[ExI] state of conflict technology

Fri Jan 10 20:54:14 UTC 2020

You hit upon a good point here that cigarettes don’t fit the mold with respect to the criteria. Studies have found the DSM-IV criteria have relative low predictive validity with respect to tobacco dependence. The impact on functioning examples DSM provides with respect to tobacco are respiratory infections, reduced cardiovascular capacity, impaired sense of smell and taste, offensive odor (of smoke), chronic cough. Mostly, people who get a tobacco use disorder diagnosis are distressed by their inability to quit successfully. If one is not impaired or distressed, they may be physiologically addicted such that they’d experience withdrawal if they stopped abruptly but they wouldn’t have a substance use disorder per se. As Bill noted, definitions are fought over and rarely perfect. There are plenty of examples of functional addicts as well. Addiction is a term that doesn’t have uniform agreement and is used inconsistently. 

> On Jan 10, 2020, at 3:36 PM, William Flynn Wallace via extropy-chat <extropy-chat at lists.extropy.org> wrote:
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> 
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> 
>> On Fri, Jan 10, 2020 at 2:22 PM Henry Rivera via extropy-chat <extropy-chat at lists.extropy.org> wrote:
>> The simplest globally accepted medical definition of addiction is the inability to control use resulting in significant impairment or distress.  
> 
> Just sent off another post on addiction before I saw this from Henry.  If we accept the definition above,then at one point I was addicted to both cigarettes and alcohol, but after I quit both, I wasn't, since I had showed the ability to control usage.  That really seems odd, doesn't  it?  But it's mental health, and definitions are fought over ever year at conventions, so I suppose that finding out how to treat people who ask for help is more important than putting a label on them.  People who don't ask are impossible, eh Henry? 
> 
> One more thing:  I was not significantly impaired in any way as a result of smoking and drinking, so where does that fit in?  I kept wanting to quit - that was the only real symptom I had.  I taught my classes as well as I could and never let any drug interfere with that - I loved it too much to go in drunk.
> 
> bill w
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> bill w
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> bill w
>> 
>> The study I referenced used the DSM-IV-TR definition of Substance Dependence which one can look up online. The current equivalent in the USA would be Substance Use Disorder, Severe in DSM 5 which one can also look up online.  
>> 
>> There is acceptance now of withdrawal from heavy cannabis use, but the symptoms are relatively mild and consist of disturbed sleep and irritability at worst. It’s rarely seen clinically in my experience. That is, people rarely feel compelled to seek professional help from this. However, meeting the criteria  for Dependence in the study I referenced would not require withdrawal. Just evidence of use of or acquiring the drug getting in the way of their functioning significantly. Things that would trigger normal people to say for example, “Hey, wait a minute.. what are my priorities here. This isn’t worth losing my job or relationship over. I better cut back or stop.” The Dependent person here would not be able to change their behaviors despite the negative impact in functioning. 
>> 
>> I am a clinical psychologist if you’re wondering, am a subject matter expert in substance use disorders and mind altering drugs, and have managed 2 substance use disorder treatment programs in my career. Currently I oversee an outpatient Mental Health Clinic, a Primary Care-Mental Health Integration Clinic, a Mental Health Walk-in and Inpatient Admissions Clinic, a disability determination clinic, and a Substance Use Disorders Clinic. 
>> -Henry
>> 
>>>> On Jan 10, 2020, at 2:43 PM, William Flynn Wallace via extropy-chat <extropy-chat at lists.extropy.org> wrote:
>>>> 
>>> 
>>> Here is me  two packs a day of Salems, probably a strong cigarette.  I did quit them cold turkey, after years of wanting to, but I'll bet you could have measured some physiological changes in me during the days after I quit. In other words, I did have a physical addiction.  I continued to want cigarettes for a few weeks but did not relapse at all.  It is arguable to my drinking a lot of coffee replaced the nicotine and so I had my dose of stimulants.  No, I did not turn into a coffee addict, though I do support the idea that there is such a thing.  Three cups at breakfast and no more.  Good for you they now say.
>>> 
>>> I took a big draw and inhaled a Salem ten years after I quit.  My thought?  "I could go back to two packs a day in a nanosecond."  Loved it.  But just too deadly.  Did not want to die that way.  I suppose some idea of being weak entered my mind and did not want to be thought of as weak by my friends and family.  Ditto for alcohol.
>>> 
>>> So by John's measure, want to quit but can't, I wasn't an addict.  I think I was, and had some withdrawal to prove it.  I cannot say what enabled me to quit.  Many will say 'willpower', but that's an elusive concept if there ever was one.  It's circular- you must have had enough willpower or you would not have been able to quit.  If you can't, it's not enough will power.  Nobody ever said how to get more.  Self-control is a better concept, like the Mischel study I posted the other day.  Some would say that if you haven't mastered self-control you are not yet an adult.  I wonder what percentage that would be. 
>>> 
>>> Cigarette smoking is probably stronger than heroin or at least as strong.  Meth too, probably more so though I have not looked at that data.
>>> 
>>> Re:  revealed preference.  I am glad to read the economics is finally getting on the band wagon: relying first and foremost on behavior.  People will say anything, especially to a health professional.  Kahneman helped that too in economics
>>> 
>>> bill w
>>> 
>>>> On Fri, Jan 10, 2020 at 12:07 PM John Clark via extropy-chat <extropy-chat at lists.extropy.org> wrote:
>>>>> On Fri, Jan 10, 2020 at 12:33 PM William Flynn Wallace via extropy-chat <extropy-chat at lists.extropy.org> wrote:
>>>>> 
>>>>> > It all depends on who gets to define addiction
>>>> 
>>>> I think a good definition of addiction is wanting to stop doing something but being unable to force yourself to do so, by that definition cigarettes smoking is about as addictive as Heroin. 74% of smokers want to stop but each year only 6% actually manage to do so, do so and live that is, I'm not counting those who stopped smoking because they died.
>>>> 
>>>>  John K Clark
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