The chief difficulty with the word “addiction” is the idea that it describes a power greater than the will. If it exists in the way we use it and in the way our legal and medical systems assume it exists, then free will has been abolished. I know there are people who think and argue this is so. But this is not one of those things that can be demonstrated by falsifiable experiment. In the end, the idea that humans do not really have free will is a contentious opinion, not an objective fact.
So to use the word “addiction” is to embrace one side in one of those ancient unresolved debates that cannot be settled this side of the grave. To decline to use it, by contrast, is to accept that all kinds of influences, inheritances, and misfortunes may well operate on us, and propel us towards mistaken, foolish, wrong, and dangerous actions or habits. It is to leave open the question whether we can resist these forces. I am convinced that declining the word “addiction” is both the only honest thing to do, and the only kind and wise thing to do, when we are faced with fellow creatures struggling with harmful habits and desires. It is all very well to relieve someone of the responsibility for such actions, by telling him his body is to blame. But what is that solace worth if he takes it as permission to carry on as before? Once or twice I have managed to explain to a few of my critics that this is what I am saying. But generally they are too furious, or astonished by my sheer nerve, to listen.
Peter Hitchens, “The Fantasy of Addiction”, First Things, 2017-02.
December 18, 2018
QotD: Addiction
August 30, 2018
Britain “forgets” to regulate e-cigarettes, youth smoking drops substantially
Last month, Matt Ridley sang the praises of the regulators who didn’t regulate:
A selection of e-cigarettes
Photo by Ecig Click via Wikimedia Commons.
Britain is the world leader in vaping. More people use ecigarettes in the UK than in any other European country. It’s more officially encouraged than in the United States and more socially acceptable than in Australia, where it’s still banned. There is a thriving sector here of vape manufacturers, retailers, exporters, even researchers; there are 1,700 independent vape shops on Britain’s streets. It’s an entrepreneurial phenomenon and a billion-pound industry.
The British vaping revolution dismays some people, who see it as a return to social acceptability for something that looks like smoking with unknown risks. Yet here, more than anywhere in the world, the government disagrees. Public Health England says that vaping is 95% safer than smoking and the vast majority of people who vape are smokers who are partly or wholly quitting cigarettes. The Royal College of Physicians agrees: “The public can be reassured that ecigarettes are much safer than smoking.”
Lots of doctors are now recommending vaping as a way of quitting smoking. It is because of vaping that Britain now has the second lowest percentage of people who smoke in the European Union. The youth smoking rate in the UK has fallen from 26% to 19% in only six years.
How did this happen here? It’s partly the fault of the advertising executive Rory Sutherland; he is the Walter Raleigh of this revolution. In 2010, he walked into an office in Admiralty Arch to see an old friend, David Halpern, head of David Cameron’s new “nudge unit”, formally known as the Behavioural Insights Team. Sutherland pulled out an electronic cigarette he had bought online, and inhaled. By then, several countries including Australia, Brazil and Saudi Arabia had already banned the sale of electronic cigarettes — usually at the behest of tobacco interests or public-health pressure groups. California had passed a bill banning them, though Arnold Schwarzenegger, then the governor, had vetoed it. It looked inevitable that Britain would follow suit.
“I was a very early convert,” Sutherland tells me now. “Partly because I was a longtime ex-smoker myself who found them much better than constant relapses; I was also interested in the placebo effect they offered by mimicking the act of smoking. But I was almost equally fascinated by the psychology of the people who instinctively wanted to ban them.”
Halpern took notice. He knew the theory of “harm reduction” — that it is more effective to give somebody the lesser of two evils than insist unrealistically on immediate abstinence. So he asked his nudge team to get digging. Over coffee at No 10, he was surprised to learn that even the anti-smoking group Ash was leaning in favour of ecigarettes. So when public-health nannies started calling for them to be banned, Halpern made sure the government resisted.
In his book Inside the Nudge Unit, Halpern wrote: “We looked hard at the evidence and made a call: we minuted the PM and urged that the UK should move against banning e-cigs. Indeed, we went further. We argued we should deliberately seek to make e-cigs widely available, and to use regulation not to ban them but to improve their quality and reliability.”
H/T to Rafe Champion for the link.
August 9, 2018
April 2, 2018
The amateur woodworker’s six stages of tool addiction
Christopher Schwarz explains the painful path most amateur woodworkers follow as they begin gathering tools:
Get Tools, Any Tools
When I first decided to make furniture, I knew I needed tools. So I went to a 24-hour Walmart in the middle of the night and bought a set of tools that looked useful, including a chisel, a block plane, a level, a coping saw and a miter box saw. I had no idea how to use them, but they looked like things a furniture-maker would own (as opposed to a plumber).The next day I started to make some shutters for our house, and realized I needed other tools. So I went to the hardware store and picked up another pile of junk. This cycle continued for a long time until I decided to start reading about woodworking instead of making things up as I went along.
Obsess Over Statistics
You get every catalog out there. You find every website that sells tools and machinery. You discover tool reviews – wait there’s something better than a Walmart block plane? And you discover statistics. Table flatness, arbor runout, Rockwell hardness, the different grades of carbide.The idea is that if you can process all of these statistics, you will be able to pick the best tools to replace your dimestore tools.
[…]
Buy Jigs to Replace Skills
The next two stages are dangerous because if you get stuck in one of them, you can go bankrupt. During the “jig” phase, you start using your statistically perfect tools and realize there is something missing because your results suck.It can’t be the tool. You did all the reading, and it is the best one out there. What’s missing is skill, but you conclude that what is missing are the jigs and accessories.
Example: Your first hand-cut dovetails look terrible, so you buy a router and an entry-level commercial jig. After weeks of messing with the jig, your dovetails look better but they are so uniform that they look boring.
So you dip back into your statistics phase and read all about dovetail jigs and buy a commercial jig that allows you to variably space your tails. But this jig only has an 18” capacity, so….
[…]
Upgrade & Stockpile
As you become more skilled, you enter the most dangerous phase of all. This is the phase where you find you have some success with a tool, such as a shoulder plane, and so you buy seven examples of it to find the one you like the best. Different sizes, different grips, different makers.You upgrade your benchtop table saw because you can finally understand the benefits of a contractor or cabinet saw. You end up with four smoothing planes, six routers and a huge credit card bill. You start comparing scratch awls and screwdrivers. You divert your online tool purchases to your workplace so your spouse doesn’t notice.
On the bright side, there is hope, or as he calls it the “Great Psychic Break”, followed (for the fortunate) by the “Please, No More Tools” phase of spiritual enlightenment.
March 9, 2018
Bad news about the Peltzman Effect and opiate use
Megan McArdle recounts the US federal government’s attempt to improve automobile safety in the 1960s and the surprisingly mixed results of those efforts on overall safety for drivers (better), pedestrians (worse) and the frequency of non-fatal accidents (higher). Those results were summarized by Sam Peltzman as indicating that most of us have an innate tendency to take more risks when we’re less likely to suffer the costs of those risks (hence, the “Peltzman Effect”). She then talks about a tragic new instance of this in the opiate crisis:
A chemical called naloxone acts as an “opioid antagonist” — which is to say, it reverses the drug’s effects on the body. It can thus save people who have overdosed.
As opioid usage has worsened in the United States, more and more jurisdictions have acted to increase access to naloxone. Not only first responders but also friends, family and even librarians have started to administer it. These state laws were passed at different times, giving researchers Jennifer Doleac and Anita Mukherjee a sort of a natural experiment: They could look at what happened to overdoses in areas that liberalized naloxone access and compare the trends there to places that hadn’t changed their laws.
Their results are grim, to say the least: “We find that broadening Naloxone access led to more opioid-related emergency room visits and more opioid-related theft, with no reduction in opioid-related mortality.”
You can never assume that the results of one study, however well done, are correct. But these results look pretty robust. If they hold up, they would mean that naloxone is not saving lives; all we’re doing is spending a lot of money on naloxone to generate some increase in crime.
It makes a certain amount of sense that the Peltzman Effect would show up particularly strongly in drug users; after all, drugs hijack the brain’s reward system, redirecting it toward drug-seeking even at high personal risk. Drug users, one would think, would be highly likely to recalibrate their risk-taking so that the risk of death remains constant, while the frequency and potency of drug use increases.
The coldly logical response to this would seem to be to discontinue naloxone use. But there’s something repulsive about that conclusion, and Doleac and Mukherjee can’t bring themselves to go there. “Our findings do not necessarily imply that we should stop making Naloxone available to individuals suffering from opioid addiction,” they write, “or those who are at risk of overdose. They do imply that the public health community should acknowledge and prepare for the behavioral effects we find here.”
March 9, 2017
“… we’re psychologically training an entire swath of the population to be crazy”
At Ace of Spades H.Q., Ace talks about the huge rise in reported personality disorders among Millennials:
Therapeutic behavioral conditioning trains people how to de-trigger themselves from triggers that cause panic, anxiety, depression, or bad behavior (drinking, etc.) That sort of behavioral conditioning teaches people to be mindful of their triggers, to understand that the trigger is just a tic with no real world purpose, and to train themselves to associate the trigger not with an adverse behavioral pattern (being in crowd triggers claustrophobia-like panic) but to train the trigger to lead to some other more benign consequence (being in crowd triggers recitation of the Ode to Joy).
The idea is that your brain has miswired itself to connect an input (too many people close to me) to an undesirable psycho-somatic reaction (heart racing, extreme anxiety), and that it takes a determined attempt to reprogram the brain and untangle those wires so that the triggering input leads first to a benign output and, ultimately, no particular output at all.
This works. Allen Carr’s How to Quit Smoking the Easy Way taught me how to re-wire the trigger (the anxiety/stress one feels when one’s 45 minute nicotine clock runs down to 0) into a different behavioral pattern (go outside, gulp in some fresh air, pace around a little bit like I used to do when smoking). It also taught me that the stress of not smoking was irrational, and that it would be helpful to view the addiction as a malignant parasite inside of me trying to manipulate my brain into keeping it fed while it ruined my body.
Works.
[…]
He realized that the process could be reversed. As brains with bad triggers could be un-triggered to be healthy, so too could completely healthy brains be deliberately taught to be triggered by harmless things and bring about various mental ailments, panic, anxiety, irrational emotional outbursts, a compulsion to violence, tantrums, etc.
And he brought this theory to a social psychologist named Haidt and asked him “Is this possible?” And Haidt said, “Damn it, not only is that possible, I think you’ve hit upon a very real malapplication of psychological techniques — we’re psychologically training an entire swath of the population to be crazy.”
Okay, he didn’t really say that. But that’s kind of the gist.
Definitely read it.
There’s no great mystery to what’s going on. People who train themselves to be cool and clear of mind will find themselves becoming more cool and clear of mind.
People who train themselves to go to pieces over every damn thing will find themselves getting better and better at going to pieces over every damn thing.
When you valorize a mental disorder and turn it into a virtue to be cultivated, guess what you’re gonna get? More mental disorders.
January 28, 2017
The “fantasy of addiction”
Peter Hitchens explains how he started an argument that “will probably still be going on when I die”.
I never meant to start an argument about addiction. I had carried my private doubts on the subject around in my head for years, in the “heresy” section where I keep my really risky thoughts. And I don’t recommend disagreeing in public with Hollywood royalty, either, which is how it happened. In such a clash, most people will think you are wrong and Hollywood is right, especially if your opponent is Chandler Bing, the beloved character from Friends. Of course, he wasn’t really Chandler Bing, just an actor called Matthew Perry — but an actor with an entourage so big it filled an entire elevator at the BBC’s new studios in central London where we quarreled.
Our debate wasn’t even supposed to be about addiction. I’d been asked onto the corporation’s grand but faded late-night current affairs show Newsnight to talk about drug courts, one of many stupid ideas suggested by the idea of addiction. I reckoned my main opponent would be the other guest, Baroness (Molly) Meacher, whose name sounds like something out of The Beggar’s Opera. While she looks like the sort of harmless, kindly housewife who knits next to you on the bus, she is in fact a campaigner for the wilder sorts of drug liberalization. If this Chandler Perry wanted to horn in, well and good. Who cared? Yet when I began to sense sarcasm mingled with unearned superiority oozing from the character from Friends, I decided to let my impatience show.
Hence my rash, irreversible plunge into an argument which has been going on ever since, consuming billions of electrons on social media, and which will probably still be going on when I die. I heard myself using the words “the fantasy of addiction.” There. I’d done it. Let the heavens fall.
Chandler Bing called me various names and was even more sarcastic than before. He is extremely good at sarcasm, even if he understands very little about the drug problem. I have never heard the words “your book” pronounced with such eloquent contempt. The final “k” seemed to contain two whole syllables. Is this a Canadian thing? He was referring to my modest volume on the topic The War We Never Fought, so energetically ignored by reviewers and booksellers that it is known among London publishers as The Book They Never Bought.
February 7, 2016
QotD: How we solved the drug problem
Today during an otherwise terrible lecture on ADHD I realized something important we get sort of backwards.
There’s this stereotype that the Left believes that human characteristics are socially determined, and therefore mutable. And social problems are easy to fix, through things like education and social services and public awareness campaigns and “calling people out”, and so we have a responsiblity to fix them, thus radically improving society and making life better for everyone.
But the Right (by now I guess the far right) believes human characteristics are biologically determined, and biology is fixed. Therefore we shouldn’t bother trying to improve things, and any attempt is just utopianism or “immanentizing the eschaton” or a shady justification for tyranny and busybodyness.
And I think I reject this whole premise.
See, my terrible lecture on ADHD suggested several reasons for the increasing prevalence of the disease. Of these I remember two: the spiritual desert of modern adolescence, and insufficient iron in the diet. And I remember thinking “Man, I hope it’s the iron one, because that seems a lot easier to fix.”
Society is really hard to change. We figured drug use was “just” a social problem, and it’s obvious how to solve social problems, so we gave kids nice little lessons in school about how you should Just Say No. There were advertisements in sports and video games about how Winners Don’t Do Drugs. And just in case that didn’t work, the cherry on the social engineering sundae was putting all the drug users in jail, where they would have a lot of time to think about what they’d done and be so moved by the prospect of further punishment that they would come clean.
And that is why, even to this day, nobody uses drugs.
Scott Alexander, “Society Is Fixed, Biology Is Mutable”, Slate Star Codex, 2014-09-10.
December 29, 2015
QotD: The health benefits of moderate drinking
Should we consider mandatory graphic warning labels on bottles of booze? Our science reporter Tom Blackwell reviewed various Canadian discussions of the idea in these pages yesterday, suggesting that it is being looked at behind the scenes by addiction researchers. Labels with colour images of diseased esophagi on liquor labels would, of course, mimic the approach Canada has already taken toward cigarettes. So, well, why not? They say if you have a hammer, everything looks like a nail: by a similar token, if your field is addiction, no doubt everything that has addictive qualities looks like an unsolved problem.
But there is one very obvious way in which liquor is not like cigarettes: scientists are reasonably sure that light drinking has positive public-health consequences. If you don’t believe me, you can look up articles like the one I have in front of me here from a 2013 issue of Annals of Oncology: its title is “Light Drinking Has Positive Public Health Consequences.” As a layman I obviously can’t be certain I have summarized this editorial correctly, but you’ll have to trust me.
Colby Cosh, “The real problem with liquor warning labels — there’s such a thing as good drinking”, National Post, 2015-12-17.
June 16, 2015
Over-diagnosis as a root cause of the “addiction surge”
Stanton Peele is not happy with the latest version of the standard psychological diagnosis document:
The American Psychiatric Association creates the gold standard for diagnoses of mental disorders in the United States — and worldwide — through its Diagnostic and Statistical Manual of Mental Disorders. DSM-IV was published in 1994. In 2013, DSM-5 was released.
As I describe in the March, 2014 issue of Reason, there are several notable peculiarities about the manual. DSM-5
eliminates the distinction between dependence and abuse. Instead it classifies substance use disorders as mild, moderate, or severe. Thus the DSM-5 does not explicitly recognize such a thing as drug addiction or dependence. But under “Substance Use and Addictive Disorders” the manual includes a category called “Behavioral Addictions” that so far consists of a lone entry: “Gambling Disorder.”
These two major conceptual changes immediately aroused suspicion. Writing in the New York Times, investigative reporter Ian Urbina accused the psychiatric establishment and pharmaceutical industry of expanding the whole treatment enterprise by including “mild” substance use disorders, as well as recognizing things other than substances as being addictive. Keith Humphreys, a Stanford psychology professor, “predicted that as many as 20 million people who were previously not recognized as having a substance abuse problem would probably be included under the new definition.”
My argument is more fundamental. The ways of thinking about substance use and disorders embedded in DSM-5 and promoted by American psychiatry are actually causing an epidemic of these disorders.
May 25, 2015
Garnet Rogers interview
Garnet Rogers’ Recovery And Music After Stan: Garnet Rogers talks about addiction, getting clean, and misunderstandings about his brother and folk music in the ’70s.
November 14, 2014
QotD: The difference between medicine and recreational drugs
I do occasional work for my hospital’s Addiction Medicine service, and a lot of our conversations go the same way.
My attending tells a patient trying to quit that she must take a certain pill that will decrease her drug cravings. He says it is mostly covered by insurance, but that there will be a copay of about one hundred dollars a week.
The patient freaks out. “A hundred dollars a week? There’s no way I can get that much money!”
My attending asks the patient how much she spends on heroin.
The patient gives a number like thirty or forty dollars a day, every day.
My attending notes that this comes out to $210 to $280 dollars a week, and suggests that she quit heroin, take the anti-addiction pill, and make a “profit” of $110.
At this point the patient always shoots my attending an incredibly dirty look. Like he’s cheating somehow. Just because she has $210 a week to spend on heroin doesn’t mean that after getting rid of that she’d have $210 to spend on medication. Sure, these fancy doctors think they’re so smart, what with their “mathematics” and their “subtracting numbers from other numbers”, but they’re not going to fool her.
At this point I accept this as a fact of life. Whatever my patients do to get money for drugs — and I don’t want to know — it’s not something they can do to get money to pay for medication, or rehab programs, or whatever else. I don’t even think it’s consciously about them caring less about medication than about drugs, I think that they would be literally unable to summon the motivation necessary to get that kind of cash if it were for anything less desperate than feeding an addiction.
Scott Alexander, “Apologia Pro Vita Sua”, Slate Star Codex, 2014-05-25.
August 13, 2014
QotD: Abstention
Earlier this year I went off the booze for a few weeks, a purely voluntary move, let it be said. Among other things, I thought might be interesting to look at life from the Other Side. So to speak.
It wasn’t quite what I’d expected. Ex-topers, those warned off by the doc, will tell you emotionally that if they’d known how much better they were going to feel with, out it, they’d have given it up years before they actually had to. This is a pathetic lie, designed to make you look like the one who’s missing out and motivated by their hatred and envy of anybody who’s still on it. In fact, not only is one’s general level of health unaffected by the change, but daily ups and downs persist in the same way.
I discovered early on that you don’t have to drink to build yourself a hangover. There were mornings when I groaned my way to consciousness, wondering dimly whether it was port or malt whisky that had polluted my mouth and dehydrated my eyes, until I remembered that it could only have been too much ginger beer and late-night snooker. Then, the next morning, I would feel fine, or at least all right, with the same mysterious lack of apparent reason.
[…]
As regards other parts of the system, my liver no doubt benefited from its sudden lay-off, but it didn’t send me any cheering messages to say so. My mental powers seemed unaltered, certainly unimproved — I was no less forgetful, short on concentration, likely to lose the thread or generally unsatisfactory than I had been before. But now I had no excuse. That was the only big difference: when I was drinking I had the drink to blame for anything under the sun, but now it was all just me. A thought that must drive a lot of people to drink.
I hope I haven’t discouraged anyone who might be thinking of taking a short or long holiday from grape and grain. The easiest part is the actual total not drinking, much easier than cutting it down or sticking to beer or anything like that. Very nearly the hardest part is putting up with the other fellow when he’s drinking and you’re just watching him. At such times you’re probable not much fun yourself either. Fruit juice and company don’t mix.
Kingsley Amis, Everyday Drinking: The Distilled Kingsley Amis, 2008.
March 16, 2014
Alcoholics Anonymous and addiction
In Maclean’s, Kate Lunau talks to Dr. Lance Dodes about Alcoholics Anonymous:
Dr. Lance Dodes has spent more than 35 years treating people who are battling addiction, including alcoholism. In his new book (co-written with Zachary Dodes), The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, Dodes takes a hard look at Alcoholics Anonymous, a worldwide organization that describes itself as a “non-professional fellowship of alcoholics helping other alcoholics get and stay sober.” Today, there are more than 5,000 AA groups in Canada alone, which are free and open to anyone. Dodes, a retired assistant clinical professor of psychiatry at Harvard Medical School, argues that some groups — and many for-profit private rehab centres based on the 12-step model — are often ineffective, and can cause further damage to addicts.
Q: How did you come to work on addiction?
A: I first became involved with alcoholism and addiction in the ’70s, when the place I was working, which is now part of Massachusetts General Hospital in Boston, needed to develop an alcoholism treatment unit. I was director of psychiatry, so I said, “I’ll develop it.” Afterward, I became involved in various addiction treatment programs, including running the state’s largest compulsive-gambling program. Over the years, I became very familiar with AA. It became clear that, while AA works for some people, the statistics just didn’t back it up. The real problem is that [doctors] refer 100 per cent of their patients with alcoholism to AA, and that’s the wrong thing to do 90 per cent of the time.
Q: AA has more than two million members around the world. You say its success rate is between five and 10 per cent. How, then, do you account for its enduring popularity?
A: AA is a proselytizing organization. The 12th step is to go out and spread the word, and they do. Because there are so many people in prominent positions who are members of AA, it gets tremendously good press. If AA were simply harmless, then I would agree that a seven per cent success rate is better than zero. But that’s not the case. It can be very destructive. According to AA, AA never fails — you fail. AA says that if you’re not doing well in the program, then it’s you. So you should go back and do the same thing you did before: Do more of the 12 steps, and go to more meetings.
February 6, 2014
E-cigarettes – growth industry or doomed by regulatory overstretch
Megan McArdle discusses the past, present, and potential future for the e-cigarette industry:
In its simplest form, an e-cigarette is a cartridge filled with a nicotine solution and a battery powering a coil that heats the solution into vapor, which one sucks in and exhales like smoke. Typically, it looks like a regular cigarette, except the tip, embedded with an LED, often glows blue instead of red. The active ingredient in e-cigarettes is the same nicotine found in cigarettes and nicotine patches.
The effects of inhaling nicotine vapor are not totally understood, but there is no evidence to date that it causes cancer. Experts and logic seem to agree that it’s a lot better than setting chopped-up tobacco leaves on fire and inhaling the nicotine along with thousands of combustion byproducts, some of which are definitely carcinogenic. Because cancer is the main drawback of smoking for a lot of people, the delivery of nicotine without lighting a cigarette is very attractive. And because it produces a wispy vapor instead of acrid smoke, an e-cigarette lets you bring your smoking back indoors, where lighting up in an enclosed space is no longer socially, or legally, acceptable.
[…]
A primitive, battery-operated “smokeless non-tobacco cigarette” was patented as early as 1963 and described in Popular Mechanics in 1965. Thomas Schelling, a Nobel prize-winning economist who helped start the Institute for the Study of Smoking Behavior and Policy at Harvard University’s Kennedy School in the 1980s, recalls that people in the 1960s were talking about a charcoal-based vaporizer that would heat some sort of nicotine solution. While those early versions might have been safer than a regular cigarette, they were too expensive and cumbersome to become a substitute for a pack of Camels in a country where, as Schelling notes, “you’re never more than 5 or 10 minutes away from a smoke.”
In a way, electronic cigarettes were made possible by cell phones. The drive to make phones smaller and lengthen their battery life led to the development of batteries and equipment small enough to fit in a container the size and shape of a cigarette. There’s some dispute over who invented the modern e-cigarette, but the first commercially marketed device was created by a Chinese pharmacist, Hon Lik, and introduced to the Chinese market as a smoking cessation device in 2004.
In the same way that alcohol comes in various guises (many carefully crafted to appeal to beginners: sweet as soda pop, for example), e-cigarettes are available in many different flavours:
E-cigarette cartridges come in classic tobacco and menthol flavors — Verleur’s company even offers V2 Red, Sahara, and Congress, clearly aimed at loyal smokers of Marlboros, Camels, and Parliaments. But most companies also have less conventional flavors. Blu offers Peach Schnapps, Java Jolt, Vivid Vanilla, Cherry Crush, and Piña Colada, presumably for people who don’t just like a drink with a cigarette, but in one.
