't know where I stand on every aspect of it. But on its face I don't think punishment and help are mutually exclusive. And the fear of punishment _can_ be an effective deterrent. (Education being, in my opinion, the best deterrent. I've never had a drop of alcohol both because of my religious beliefs and the growing understanding that I'm very likely a drunk trapped in a sober body.)

> It can be perfectly appropriate to punish people for making poor choices while at the same time helping them overcome some of the natural consequences of those choices.

Then we are still not talking about the same kind of punishment. I refer more to "they did this to themselves and have it coming" types of attitudes, of the self-serving moral outrage kind[0]. Which is not the kind of "tough love" you are talking about.

[0] http://reason.com/blog/2017/03/01/moral-outrage-is-self-serv...

There is a reason humans evolved morality to regulate bad behavior. Morality helps you resist your base desires and do what is better for yourself and the group in the long term.

Do people become addicts because of moral failing? In some (many?) cases, yes. Not all, and not undeserving of treatment/help to recover in any case.

Fascinating how often it gets subverted by a portion of the group though.

One of my favorite lines of the Bible are these simple words from Jesus Himself: "They that are whole need not a physician; but they that are sick." It turns out that most of us are more like the Pharisees that Jesus railed against: convinced of our own moral superiority. I think that's a natural instinct of human nature (independent of one's professed religious beliefs).

> I was wrong to get involved with certain things

IMO you're judging yourself harshly. For most people who use drugs and/or alcohol a hangover is the worst consequence. If you're around other people using them and they're having fun I expect it's very hard to stay conscious of the fact that the risks are elevated for you, given your family history

My issues weren't with drugs or alcohol (there are plenty of other things to get addicted to in this life). Nor am I judging myself harshly. I'm a data guy and love that math doesn't have feelings. When you are adequately educated of the consequences and jump in anyway there is a manifest fault in judgment. Mercifully I've been able to recover, but life would have been a lot easier had I made different choices when I was quite young rather than clean up messes when I was much older.

> Perhaps we can start treating addiction like a disease and not a moral failing?

Curious. What advantages would that change of mindset bring?

The idea (I'm not particularly for or against) is that a victim of a disease can seek help & compassion; a morally bankrupt individual can find only scorn. Then it just comes down to whether you think help & compassion helps people right their ways more than admonishment & ostracism.

If people are not deemed to be bad/evil/degenerates because their brain chemistry demands they seek out a certain drug, then we as a society can re-organize our efforts to helping them be safe and recover more quickly. We can provide clean needles and addiction treatments, rather than jail cells and criminal records.

> We can provide clean needles and addiction treatments

1. how do clean needles prevent overdose?

2. https://americanaddictioncenters.org/rehab-guide/state-funde...

We already have state funded addiction centers free of cost. I am not sure how well funded they are though.

Handling opiod addiction as a disease starts with decriminalizing the drug. (It should remain a controlled substance, of course).

The next step is to make appropriate doses available to addicts at a cost that eradicates the illegal trade. These doses are administered in clinics, under the supervision of pharmacists and other professionals. This enables addicts to live their lives. The doses are offered in liquid form, not tablets. When mild and pure doses are readily available, the incentive to steal fentanyl and cut it with baby formula goes away.

The next step is to encourage addicts to reduce their dosages and do other things to get their addictions under control.

Along with all this, provide strong continuing education to working medical professionals about pain medication and addiction. Make it a point of pride among them to avoid getting their patients addicted.

The present system in the US is dominated by 12-step thinking. https://www.projectknow.com/research/alcoholics-anonymous-12... While 12-step programs help a great many people, they have two problems.

1. The whole "nature of our wrongs" approach (moral failing).

2. The cold-turkey approach, which ignores the possibility of physiological help to get through physiological withdrawal, and makes relapses more likely.

Other paths to treating addiction besides 12-step-centric ones are worth trying.

Portugal is following this path with reasonable success.

In the US it's hard to make this change. More than a century of systematic demonization of addicts has made the "moral failing" approach the norm. And, successful decriminalization of opiods will throw a lot of law enforcement people out of work.

But it's still worth trying, especially considering how many other things aren't working.

It would be good to compel Purdue Labs and other opiod-peddling drug marketers to disgorge some profits to help finance experiments in this kind of thing.

Why not both?

Because treating something like a moral failing is hardly helping anyone. Instead treating it like a disease means actually helping people in the situation they are.

“Treating something like a disease” encourages one to not take ownership of the issue but instead provides a mechanism to play victim and give up. It’s victim mentality, denies the concept of freewill, and sets the stage for all sorts of slippery arguments.

> Perhaps we can start treating addiction like a disease and not a moral failing?

My friend who died from heroine overdose.

Here is his story, my friend got banned from online forums. In his opinion, he was banned for posting political rants. And moderator told him, do not do this here. So, he felt is not accepted in the community and got addicited to heroine.

These days, some moderators think they are lords of the universe and ban anyone like a robot.

It's failure of the soceity in part of his personal failure.

Addiction progresses like a disease, but begins as a moral failing. If I were to begin using heroin today, it would be by conscious choice, not because there's something wrong with my body.

Except for 12 year old Travis whose mom introduced him to heroin and now he can't stop. Travis has morally failed because he is doing drugs and it's all his fault.

It’s important to not drive logic using analogy. For every “Travis” there’s lots of others with different circumstances.

There are many social determinants that affect behavioral risk factors.

We need to work to address risk factors as well as provide appropriate treatment.

The US has some data, but there are more gaps that need to be filled. [0]

[0] https://www.cdc.gov/brfss/index.html

Could it be, at the onset? The decision to take drugs? Where one is suffering from depression or some form of chemical imbalance? Or, could one be prone to risk taking behavior? Is the precursor to risk taking behavior, biochemical?

So we are not responsible for any of our decisions? We’re just slaves to our neurobiology?

It's a mix of both. We do have the ability to overcome our neurobiology. It takes rigorous and conscious effort to retrain your neural network - hence why Cognitive Behavioral Therapy can be as effective as Antidepressants.

I don't know if it's a true "decision" to take drugs for many people. If they have crippling pain due to an injury, they may be prescribed pain medication and then find they can't get off. See my other comment for a scenario.

It’s complex because there are different reasons for addiction.

Prescription rates are very high to support your example [0]

Recreational use is a bit harder, for me at least, to gauge. I found the 2017 global drug survey [1] showing about 2% opium/heroine use among respondents.

[0] https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

[1] https://www.globaldrugsurvey.com/wp-content/themes/globaldru... (I wasn’t very familiar with this source, but I saw 10+ citations including some respectable journals like BMJ, https://www.globaldrugsurvey.com/about-us/methods-and-limita...

What if you were injured on the job, were prescribed opioids by your trusted physician, became addicted, had the prescription ended, then what? If you've not dealt with opioid withdrawal, you may easily say you'll stop there. However, many cannot, and move into black-market pills ($$), then into heroin ($), and that's where the fentanyl comes in with numerous added deaths in recent years.

It certainly feels to each person that they are in control of their decisions. However, there is strong, convincing evidence that people are easily influenced and often times can be led to make bad decisions. This is true for all of us. I’ve never had an inclination towards drugs but I know this has much less to do with my morality or lack of personal failings and much more to do with luck.

It’s ok to view addicts with grace and be thankful that the forces that led them to addiction did not affect me thusly. My failings happen to occur in other areas of life.

Were all in control of our own lives, we live according to ourselves. The buck stops with me on how I live my life

You seem very sure of yourself in this. Perhaps read up on the topic more than you already have. Read Nudge and other such books by behavioral economists. There are experts in neuroscience who disagree with your view. It’s worth considering how this is possible.

https://neurosciencenews.com/neuroscience-choice-psychology-...

https://www.google.com/search?hl=en&q=are%20we%20in%20contro...

The problem with neuroscience is that they know nothing. For instance, it was considered true that neurons in the brain dont change and adapt, and then the concept of nueroplasticity came along, it was revolutionary. Twenty years later, a new study comes along and says that our brains are not as dynamic as we thought afterall. Human history is ripe with "experts" who were wrong, sometimes for centuries.

There are instances of where experts got it wrong. But to claim that neuroscientists know nothing is a bit arrogant. They certainly know more about the brain than you do (unless you too are a neuroscientist). I'm guessing you are not a neuroscientist. You hold a belief about decision making that is at odds with some experts and you have no expertise in the subject. A reasonable person would, at the very minimum, conclude that there is the possibility that their conclusion is wrong.

We can point to instances where experts got it wrong. We also can point to instances where they got it right. The people who study intensely an area are more likely to be right about that area than a non-expert. Physicians sometimes get diagnoses wrong. Yet a reasonable person pays attention to what they say.

I would consider myself an amateur neuroscientist, in the sense that I frequently read blogs on the newest publications and findings, have a decent background in pharmacology literature.

Aside from FMRI scans, which give us a very broad picture of the brain, there is no way to really tell "whats going on". We have not developed that yet.

What neuroscientists currently know, aside from FMRI scans, is that certain behaviors are associated with certain genes. They can say, people who had gene X and went through life situation Y, were Z percent more likely to have a bad outcome. This is where the human behavior is deterministic idea (and "evidence") comes from. One specific expert on human behavior is Robert Sapolsky from stanford, who no doubt understands human behavior deeply. Almost all of his conclusions are driven from the method I exclaimed above. Everything is a statistical conclusion on how the average person behaves, which is a huge error in modern science

Many diseases are the results of choices, often the culmination of thousands of little, to use your words, "moral failings". Cancer, heart disease, diabetes and even suicide attempts fall under that umbrella.

I don't see the need to make a distinction here, unless your intention was to imply something that was unsaid?

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