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Comment by sigfubar | Hacker News Reader

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.

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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

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.

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?

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...

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

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