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Comment by toomuchtodo | Hacker News Reader

The growing scientific case for using Ozempic and other GLP-1s to stop addiction -https://news.ycombinator.com/item?id=40357196

https://recursiveadaptation.com/p/the-growing-scientific-cas...

> The consistency that I'm hearing from all across patient groups is gain of control, whereas previously, there was a loss of control… All of a sudden they're able to step back and say, 'oh, well I had this shopping phenomenon that was going on, gambling, addiction, or alcoholism, and all of a sudden, it just stopped,'

- Dr. Gitanjali Srivastava, Vanderbilt Medical Center

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Fiddling with our "reward centre" does not seem like it can have a localised effect to a couple of unwanted behaviours. I'm not sure we are braced for how widespread or impactful the other consequences might be especially if a vast percentage of the population take them life.

For example, could they significantly change voting preference? Why wouldn't they? Do we not respond to political messages with our "reward centre"? Will we find political charisma more or less entrancing? Will we find calls for vengeance and punishment more or less attractive? Does tinkering with desire and reward dull our emotional response? Will we find compassionate appeals to help less fortunate more or less attractive? Does "enhanced control" manifest as a political preference for rational altruism or as machiavellian selfishness?

If taking a substance removes our desire to shop, then I'm sure there are powers in this world that will stop it from happening.

Illicit drug trade has demonstrated that even long term prohibition does not work.

Depends on the molecule. Cannabis can be produced by any teenager in a closet with a grow light. Quaaludes on the other hand are now impossible to come by.

I imagine the reason for the popularity of Quaaludes was easy access. Remove that, and the myriad other substances available become more attractive, be it MDMA, LSD, magic mushrooms, 2-CB, Ketamine, cocaine, heroin, or a number of others.

The interesting thing is the rise of fentanyl in the wake of marijuana legalization. The cartels were making tons of money off illegal marijuana. When marijuana went legal, a lot of that money went away. But the cartels already had this distribution channel and weren't about to go legit. So they found this other way of making money with the existing channels they had.

And China is happily funding fentanyl as low intensity warfare on the united states, supplying the raw materials and likely providing "other" support.

It really does highlight how failed the drug war is. The only effective weapon against rampant cartel violence is decriminalization and legalization.

I just watched Sicaro over the weekend, yeah about 4 years late. The thing is a right wing wet dream take on the drug war, and the interesting thing is it's exactly like the vibe that came out of Vietnam war, another failed war.

"The politicians won't let us use unrestrained violence to win". Of course, both the Vietnam were and even more so the drug war are founded on completely illegitimate policy foundations, and only continue because of budgetary territory defense and a lack of desire of unelected officials to maintain power.

The point is preventing regular mass consumption.

Sell AMZN and buy LLY

It strikes me as an ideology of hatred towards humans to argue against something so incredibly beneficial for the individual in this way. Yes, being free from addiction will certainly change the way people vote and their political outlook on life, just as exercise and eating healthy will do.

It is not selfish to improve yourself and it does not make you sick that somebody else is healthy. You know very well that people who dedicate themselves to being healthy are very eager to help others as well.

It strikes me as incredibly naïve to think that we've just stumbled into an absolute cure for addiction, no caveats. That's second coming level of world change from "just take this drug once a day". Being cautious about <insert new thing> is not hatred towards humans.

Yeah, isn’t that how the (most recent) opioid epidemic got started - a pharma company telling everyone their new opioid was way less addictive - almost a sort of miracle cure?

Sure, but it’s also how antibiotics started, and that time it turned out that the miracle was real. It’s not something we can presumptively rule out.

Being cautious isn't presumptively ruling it out.

The difference here is everyone involved in the opioid epidemic knew opioids were addictive. They just enjoyed the CYA aspect of it.

It’s like sexual harassment training. Literally no one needs to be “educated” that sexually harassing your coworkers is bad. It’s done to cover the companies ass and for no other reason. The drug companies offered that cover and the rest of the establishment knowingly used it to cover their bad actions. No doctor prescribing hydrocodone thought it was a non-addictive substance.

Perhaps there will be some severe second order long term side effects with GLP-1 drugs. Time will tell, but considering we are nearly 20 years in on these and on 4th and 5th generation therapies I suspect we would have had a small hint of those by now.

I’m extremely cautiously optimistic about these drugs. They seem to be an antidote to the poison that is the modern western lifestyle.

That's a different argument completely. The comment I responded to was an argument that assumed that the drug was a cure, no caveats.

> It strikes me as an ideology of hatred towards humans to argue against something so incredibly beneficial for the individual

It’s not an ideology of hatred to consider unintended consequences.

This is the plot of like 20% of science fiction, where unintended consequences backfire at a societal level.

That might arise from curiosity, imagination, or concern for the future of our species.

There are studies that show when dopamine receptor activity is inhibited in mice, their motivation for basic survival plummets. They will continue to consume food if it placed in their immediate reach, but they will otherwise put forth only the bare minimum effort to survive.

That is to say, there are very real implications of messing with hormone responses, and it’s definitely not a given that it doesn’t backfire spectacularly down the road.

I also think most people would and should choose the quality of life now, even if that has longer term side effects we don’t know about yet.

> It’s not an ideology of hatred to consider unintended consequences.

It seems as an ideology of hatred to sacrifice the well being and health of real humans to prop up the false belief in something called "society", which has never existed and will never exist.

I have nothing against arguments questioning the side effects of the drugs for the individual, but that's another debate.

Should we also argue against exercise and a healthy diet, since these things also have an impact on people's political views?

Don't worry: we mostly don't have a "reward center". If you're thinking of ventral striatum, it does something more like motor vigor. https://mitpress.mit.edu/9780262044059/vigor/

Personal anectode / not a doctor / YMMV.

I started Ozempic about 3 months ago, prescribed by a nutrologist, first with the minimal weekly dose of 0.25mg, then 0.5mg, now back to 0.25mg to control my glucose levels (prediabetes). During this period, I lost about 25 lbs, which is fine (but I lose weight easily, just by exercising, so I wouldn't call this phenomenal by itself).

The biggest difference I felt was indeed in gain of control, being more aware of my body and living in the moment. I've been practicing meditation for a long time, and what I can say is that the drug keeps you in a medidative state for longer (most of the week).

The result is that I still like fatty foods and sweets, but I don't crave them. Binge eating has stopped, and all addictive/obsessive behavior, including social network / news sites / porn consumption has stopped.

I am normaly hyperfocused, but my standard m.o. has been peaks of absurdly high performance interspaced with a hiatus of low productivity/creativity. Right now, the the ability to focus on what I want/need to instead of what serendipity brings my way has been awesome.

Curious if you consumed alcohol or any other substance before and if you still do after?

Alcohol, socially. Before I'd have 3 or 4 drinks, now it's 1 or 2. Sometimes I don't feel like drinking at all.

My perception of some foods is different as well. For instance, as I mentioned, fat still tastes good but doesn't attract me as much any more. Fish otoh tastes much better.

Huh. sounds more like an ADHD drug than a weight loss drug.

I actually hate eating and routinely have conflicts of "I'm physically hungry but have no appetite". I wonder if Ozempic would make me gain weight.

Maybe we should consider ADHD from the perspective of addiction?

ADHD is strongly correlated with both obesity [1] and addiction [2]

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859965/

[2] https://www.sciencedirect.com/science/article/abs/pii/S01651...

That's what I thought, too.

It's not all rainbows, though. One thing I have to do is to set an alarm to drink water (otherwise I'll spend 6, 8 hours without water and have a headache).

Also, I might be the perfect Ozempic patient as I just entered the prediabetes spectrum with 5.7% glycated hemoglobin and have high muscle mass.

Makes sense to me. Im on keto/carnivore, when im strict w no cheating. After about 2 weeks im reorganizing and less interested in videogames. I think, sugar is stressing out the whole system

Root cause is a hormone imbalance, GLP-1 agonists patch a reward center in the brain (scoped to addiction, whether that be food, drugs, alcohol, gambling, etc).

What’s interesting is that we’re about to have a large scale natural experiment around addiction and whether it is chronic due to brain chemistry or more willpower as GLP-1 agonist uptake rate skyrockets in the general population (which should result in addiction reduction at scale).

It'll certainly affect how society views addiction in general. Most people don't have a good picture of addiction, and don't understand that a drug addict can no more stop doing drugs than you can yell at a cripple to get them to stand up. it's a mental disease, not a moral failing, and as we learn more about the brain, we're going to find out that who we are comes down to just getting lucky with chemistry and physics.

The sci-fi future is what if you could go into a clinic and get your personality tuned up. Yes I'd like to add some humor but not sarcasm to my personality. Give me a bit more motivation, and I'd like to like jazz.

It may be that it flattens all affect rather than addictions in particular. "Ozempic personality" is associated with anhedonia.

https://www.healthline.com/health-news/ozempic-personality-c...?

I deal with my own addictions but I'm not happy about the prospect of trading them for less joy of life in general.

For me Ozempic isn't an option because it's associated with reduced gut motility and I already have serious problems with that.

Frankly, I'm enjoying life a hell of a lot more now that my feet, knees, and back aren't killing me all the time.

The article you linked actually gets into that, in a quote from a doctor disputing the validity of the concept of "Ozempic personality".

Right, but we’re talking about people that aren’t necessarily obese using it.

That said it’s not like there aren’t widely used drugs that mess with reward centers. Stimulants and antidepressants both come to mind.

I know it's really tired, everyone knows it, and it is repeated constantly:

Drugs affect different people in different ways.

If 20% of ozempic patients have personality changes, that is very significant. Yet you would still have 80% of users going around saying they never had any issues with it and those who are might just be doing it wrong/misunderstanding/confused etc.

I guess also: a drug might affect the same person in different ways based on different circumstances, age included.

100% of patients who have taken ozempic have had a personality change. The change is that they're now on ozempic. This causes many of them to eat less. Which is also a personality change. So the more useful question is how does their personality change, how much does it change, and is it a desirable change, according to them or others.

Is hedonism joy?

In the same vein, is self-forced pleasure joyous?

Of course it is

Always in all circumstances for everyone? I disagree. One can continue to behave hedonistically without reaping the joy it once gave due to adapted thresholds in the brain.

  anhedonia (noun): an inability to experience pleasure.

Pleasure is not limited to joy but joy is a pleasure. I can't imagine unpleasurable joy.

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