Drug addiction: The complex truth | Hacker News Reader

Drug addiction: The complex truth

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231 pointscarey134 comments

I remember from college my Econ 101 textbook had a sidebar on heroin use by military personnel in Vietnam - apparently (according to my memory of an unattributed source) 90% of personnel stationed in Vietnam tried heroin at least once, and then 89% of them stopped when they left.

Why an economics textbook? The authors were trying to illustrate 1) the role of substitutes on consumption of a particular good - there was no TV, no bridge club, no women except prostitutes to go out with, so heroin "cornered the market" on recreational activities, and 2) the fact that people will adjust consumption of almost any good in response to its changing price - heroin was incredibly cheap, so people took more of it.

Anyway, I always looked skeptically at claims that trying it once guarantees addiction after that.

Heroin has properties attractive to people in a hopeless, brutal war beyond what they can get from bridge club. Self-medication is not exactly recreation.

You should also look skeptically at claims that having unprotected sex with possible HIV carriers guarantees that you will get HIV. But you should still put a goddamn condom on.

"to people in a hopeless, brutal war"

Exactly. Because it's heroin combined with other shit going on that almost certainly causes brain changes and chemical reactions on it's own.

So heroin in combo with war is not the same as heroin while visiting disney world on a nice summer day on your vacation (clearly my hypothesis nothing to back this up).

(There is by the way another "addictive" type behavior that starts at a time in ones life that, while not at war, is a time of deep changes in personality as well as hormonal changes. My hypothesis also suggests that this would add to the addictive nature of this activity as well in some people.)

http://en.wikipedia.org/wiki/Rat_Park

tl:dr; Rats given access to their choice of clean water and morphine water, and placed in two enclosures: Rat cage and rat park. Rats living in a miserable rat cage will develop a morphine habit. Rats living in a pleasant rat park will avoid the morphine. Rats moved from rat cage to rat park easily kick their morphine habit after a brief period of withdrawal symptoms.

tl:dr;tl:dr;

Rats self-medicate with morphine IFF life is crap.

That's the premise of the article we're discussing. They mention that experiment specifically.

It's not so much try it once and you're hooked, but for a certain percentage of those who do try it can get hooked in the first try. For many or most others, it takes persistent use (which will often happen when the first try doesn't get them hooked).

Illicit drugs are not immune to the placebo effect, either. When people are bombarded with messages that illicit drugs are irresistibly pleasurable, they are primed to overrate the effects when they try them. Reality is always complicated.

Anything that has to be spread to "The Masses" through marketing, propaganda or public education campaigns need a simple message to work. Simple, clear, strong messages with no room for debate. Just say no. Just Do it. The Real Thing.

Exaggeration is absolutely essential if you want to get people to react. You cannot rely on reality to provide the necessary frightening statistics.

So for example, almost everyone (including smokers) overestimates the risk of lung cancer caused by smoking by an order of magnitude. The danger of second hand smoke by even more. Cigarettes are unhealthy, but people are too irrational to react to that. In order to get a reaction, the dangers must be multiplied.

Another good example is HIV transmission. Most people assume the transmission rate is close to 100%. Someone who has had sex with a HIV+ partner and survives dodged a bullet. In reality, transmission rates after a single exposure are very low. It depends on the sex act and viral load but even for high risk activities like anal sex, infection rates are in the low single digits. They are estimated around 0.1% per exposure for vaginal penetrative sex.

Campaigns that made you think of how many people are 5 shags removed from you (your ex & her exes & his exes..) implied that infection rates were near 1%. People bought it. They started using condoms. The spread slowed or stopped. A 0.1% risk would not have done that.

So yeah. Marketers lie. So do propagandists. The layman public simplify. It's how shoes get sold. it's how public opinions are changes.

And yet many times when savvy people notice that they are being lied to they discount the entire message and can end up engaging in more destructive behavior than they would have otherwise. Public health messaging should never contain exagerations or lies even of ommision.

You have a strange standard for 'savvy' people.

One aspect to the "instantly hook a user" theory that I have not seen mentioned here is the following:

Taking a potent drug like heroine or cocaine for the first time is described by some users as "pushing open a door to a very enjoyable place you did not know existed". Once this door is open, you will always know that this place exists, you can not "unknow" the experience.

While some people might be able to handle the knowledge of this enjoyable place and are able to choose when and if to go back, some might not be able to. Therefore I believe it makes sense to tell people not to open the door at all.

I also can imagine that the first time with these potent drugs is a positive experience for many, unlike the first cigarette or the first beer a person ever tries. The second cigarette is not smoked because the first was so good.

I have previously commented on this topic on HN, but since it's back i'll go again.

As a medical student I was taught that addiction is a spectrum. Each drug falls somewhere on that spectrum in terms of addiction potential, (And as GotAnyMegadeth comments, Nicotine is more addictive than Heroin) and every person has some prior probability of becoming addicted, due to the complex interplay of social/biological factors that go into the nature of an addiction).

Okay - so Heroin is less addictive than Nicotine. We know this. People understand this if they think about the nature of addiction. Doctors are taught this at medical school. Community mental health, nurses and doctors talk to lots of people who have tried hard drugs and never got into them.

But what is the destructive potential of trying heroin and becoming addicted? Obviously much greater than with nicotine (Although nicotine products may well result in your death one day too).

This information isn't particularly new, and certainly hasn't been buried by the powers that be in an attempt to strengthen anti-drugs arguments (at least in Australia)

Nicotine is less addictive than heroin only in one measure of addictiveness. There are others, e.g. reinforcement, in terms of which, both heroin and cocaine are more addictive.

And with regards to the article, this is nothing new. Who hasn't caught onto the fact that anti-drug materials exaggerate everything and are full of lies (LSD is bad apparently).

Are you sure you are talking about the destructive potential of heroin itself and not the circumstances in which it is consumed? It is not necessarily an IV drug, but the price, driven by criminalization, makes smoking prohibitively expensive (see the other comment about the Vietnam soldiers). In countries where the distribution of syringes is criminalised (Russia, USA), syringes are reused and shared. The price of the drug encourages the users to resort crime to obtain it and neglect other aspects of their lives (nutrition, hygiene, living conditions). All of those aren't necessarily effects of the drug itself.

I agree with the point you are making, but for clarity's sake wanted to add that syringe distribution has many different legal (and pseudo-legal) standings across the US. In Boston (not sure if it is all of MA) you can buy needles and syringes from a pharmacy, while in Maine they require a prescription; however, many communities in Maine still have needle exchange programs

If you look at heroin and meth addicts, I think it's pretty easy to see that it's not only dependent on price (which for meth is quite cheap in some countries). A lot of addicts will in the long run be unable to hold a job because of their drug use, and will only turn to crime when that happens.

On meth: remember in the US this is a legally prescribed medication, and effectively indistinguishable from other amphetamines such as the Adderall mixture. There are plenty of professionals using amphetamines. The difference is probably that they're not smoking it for a rush, but using it to gain a long mental advantage. They're certainly very functional.

On heroin: Opiates are far less harmful than smoking, as long as you don't overdose (which is often caused by improper labeling or mixing with other drugs). You'd be surprised how many professionals are using opiates (such as time-release oxycodone) daily. Again, the difference is in using it for the mental advantage, not IV'ing it to get a rush and high.

It's just that in general, you're not going to have such people confess their usage due to negative social stigma. Thus the only "addicts" you see, are the ones that couldn't hold a job, couldn't get a supply (it's generally easier to buy heroin than proper opiate pills), and so on.

Well, I think that a big part of those "functional" users are like functional alcoholics. They continue for many years to hold a job, but their daily usage causes problems for everyone around them.

At least that's the story you'll often hear at family group meetings. Not the usual homeless drug addict story, but people keeping up appearances while hiding some pretty big problems.

My brother was a functional meth user for many year before he lost his fiancée (mostly because of the anger outbreaks and lies, we didn't know he was using then), then his license and car, and finally his job. Of course then again there may be far more people that just continue using without ending up in the same situation.

Well, I'm just gonna say arguing anecdotally is pointless. However, functional opiate and amphetamine users are not "hiding a big problem". In many cases, this is enabling them to deal with high-stress situations, or think more clearly. One example is Paul Erdős, a brilliant mathematician that used amphetamines quite a bit and found no reason to not use them. No hiding, no problem, no "keeping up appearances".

Don't by into the "addiction is bad" story that DARE and the like sell.

https://en.wikipedia.org/wiki/Paul_Erd%C5%91s

While I've had a very liberal view regarding drugs and certainly not bought into any campaign stories, I've also become much more respectful about their potential consequences in the past years from firsthand experience. It would be interesting to see more about how prevalent drug use is. I do think you underestimate the negative consequences they can have. Drugs like meth and cocaine don't just cause the users to think more clearly, it can also cause some big behavioral changes. For instance, it's not far-fetched that the economic crisis has been at least partly been caused by overconfidence from drug use: http://www.theguardian.com/business/shortcuts/2013/apr/15/co...

Are you talking about pure nicotine or tabaco? I read that pure nicotine (as found in e.g. nicotine gums) is little to non-addictive.

Like lots of folks I drink a bit, and I smoke the occasional celebratory cigar. I'm fortunate to not have found myself addicted to anything though (that I'm aware of at least).

However, I have family members who have deep addiction problems. Life affecting. One thing that I've noticed is that even when they get off of the substance, the addictive personality traits are still there -- years later.

One of my relatives, for example, managed to get herself off of drinking and smoking completely and was in counseling. The addictions, and the kinds of behaviors that come with maintaining addictions (all kinds of dissociative, anti-social, manipulative weirdness) were ruining her life. Strange thing was, after removing the substance, the behaviors persisted.

Many months later, after quitting drinking and smoking, we found that she was latching onto other activities in an addictive way. For example, she found a puzzle game on her phone that she would play obsessively* -- forgetting to eat, sleep, show up for work, having basic human interaction and even requiring physical therapy at one point for the muscle strain of sitting in the position to play the game for hours on end. Crippling physical pain wasn't even enough to get her to stop -- it was what was providing her "fix". She would sit, literally for days straight and play it. Counseling eventually got her to recognize this addiction, but it was harder for her to stop since she had her phone on her at all times.

Then one day she stopped and we all breathed a sigh of relief -- she started sending emails again and generally became more communicative. A few weeks later the behaviors started again, but it wasn't with her phone. Turned out she had just found a computer game she liked more and switched off the phone game.

Today she manages a bit better, but she went through a smoking binge for a while. She's "quit" again, but now just habitually chews nicotine gum. Apparently the nicotine helps keep her off of other more destructive behaviors (like playing phone games obsessively). When she feels stressed, she just chews some nicotine gum and that seems to get her through the craving. She's back working a regular job now and doing okay, but the idea that she'll find some other, better, satisfier, scares everybody.

* - obsession is outright scary when you see it in another human for real. It makes a mood swing look like a flat affect. A person who's addictively obsessed with something is almost feral, operating on instinct -- except with human level brain power to alter their environment to maintain the obsession.

Thanks for sharing. I have never seen the type of addiction you described first hand. Firstly, I wonder how prevalent this "level" of addiction is. Secondly,what type of environmental and genetic factors influence it

This is the rule, not the exception, among addicts. Every recovery program (12-step or not) emphasizes that drugs are not a drug addict's only problem. Obviously they are a very destructive part of the problem, but every addict who stops using long enough learns that -- surprise! -- they're still a self-centered, fear-driven, manipulative, obsessive person. That stuff doesn't just go away when you stop using; if anything, it flares up in other ways (as you've seen firsthand).

Source: many years clean in NA

That's very interesting. Do you think addicts already have those personality traits from before they became addicted, or the traits developed as a result of the addiction?

From anecdotal experience I would say that behavior is __always__ first.

I can even think of more than one person of top of my head that is obsessive about stuff and does not consume drugs.

Most addicts are abused (or experience comparable longterm stress) as children, which causes brain damage, which leads to addiction. There is a certain genetic component also, but it mostly has to do with your childhood.

This sounds rather much like speculation to me. Do you have any sources to back up your "Most" statement. Since the disease is generational, quite often children of addicts will have a stressful upbringing, but your theory of brain damage from stress causing the addiction is quite a stretch.

Gabor Mate discusses this in his Angry Ghosts book. If you search through my comments for his name, there is a link to an interview where he discusses this also.

I did not find your comments, but I did a quick google search. Here is one refutation that I found: http://www.psychologytoday.com/blog/addiction-in-society/201...

It says just about what I would have guessed too. :)

What's the point of reading a refutation if you haven't read the original? You don't even know what you're reading.

It's not necessarily always "abuse" so much as mis-parenting and/or unhealthy environments. I forget who said it but there's a quote that goes something like this: 'All healthy families share similar traits and patterns, but unhealthy families all have their own hosts of unique issues.'

For one source that hit home for me, see Addiction as an Attachment Disorder by Philip Flores

That is the first line of Anna Karenina: "Happy families are all alike; every unhappy family is unhappy in its own way."

I used to read obsessively as a kid. I also ate lots and lots of candy- I'd finish entire packets at one go. Went on to be an internet addict and cigarette smoker.

I think... I just never learned focus, discipline, self-control, portion-control, when to stop. I think it's a habit more than anything else. I think I've always had some "addictive" personality, but I think I could've kept it in better check if I developed habits of discipline and control- which I never really did.

Yes, and almost every program I've seen people go through has tried to force them to "accept jesus as their savior". That's where they fail.

Religious practice can be remarkably effective at curing afflictions of the mind including depression and addiction. I knew a guy who recounted his story of being continuously depressed, addicted to everything he could get his hands on. One day he, on a whim, walked into a church, and was instantly cured of everything. Now he can hold a job, work towards a future. Doesn't go to AA meetings, doesn't need to. It's like God flipped a switch in his brain, is the way he described it. You'd think a guy like that would be preaching God from the rooftops, but he doesn't. He's real chill, easygoing.

I have met several people addicted to religion. It's socially accepted and can fill the needs of some people vary well, but it can also be just as destructive as heroin.

It's unfortunate that this has been your experience. Where I am from recovery groups are as hand-off when it comes to personal religious/spiritual/atheistic beliefs as they can be. I've never once had someone try to push a set of beliefs on me, and I am grateful they haven't tried as that would have pushed me out of recovery faster than anything.

The religious basis of AA (Alcoholics Anonymous), after which nearly all 12-step programs are modeled, does not require "accepting Jesus as your savior". It does require, however, accepting that a "higher power" might restore you to sanity.

This is a very important distinction, because AA goes to great lengths to clarify that the "higher power" is one of your own understanding. It is not Jesus, it is not a Christian-Jewish-Muslim God. It is simply something "bigger than yourself" which exists and which you can feel comfortable addressing.

It could be the Pacific Ocean for all you care. It just must be bigger than you.

This.

If you're not religious, community can be your higher power. The point is more that will-power alone is not enough for some people.

I agree, but would say this its not that will power alone won't work, but that some people don't believe in the power of there own will, and need to submit (at least to start with) to another force. Once people break the cycle they can come to realise that they do have the power within them.

That's the rub, though; for whatever reasons, physical or psychological or both, some people do not and cannot provide enough will power alone and need help.

This is why addicts talk to other addicts; because other addicts "get it" and can provide help in overcoming the problem that isn't just "learn how to use your own will power". That's just condescending.

It's obvious, really; if it were that simple, there would be a great deal less addicts in the world.

A wise old woman in AA once told me that addicts are just like everybody else, only more so." You will find a full spectrum of introverts to extroverts in Recovery. H I don't think a definition of addictive "personality" is used. Most addicts are using to manage extreme negative internal states. Not everyday bad moods.

I agree with the poster who mentioned Infinite Jest as capturing some of the subjective experience of the "insanity" of an addict.

You seem to be suggesting an initial addiction caused an addictive personality, but are you sure your relative wasn't prone to addictive behavior to begin with?

I thought the suggestion was an addictive personality causing the initial addiction and also subsequent ones.

I find this like saying that other people might have addiction problems, but you don't have the personality so you can take it or leave it.

>One thing that I've noticed is that even when they get off of the substance, the addictive personality traits are still there -- years later.

The OP can chime in, but your interpretation (which I considered) doesn't seem to fit what I just quoted.

I can't say whether the addictive substances caused the addictive personality traits or vice versa, but it's definitely a facet to consider.

From my observation and knowledge over time I think your statement "prone to addictive behavior to begin with" is correct.

That said I'm not reading what you are saying the OP is possibly suggesting at all.

He says:

"One of my relatives, for example, managed to get herself off of drinking and smoking completely and was in counseling. The addictions, and the kinds of behaviors that come with maintaining addictions (all kinds of dissociative, anti-social, manipulative weirdness) were ruining her life. Strange thing was, after removing the substance, the behaviors persisted."

I don't see anything that suggests that the initial addiction caused further addictions at all in the above paragraph.

>Strange thing was, after removing the substance, the behaviors persisted.

This part. Seems an odd thing to say if you knew the person had addictive behavior before... perhaps I'm misreading it.

How would you know if they had an addictive personality if there wasn't a pattern of addictive behaviors?

Often, these things start at such a young age that it's impossible to separate and find cause and effect.

It's anecdotal of course, and correlation doesn't equal causation and all that, but the people I'm close to who seem to really have addiction issues seem to be people who had addiction issues a priori.

e.g. I can't even conceive of a scenario where I could find myself thinking about willingly even trying heroin or cocaine. But I have a few family members and (former) friends with addiction problems so severe that pounding a case of beer before snorting lines is what they call a normal Thursday afternoon and heroin is considered a weekend recreational sport. Something predisposed them to the notion that this was a valid idea whereas I can't even conceive of it.

For example, she found a puzzle game on her phone that she would play obsessively

Actually an interesting observation on how difficult it is to draw the line between obsession and passion. It seems that she (can devlop) an extremely high level of focus, something that what would probably regarded by many as a trait for becoming successful in a specific discipline.

Yes, that's what I thought, too.

If only she could bring herself to getting hooked on a creative endeavour, she would achieve remarkable results.

Well anything that goes to this type of excess will be a problem though:

"a puzzle game on her phone that she would play obsessively* -- forgetting to eat, sleep, show up for work, having basic human interaction and even requiring physical therapy at one point for the muscle strain of sitting in the position to play the game for hours on end."

What we are probably dealing with here is more than a simple addiction (to which your suggestion is good and would definitely be in the right direction). What we have is a mental problem that includes addictive traits.

After all the DSM is fairly arbitrary (as are medical definitions).

The problem with that is the delayed gratification - most productive endeavours these days require months on end of hard work before any reward can be expected - especially if you start out as a non-expert.

Reminds me of the famous toddler marshmallow experiment - how kids able to endure delayed gratification tend to be more successful later in life.

To me, this and the parent post are the most interesting thing here. I find myself to be quite like the parent's family member in that all that I do is obsessive, often to the point of self-destructive results. It's always been this way with work and hacking (to the extreme) and certainly for other less productive things like alcohol, food, news (ctrl-R) and especially television/films.

What I'm wondering is if we could extract some positive gain from this. Maybe there's a way to gamify certain activities so that people could hook themselves on something positive. I know this has been done for certain types of exercise (I can't recall any webapps right now but a simple search for mobile apps should show a hundred or so.) I'm curious if it would work for such things as meditation, self-study, diet, social activity, etc.

I get the feeling there's a lot of research out there about gamification, but I wonder if there are any webapps out there allowing people to gamify <whatever> in their life so as to allow the person to more efficiently build positive habbits. If it hasn't been done, maybe this is a new market niche to be taken advantage of.

If anyone finds anything or is interested in potentially collaborating, let me know. I'll be looking into it myself in the meantime.

EDIT: After reading a bit, I just remembered https://chains.cc/ was posted to HN a while back.

An example is: 7min for iOS has badges and achievements. You should look at the companies that Badgeville or someone similar has worked on. Amazon has the layer of highlighting and the percentage you've read and that can be gamified and sold to them. Watching TV shows and series has been gamified by apps like GetGlue. Civic participation is already being gamified. It's highly saturated.

habitrpg.com

Great and free. Thanks for this, I'm giving it a try. I was _this_ close to building something similar myself, glad I found a really good version already built. :)

https://www.superbetter.com/

I almost agree with you, but there's a qualitative difference between obsession and focus just like addiction vs. dedication.

Focus/Dedication is something you can choose to do, it's a tool you can use (though some people's tools work better than others). When you need to stop you can and then move onto other things.

Obsession is something that controls you, you are the tool being used, and when it's time to move on the obsession continues to control you keeping you under its thumb.

The book Infinite Jest by David Foster Wallace is an astoundingly good illustration of this. He follows characters as they use work, tennis, video entertainment, and even addiction recovery itself as addictions. I feel as if my understanding of addiction and its depths was deepened a great deal. The older I get the more healing from addiction seems like an actual real miracle.

Pretty sure you are addicted to oxygen. You are probably addicted to hackernews also. This is not meant to be a banal comment. Addiction is not necessarily a bad thing. You could be addicted to hard work, for example. You could be addicted to your family. Being so addicted to your family that you would be willing to die in order to protect them is not necessarily a bad thing.

Addiction or dependence or obsession is usually defined as a behavior that causes negative consequences for the individual that they would prefer to avoid.

In that case, oxygen and protecting your family would not be regarded as addictions.

Protecting your family could actually become an addiction/obsession depending on its intensity. Someone could be so intent on protecting their family constantly that they avoided sleep, or spent much of their money on weapons/security system upgrades, or prevented them leaving their home. In that case, all of those would certainly be negative repercussions.

Addiction isn't typically construed as mere dependence or devotion. Our taboo of addiction stems from the negative consequences of maintaining the object of dependence.

Forsaking all news sources except HN is narrow-minded, but not a good example of addiction. Spending hours refreshing, and replying to all the comments to the point where you are neglecting other responsibilities: addiction.

edit: oops, redundant reply because I had this open for 30 min & didn't refresh before replying.

Is this post a joke, or are people actually so completely out of touch with reality that they become "rabid nicotine junkies", and their families see them as in need of help?

Has she been robbing people to pay for her habit? Selling herself?

We should not look towards drugs to satisfy the void in our lives.

We should not look to eating for pleasure, just for health.

We should not look to our career as a source of fulfillment - it's just a means to an end.

We should not look to our mates as a source of salvation - we should focus on giving.

We should not look to our kids as objects to make us whole - we should focus on giving...

Ok, so if we're gonna take away all these things as "drugs", what's left?

Nirvana, according to some.

Nothing is left and the human life is truly devoid of meaning.

you have a lot of opinions on what we all should do

christian I presume?

Ha. I wanted to edit my post and add "(And please don't say God)". So the answer is no :)

That is basically the point of Ecclesiastes. King Solomon had access to everything, being king of one of the most powerful kingdoms of the time, worked his way through that whole list, and then at the end decided it was all pointless. He was a smart Paris Hilton, just with more money and absolute power.

And the most oft-repeated phrase in Ecclesiastes is, "Eat, drink, and be merry"

Did you read the article? He's quoting that...

Also is it necessary to bring an unrelated belief system into this...?

Just work, and staring at a wall.

This is the real question. I think there are only three choice categories:

* Reject everything. This is basically the path of the Yogi.

* Assign meaning to something. It could be your kids, your spouse (I wouldn't recommend that one), philanthropy, a "vision," or whatever. If people ask why it's important to you, don't explain in logical terms. "I decided that it would be."

* Stop thinking about it. Chase the dopamine. I think most people do this, even the most thoughtful people. It might even be impossible to escape attachment and emotion.

In the end, attachment and emotion are truly illogical experiences. Do we embrace that illogic completely, try to "control" it, or struggle to reject it entirely?

I was under the impression that the Yogi was able to reject everything because he had disciplined his mind to become a self-activating dopamine dispenser. Isn't there a neuroscientific study somewhere that points to this?

Why do you recommend not assigning meaning to your spouse?

I think the Yogi is eventually one with it. He doesn't try any of the methods you offered. Controlling it, embracing it, or rejecting it. He just let's it be. And in that way he becomes free from it.

In my (admittedly limited) experience, people are taking a big risk by making their spouse a critical source of meaning in their life. I think the problem is that it's reliant on reciprocation, whereas the others aren't (except children to some extent).

With respect to your comment on the yogi: note that most yogi follow some number of vows [0] and abstentions [1] that seem to me to be very much an attempt at "controlling it." Eventually I guess they don't need to "control it" anymore, once they reach Samadhi, but in practice the path of the Yogi is typically one of repression.

[0] http://en.wikipedia.org/wiki/Yamas

[1] http://en.wikipedia.org/wiki/Niyama

I totally agree. I think in real life most people decide following these path's will allow them to reach enlightenment or at least come closer. Despite that I don't think one who has reached enlightenment feels they're controlling anything at all, nor does that bother them in any way.

I think it's silly to try to subscribe to a set of rules that just aims to get rid of all the bad stuff. It makes more sense to me to simply balance the consumption of these "drugs" (narcotics, alcohol, food, games, children, sports, etc). In fact, don't even call them "drugs"; call them "desire satisfiers". Satisfying any given desire has a cost and a benefit, and we all exist in this huge, messy web of conflicting desires that have varying and dynamic costs/benefits. The challenge of living is trying to balance the satisfaction of all our various desires.

They aren't taken away. You can still experience those great things, but don't make those experiences the purpose. The result is emotional balance and fulfillment.

Moderation in everything including abstinence and excess.

You should not look at any of these as a sole path but enjoy all of them in moderation.

I moderate my moderation. :)

Does anyone really think "one try ... is enough to get us hooked"? They can't know any overt functional drug users if that's the case. Cocaine in particular isn't instantly addictive. If anything on the few occasions I've used it, it actively put me off.

"If anything on the few occasions I've used it, it actively put me off."

Cocaine can't have actively put you off that much if you did it again a few times. Reminds me of the joke "Quitting smoking is easy. I've done it lots of times."

Why does this need to be the case?

I guess for most people it is more like "there's so many movies about this stuff and famous people take it, it MUST be good, I need to try".

Considering I've not taken it, or even thought about taking it, for over 15 years, I'd say you are wrong.

I enjoyed your comment so I don't want you to think I'm being rude but I think there is a difference between trying a drug (maybe more than once) versus becoming addicted to it and needing to quit.

My best (and personal) example is that I would smoke a cigarettes with friends back in college whenever we were out and drinking. It provided a good additional buzz and it was somewhat social. I'd even buy my own pack so I could have one if my other smoking buddies weren't around (also when I was out drinking). I averaged 2-4 cigarettes per week and I'd even go weeks without smoking as well. It was sporadic and I didn't enjoy cigarettes any other time. When I saw people smoking during the daytime I would actually be kind of disgusted at the thought of smoking. So I guess my point is... was I addicted? I don't think I was. Was there ever a line that I would say that I "quit smoking"? Eventually I did stop my "casual" routine. Even now, I think I would still smoke a cigarette if I was put back into similar situations.

I think it's completely reasonable to have tried a drug many times and not be considered addicted. On the contrary, many of those same college friends I smoked with I would consider to be addicted. It wasn't a limited activity. It was an anytime and anywhere activity.

Perhaps it's an acquired taste. It took me loads of tries to get olives, ale and death metal. I was actively put off all of those several times, now I survive on pretty much just those...

A while back (some years perhaps) on Reddit there was a story about someone who basically documented their experiment with heroin. It could have been a hoax of course, but most agreed it wasn't.

It was this person who was already doing milder illegal drugs. He goes to his dealer and dealer proposes something different this time. He decided to try heroin. Had pretty high confidence he wouldn't get addicted. Anyway he describes his first try. Then as weeks went on he periodically posted updated. He kept justifying going back to trying it. Gets addicted. Long story loses his job, girlfriend, goes into rehab for a long time. Pretty harrowing story.

EDIT:

Thanks to japhyr56 who found the link:

http://www.reddit.com/user/SpontaneousH/submitted/

So you've got an anecdote, and you didn't even link to the source of the anecdote.

Sorry I tried to find it but couldn't at the moment. It was some years back and reddit's search is not the best it seems.

Anyway the idea was that many go in thinking they can handle but it turns out they can get addicted the first time and it can ruin their life pretty quickly.

I think the main problem is that lots of people who have heard the "try it once and get hooked" story realize that they did try it once without problems, and therefore assume that addiction won't be a problem. From once to a few times to regular use to addiction is a slippery slope that most avoids, but for some it can take several years. But none of them started it with the assumption that they themselves would get addicted, and along the way made up many rationalizations for their drug use. So in that way, this anecdote is interesting.

Was it one of these?

http://www.reddit.com/user/SpontaneousH/submitted/

Or this one?

http://www.reddit.com/r/IAmA/comments/jcxow/iama_functioning...

Thanks for finding it, it was SpontaneousH one.

The author proposes this theory is incorrect but doesn't cite any scientific sources that state "all it takes is once." (They do cite a drug scare web page.) They then go on to say that environmental factors influence drug use, which is obvious. This article isn't a very good advertisement for their "MindHacks" book.

Kind of on topic: I was surprised to find out that Nicotine is thought to be more addictive that Heroine...

http://en.wikipedia.org/wiki/Nicotine#Dependence_and_withdra...

Nicotine itself (without the byproducts that happen when burning tobacco) is not even that bad [1] (deadly in relatively low amounts but unless you take it concentrated it's very hard to reach those levels). Unhealthy? Yes, but probably not much worse than caffeine [2].

Besides, Nicotine itself is not that addictive "Technically, nicotine is not significantly addictive, as nicotine administered alone does not produce significant reinforcing properties. However, after coadministration with an MAOI, such as those found in tobacco, nicotine produces significant behavioral sensitization, a measure of addiction potential." [3]

[1]: There are a few studies that look at nicotine excluding cigarettes on Google Scholar.

[2]: Compare http://en.wikipedia.org/wiki/Nicotine#Pharmacology and http://www.energyfiend.com/harmful-effects-of-caffeine

[3]: http://en.wikipedia.org/wiki/Nicotine#Psychoactive_effects

>>[2]: Compare http://en.wikipedia.org/wiki/Nicotine#Pharmacology and http://www.energyfiend.com/harmful-effects-of-caffeine

Cough, was that completely honest? since you linked to Wikipedia for Nicotine, I suspect you did know you'd get lots of really good effects by linking to Wikipedia for caffeine. :-)

http://en.wikipedia.org/wiki/Health_effects_of_coffee#All-ca...

Wikipedia had a lack of harmful effects of caffeine (or at least none written in a way I as a layman can understand) and I thought a site with articles about caffeine selling caffeine products would make an okayish substitution.

Again for nicotine there is no convenient list on Wikipedia, so:

> In one study, a group of Alzheimer's patients were given nicotine patches, while another received a placebo. Those with nicotine patches maintained their cognitive abilities longer and sometimes even recovered lost cognitive function.

> Contrary to popular opinion, the study showed that nicotine actually boosts the growth of new blood vessels.

> In 2006, Duke scientists found that people with depression who were treated with nicotine patches reported a decrease in their depressive feelings. The results were perhaps not surprising for a drug associated with imparting a "buzz." However, the research also showed a direct link between nicotine and an increase in the release of dopamine and serotonin, two vital neurotransmitters. A lack of dopamine or serotonin is a common cause of depression.

-- http://health.howstuffworks.com/wellness/drugs-alcohol/nicot...

again, there is much more on Google Scholar.

I find that nicotine's addictiveness is due to legality. That being said, I quit the various opiates much easier than cigarettes.

As a smoker, I wish it was illegal tomorrow. Then I could buy one or two smokes every now and then, but I would have to go well out of my way.

At $10 per cigarette, in a neighborhood where you're likely to get shot.

But they're illegal in order to keep us safe.

Right.

As someone that has smoked [1] I think legality is important - but it's also the relatively mild effects.

If you're getting frustrated at work, you can take a break, give yourself a quick "boost" by stopping for a cig, and then go back to work. Something that's not really possible with heroin, or marijuana or any other "drug" apart from caffeine.

[1] ten years on and I still don't say "ex-smoker" as one of the mental tricks to help me deal with it

EDIT formatting

You can also extract enough pure nicotine from a pack of cigarettes to kill a man, if you know how. It's not hard.

Nasty things.

Time for a cigarette break.

I worked in a neuroscience lab for years - our rats were housed in pairs, in extremely small cages. They were required to have "environmental enrichment" by LAR (Lab Animal Resources), which for us meant a small stick for it to chew on. So yes, a lot of research is done on animals that are not exactly what I'd consider healthy or normal.

"Drug, Set and Setting" by Norman Zinberg is another classic. Andrew Weil has talked about it (search YouTube). His thesis was on nutmeg as an addictive drug. Almost anything can be addictive given the right setting.

"Addiction is a Choice" by Jeffrey Schaler. Saying it is a choice is not at all meant to cast blame, but to emphasize that to use drugs is a choice given one's life circumstances, and is influenced by many variables. To focus on the drug use itself is to neglect real "problems of living" (as Thomas S. Szasz called them). By viewing it as a choice, one is also empowered to end their addiction, but it must be voluntary and not coerced by family members or the state.

I sometimes think of unhealthy addiction as being trapped in a local minimum of pain -- given limited resources, including limited personal strength to change the circumstances or environment one is in (e.g., job, marriage, housing), then addiction to a substance, or even a non-drug activity, can become a local minimum of pain, all avenues out of which produce, short-term, more pain than the status quo.

So it can be philosophically argued that addiction is a rational decision given the circumstances and the resources available. The key to successful addiction treatment is not behavior modification or "education", but providing resources so that one may escape local minima, and without punishing them for any behavior which does not harm others (hurt feelings doesn't count).

If the drug use is focused on and punished, even criminally, it never addresses the underlying issues which led to drug use being an escape from pain in the first place.

In the current system, harsh punishment for drug use, or paternalism over one's life in the name of "protecting one from himself", becomes more important than the principles of improving happiness or avoiding coercion against fellow humans.

We acknowledge that the drug addiction is a complex issue and with our current understanding of human psychology it's hard to generalize the rationals behind the addition.

With regard to the law system, it basically boiled down to this: if such a behavior or activity does have the potential to threaten recipients in their well-being and the others around them, then it's probably better to ban it to allow a more harmonic society. Such as jay-walking, it is also illegal.

However, do people still jay-walk? Of course they do, because it provides convenience, a sense of accomplishment -> dopamine. So is it similar to drug use? Of course. The difference is that jaywalking laws are enforced way less than hard core drug uses.

Now laws aren't always black and white, judgment is often involved. Outside of law, mentally should we be more accepting and acknowledge drug use instead simply putting it down? Sure why not. As long as you can safely understand that it won't cause harm to you or your surrounding. But can anyone be absolutely certain of that? Afraid not.

"when stories about the effects of drugs on the brain are promoted to the neglect of the discussion of the personal and social contexts of addiction, science is servicing our collective anxieties rather than informing us." This.

Also, for who missed the link in the article: http://www.stuartmcmillen.com/comics_en/rat-park/

"When Alexander’s rats were given something better to do than sit in a bare cage they turned their noses up at morphine because they preferred playing with their friends and exploring their surroundings to getting high."

Well, AFAIK, this doesn't happen with most humans struggling with addiction to hard drugs. Addicts will neglect everything, namely social activities, in order to get what they need.

As far as you know. Firstly, the study is about the onset of addiction from one single experience with the drug. People that take a drug once and decide to not do it again don't attract the same social and media attention as heavy users. Similarly, if functional users of hard drugs exist, you are unlikely to hear about them. This is one of the effects of the drug prohibition: it hides a lot of data.

More worryingly, science becomes compromised when researchers cannot attract funding to explore unpopular hypothesis.

This. People assume that all opiate users are crackheads committing armed robbery. Many are highly skilled, highly paid professionals.

I must confess a certain amount of cognitive dissonance seeing middle-aged men in tailored suits scoring heroin on the street!

These days there is no need for that. They can just visit a "pain clinic" and get a prescription.

Apparently not in St Kilda.

I was :) I even ran a startup while I was using. Heroin is not a drug that discriminates.

>Well, AFAIK, this doesn't happen with most humans struggling with addiction to hard drugs. Addicts will neglect everything, namely social activities, in order to get what they need.<

Do you have any tangible data to support your claim?

nice try, but data are by definition intangible

Nope, synonym for tangible is factual, data is by definition factual:

http://www.merriam-webster.com/dictionary/data

http://www.thefreedictionary.com/data

Definition of tangible:

-substantially real , material

-capable of being precisely identified or realized by the mind

-capable of being appraised at an actual or approximate

We must have different dictionaries - to me tangible means perceptible by touch. But since language is defined by usage, I accept your broader definition.

http://oxforddictionaries.com/definition/english/tangible?q=...

For many people activities you mentioned is so called cage. Getting high is a way to get away from socializing, playing, friends and family.

And why? That is up to individual to answer, if he dares.

Addiction is a topic that has been poisoned by deliberate Drug War propaganda. Almost everything about drugs on TV shows, which are paid to include it in their content, is government approved propaganda.

But wait, it gets worse: Non-addicted people are sent for "treatment," in order to avoid jail. So there is a whole industry of quack medicine diluting and poisoning the real science of addiction.

The Drug War is the foundation on which most of the prison industry, and most of the budgets of police departments rests on, plus whole federal law enforcement agencies, large segments of Homeland Security, etc. Truth is a low priority. Question everything you think you know.

I didn't. I was what they call a "functional" addict, hooked on heroin. I have been off heroin and on suboxone for a year, after being addicted since I was 16. I held down a normal life, achieved a lot, and still used.

I stopped because of existential issues. I decided that having a chemical have that much power in my life, even if I kept it somewhat at bay, wasn't worth it. That was a very personal thought and decision.

What you will find, is no two addicts are the same, and broad generalisations don't hold very well. That's something that good councilors accept and work with :)

Addiction is not just about the substance (alcohol, cocaine, heroine) or the behavior (Sex, gambling, video games).

A person is an addict even before that person has that first try. There are many other factors that condition someone to become an addict. There are genetic factors, environmental factors, other underlying mental issues, etc.

True, that's why you should try to recognize your addictions before falling trapped. Like if you're super hooked to boost from caffeine, it might not be good idea to try meth.

This is a misunderstand intentionally propagated by the 'treatment' system. Sure there are plenty of factors that can play into a pre-disposition, but it is the act or the chemicals that begin a physical re-wiring of the brain. It is because of having new additional receptors, or having blocked receptors, or a number of other changes that we have what we call 'physical addiction', and that doesn't happen until "that first try".

It is also, in almost all cases, reversible. The receptors adapt, pathways change, hormonal sensitivities reset.

Imagine what it must be like in North Korea then?

This was very interesting. Thanks!

My question is this: if the rats knew that taking the morphine after moving to the park would keep the withdrawals away, would they have still taken the water?

Yeah good question! Reading that story, I understood first that rats like sweet things and hate bitter things. Second that rats are usually willing to take Hobson's choice, and the point of the article being that most scientists don't realize that's what they've actually been testing.

I understand that heroin withdrawals are pretty terrible, I've even heard said that "you'd do anything" to make them stop, but they can't kill you in a sort of way that alcohol withdrawals can.

It sounded from my reading more like toward the end of the experiments though it was becoming clearer that the rats in Rat Park genuinely did not like the effects of the drug on their normal lives, and when they had the other option of socializing, they were only still taking the drug to get at the delicious sucrose.

I have 2 rat pets. I can confirm that they LOVE sugar. It probably is the single thing that makes them fight each other for it (if one finishes candy first etc)

I hope there's more studies done like this. I have always felt there's a lot of false information about drug addiction out there--even among Psychiatrists. I know that there's many addicts out there who are literally afraid of quitting a drug; especially opiates and alcohol. 'I'm not going to get dope sick', 'my doctor wants me to spend my last 30 grand on rehab', 'I was told I will have the DT's.' I have found with most drugs-- tapering off works. This is especially true with alcohol, and opiates. No, it's not simple, but many of you don't need to wipe out your savings on hysteria. Most MD's won't talk about tapering because of liability, but if you don't have the money for a fancy rehab, many of you can taper off alcohol, and opiates, and even benzodiazepines.

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