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Comment by PragmaticPulp | Hacker News Reader

> The real issue here that people don't seem to want to face is the WHY. Why do so many people want to check out of life completely by abusing medicine

People start using drugs for different reasons. It's not correct to say that everyone starts abusing drugs as a form of pure escapism. A lot of drug users start because they're simply seeking recreation and someone is nearby to make drugs available to them. It's as simple as that.

> You are broken because society is broken.

Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.

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I feel like your first paragraph and your second one contradict each other.

They start for various reasons, like your example of "seeking recreation" and having a certain person nearby.

They don't stop because they cannot stop due to a physical addiction. I do not think personal responsibility is the right topic for that once it has gotten to that point. They've entered a state of physical dependence in which the reason they started is kind of irrelevant, and it's very difficult to quit, through no fault of their own.

> They don't stop because they cannot stop due to a physical addiction.

What you wrote here is actually the issue I was trying to communicate: The notion that addicts are helpless and that the drug and/or society has already determined their outcome is the problem. This sets up a defeatist attitude where people feel like they shouldn't even try to overcome addiction because their contribution to the equation is 0%.

Different addiction programs handle this in a different way. AA/NA famously have the "submitting to a higher power" concept that is very divisive, but appears to work for many people. Other programs basically teach the user that they do have some control over their life, and that they need to start exercising little bits of control to move in the right direction (even if they can't choose to end their addiction tomorrow).

What doesn't work is telling people "it's not your fault" or trying to comfort people by blaming their problems on purely exterior sources. Addiction treatment specialists refer to this as "rescuing behavior" and will go out of their way to discourage it from support groups and in friends and family.

This is the problem with addiction explanations that try to shift the blame to society: They give the user an excuse to continue believing that they are 100% victim with no control over navigating their way out of their situation.

Thinking it’s not my fault worked for me. Your argument is a conservative argument.

Addiction treatment specialists are basically witch doctors

Why don't addicts get large doses of intravenous NAD+ by default? That would alleviate 90% of their addiction inside brain as they are typically brutally NAD+ depleted and on the hunt for anything that raises NAD+/FAD+ in the brain.

Conflating a holistic approach that acknowledges the material effect of the context around a person with the assertion that those things existing nullifies the contribution of said person's agency is one of the very stupidest contributions of individualism to society. Things can materially make abuse more likely. Actions can be taken _by society_ that will make any particular _individual_ abuse less likely, whatever the specifics in each individual situation. It is still largely effort by an abuser and their closest contacts that will make _specific, individual_ abuse less likely in the future. None of these analyses contradict.

There's a division between mitigation, where empowering people to get rid of their addiction, and root cause, around changing society to stop pushing people into addiction.

Not looking more broadly means youll never fix problems like doctors over prescribing pain killers, especially without explaining their risks

It's two separate conversations, for different purposes

> What doesn't work is telling people "it's not your fault"

> trying to comfort people by blaming their problems on purely exterior sources

These are not the same thing.

The former is literal truth. The latter hints at intention, blame, denial.

It's not their fault, but they can get through it. You can hold these two simultaneously.

Why is it not someone’s fault when they get addicted after choosing to do a known-addictive substance? “Not their fault” certainly doesn’t describe all addicts.

They don’t need to be faultless to deserve compassion.

The more life experience I have the more I conclude that assessing the existence and extent of someone's fault is a pointless exercise. People tend to exhaust enormous amounts of pointless energy stuck in that place.

Your last sentence drives it home. They deserve compassion. Who cares about subjective assessment of fault once you reach that conclusion?

Largely agreed.

To your last point, people who believe having an internal locus of control is useful for preventing (not necessarily treating) addiction.

> A lot of drug users start because they're simply seeking recreation and someone is nearby to make drugs available to them. It's as simple as that.

Let's be clear here: someone's stated reason for using opiates might be recreation, but nobody starts shooting heroin for recreation without some pre-existing reason for self-destruction. It's not a secret that opiates are dangerous. People with normal self-preservation instincts find other ways to recreate.

> > You are broken because society is broken.

> Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.

What this boils down to is that the addict has to understand, "Society isn't going to help you, so you have to help yourself." That's important for addicts to understand because it is, unfortunately, true. But if we lived in a society which actually gave enough of a shit about its citizens to help them when they have problems, the importance of understanding that society won't help them would obviously take a smaller role.

I want to be absolutely clear here: there is not effective help for the causes of addiction. For example, a common cause of addiction is homelessness. Contrary to HN opinion, the solution to homelessness is simple. The solution to homelessness is homes. Not shelters--don't embarrass yourself with the "I don't know what the word 'home' means" argument. The fact is, 1% of the US military budget would build a home for everyone in the US. It's not difficult: the reason it hasn't happened is that there are a lot of people opposed to it. Instead, we build shelters where nobody has any privacy or feels safe or can have a pet or storage for their belongings (that's just like a home, right!?), and only in places where they don't inconvenience anyone society cares about, and then blame the homeless for being hard to help when they choose not to pretend that our half-assed solution does anything to solve their problems.

Many people get addicted to drugs after being prescribed them following surgery or injury. I know someone this happened to exactly. They gave him a bunch of opiates for pain management and he took them as directed and wound up an addict. I think a lot fewer people "choose" to get addicted to medicine in this way than either you or the GP are implying.

And now big pharma will "cure" them of the disease they pushed.

Also how is it a vaccine?

When I was a teenager I was prescribed tramadol after a surgery.

I was in considerable pain so I took it as directed. It was hell a strong stuff and I basically slept 18 hours a day.

A week later I was still in pain, but less. I reduced my dosage below the prescription to only take a dose before bed to make it easier to stay asleep.

Well, did I notice the effects of dependence. It was subtle but throughout the day I'd have intrusive thoughts along the lines of "I haven't had a painkiller yet, I should have one"

If I'd taken the prescribed dose till completion I'd hate to think what my brain would have done.

That scared me enough at the right age that I've never taken illicit drugs. And any time I'm prescribed painkillers Ive ignored the dosage and take just enough to manage.

Tell them to take NAD+ boosters like NR or NMN, or even the good old vitamin B3 in large quantities (1g/day). Addiction is often a sign of NAD+/FAD+ depletion in the brain.

You keep posting this over and over again with no source. If addiction to opiates was as simple as taking vitamin B3 and solved easily with the information in an internet comment there would be multiple studies and I suspect all over the news.

Maybe if you looked it up ("NAD therapy"), you'd have found it, like this one:

https://www.webmd.com/mental-health/addiction/nad-therapy-ad...

https://pubmed.ncbi.nlm.nih.gov/31917996/

https://www.mdpi.com/2076-3921/9/5/425

"The late John P. Cleary, MD, explained that we are likely to experience strong cravings for substances like alcohol when our NAD+ receptor sites are empty. That’s because alcohol drives the formation of the chemical compound acetaldehyde, which then interacts with dopamine to yield morphine-like compounds that temporarily quell cravings and withdrawal symptoms. When the NAD+ receptor sites become unoccupied again, however, the withdrawal symptoms and alcohol cravings come rushing in, driving us back to the bottle."

I don't think these are mutually exclusive. Society wide problems cause a huge fraction of the population to experience severe emotional trauma, and the process of addiction largely seems to be an experience of trying to escape the feelings associated with that. If you can understand this process, you can take ownership of it, and have a path to beating the addiction itself.

Ultimately, there is a lot of disagreement about what addiction is and how it really works, but I think this emotional trauma aspect is a key part of explaining why one person can use a drug recreationally or for medical purposes without addiction, and another can't. It explains a lot of weird observations that just didn't make sense with the classical chemical/neutrotransmitter model of addiction.

These links I think help explain this better than I can:

How Childhood Trauma Leads to Addiction - Gabor Maté https://www.youtube.com/watch?v=BVg2bfqblGI

Comic explaining the Rat Park research on addiction https://www.stuartmcmillen.com/comic/rat-park/

These ideas have explained why I personally have never been able to fight addictions through willpower alone, but have been able to eliminate addiction with other techniques that seem unrelated- therapy, meditation, exercise, hobbies, friends, ending bad relationships, etc. It seems that while chemical/physical addiction is a thing, emotionally and mentally healthy people don't experience opioids as a positive thing, such that the effect of the drug itself actually discourages it's use, and even motivates the experience of withdrawal.

Attempts to replicate the Rat Park experiment have failed: https://en.wikipedia.org/wiki/Rat_Park#Criticisms

It gets cited in a lot of pop-science and podcasts, but it's not actually the groundbreaking, universally-accepted study that people think it is.

Likewise Gabor Mate is more of a podcast, pop-science guy, not a real researcher. Take his podcast and YouTube content with a grain of salt.

I don't think psychology has advanced to the point where we can test ideas like this in a peer reviewed study on humans, yet as a personal experience- I have found that it is self evident once I looked deeper into my own feelings and actions. I feel those links do a good job of explaining the idea.

This reminds me, for example of the debate over Carl Jung. Some people say he set the field of psychology back with his scientifically untestable theories. Yet, I think it's obvious there is something to what he was saying, and it's likely he wasn't onto nonsense, but rather he was way ahead of his time.

>Society wide problems cause a huge fraction of the population to experience severe emotional trauma and the process of addiction largely seems to be an experience of trying to escape the feelings associated with that.

So then why weren't addiction problems more widespread historically, like say 1900-1960? Life tended to have a lot more of what are generally considered traumatic experiences back then.

Weren't they? Perhaps they were just using different drugs, e.g. alcohol. You can't use a drug to escape negative feelings if you don't have access to it.

And perhaps nobody cared enough to log it, especially in the lower classes

You just shrugged off opium dens, or moonshining, or whatever substances could be had. The demon liquor and marijuana and heroin were all well known.

But, people didn't care about the poor. Whether or not they do now, they do collect data about them. We don't necessarily have great understanding about prevalence of who used them how often, so we shouldn't pretend there was a significant difference unless there's a reason to. Nostalgia or rose-colored glasses or pretences of a better time aren't valid reasons to break from expectation.

While these points are valid, it's also a highly individualistic perspective. Social bodies have complexities and dynamics of their own. The obsessive pursuit of financial and political resources could also be seen as a kind of addiction, optimizing for one thing to an unhealthy degree while refusing to contemplate the negative consequences. There are certainly big payoffs to be had this way, but foreclosure of other possibilities can eventually lead to a dead end. A more harmonious, proportionate approach may not be as dramatic or impressive, but endure better.

> Variations of this concept are frequently used by drug addicts to justify continued behavior.

Think about it as a policy maker. You have a choice whom to blame - an individual or their environment.

If you blame the individual there is nothing you can do - we can’t change other people.

If you blame the environment now there’s something you can do. You can try to reduce supply by making it illegal (only works to a point) or you can try to reduce demand by increasing overall quality of life - housing, healthcare, and generally a way to escape the clutches of the rat race that is life in America for so many.

>Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.

I feel like the use of this argument should depend on the scope of the person who is speaking.

Law-makers and society-enablers should consider things in the far-scope of "society's fault", whereas this consideration is less useful on a personal scale other than for the purposes of blame-redirection.

>abusing drugs as a form of pure escapism

>start because they're simply seeking recreation

These are the same thing. Happy people don't seek to drown every waking moment in constantly escalating recreation, they got things to lose and when they are out having fun and an opportunity comes around to do drugs they are surrounded by friends and loved ones who care for them enough to not let them ruin their life for lolz.

>Taking ownership of actions and consequences is one of the key pivot points in helping people get control.

Control of what? That's the point of drug abuse - what is there to be controlling? We are gears in someone else's system, purpose is rarely possible in modern society. Address why this is.

> A lot of drug users start because they're simply seeking recreation and someone is nearby to make drugs available to them

This is true for drugs in general, but not many people are stupid enough to take opiods recreationally.

> but not many people are stupid enough to take opiods recreationally.

Recreational opioid use is extremely common. People seek out opioids for their recreational value, including drug-naive users.

Perhaps we should start being honest about which recreational drugs present the greatest dangers of addiction and harm.

At least when I was in school, we were still teaching kids that pot was just as bad as opioids. You can't expect kids to find out that you're lying about the dangers of pot, while expecting them to take the warning about opioids seriously.

I know the UK did research a decade ago to rank which drugs were the most harmful for the drug user and for how the drug user treated those around them.

https://www.bbc.com/news/uk-11660210

You shouldn’t dismiss people’s opinions because they’re addicts… I agree with this hypothetical addict that you think should be ignored.

Society encouraging people to take ownership of their actions and consequences is also part of how that would take place.

There's absolutely some truth to that though. People do not fall into addiction at the same rate in all societies.

That's tricky though, as access to the drugs varies by society also.

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