YES I'm sure some of us can quit on our own or can "grow out" of our addiction if we don't end up dead or in jail first. I'm sure there cancer patients out there who are cured and have never had a single treatment, but you can bet that most people with cancer get some sort of treatment and help.
Bottom line is, YOU DON'T HAVE TO GO AT IT ALONE. There is help available, so why not use it? AA, NA, HA ,CA, Wellbriety, going to therapy, medical professional, it's all there to help so use it. You doesn't HAVE to take 15 years to "grow out" of alcoholism if you can get the support you need to help you quit sooner.
Tonight I'm speaking at a DETOX and I suggest that they go through the 60 day RIT program that it offers so they have a better chance of beating their addiction. Again, please don't wait to get help. You don't have to fight this battle alone.
The problem of wanting to "cure" addiction by using drastic measures like cold turkey or rehab is that it may not be the best course of action. Perhaps it is better for many people to acknowledge that the addiction is in fact "just a phase", and that a proper way of dealing with it would be to accompany the addiction so that the person wouldn't be harmful to himself and others, until the person reaches the point where they "outgrow" it naturally.
I agree that rehab is not always the best solution, because it does not teach the user to wilingly bot use drugs, just forces them not too.
You can't just group all "hard" (what exactly does this mean anyway? Is diamorphine "hard" but morphine not? Codeine? Tramadol?) drugs under one umbrella. You ESPECIALLY need the appreciate the differences between, for example, benzodiazepine (are these "hard"?) withdrawals and crack withdrawals. An addict withdrawing from crack/coke mainly needs sleep and nourishment, "cold Turkey" is a realistic option. An addict who is physically dependent on benzodiazepines will have a grand mal seizure and die if you attempted to force them to "cold Turkey". Gabaergic withdrawal (alcohol/ benzodiazepines/barbiturates/GHB) is a death sentence, opioid withdrawal (diamorphine/morphine/ methadone) sincerely feels like a death sentence but is very rarely lethal (and then almost always a result of dehydration), stimulant withdrawal (meth/coke) is never lethal. I've oversimplified greatly, but I think you get the point.
Also note how alcohol withdrawals are often lethal. Very few people classify alcohol as a "hard" drug comparable in seriousness to heroin, but from a physiological perspective alone, alcohol dependency is far more damaging to the user than heroin dependency. A dependent user could use opioids every day of their life and die at a normal age, completely healthy (the negative health effects from opioids are almost entirely a result of users being forced to turn to a black market). This cannot be said for alcohol.
Before advocating for any policy in regards to a serious public health issue, please at minimum read up on the literature regarding physical drug dependency, the differences between the major classes of commonly abused drugs, and which (humane) approaches other countries have tried which have yielded positive results.
The article is essentially asserting that of the people who clinically qualify as addicts earlier in their lives, about half of those people don't by the time they are in their 30's, and that the pursuit of treatment doesn't necessarily correlate to that outcome.
That isn't to say that there are people who absolutely need to treat addiction as a disease, and that viewing the next drink as an existential threat isn't an important part to their recovery.
When I was a teenager and in my 20's, my drinking and drug use was out of control, and I did enter treatment including 12 step programs. Those weren't particularly effective at keeping me sober in part because of the mantra that "hey, you have a disease, and you don't have control". That's sort of a self-fulfilling prophecy to a younger brain.
What ultimately happened to me was that the life I wanted wasn't compatible with drug and alcohol abuse, and I moved on in my mid-20's.
I do occasionally drink now (in my 40's), but there's no fathomable way that I could see myself going back to what I did when I was young, and no clinician would diagnose me as an addict or alcoholic today.
So yes, the article is dangerous if you are part of the subset to which it doesn't apply. The question is whether we should be treating all addicts in the same way. One answer might be "use the disease model on all addicts because it may apply". Another might be to try to treat this as a leaning disorder.
Right now, we don't know the answer, so I agree with much of your practical advice: if you need help, it's out there, in the form of free communities of 12 step programs, as well as medical treatment programs.
But it's just as dangerous to propose that simply because you have issues in your life that some religiously-motivated program like AA is the way to go.
We should provide people with help that's scientifically developed and proved to be effective, and AA and its various sister programs are neither of those. They're just "get the drunks to worship god instead" programs. In recent years they've gained the thin veneer of talking about a "higher power" instead of "god", without becoming any more scientific or empirically-supported as a result.
If you have a problem with addiction start by talking to your physician, not a church group.
I go to Agnostic meetings that don't involve any prayer or spiritual aspect, just a group of drunks gathered together helping each other to stay sober. So if the whole religious or spiritual aspect of the program leaves a bad taste in your mouth, try finding a secular meeting in your area: https://secularaa.org/tsml_meeting/
In any case, the motivation for my comment was to point out that many of these "xA" programs are inspired by the 12-step "AA" program. That program is not scientific, or even amenable to change as new evidence about the efficacy of sobriety comes in.
Rather, it's dogma. Whatever white-washing of AA's mention of "God" over the years as "higher power" doesn't change the fact that it's not science-based.
Does that mean it's completely useless? No, but as others have pointed out studies of its effectiveness are rather damning. It just bears pointing out when treatments for addiction are discussed that AA is a dogma-based therapy, because many people suffering from addiction think AA is just what you're supposed to do.
It works for some, but anyone who says its not a christian organization is absolutely lying - its like taking the caramel coloring out of cola - its still cola, it still tastes like cola, you just took away the color that reminds people that its cola.
Physicians aren't a cure-all, because there's no guarantee they've been trained in addiction medicine. After a few doctor visits and them hearing the word "anxiety", you might just leave with a new prescription to Xanax or some other benzo, which could be a virtual death-sentence for someone with a dual-diagnosis.
That is not to say that AA is for everyone, but this advice to just “talk to a physician” as if that is the only fix is absurd. Look at how many people are hooked on opioids after “talking to their physician.”
For what it's worth, my wife, son, parents, siblings and co-workers all would say that 12 step has improved our relationships.
The anecdotes are meaningless. AA can work for a small subset of individuals, but It makes no sense for America to push AA as a first line treatment. AA is not a treatment, it’s a self-help group with poor results.
Pardon my disdain, but promoting AA over other solutions is frustrating for this formerly silent family in America who are fed up with the 12 step answer.
I am pretty skeptical of a claim like that.
It works for some people. It's also completely free, which you can't say about medical intervention. Around here, detox and rehab facilities have 6 month long waiting lists and cost tens of thousands of dollars.
I am skeptical about that too. I'd be surprised if both rehab and AA don't have a statistically significant effect on addiction treatment.
People tend to expect that rehab will cure addiction, and become disillusioned with the reality that addiction is a chronic illness. Relapse rates are high in chronic illnesses, like diabetes and hypertension, the latter having a relapse rate of 50%-75% according to the NIH. Addiction is no different, and its relapse rates are between 40%-60%, even with ongoing treatment. Efficacy rates will reflect this harsh (and often very expensive or deadly) truth.
Also instead of taking the time to write out multiple comments expressing your doubt as to the efficacy of AA, you could've found the information you needed in a single google search.
"Dr. Maté's approach to addiction focuses on the trauma his patients have suffered and looks to address this in their recovery"
>if we don't end up in jail first
The former statement does not work because of the latter. Any additional person that knows about it is a risk to your freedom.
Never had someone tweeted one my comments before :)
After I moved out, it was an anchor of sorts and I started playing even more. By this point, my gaming habits definitely matched up with the definition of addiction - at one point, I even went ~2 days without sleeping and eating.
The big change for me was getting a job. I couldn't fuck this up (considering I had already flunked out of university, getting a job in my dream field was a miracle), so I quit computer games. I've "relapsed" a few times since and every single time it has been horrible. It consumes me completely. I have now also decided to basically cut out any easy-to-consume entertainment out of my life. I spend my free time on books, nature and sports.
Looking back, it's the experience of totally fucking up my life through addiction that has helped me beat my addiction.
I would wake up early in the morning, play the game until someone mentioned I should eat, I would eat, then continue playing, until someone mentioned I should eat, I'd continue playing until late at night, go to sleep and continue.
I was extremely addicted and attached to the game. I dreamt about it, I thought about it, fantasized about it.
1 year passed, I started 8th grade and all of a sudden WoW and other computer games were extremely boring. I could play them for about 30 minutes and would just get fed up with any game.
I was like that for years, and just recently I started Super Meat Boy and it had the same addictive fulfilling qualities that I felt when I was a kid, and I could spend hours on it. I completed the game, switched to playing others, but still couldn't get addicted to anything.
I rarely play games now. Max 8 hours total playtime per year.
I would not believe that this was possible if the same thing didn't happen to me. Also about World of Warcraft. Just once.
The next day I got bored killing creatures on some side quest, a thought came through my mind ("what am I doing with my life?"), and I've never looked back.
That's when I realized that dreams are a mechanism the brain uses to train itself in a best-effort simulation of recent new challenges. Probably for committing new learnings from conscious understanding roughly analogous to symbolic AI to subconscious pattern matching more similar to ML. Months after I remembered those minesweeper dreams, I was able to multitask any though process that did not involve eyes and hands parallel to the game, in fact I solved my fastest boards when my conscious mind was completely distracted from the game. (and it was an addiction, and I've grown or of it)
Evolution doesn't tend to waste things. As long as some processing is happening, it might as well be put to good use.
I'm a casual gamer but at times I do lose grip on reality when playing certain games. I feel like understanding what causes the addictive behavior really helps.
For instance most RPG titles employ the same techniques as gambling, and gaming addiction is often equivalent to gambling addiction. Before getting excited about that item drop, think of it as just pure math (probabilty theory) and that it's nothing special about you finding that item.
Unfortunately this type of gambling in video games has a more severe form these days, with the increasing trend of microtransactions and "loot boxes". These can impact your wallet as opposed to just your time.
I am by no means addicted to easy-to-consume entertainment, but I'm worried that it does impact my ability to focus on boring but important things. Could you share what steps you took, or what process you followed, to cut those forms of media out of your life?
Has doing so reaped benefits besides more time to spend on other things?
It's really weird to explain but sometimes when I'm alone and have free day I want to play games but at the same the moment I start them I just can't do it for some reason.
I'm currently clean, however I feel like I am always just one small slip away from sinking into the abyss, it takes a concentrated effort almost every day to avoid this abyss, I certainly don't feel like I'm growing out of it. I am happily married and have a high paying job that I love, I'm generally really quite happy about life but still feel the darkness calling.
You can apply the same ideas to drugs and alcohol, and he actually goes over that near the end of the book. I have still found myself snorting the odd line of coke when it has been laid out, but I haven’t bought any drugs since reading the book. I can’t really handle them now anyway. Last weekend I actually refused, which is a first in ages.
The book will help you to build the massive mental fortifications needed to realise that the abyss tobacco and other drugs create are shit and do you no good. Give it a go even if you’re not smoking currently.
I stopped smoking a year ago without any effort: I just started to forget to do it, day after day, and one day realized that I no longer smoked on a regular basis. Guess it wasn't a real addiction after all.
I enjoyed the taste of some tabaccos as well, though the after taste was always unpleasant. Thankfully, smoking never became an addiction for me
Because if there was no nicotine high / dopamine response to smoking, then sales of cigarettes would fall to almost nothing indicating that 'what people like' is the 'dopamine'.
Vapes have been around for at least 20 yrs and have not replaced cigarettes in any way... nicotine pills are even older and continue without a significant dent in the tobacco industry.
Vapes have not been common in any easily usable format for 'the last 20 years' - it's really only been in the last few years have the formats really been workable.
And they have vastly changed behaviour, especially where it matters - among young people. There is essentially a vaping epidemic going on right now in high schools, and vaping has actually replaced smoking and then some .
Also I should point out that vaping and nicotine gum, are not perfect substitutes for smoking, so it's also hard to compare.
Do you know what the sales of 0mg nicotine 'juice' are compared to those with nicotine? Almost nada. Without nicotine vaping, then 'vaping' simply would not exist - there wouldn't be enough demand to justify the market for it.
Essentially nobody buys cigarettes without nicotine i.e. 'just for the taste'. The market is essentially non existent for that product. Ergo, it's the 'high' they are after.
I say this as a former smoker/vaper.
Addicts build up a myriad of justifications for their addictions.
I liked the taste of cigarettes. They helped me wake up in the morning. I smoked to concentrate. I smoked to distract. I smoked to relax. I smoked so I wouldn't overeat etc.
At the end of the day, I didn't really smoke for those reasons. I smoked because cigarettes were chemically rewarding and I had become conditioned/dependent on smoking.
I loved [good quality] cigarettes and beer or coffee or whisky.
I don't regret quitting at all. I do wish I could enjoy it without getting addicted—but I can't. That said I don't like the smell anymore, and I have very little inclination to start up again. I don't think having a smoke would cause me to fall right back in anymore, but few occasions are worth it.
But yeah, always loved smokey smells and flavours (I love peaty scotch). So that premise you targeted is a bit naive on the author's part.
For the record, I quit without any aids outside of a bad illness for about a week and the desire to stop.
Incidentally, even before reading it this time I believed that I liked the taste. I realised later that I really didn’t like the taste after all.
I commend you if you’ve managed to stop of your own accord without any effort. The problem is that a lot of people will try that like me and then fall back because they don’t have the mental framework to maintain the realisation that smoking is worthless.
Thank you, and sorry if it's too personal to ask
It saved my life, my marriage, my sanity and my family.
However this addiction function exists at 'lower' level than the intellect, which is why its so hard for the higher function (the tiny conscious part) of the brain to stop an unwanted addiction.
You grow out of addiction when the lower level brain decides that your addiction is not actually required for you to get food or sex.
You can accelerate removing an unwanted addiction by paying very close attention to the mechanics of the activity and by simply introducing new activities especially if those activities are completed with food or sex.
You are confusing "addiction" with "reward". Addiction is not required nor beneficial.
It may be more correct to say that motivation operates at a higher level than intellect. Motivation directs attention and overrides decision. The same mechanisms which make it hard to wilfully stop taking a drug make it hard for you to wilfully drown yourself or starve yourself if you decide to.
I'd say that you grow out of addiction simply because your motivational calculus changes. Maybe there's something new from which you can get an influx of dopamine (perhaps new people or activities), or maybe a near death experience with the drug now means the thought of it triggers a noradrenaline response, and the fear overrides the motivation towards it.
as a weak example mice in lab choose socialization over drugs often.
Edit. Writing from my phone
Sure, if you count in as "died from addiction" everybody who was essentially taken by old age, just earlier than what might have happened with a healthier lifestyle, then the majority turns again. But those numbers never really make sense, except for constructing alarmism. Everybody who merely "lost years" (as opposed to something closer to the cliche of overdosing on a public toilet) would have also lost years to burgers, pollution, sedentiarism and stress. Which one was the killer?
Also it cites several studies in support of its thesis.
Contrast that will ADD/ADHD. I'm not convinced it has anything to do with maturity or a lack thereof. Sure, mindfulness meditation helps quite a bit. But I think you can be mature, self sufficient, polite, etc, and yet still have ADHD, or immature, etc. and have ADHD. Not to say I'm a shining beacon of perfection with no room for self improvement, but the point is there's little to no correlation there.
So many of the ADHD children are basically immature compared to the rest of the class, no wonder since the difference between the oldest and youngest are almost a year.
There is a very good video about 30 essential things parents should know about ADHD
One of them is that when unmedicated on average a person with ADHD has the maturity of someone 2/3 of its age.
Its is just an average, but is relevant to think how different a 14 years old and a 21 years old are (or 20 and 30).
While I agree with you that the correlation here doesn't have any direct relation to addiction based on the evidence provided (a study connecting ADD/ADHD to addiction would be VERY interesting), I think that the author included it to show that not all mental health conditions have a low recovery rate.
First off, I am 100% sure some people do "simply" grow out of their addiction. But what does that mean? What life changes happened during that period of growth that caused addiction to be a more manageable personal issue?
For me, most recently at least, it was when I simply could not find a vein anymore. I had always had poor vein access and after close to 5 years of IV'ing black tar heroin, I had more abscesses than I had available veins. Muscling tar is not pleasant, often leads to an abscesses at the injection site, and has poor bioavailability, but if you are sick and have spent 20 minutes poking yourself at least 20 times (hopefully going through 2-3 syringes in the process as well, and having to deal with backloading your dose), the option becomes more appealing. All of this poking around looking for a flash leads to abscesses as well.
With a lifetime of poor vein access, I was doing all the things they did to me in the hospital when I needed an IV: heated blankets, hydration, using alcohol swabs, tourniquets, at least attempting to rotate injection sites, and so on. When I discovered my hands and feet had slightly easier access, I was elated, but that only lasted a couple years, and it really, really, really hurts to miss in your hands and feet.
Is that what they mean by "simply growing out of it"? If so, I feel kind of insulted.
Eventually, after simply not being able to get high via IV anymore unless I got lucky, I did one last big detox (probably at least my 20th, including 2 in-patient ones), went back to my suboxone doctor, and have been stable on a low-ish dose of the sublingual suboxone for several years now.
In my recovery I have been to hundreds of NA/AA meetings and volunteered with harm reduction groups and this concept of "I simply grew out of it" is not a common theme. What is much more common are things like 1) I couldn't stand sleeping outside anymore, 2) I got pregnant, 3) I ran out of vein access, 4) I had a real opportunity to stop using and took it (like rehab or strong social support or job support), 5) I was sick and tired of feeling sick and tired, and so on.
Just to be sure, I am not saying "simply growing out of addiction" via "natural recovery" -- as the article discusses -- is not a thing. It's just not enough of a thing to warrant much attention on. A sincere congrats to the people who grow out of it (and, like I said, I'd like to hear more about what that growth process looked like), now let's help the millions of others who haven't.
I wanted to comment on one of your last sentences - that "natural recovery" doesn't warrant attention. I think there's a certain bias here given your own experience. If you go twelve step meetings, you'll find people who's lives were on the brink of ruin and who have pulled themselves back by living the steps. But I think even NA/AA would acknowledge that the percentage of people who walk into an meeting once who get sober and continue to attend meetings is small (if I had to proffer a guess, it'd be less than 10%, but I don't have a good basis for that). So the question is really "what happens to the other 90%"? Some will certainly die from their addictions, destroying themselves and the lives of their loved ones in the process. Others are going to "grow out" of their addictions. It may be that the percentage who grow out of their addictions is actually higher than the AA percentage (and that seems to be what the article implies). That actually _does_ merit attention (and I think we'll find that in most cases the growth mirrors some of the steps that you'd see in AA, just without AA).
Of course, those that _don't_ grow out of their addictions would be far better served working a program, and we don't have a good way to distinguish which group any addict is in, so that puts us back to where we are, which is in not knowing the best way to treat addiction. :(
(Personal note: I was clearly an addict and alcoholic in my late teens and twenties, and this period of time involved multiple trips to rehab, as well as AA/NA meetings. None of that "worked" for me, but what worked was the development of some additional maturity (late 20's) that was able to see a life that I wanted which was incompatible with my behavior. As an adult in my 40's, nobody would define me as an alcoholic or an addict. I'll occasionally drink, but drinking to excess really just doesn't fit into my life anymore.)
There's also got to be some kind of chemical/medical aspect to how a certain substance affects you individually, apart from how it affects everyone else. I was more of a cafeteria drug user and got bored really quickly and the only objective was to be high(or low), not necessarily an obsession with one kind of drug. For instance, heroin withdrawals were never stereotypical for me. I'd always thought of it as a high wearing off, and would fix it with any other drug that was available, it didn't strictly have to be heroin.
Good on you for staying clean, friend.
Telling someone that they will surely relapse based on an equally anecdotal assumption looks unjustified to me.
But the cravings probably won't go away forever. The ever seductive siren of intoxication will whisper it's sweet songs into your ear, beckoning with lustful reveries of that familiar bliss that you once knew, nearer, louder in strife. Alas, with time, the voice softens, should you have the will to resist recurring temptations in the meanwhile.
In my case, it was just a massive waste of a decade for little to no gain other than some momentary feelings of almost-euphoria. It's just so superficial and a kind of escapism, at least was for me.
Anyway, addiction is a lot more complex for generalizations, obviously. I met an older gentleman in rehab who was there for the 50-something time. That kind of put things in perspective for me.
This is based on my experience.
Of course, you can not expect that many years of addiction to simply not have any residual effects, for example I still do play video games a lot but I can't say I'm addicted to the point of skipping my job or destroying my whole life. In my case, it is not that dangerous to play video games but for a substance addict, it gets extremely dangerous and they surely struggle harder than I do.
I think, instead of trying to cure the addiction first, the underlying cause of the addiction itself should be cured. After that, getting over the addiction becomes easier.
Edit: I see comments on people concerned of addicts treating their problems as a phase. It is not a phase, you need to get the bottom of the problem first. It can get extremely hard to fix the underlying problem, especially if you do not get any help, so do not treat the addiction as a phase, but treat it as a symptom of a much bigger problem and fix the problem first while treating your addiction.
"moving from a less structured environment like college into a more constraining one like nine-to-five employment, "
I knew people in SF who just 'moved away' and the change in setting, the lack of immediate access to 'the party lifestyle' and all it entails, means they just 'shifted gears' and cleaned up immediately.
So I'm not sure if the 'aging out' due to brain developments is entirely the story here, rather than perhaps time allows for people to find other patterns of lifestyle.
Though I do think the point about '18 years old' is quite powerful - keeping teens away from bad stuff might seem to be quite a good idea.
... that said, there could be other factors at play: kids from 'good, conscientious families' simply may not be quite as likely to need to try alt things, and less likely to get caught up later in life anyhow. There'd seem to be all sorts of other correlating factors there, however valid the point may be unto it's own.
Most “addictions” seem to be advanced exercises in bullshit artistry, from my perspective. But, the one that really throws me is compulsive gambling. This is the line where I draw clear distinction between chemical dependence, and... something else.
Compulsive gambling definitely isn’t bullshit. You can sense that it’s a very powerful, real habit that people lose control over.
Most other non-substance oriented addictions I tend to ignore, and gambling is my bellwether for nonsense.
Cigarettes, for example, are mostly nonsense. The nicotine in tobacco is such a mildly addicting component, that a deeper truth sits behind it: people who refuse to drop cigarettes are trying to dominate a negotiation, regarding personal choices. They want the freedom to make bad choices.
Cigarettes are easy to quit. The chemical dependence is pathetically tame. The people that insist on retaining the habit are really engaging in social signaling. They learned this aspect of power and status as teenagers, and this alone puts cigarettes in a station of nostalgia classified as comparable to first cars, first kisses and favorite music artists. That’s why people don’t quit.
Other substances are tougher, for sure, but chemical dependence is only part of the story. Controlling obsession is an entirely different skill. It’s nit just about willpower, but also about deepley held beliefs and self perception.
It’s not a new concept. It predates modern psychology with tales like Samson and Delilah and deriving strength from a lack of haircuts, or Dumbo’s magic feather. Superstition isn’t just about magical thinking, and can take root in daily rituals and bahvior.
That’s probably why people might seem to grow out of it sooner or later. At some point, life interrupts and breaks the spell, one way or another.
Is it up to you to dictate what other people's experiences are? If someone has a crippling addiction to sex (a non-substance oriented addiction), do you believe that you can tell them that what they are saying is "nonsense" and that it actually isn't an addiction, and that they just need to "have more willpower". How is that in any way helpful?
If you are open to hearing about what the medical, psychotherapeutic, and academic communities have been learning and working on in the past few decades around addiction research and treatment, A good place to start is the work of Dr. Gabor Maté: https://drgabormate.com/topic/addiction/.
There is a notable exception - smoking.
In all seriousness smoking has more "habit/ritual" components to it given oral fixation - in addition to the chemical aspect.
Does this data take into account all those who died and therefore didn't "grow out"?
I think the biggest issue with the colloquial idea of addiction is that most people don't realize it's a lot more dependent on social circumstance than it is on the "reward circuitry". People don't become addicts because of any certain drug or mechanism, they do so because they're trying to "deal" with some sort of social issue.