
Brain, Mind, Body and the Disease of Addiction - happy-go-lucky
http://www.npr.org/sections/13.7/2016/12/16/503317842/the-surgeon-general-s-new-report-on-addiction
======
md224
"Addiction" is a very tricky concept... Wikipedia defines it as "compulsive
engagement in rewarding stimuli, despite adverse consequences". But what if
the person engaging in the behavior doesn't mind the adverse consequences?
What if the only adverse consequence is a slight decrease in life expectancy?
How bad do the consequences have to be before a behavior becomes pathological?
The line we draw here seems rooted in personal values, not an objective
standard.

What if someone uses amphetamines daily and really doesn't want to give them
up. Are they addicted? What if they later learn they have ADHD and they've
just been self-medicating? What if they don't have ADHD but the drug just
improves their life? What if their name happens to be Paul Erdős?

If someone suffers depression from opiate withdrawal, we call them an addict.
If someone suffers depression from going through a breakup, it's just par for
the course. And yet both scenarios are withdrawal from a pleasurable stimulus.
Why is one acceptable and the other not?

~~~
concinds
> But what if the person engaging in the behavior doesn't mind the adverse
> consequences?

Addiction is by definition not something that is indulged in voluntarily by
carefully weighing the consequences. I recommend you familiarize yourself with
the Jellinek Curve, which accurately describes the guilt and shame that
results from addiction.

> What if the only adverse consequence is a slight decrease in life
> expectancy?

Addiction itself not only has much worse consequences than that, but you're
omitting the fact that addiction is present for a reason. Addiction is self-
medication of excessive pain, and that excessive pain has deep, significant
adverse effects. There is a reason that addiction is often comorbid with
family dysfunction; addiction is a response to pain, not just a cause of pain.
"Curing" an addiction involves reducing this pain to remove the need for self-
medication.

> The line we draw here seems rooted in personal values, not an objective
> standard. We need to recognize that subjectivity when we discuss addiction.

The line is very clear. If you compulsively use, in a way that harms you, to
relieve inner pain, it's addiction. Treating addiction as a "subjective" thing
just ignores the pain-dimension which drives people to addiction in the first
place, to run away from their pain.

Society's focus should be on becoming more nurturing and cohesive, which'll
hopefully result in fewer people being in so much pain that they'll destroy
their lives and relationships just to feel remotely human.

~~~
md224
> Addiction is self-medication of excessive pain

Well if you're going through excessive pain, self-medication sounds like a
pretty reasonable response. What are you going to do, just suffer it? Therapy
is nice but it doesn't solve everything.

Would it be better if you took the "self" out of the equation and were
supervised by a professional?

> If you compulsively use, in a way that harms you, to relieve inner pain,
> it's addiction.

So this requires all 3 parts though, right? If you compulsively use to relieve
inner pain but without harm, that's okay, right? How much harm is allowed
before it's addiction?

~~~
concinds
> Well if you're going through excessive pain, self-medication sounds like a
> pretty reasonable response

No, it's a survival mechanism. It only reduces the pain superficially and
temporarily. It's like giving an adrenaline shot to Atlas instead of getting
the Globe off his back.

>So this requires all 3 parts though, right? If you compulsively use to
relieve inner pain but without harm, that's okay, right? How much harm is
allowed before it's addiction?

It's all motivation. Addictions are a way to deal with deep-seated and
excessive shame, guilt, fears, hopelessness, despair, and loneliness. If
that's why you take a drug, you're only hurting yourself by not seeking help
for the aforementioned problems. If you're taking a drug just for fun, that's
fine.

Note that many addicts will lie to themselves and pretend the latter applies
to them.

~~~
projektir
> Addictions are a way to deal with deep-seated and excessive shame, guilt,
> fears, hopelessness, despair, and loneliness.

Has this link been established? I haven't got the impression that these things
have such a causative link. People can be perfectly normal but have addictive
tendencies where they can't touch things like alcohol or gambling, and then
some people may be fairly miserable but not get addicted to things.

Addictiveness always seemed like its own trait, and the claim that people who
get addicted to things must be miserable better have some solid evidence
behind it. Really not a fan of the whole trend of trying to tell people they
have "deep seated problems".

~~~
crawfordcomeaux
I used to think the same way. As an addict of 20+ years who's been in recovery
for about a year, I hated hearing that my family system was something I needed
to work on, as opposed to what seemed to me like more relevant/prescient
issues of not being able to develop basic self-care behaviors/routines for
myself.

Then I came out of denial about being sexually traumatized numerous times by
someone close to as a kid in March. The changes I've undergone since have been
dramatic as hell & I became a completely different person within a week. I
started learning to: speak my fears, say what's on my mind, abandon seeking
the approval of others, let go of my anxieties, allow myself to feel my
feelings, identify emotions I hadn't felt before or at least not since I was a
kid, and more.

I now think we need to tell people the most thorough approach to dealing with
addiction starts with assuming there's a deep seated problem until another
cause has been proven because that mindset helps break through any denial the
addict may not be aware of. I was certain my experiences hadn't traumatized me
& it was only after I developed the habit of questioning everything I thought
about myself that I challenged the assumption it wasn't traumatic.

The problem I foresee is people taking a less-than-compassionate approach or
not educating the addict on the reasons for THE ADDICT to adopt that line of
thinking. Once an addict is willing to admit they have a problem & to work on
it, then we can ask the questions of how thorough they want to be with their
recovery & whether or not they're willing to take a scientific approach for
the sake of being thorough.

~~~
projektir
This seems like you are talking your situation and trying to apply it to
everyone else. This is exactly the kind of thing we must not do, because
that's a lot of people to convince of deep-seated problems and a horrible
thing to imply if we're wrong. I am not convinced even from your description
that the causality is as you say.

Addictions are often associated with substances or activities that are
pleasant. It is not at all surprising that people who are in pain want to
engage with pleasant substances or activities. So it is, again, not
surprising, that some of those people may get addicted.

Yet, many people don't. Many people successfully "self-medicate" with such
substances in the worst of times and don't become hopelessly addicted to them,
easily dropping them once the aggravating factor goes away, and sometimes the
substance even helps. And then there are people on the other side, where their
life is completely normal and can instantly go off the rails if they have even
one beer. People for whom addiction isn't a solution for a problem, but the
cause.

~~~
crawfordcomeaux
I'm not looking to convince anyone of having deep-seated problems.

Here's a reframing of my argument. I think:

\- two sources of addiction that are the most difficult to identify are
undiagnosed/unknown physical causes and undiagnosed/unknown psychological
causes.

\- belief impacts the brain's ability to recognize or ignore patterns

\- medical professionals usually better able to diagnose/discover physical
causes than patients because they've received a lot of training & have access
to good tools for examining the patients

\- medical professionals need to practice assuming (ie. TEMPORARILY choosing
to believe) something's physically wrong with the patient (especially since
addictions has physical effects on the brain!) in order to reduce the
incidents where a patient's issues are easily dismissed as psychosomatic

\- mental health professionals lack good tools for diagnosing/discovering
mental issues & can't directly inspect a patient's psyche

\- patients can help mental health professionals diagnose/discover mental
issues, as well as confirm the absence of any, by assuming
(again...temporarily & only during the time when with the professional) they
do have deep seated issues & they simply aren't aware of them

Once someone's willing to explore their own psyche with curiosity and if
they're willing to share w/the professional whatever comes to mind, they can
start making a list of things in their past that seem questionable, including
the things they normally wouldn't consider.

If there's anything I'd like to convince people of, it's the benefits of
learning how to temporarily challenge one's own standard patterns of thought,
ie. having an open mind.

------
panglott
This is the problem with "mental health" as a metaphor from bodily health.
It's better than simply moralizing about addiction, sure, but leaves people
with very muddled thinking about the topic through taking the metaphor too
literally.

So much of these debates seem like there's a confusion of causes and symptoms.
Childhood trauma is as predictive of addiction in adulthood as obesity is of
heart disease. Loneliess and personal trauma are just enormously corrosive to
a person's mental well-being, but it seems like the mental health frame rarely
attempts to deal with problems like that.

~~~
concinds
> it seems like the mental health frame rarely attempts to deal with problems
> like that.

I think viewing mental health as similar to physical health is useful (since,
in mental as in physical health, lack of symptoms does not indicate good
health). It's that we have no clue how to bring people from low psychological
health to solid psychological health.

For physical health, you need a good diet, exercise, and sleep. What do you
need for mental health? Meditation? Even then, doctors have never told
patients to "meditate more", whereas they do tell obese patients to eat less
and exercise more. I know meditation isn't effective at solving pathologies,
but it's telling that we as a culture have no clue what causes and promotes
pathology in the first place.

~~~
crawfordcomeaux
For the past two weeks, I've starting developing/discovering a testable theory
for how the mind/body/brain work together by viewing the brain as a neural-
network-based machine that can rewire itself, the mind as a VM that runs
programs in a well-typed functional language w/effects & coeffects. All 3 are
inputs/outputs and the body is the only one able to carry out effects on the
external environment.

I've been able to dramatically reduce my daily anxiety without medication in a
matter of minutes. I'm finding the model directly implies things we already
know, such as why first impressions are important & how to overcome bad ones,
as well as aspects of how bad first impressions are related to trauma in some
ways. Using the model, I came up with a technique to drastically improve the
rigid action in my left pinky for 30 mins to the point that it moved almost as
smoothly as my right pinky. 10 years of playing piano and/or sax when growing
up didn't help it at all, but 2-3 mins of a simple exercise practically cured
the issue.

I'm currently looking for experts to help me flesh out what I believe to be a
new approach to mental health that's more effective & can more easily be
specifically tuned for individual problems. What I need are category/type
theorists to help w/the mathematical model, neuroscientists for the brain
stuff, and anyone else willing to explore/play with the ideas. I could also
use help figuring out a way to develop an open source science experiment that
anyone can participate in & that produces scientifically legit data.

~~~
concinds
My current model of the psyche is based on Internal Family Systems theory[0],
which seems much more accurate, useful and potentially more effective than
current models. I'd be very interested in playing with your ideas and seeing
how the two models can improve each other.

[0]: [https://www.selfleadership.org/outline-of-the-Internal-
famil...](https://www.selfleadership.org/outline-of-the-Internal-family-
systems-model.html)

~~~
crawfordcomeaux
I'm familiar with the basic concepts of IFS & think they line up really well
with the foundations of my model. I've only read the first few sections of
your link, but will read the rest today.

Would you be willing to call me at 206-432-7671? I'm not great w/email right
now, but if you'd rather that, it's crawford.comeaux@gmail.com.

------
concinds
95% of the article explains how addiction isn't just a disease of the brain.
The conclusion is a non-sequitur claiming that people only have compassion for
addicts because they view addiction as a "brain disease". Am I
misunderstanding this?

For reference, he's the NPR article on the SG's report on addiction[0]. All
the Surgeon General is trying to do it to shift addiction from an issue of
personal blame that's widespread in the culture ("he's just an alcoholic!")
and make people view it as a complex pathology that we need to address. The SG
also proposes school programs to teach about substance misuse, and stress-
management, as stress obviously contributes to addiction. What's unreasonable
about any of this? The article in OP seems impossibly nitpicky.

[0]: [http://www.npr.org/sections/health-
shots/2016/11/17/50240240...](http://www.npr.org/sections/health-
shots/2016/11/17/502402409/surgeon-general-murthy-wants-america-to-face-up-to-
addiction)

~~~
JacksonGariety
The author is a philosopher. He's raising the question of why we seemingly
need to reduce people's behavior to their neurology in order to have
compassion for them. It's a philosophical question.

~~~
concinds
I missed that he was a philosopher. Still underwhelmed by the article. He's
raising the question, but doesn't even attempt to answer it.

And he doesn't even demonstrate that we even feel a "need" to do this to feel
compassion. That's why it feels like a non-sequitur. The article is more quip
than demonstration.

~~~
JacksonGariety
Philosophers aren't in the business of pretending to have answers.

By "need" I just meant that it was a matter of course that the surgeon general
said it.

------
mjevans
I believe the reporter is still trying to place blame. This is both counter-
productive from a treatment standpoint, and also probably in direct conflict
with what the /lead/ for experts in the US has stated is the case.

That once addiction has set in, it is every bit as much a disease that
requires external intervention and treatment to correct the imbalance as the
other conditions.

~~~
twblalock
The author is arguing that the reduction of addiction to a neurological
concept ignores a long list of other components to addiction, some of which
are moral, some of which are environmental, and others.

The author further argues that people make this reduction because they think
it prevents addicts from being blamed for their addiction, and that doesn't
make sense because when you talk about what is going on in someone's brain,
you are talking about most of what you consider to be the person, including
that person's personality, beliefs, thoughts, feelings, etc.

So, it's not an attempt to blame anyone. It's an argument that the mechanisms
people use to deflect blame don't make sense.

In other words, people who blame addicts for their addiction have no reason to
stop blaming them if addiction is reduced to a neurological pathology, and
people who don't blame addicts have no reason to start blaming them if
addiction is reduced to a neurological pathology. The neurological pathology
thing doesn't make a difference.

------
LordHumungous
>This marks, by the way, a difference between addiction and chronic diseases
like diabetes, with which the surgeon general compares it. Both diabetes and
alcohol or drug addiction have life style components. Bad diet and low levels
of exercise trigger type 2 diabetes in those prone to the disease. In a
similar way, drug abuse causes addiction. __But diabetes comes down, finally,
to a difficulty managing glucose levels in the blood. __You can 't say that
addiction boils down to something straightforwardly physiological in the same
sort of way

Is diabetes really that straightforward? Diabetes and heart disease are linked
to obesity which is linked to diet and exercise. Most people who are pre-
diabetic or hypertensive can reverse their condition through lifestyle
changes, yet most fail to do so.

And I would disagree that addiction lacks a physiological component in its
later stages. Withdrawals are absolutely a physiological phenomenon and a big
reason why people continue to use.

------
MarkPNeyer
There's a huge difference between illness and injury.

A broken leg isn't a disease, it's an injury. You treat the injury - avoid the
situations which lead to it - and things are fine.

Moralizing is destructive, but so is saying "now it's not your fault that you
went skiing without knowing how."

I think the best way of looking at lots of mental health issues is through the
lens of _injury_, not illness.

More on this: [https://markpneyer.wordpress.com/2015/06/01/broken-leg-
disor...](https://markpneyer.wordpress.com/2015/06/01/broken-leg-disorder/)

------
benevol
PSA: There have been lots of reports of people getting rid of their addiction
or obsessive-compulsive disorder (OCD), as a byproduct of their experience
with LSD or psilocybin (the active substance contained in "magic mushrooms").

------
projektir
> The slogan that addiction is a chronic disease of the brain is meant to put
> the addict beyond the reach of moral reproach — and addiction itself
> squarely into the domain of the medical rather than the moral.

> Now, I agree that addicts should be treated with love and compassion instead
> of judgment and punishment. But what does it say about us if the only way we
> can muster compassion and love for those among us with substance abuse
> problems is by suggesting that they are solely bystanders unjustly afflicted
> by mechanisms in their brains?

This is a recurring problem that I think is only going to get worse once we
get more knowledgeable about many things. Genetics, mental processes, ethics.

I believe it's tightly coupled to the idea of total free will, and as long as
that idea is the dominant philosophy of a society, it cannot have compassion
for these people as it perceives them as acting freely. This leads to the just
world hypothesis. We feel compassionate about injustice; negative outcomes
coming from free will are, by definition, not unjust. Among those whose desire
to have compassion is great enough, they have to say that the people in
question are dealing with a physical problem, as physical causes are the only
things that are perceived as capable of encroaching on total free will.

In reality, there is no problem. A person may have a mental model that leads
them to addiction. That mental model, most likely, makes sense to them and in
their circumstance. Note that mental problems are not fully logical - we're
not solving the framing problem. Genetics and environment are pieces here.
Given this model, they choose addiction, because in their model, it makes
sense. It turns out (we think, md224 has some interesting comments on that
part of the equation) that their model is somewhat faulty, and now in addition
to having a faulty model and knowing that it's faulty somewhere, they have the
expected effects of physical addiction to deal with. Just reading this
paragraph shouldn't lead anyone to believe that it will be straightforward for
them to suddenly develop a perfect mental model to deal with the addiction
from this situation, even if such a thing is possible. The person has made a
choice, but it doesn't really matter that they did, and the choices they
continue to make, may, again, not matter. There's nothing magical about
choices, they're still limited by one's mental model and therefore will never
be truly free. They may find a way through to a good model. Or maybe some good
people will help them make their way there. Or perhaps a physical intervention
will accomplish the same even faster.

Feeling compassion towards someone trying to navigate this complex world?
Easy. Just get rid of the idea that we're all sitting in front of two nicely
presented plates where one clearly has good choices on it and the other
clearly has bad choices on it. That's not how it works.

But we can't think like this. The philosophy of total free will does not allow
it. A person either has free will or they don't. Therefore the plates must
clearly be there, and any good person will choose things from the right plate.
Therefore, any person choosing addiction is fully aware of the outcome and
expects exactly the same thing that we expect, so if it happens to them, we
get to blame them and put the _full_ weight of the responsibility that free
will implies upon them. And from there comes pain.

The terms we use when we talk about agency: attitude, personal responsibility,
consequences. These terms became steeped in guilt and shame and authority.
Because that is the price we put on agency: if you want to have it, you must
feel constant guilt and shame, over any decision you make that _we_ didn't
want you to make that has a negative outcome. These are not light emotions,
and especially those raised to be good and conscientious will be rather
vulnerable to them. These inform of one's status and worthiness and acceptance
in the tribe. To feel constant guilt is to not just make mistakes, but to also
be wrong fundamentally, as we know one must not feel it constantly. What is
one to think when they are convinced by others that they, completely freely,
constantly make bad choices? That's a hell of a cross to bear.

Little surprise is it, then, that many people decide that they don't want any
of that agency if it comes at the price of constant pain and living life at
the lead of someone else. We want to avoid pain, not experience it. They
either deny the choices themselves, or deny that they made them, or deny that
the choices existed. Anything else leads to pain. They are not allowed to
merely banish guilt and shame and reclaim their agency due to the philosophy
of total free will, so they just banish all of their agency all together.

