[ExI] addiction

Wed Apr 6 22:58:41 UTC 2022

This is a can of worms. 

I hesitate to speak up because it’s complicated, unresolved among subject matter experts to some degree, and hard to explain briefly. But how can I not speak up—my dissertation was on willpower, I’ve run two drugs treatment programs including one system of which I currently have clinical and administrative oversight, I teach and train on this subject, I’m abreast of the latest literature, I’ve worked in this field for 23 years professionally. 

Darin’s response is closest to correct. Will knows what he’s talking about too. 

The simplest way to describe what most people refer to as addiction is the inability to control use. There are people who functionally are unable to control their use of some chemicals despite negative consequences. Few would disagree about that. I see these people in my professional life and in my personal life, but maybe I’m unique in that sense. I’ll have to say trust me if you have no personal knowledge of this. 

Volkow from NIDA has been promoting the idea for a while now that the data support that addiction is a “brain disease.” She means a disorder characterized an inability to stop use despite catastrophic consequences, in some cases, and caused by a combination of a faulty/hijkacked “go” or reward system and a faulty “stop” or control system. Some are born predisposed to this and others develop it solely from their environment (aka it’s learned). There are efforts to find biomarkers and genetic determinants of things like “alcoholism.” The best we’ve found so far is twin and relative studies showing things for example like the risk of alcohol dependence in relatives is increased about 2-fold. This is the standard model in the field at the moment and promoted by NIDA. 

The contrasting view expressed at the start of this thread and pushed by plenty people may acknowledge some of the above but adds more weight to the willpower aspect in the end, dismissing so-called addiction as a failure of willpower or morals. There’s variations on this with some people being downright a-holes and extremely judgmental and others who leave a little room for a different perspective or experience outside their own e.g. “I could stop but I could see how it might be harder for someone else, especially if they are dope sick.”

Interestingly, at least to me, my colleague Carl Hart who I mentioned in another thread who wrote the book Drug Use for Grown Ups disagrees with NIDA on this one. He doesn’t put it all on willpower however. You can see his position in his TedTalks or read about it, but briefly I’ll quote from another article 
https://psmag.com/news/addiction-is-not-a-brain-disease:
“Some people think that [the addiction-as-disease narrative]is more compassionate,” says Carl Hart, chair of the psychology department at Columbia University, who has spent decades studying how drugs affect the brain and behavior. Unfortunately, Hart writes, there’s not much to support the theory that addiction is a disease of the brain, and it has done more harm than good.
The problem, as Hart explains, is that, if addiction arises from the effects of drugs on the brain, there are two paths to a solution: eliminate the drug from society (via restrictive policies and law enforcement) or look for a fix within the brain. But there are several problems with these approaches:

1. Relying on law enforcement to remove drugs from communities has led to rampant discrimination.Viewing drug use as a chronic medical condition has not prevented drug use from being a criminal justice problem. Roughly 20 percent of the people in our nation’s prisons and jails were locked up for non-violent drug offenses. And black Americans are significantly more likely than whites to be incarcerated for drug offenses, despite equivalent or sometimes lower rates of drug use.

2. The drugs themselves are probably not to blame.Indeed, drugs have the same neurochemical effects on the brain of every user, but only a small subset of people actually become addicted. And despite decades of research with increasingly powerful brain imaging technologies, there is still no scan that can discriminate between addicted and casual drug users, or make predictions about who will go on to abuse drugs. “To date,” Hart writes, “there has been no identified biological substrate to differentiate non-addicted persons from addicted individuals.”

Rather than a disease, addiction is more likely a learned behavior. 

Both the NIDA position and Hart’s are supported by the data to some degree. We will need more data and more research before there is a consensus. The result lies probably somewhere in between. It may also be nuanced such that for some people it is more learned and for others more biological. It may be different for different chemicals. We just don’t know yet. 

An introductory article about the topic of things like porn addiction, shopping addiction etc is
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328289/#!po=1.38889

An important takeaway for you all:
Addiction is treatable whatever the etiology. We can help people develop better self-control, develop better and alternative coping strategies, reduce risk of relapse, and find less risky ways of using drugs (like controlled drinking strategies) for people who don’t want to stop using. 

Ultimately Hart is correct too that most users of addictive substances don’t become addicted. So getting rid of or controlling access to substances that people enjoy is not a rational solution in my humble but expert opinion. We will as a society however need to help that small percentage that will have problems controlling their use despite negative consequences. Telling them to “try harder,” humiliating them, and shaming them doesn’t work however. Embarrassingly, we tried that as a field in the 1970s and 80s. 

-Henry 

> On Apr 6, 2022, at 4:35 PM, Darin Sunley via extropy-chat <extropy-chat at lists.extropy.org> wrote:
> 
> Complex behaviors can be executed via psychological compulsion/"irresistible impulse".
> 
> Handwashing being the canonical example.
> 
> On Wed, Apr 6, 2022 at 2:27 PM Will Steinberg via extropy-chat <extropy-chat at lists.extropy.org> wrote:
>> Yes, food addiction is a crisis right now and yet people have decided to enable it with "healthy at any size" movements.   I didn't see any "healthy at any dose of dope" movements around when I was a junkie...
>> 
>> On Wed, Apr 6, 2022, 3:06 PM spike jones via extropy-chat <extropy-chat at lists.extropy.org> wrote:
>>>  
>>> 
>>>  
>>> 
>>> >… On Behalf Of Will Steinberg via extropy-chat
>>> Subject: Re: [ExI] addiction
>>> 
>>>  
>>> 
>>> >…Willpower is complicated.  I do think addicts need personal responsibility to heal, but so do stroke victims trying to relearn how to speak or move their arm.  Would you say they simply aren't trying hard enough?  It's fucking hard
>>> 
>>>  
>>> 
>>>  
>>> 
>>>  
>>> 
>>> Thanksgiving at my grandparents’ house with my uncle was like Homer at the Frying Dutchman:
>>> 
>>>  
>>> 
>>> https://www.youtube.com/watch?v=1kzb6uf0U0k
>>> 
>>>  
>>> 
>>> Oh that lad enjoyed his food.
>>> 
>>>  
>>> 
>>> spike
>>> 
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