
Drug addiction: The great American relapse - prostoalex
http://www.economist.com/news/united-states/21633819-old-sickness-has-returned-haunt-new-generation-great-american-relapse?fsrc=scn/fb/te/bl/ed/americanrelapse
======
onelittlepoint
I'm an upper-middle-class, white, software developer with a CS degree from a
top university. I do not drink a drop; I do not "get high."

But I used to be a heroin addict.

Before then, I used Oxycontin - crushed up and snorted - which was a great
kick and very, very easy to fall in love with when you first try it.

The Oxycontin pill formula switch had ominous effect. In short, my pusher had
no clients anymore and switched straight to heroin. Turned from kids snorting
pills for highs into a shooting gallery almost overnight. The last "classic"
Oxycontin I remember hearing about went for $160 a pill.

Like Scudo, I started with brown heroin. Snorting it also. And under the same
delusion that somehow snorting it made me "not a heroin addict."

Nothing like the cognitive dissonance of a dozen middle-class white kids
making their first casual acquaintances with heroin.

But drug has a noxious, subtle allure. One night, with only a few $20s in my
pocket and the ATM just out of walking distance, I chased down a bit more
rush. Someone showed me how to shoot it.

"You put the needle in your arm." Casually as ever. Like explaining how to
pull a good espresso. "You're new to this so your veins are easy to find. Not
like mine. When you pull back the plunger - like this," drawing blood, "you
know you've found it." Had it done for me, because I was scared and couldn't
hit.

I threw up a lot and felt better than uninitiated will ever comprehend.

Months passed. Then something started happening, something I hadn't dealt with
before: People started dying. Kids who had futures started dying.

I won't bore you with the howls of addiction and disaster that followed, nor
with my own personal triumph of escape. But I will leave with one point:

This article is spot-on; the elephant in the room for many a community of
parents who can't stomach much longer watching more of their kids die.

Heroin is not just in the underbelly of the world anymore. We need to stop
treating it like a pariah and start actually trying to fix it.

~~~
tim333
It's always seemed to me the fix is technically quite easy even if politicians
find it hard to vote for - provide safe heroin or similar to addicts for free
/ low cost at addiction treatment centres while at the same time keep
supplying drugs on the open market illegal. That way the dealers lose most of
their income and get other jobs, the addicts are at least safe and the general
public don't get their stuff nicked. I don't know why it's so hard to get that
implemented. It has been done in the past in the UK and it works.

~~~
netcan
I'm generally in favour of drug legalization and I think we should carefully
experiment with even legalizing heroine/opiates.

However, I don't think this is a "fix" any more than legal alcohol is a fix
for alcoholism. Legal or not, there will be user and there will be addicts.
Legality might be an improvement but it doesn't solve the problem.

I don't know if there is a solution. An effective treatment for addiction is
the only thing I can think of. We don't even have effective treatments for
eating disorders.

~~~
valarauca1
A quote I like to fall back on is the one from Portugal, which no longer has
(edited) criminalized substances.

"If you realize addiction is simply a symptom of a deeper underlying mental
illness. Treat the illness, you solve the addiction."

But yes there will be addicts.

~~~
mercer
While I think it's a huge improvement to see addiction something other than a
'crime', I think assuming it's a symptom of a deeper underlying mental illness
is still not ideal. It's too simple.

Consider addiction to smoking. There are plenty of people who picked up
smoking for no other reason than 'fitting in' or 'curiosity'. Which I'd hardly
call a mental illness. Many of these people kept smoking, and sadly probably
many of them died from smoking.

Similarly, I suspect there are many alcoholics who slowly became so because
they entered a culture of alcohol.

Addiction is a powerful thing in itself, and while the solution to many might
be uncovering the underlying mental illness, for many it might 'just' be a
matter of unlearning a powerful, destructive habit.

Of course in both cases professional help is necessary, but treating an
'underlying mental illness' in cases where there are none can also have bad
consequences.

Among the many addicts and ex-addicts I've known, there have been more than a
few that were actively treating a 'deeper underlying mental illness' that I
suspected didn't really exist in the first place. And while that's probably
better than being an addict, it's still not good.

in fact, this is one reason I have issues with the approach Alcoholics
Anonymous. They seem to treat all alcoholics as sufferers of a lifelong
disease, and I cannot help but wonder if being constantly reminded of a thing
you don't want to do anymore is a good solution for all people. For some,
sure. Some people might have the 'alcoholism gene'. But I don't think that's
always the case.

~~~
valarauca1
There is a difference between chemical and psychological addiction you
completely overlook. I was generalizing the later, as it can be dealt with,
with consoling.

The former can be very nasty and serious. It didn't mean to belittle it, or
people who've fallen prey to it.

~~~
mercer
There's a difference, but it's not black and white, and I find it hard to
imagine that most chemical addictions we know are bad enough in themselves to
cause the extreme behavior that addicts exhibit.

Regardless, I was primarily thinking about the psychological side of addiction
in the above post, and I think my point still stands. There are many examples
of (almost) purely psychological addictions that people suffer from, and also
in those cases I think it can be an interplay of habit formation, personality
characteristics, and environment, that 'maintain' it, and not always 'deeper
issues' (although I suppose one could consider environment a deeper issue...).

------
lmg643
I'm not so sure that enforcement-led mechanisms won't work, at least, if there
is global coordination focused on production.

The Taliban, for all its faults, was able to effectively eliminate opium
production back in 2001, and Afghanistan is 80% of world supply:

[http://www.nytimes.com/2001/05/20/world/taliban-s-ban-on-
pop...](http://www.nytimes.com/2001/05/20/world/taliban-s-ban-on-poppy-a-
success-us-aides-say.html)

After 14 years of US intervention in Afghanistan, we have succeeded on at
least one metric - all-time record opium production:

[http://time.com/3580627/opium-afghanistan-record-high-
united...](http://time.com/3580627/opium-afghanistan-record-high-united-
nations/)

It stands to reason - if our foreign partners are able to resist local
corruption, we could stamp out production. (So far, only religious fanatics
seem to be able to resist.)

~~~
jaredhansen
Maybe the fact that the Taliban ("for all its faults", indeed) is one of the
only regimes on record to significantly reduce opium production should tell us
something?

~~~
jerf
That if we use the same tactics as the Taliban we too could stomp out drug
use? I'm not sure you're going to get a lot of support there; it sounds like a
cure worse than the disease. [http://abcnews.go.com/International/taliban-
behead-17-singin...](http://abcnews.go.com/International/taliban-
behead-17-singing-dancing/story?id=17084797)

------
recondite
It seems with all the media that's been produced about heroin addiction
(movies like Requiem for a Dream, Trainspotting, Traffic, etc...) that the
risks of shooting up are fairly well known.

Yet, people still continue to use and get addicted to the drug. I feel a great
deal of pity for the people whose lives have been destroyed by heroin, not
just because of their addiction, but because of the underlying pain that must
have been there for them to get to that point.

~~~
hedning
I think the public at large thinks heroin is much more dangerous than it
actually is. The rate of addiction is about 23%[1], compared to alcohols 15%.
You don't get addicted just by shooting up one time. And opiates aren't
actually that destructive on the body either, the lifestyle of a junkie is
though.

[1]: Comparative Epidemiology of Dependence on Tobacco, Alcohol, Controlled
Substances, and Inhalants: Basic Findings From the National Comorbidity Survey
([http://www.umbrellasociety.ca/web/files/u1/Comp_epidemiology...](http://www.umbrellasociety.ca/web/files/u1/Comp_epidemiology_addiction.pdf))

~~~
orbifold
15% of people who drink alcohol become alcoholics? That seems steep...

~~~
klibertp
Not really, but it depends on your definition of alcoholism a lot. For
example, if you treat every alcoholic as "alcoholic for life, with some of
them sober" it makes sense.

~~~
orbifold
I took a look at the study and indeed they defined it as Alcohol dependent at
one time in life.

------
netcan
The prescription-to-addiction pathway is an unforced error.

If someone is prescribed opiates for long term pain the risk of addiction is
serious. If 5% of patients had strokes, doctors would cut down prescriptions
to immediately life threatening use only. I don't know what duration/dose gets
you to 5%, but I suspect whatever it is you will find those are not as
uncommon as they should be.

To generalize, doctors misunderstand and underestimate addiction in a lot of
way. Maybe treating addiction is not their domain but this is a violation of
their basic creed.

Palliative care. Post trauma emergency care. Short term post op recovery.
These are reasonable uses of opiates. An open ended prescription for chronic
back pain is dangerous.

------
austerity
It's quite telling that the heroine chose to sell her oxycontin and buy heroin
instead of telling her doc she's hooked and suffering withdrawal.

~~~
valisystem
This explains those kind of behaviors :

[http://np.reddit.com/r/Drugs/comments/1rhn38/heroin_users_of...](http://np.reddit.com/r/Drugs/comments/1rhn38/heroin_users_of_rdrugs_are_you_addicts/cdo968m?context=3)

~~~
doctorfoo
> It doesn't just kill physical pain like ibuprofen, it also kills
> psychological pain, emotional pain and the pain caused by social phobias.

Huh. I've tried quite a few different meds in the search for a chemical cure
for social phobia, and always, somebody eventually suggests opiates as the
only thing that will truly act as an "off" switch. (Accompanied by the usual
dire warnings.)

I don't think I'll ever risk it though. But I can see why some people do. I
wish the pain killing component could be separated from the addictive part.

That reddit link was a very interesting read.

~~~
graeme
>Huh. I've tried quite a few different meds in the search for a chemical cure
for social phobia, and always, somebody eventually suggests opiates as the
only thing that will truly act as an "off" switch. (Accompanied by the usual
dire warnings.)

I've gone from mild social anxiety to serene confidence in social settings. No
drugs.

What helped was treating it as a skill like any other. I was anxious because
frankly, I sucked at social interactions. I didn't know how to make small
talk, eye contact, and the very fact that I worried about how I was doing made
people enjoy talking with me less.

So one by one I identified skills I lacked, and worked to acquire them in
small, incremental steps.

For instance, talking to strangers. Start by asking a stranger the time. Then
do it a few times. Notice that everything goes well. Once you've done that a
few times, you've now got that as a skill.

Interacting with strangers. When you're at a store, make a comment to the
cashier about something in the environment. They'll respond. Then you respond
with something. Note how they react. Do this a bunch of times and it'll become
natural.

Etc, etc. Look at people who are good at social interactions. What are they
doing differently? What skills can be isolated and learned?

Anxiety itself can be approached laterally, with meditation. I don't recommend
this route, but what worked for me was a major health crisis that forced me to
confront death and loss. After that, social difficulties paled in comparison,
and I'm not afraid of any social interactions anymore. Mindfulness was what
let me get through that time of trouble by growing, rather than shrinking into
misery.

What's good about social difficulties is that they are very easy to practice.
All around you every day are thousands of opportunities to interact with
others. If a skill can be practice, and you can get feedback, then that skill
can be learned.

~~~
pm90
Yep. While Im sure there are a lot of people with medical issues that make
them become socially inept, I think that social skills in general are just
that: skills. You can't start programming like a pro from day one, it takes
years of effort. And so does this skill.

------
PaulHoule
Law enforcement in many rural areas feels under seige from heroin. Around
Ithaca NY a few weeks ago they found a dead black guy floating face down in a
ditch behind Walmart and then the next week a white kid od'd. So there is a
very real body count here.

~~~
MichaelGG
The body count is far higher from the number of people jailed or "forced" to
become criminals because of the illegality of a relatively side effect free
drug.

~~~
PaulHoule
People who mix opiates with alcohol or benzodiazepines face serious risk of
death. 9 times out of 10 you find a person like this face down on the floor
and you rouse them and they are a bit discombubulated for a few minutes.
Sometimes you can't rouse them but they will wake up when the chemicals wear
off. Sometimes they don't wake up.

And yes, the illegal status of opiates and the criminal network enforced by
that is a part of the problem, but the fact is that first responders and
ordinary citizens are facing collapses like the one above today.

------
vermontdevil
The path to addiction via prescription is ironic given how surgical procedures
have gotten less invasive.

Wonder if the numbers will regress over time now that new entrants to the
hospitals will get less access to opioids

------
jqm
Based on this article, it seems that one answer might be further research on
non-opioid painkillers. Sure, there will still be experimenters/thrill seekers
who wind up with problems, but the people exposed through the prescription
system (most?) will greatly be reduced.

------
bigbugbag
Can someone provide a mirror link to the article ? this fails to load on both
my 3 browser, blocked at some explicit consent page:
[http://i.imgur.com/Ui4ARZe.png](http://i.imgur.com/Ui4ARZe.png)

------
Folcon
> Now that heroin addiction is no longer a disease only of the urban poor,
> however, attitudes are changing.

I wonder how much society would be different if reactionary assumptions like
this weren't the norm.

------
amelius
If you're thinking about what is the culprit here, then consider that the
whole of our economic system is flawed, because capitalism encourages the
creation of addictive goods.

It is the world we live in that transforms us into addicts.

~~~
venomsnake
People have used chemical mood enhancers in all kinds of society and economic
systems.

