Everything We Think We Know About Addiction Is Wrong?

Great Debates
1

Just stumbled across this video, adapted from the book Chasing The Scream: The First and Last Days of the War on Drugs, that claims that what we think we know about addiction is wrong. The video posits that we assume that doing lots of drugs (such as heroin) leads to a physical dependency, citing that postsurgery patients often take strong morphine without becoming addicted. The video also cites experiments with rats. Though rats given plain water and heroin/cocaine laced water will take the drug-laced water till they overdose, rats put in a fun environment with toys/other rats won’t take the drug water (or will take a bit of it but won’t overdose).

The video goes on to bring up a real-life analog for the rats: the Vietnam war. Soldiers used drugs overseas but, according to the video, few came back addicted. (Which right off the bat seems like a messed-up thing to allege.) So basically the overarching idea is that drug addiction isn’t caused by chemical dependency but by something missing in the person’s life. Then there’s some cute animations about how addiction can be anything–pornography, smartphones, etc.–and how we just need to connect.

On the face of it, the video seems laughably simple. There are plenty of people who are integrated members of society yet who struggle with chemical addiction. Plus, there’s the genetic component to addiction. Seems to be that some people may begin drugs because of some larger problem but that a physical dependency isn’t just going to go away because you have a few more friends.

2

Yes

3

I don’t know that “everything we know is wrong,” but the AA-derived model of “addiction is absolute, progressive and incurable” is pretentious bullshit on a par with original sin. IMHO, there needs to be a conscious and total purging of this amateur, pseudo-religious, untestable nonsense from addiction theory and treatment.

4

The alternative explanation is certainly simpler, if nothing else. Chemical dependency can never be the only reason somebody takes drugs, so the assumption that a person will take drugs for the tenth time for the same reason they took it the first time is a reasonable starting point.

5

It’s also clear that many of the assumptions about drugs being addictive are misguided at best. As many as 1/3 of regular heroin users are not chemical dependent, by whatever means used to determine that.

A significant part of “treatment” for heroin addiction is maintenance methadone, which is effective at suppressing heroin use, but is still an opioid, just one that legal.

Drug users who live in a stable, non-impoverished environment, surprise surprise, have a much lower rate of harmful behaviors associated with “addiction” than those forced to resort to criminal (or criminalized) activity to pay for drugs. Seems obvious, but again, goes to our assumptions.

There’s no evidence that the “disease-based” models of addiction have any more success at “curing” it than those that treat addiction as a failure of will-power (like AA).

It’s not clear to me that there’s evidence for “genetic” addiction that can be separated from “growing up in a home with a drug/alcohol addict” environmental explanation.

But I’d agree that most of the way society approaches addiction is wrong.

6

Well, with respect to alcohol, the CDC did a study recently in which they looked at a large body of “heavy” drinkers - 35 drinks a week or more - and evaluated them for DSM IV alcoholism.

The percentage of heavy drinkers who evaluated as alcoholic?

[ 10% ]

7

Almost Everything We Think We Know About Addiction Is Right. The problem is that much of it will be conflicting and inconsistent. That’s because people and their addictions are not all alike.

8

That’s one of my favorite youtube channels, it’s interesting that in all the things that they’ve done, this is the one that has gone viral. That said, I feel like while there’s a lot of interesting information in here, and I sort of like the conclusion, he sort of went into a bit more of a philosophical direction than the channel normally goes. That is, I think the main point that the video is trying to make is more that our approach to TREATING addiction is wrong. Why are we locking people up and telling them and treating them as though they’re sick? He sort of glosses over the physical withdraw symptoms in some cases, but I think the point is that we’d have a greater success rate in treating addiction if could provide to people with addictions a positive connection to people or other things in their lives.

Speaking more from my personal experience, everyone I know who has an addiction and has talked to me about their struggles with it, there’s always some gap in their life that it fills. They seem to start to get better when that gap gets filled, typically with friends and family, and they tend to revert when those connections start to fade. I’ve watched several of these people do really well, reestablish family connections, hold down steady jobs, deal with the general mundane details of life, and then when stuff starts to go wrong, they turn back to the addiction, and it quickly compounds and their life falls apart.

And while I’ve never been addicted to any substance; hell, I only drink alcohol occasionally, and only tiny amounts of caffeine in tea or whatever. However, as is mentioned in there, I have had psychological additions to games and other similar things. Overwhelmingly, as I’ve looked back in recent months, that my time spent with games was always inversely proportional to how many healthy relationships I had in my life. And even though I had some particularly tough times in recent months, and I found my desire to play increase, I also found that my issues compounded the more I played. Once things finally started to turn around, and I made a point of making a big cut in that, I have more time for friends and family, I’m generally much happier, and my only desire to even touch them now is entirely for social reasons. I’d flat out quit entirely if it weren’t for the fact that I play with my brother and a good friend.

So, I guess, I think he is overzealous and preachy with the point he’s making, but I do think we’d probably see better results in treating addiction and a lot fewer to start with if we did a better job of being inclusive and socializing and reduced the stigma attached to addiction.

9

Eh? I grew up in a completely smoke-free home (my dad stopped smoking a pipe slightly before my conception), and one with no other addiction issues. But I am both physically dependent on nicotine and psychologically dependent on cigarettes.

10
11

I grew up in a house usually blue with cigarette smoke, especially during family gatherings, and am in the great minority of nonsmokers in my extended family. I tried one giveaway 4-pack around 12 or 13, hated it, have had precisely one memorable drag in the decades since.

12

Ibogaine experiences seem to include an introspective reassessment of emotional material in the person’s life. Often resulting in an immediate cessation of craving.

13

I am not clear on what we believe about addiction that is disproved by the discovery that addicts have gaps in their lives.

But suppose that this is most of the reason. I can’t watch the video right now - does he say specifically what those gaps are?

Regards,
Shodan

14

It’s overstating the conclusions. It’s missing a big factor. Both of the situations where people didn’t become addicted was because the drug was being used for pain management. And it’s long been known that addiction is less likely in those circumstances. In fact, it’s the reason doctors are taught to avoid giving enough to remove all the pain.

Yes, it’s true that drugs are less addicting if you have alternatives. Our own natural highs can overcome the desire to do drugs in the first place. But that’s not new either. It’s what the anti-drug advocates have been saying for decades.

What’s new is just recognizing that the way we treat addicts is only making problems worse. And even that was obvious if you thought about it.

15

That they lack “connection” with other people. That they are socially isolated. That people turn to drugs to get the effects they would otherwise get from socialization.

The main thing is that it disproves that harsh treatment of drug addicts works. But, again, that’s not really new. But it is nice to have a real test to confirm it.

Addiction is not automatic, as we used to think. But it’s not like AA hasn’t been saying that forever. Alcoholics have a mental illness, they say. It’s why some people can drink freely and others can’t.

I for one know I cannot.

16

If the problem is lack of social connection, then I would have thought that treatments like AA that offer a social group would work better than they do.

And diversion to AA is a pretty common alternative to other kinds of sanctions. So if the premise is correct, “how we treat addicts” is not wrong.

Regards,
Shodan

17

Perhaps they need to make social connections with people who aren’t addicts. Anyway, even if that works it’s only going to be on a limited percentage of addicts. There’s no one cause or solution to addiction, and sequentially moving through different solutions to be applied to everyone won’t be effective.

18

Two years ago, my son was in the hospital for two months and was on morphine for 3 weeks or so while on ECMO. He spent the last 3 weeks of his stay on methadone to counter the potential addiction. Based on this, I don’t accept the statement that post-surgery patients have no issues with morphine.

19

I don’t disbelieve you, but…One personal example does not a cite make!

20

Different people clearly have different reactions to different things. For some people weed doesn’t do anything. Some people get addicted to video games that are barely disguised Skinner boxes. Saying they’re secretly depressed doesn’t seem that useful.

Another angle is social drug use.