
Drug addiction: The complex truth - carey
http://mindhacks.com/2013/09/13/drug-addiction-the-complex-truth/
======
ArbitraryLimits
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.

~~~
pekk
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.

~~~
Pxtl
Related:

[http://en.wikipedia.org/wiki/Rat_Park](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.

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

------
netcan
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.

~~~
guelo
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.

~~~
z-factor
You have a strange standard for 'savvy' people.

------
oneofthose
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.

------
robbiep
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)

~~~
konstruktor
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.

~~~
snom380
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.

~~~
MichaelGG
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.

~~~
snom380
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.

~~~
MichaelGG
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](https://en.wikipedia.org/wiki/Paul_Erd%C5%91s)

~~~
snom380
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...](http://www.theguardian.com/business/shortcuts/2013/apr/15/cocaine-
bankers-global-financial-crisis)

------
bane
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.

~~~
NotAnEngineer
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

~~~
dusklight
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?

~~~
Alex3917
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.

~~~
zafka
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.

~~~
Alex3917
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.

~~~
zafka
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...](http://www.psychologytoday.com/blog/addiction-in-
society/201112/the-seductive-dangerous-allure-gabor-mat)

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

~~~
Alex3917
What's the point of reading a refutation if you haven't read the original? You
don't even know what you're reading.

------
AznHisoka
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?

~~~
delluminatus
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?

~~~
codyb
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.

~~~
delluminatus
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](http://en.wikipedia.org/wiki/Yamas)

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

~~~
codyb
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.

------
rwmj
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.

~~~
onion2k
"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."

~~~
strickjb9
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.

------
GotAnyMegadeth
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...](http://en.wikipedia.org/wiki/Nicotine#Dependence_and_withdrawal)

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

~~~
hackula1
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.

~~~
borkabrak
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.

------
jmcgough
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.

------
pcvarmint
"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.

------
gtr32x
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.

------
talles
"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/](http://www.stuartmcmillen.com/comics_en/rat-park/)

------
jmngomes
"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.

~~~
TelmoMenezes
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.

~~~
westicle
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!

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

~~~
westicle
Apparently not in St Kilda.

------
cwarrior
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.

~~~
jasallen
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.

------
FollowSteph3
Imagine what it must be like in North Korea then?

------
blueblob
This was very interesting. Thanks!

------
mumbi
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?

~~~
yebyen
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.

~~~
Ziomislaw
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)

------
marincounty
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.

