6 ms·

Brain, Mind, Body and the Disease of Addiction

62 points by happy-go-lucky 10y ago

mjevans 10y ago
I believe the reporter is still trying to place blame. This is both counter-productive from a treatment standpoint, and also probably in direct conflict with what the /lead/ for experts in the US has stated is the case. That once addiction has set in, it is every bit as much a disease that requires external intervention and treatment to correct the imbalance as the other conditions.
- pg_is_a_butt 10y ago
  until we realize that addiction to living is the only thing keeping us going. you're all idiots.
- twblalock 10y ago
  The author is arguing that the reduction of addiction to a neurological concept ignores a long list of other components to addiction, some of which are moral, some of which are environmental, and others. The author further argues that people make this reduction because they think it prevents addicts from being blamed for their addiction, and that doesn't make sense because when you talk about what is going on in someone's brain, you are talking about most of what you consider to be the person, including that person's personality, beliefs, thoughts, feelings, etc. So, it's not an attempt to blame anyone. It's an argument that the mechanisms people use to deflect blame don't make sense. In other words, people who blame addicts for their addiction have no reason to stop blaming them if addiction is reduced to a neurological pathology, and people who don't blame addicts have no reason to start blaming them if addiction is reduced to a neurological pathology. The neurological pathology thing doesn't make a difference.
md224 10y ago
"Addiction" is a very tricky concept... Wikipedia defines it as "compulsive engagement in rewarding stimuli, despite adverse consequences". But what if the person engaging in the behavior doesn't mind the adverse consequences? What if the only adverse consequence is a slight decrease in life expectancy? How bad do the consequences have to be before a behavior becomes pathological? The line we draw here seems rooted in personal values, not an objective standard. What if someone uses amphetamines daily and really doesn't want to give them up. Are they addicted? What if they later learn they have ADHD and they've just been self-medicating? What if they don't have ADHD but the drug just improves their life? What if their name happens to be Paul Erdős? If someone suffers depression from opiate withdrawal, we call them an addict. If someone suffers depression from going through a breakup, it's just par for the course. And yet both scenarios are withdrawal from a pleasurable stimulus. Why is one acceptable and the other not?
- concinds 10y ago
  > But what if the person engaging in the behavior doesn't mind the adverse consequences? Addiction is by definition not something that is indulged in voluntarily by carefully weighing the consequences. I recommend you familiarize yourself with the Jellinek Curve, which accurately describes the guilt and shame that results from addiction. > What if the only adverse consequence is a slight decrease in life expectancy? Addiction itself not only has much worse consequences than that, but you're omitting the fact that addiction is present for a reason. Addiction is self-medication of excessive pain, and that excessive pain has deep, significant adverse effects. There is a reason that addiction is often comorbid with family dysfunction; addiction is a response to pain, not just a cause of pain. "Curing" an addiction involves reducing this pain to remove the need for self-medication. > The line we draw here seems rooted in personal values, not an objective standard. We need to recognize that subjectivity when we discuss addiction. The line is very clear. If you compulsively use, in a way that harms you, to relieve inner pain, it's addiction. Treating addiction as a "subjective" thing just ignores the pain-dimension which drives people to addiction in the first place, to run away from their pain. Society's focus should be on becoming more nurturing and cohesive, which'll hopefully result in fewer people being in so much pain that they'll destroy their lives and relationships just to feel remotely human.
  - md224 10y ago
    > Addiction is self-medication of excessive pain Well if you're going through excessive pain, self-medication sounds like a pretty reasonable response. What are you going to do, just suffer it? Therapy is nice but it doesn't solve everything. Would it be better if you took the "self" out of the equation and were supervised by a professional? > If you compulsively use, in a way that harms you, to relieve inner pain, it's addiction. So this requires all 3 parts though, right? If you compulsively use to relieve inner pain but without harm, that's okay, right? How much harm is allowed before it's addiction?
    - concinds 10y ago
      > Well if you're going through excessive pain, self-medication sounds like a pretty reasonable response No, it's a survival mechanism. It only reduces the pain superficially and temporarily. It's like giving an adrenaline shot to Atlas instead of getting the Globe off his back. >So this requires all 3 parts though, right? If you compulsively use to relieve inner pain but without harm, that's okay, right? How much harm is allowed before it's addiction? It's all motivation. Addictions are a way to deal with deep-seated and excessive shame, guilt, fears, hopelessness, despair, and loneliness. If that's why you take a drug, you're only hurting yourself by not seeking help for the aforementioned problems. If you're taking a drug just for fun, that's fine. Note that many addicts will lie to themselves and pretend the latter applies to them.
deleted 10y ago
[deleted]
concinds 10y ago
95% of the article explains how addiction isn't just a disease of the brain. The conclusion is a non-sequitur claiming that people only have compassion for addicts because they view addiction as a "brain disease". Am I misunderstanding this? For reference, he's the NPR article on the SG's report on addiction[0]. All the Surgeon General is trying to do it to shift addiction from an issue of personal blame that's widespread in the culture ("he's just an alcoholic!") and make people view it as a complex pathology that we need to address. The SG also proposes school programs to teach about substance misuse, and stress-management, as stress obviously contributes to addiction. What's unreasonable about any of this? The article in OP seems impossibly nitpicky. [0]: http://www.npr.org/sections/health-shots/2016/11/17/502402409/surgeon-general-murthy-wants-america-to-face-up-to-addiction http://www.npr.org/sections/health-shots/2016/11/17/50240240...
- JacksonGariety 10y ago
  The author is a philosopher. He's raising the question of why we seemingly need to reduce people's behavior to their neurology in order to have compassion for them. It's a philosophical question.
  - concinds 10y ago
    I missed that he was a philosopher. Still underwhelmed by the article. He's raising the question, but doesn't even attempt to answer it. And he doesn't even demonstrate that we even feel a "need" to do this to feel compassion. That's why it feels like a non-sequitur. The article is more quip than demonstration.
    - JacksonGariety 10y ago
      Philosophers aren't in the business of pretending to have answers. By "need" I just meant that it was a matter of course that the surgeon general said it.
  - ths 10y ago
    We have an easier time categorising a disorder as a disease rather than a moral failure when we see clear neurobiological correlates. But as we know (or at least currently believe), the separation of disorders into "hardware" (non-moral/impersonal) and "software" (moral/personal) is ultimately an illusion: The material substrate for our personality is precisely our neurobiology. For example, ΔFosB overexpression in the Nucleus Accumbens following repeated reward stimulus is "the most significant biomolecular mechanism in addiction since its viral or genetic overexpression (through chronic addictive drug use) in D1-type medium spiny neurons in the nucleus accumbens is necessary and sufficient for many of the neural adaptations and behavioral effects (e.g., expression-dependent increases in self-administration and reward sensitization) seen in drug addiction" (https://en.wikipedia.org/wiki/FOSB#Role_in_addiction https://en.wikipedia.org/wiki/FOSB#Role_in_addiction) If we reach a point where we also find sufficiently convincing neural correlates for the more "high-level" aspects of addictive psychology and personality, wouldn't that eventually lead to us treating the whole complex in non-moral terms? My feeling is that we intuitively choose the conceptual structure that we feel is most functional, given our state of knowledge. Morality is just another model for predicting and interacting with the behaviour in question, albeit less formal and more heuristic-based.
benevol 10y ago
PSA: There have been lots of reports of people getting rid of their addiction or obsessive-compulsive disorder (OCD), as a byproduct of their experience with LSD or psilocybin (the active substance contained in "magic mushrooms").
panglott 10y ago
This is the problem with "mental health" as a metaphor from bodily health. It's better than simply moralizing about addiction, sure, but leaves people with very muddled thinking about the topic through taking the metaphor too literally. So much of these debates seem like there's a confusion of causes and symptoms. Childhood trauma is as predictive of addiction in adulthood as obesity is of heart disease. Loneliess and personal trauma are just enormously corrosive to a person's mental well-being, but it seems like the mental health frame rarely attempts to deal with problems like that.
- concinds 10y ago
  > it seems like the mental health frame rarely attempts to deal with problems like that. I think viewing mental health as similar to physical health is useful (since, in mental as in physical health, lack of symptoms does not indicate good health). It's that we have no clue how to bring people from low psychological health to solid psychological health. For physical health, you need a good diet, exercise, and sleep. What do you need for mental health? Meditation? Even then, doctors have never told patients to "meditate more", whereas they do tell obese patients to eat less and exercise more. I know meditation isn't effective at solving pathologies, but it's telling that we as a culture have no clue what causes and promotes pathology in the first place.
  - crawfordcomeaux 10y ago
    For the past two weeks, I've starting developing/discovering a testable theory for how the mind/body/brain work together by viewing the brain as a neural-network-based machine that can rewire itself, the mind as a VM that runs programs in a well-typed functional language w/effects & coeffects. All 3 are inputs/outputs and the body is the only one able to carry out effects on the external environment. I've been able to dramatically reduce my daily anxiety without medication in a matter of minutes. I'm finding the model directly implies things we already know, such as why first impressions are important & how to overcome bad ones, as well as aspects of how bad first impressions are related to trauma in some ways. Using the model, I came up with a technique to drastically improve the rigid action in my left pinky for 30 mins to the point that it moved almost as smoothly as my right pinky. 10 years of playing piano and/or sax when growing up didn't help it at all, but 2-3 mins of a simple exercise practically cured the issue. I'm currently looking for experts to help me flesh out what I believe to be a new approach to mental health that's more effective & can more easily be specifically tuned for individual problems. What I need are category/type theorists to help w/the mathematical model, neuroscientists for the brain stuff, and anyone else willing to explore/play with the ideas. I could also use help figuring out a way to develop an open source science experiment that anyone can participate in & that produces scientifically legit data.
deleted 10y ago
[deleted]
projektir 10y ago
> The slogan that addiction is a chronic disease of the brain is meant to put the addict beyond the reach of moral reproach — and addiction itself squarely into the domain of the medical rather than the moral. > Now, I agree that addicts should be treated with love and compassion instead of judgment and punishment. But what does it say about us if the only way we can muster compassion and love for those among us with substance abuse problems is by suggesting that they are solely bystanders unjustly afflicted by mechanisms in their brains? This is a recurring problem that I think is only going to get worse once we get more knowledgeable about many things. Genetics, mental processes, ethics. I believe it's tightly coupled to the idea of total free will, and as long as that idea is the dominant philosophy of a society, it cannot have compassion for these people as it perceives them as acting freely. This leads to the just world hypothesis. We feel compassionate about injustice; negative outcomes coming from free will are, by definition, not unjust. Among those whose desire to have compassion is great enough, they have to say that the people in question are dealing with a physical problem, as physical causes are the only things that are perceived as capable of encroaching on total free will. In reality, there is no problem. A person may have a mental model that leads them to addiction. That mental model, most likely, makes sense to them and in their circumstance. Note that mental problems are not fully logical - we're not solving the framing problem. Genetics and environment are pieces here. Given this model, they choose addiction, because in their model, it makes sense. It turns out (we think, md224 has some interesting comments on that part of the equation) that their model is somewhat faulty, and now in addition to having a faulty model and knowing that it's faulty somewhere, they have the expected effects of physical addiction to deal with. Just reading this paragraph shouldn't lead anyone to believe that it will be straightforward for them to suddenly develop a perfect mental model to deal with the addiction from this situation, even if such a thing is possible. The person has made a choice, but it doesn't really matter that they did, and the choices they continue to make, may, again, not matter. There's nothing magical about choices, they're still limited by one's mental model and therefore will never be truly free. They may find a way through to a good model. Or maybe some good people will help them make their way there. Or perhaps a physical intervention will accomplish the same even faster. Feeling compassion towards someone trying to navigate this complex world? Easy. Just get rid of the idea that we're all sitting in front of two nicely presented plates where one clearly has good choices on it and the other clearly has bad choices on it. That's not how it works. But we can't think like this. The philosophy of total free will does not allow it. A person either has free will or they don't. Therefore the plates must clearly be there, and any good person will choose things from the right plate. Therefore, any person choosing addiction is fully aware of the outcome and expects exactly the same thing that we expect, so if it happens to them, we get to blame them and put the full weight of the responsibility that free will implies upon them. And from there comes pain. The terms we use when we talk about agency: attitude, personal responsibility, consequences. These terms became steeped in guilt and shame and authority. Because that is the price we put on agency: if you want to have it, you must feel constant guilt and shame, over any decision you make that we didn't want you to make that has a negative outcome. These are not light emotions, and especially those raised to be good and conscientious will be rather vulnerable to them. These inform of one's status and worthiness and acceptance in the tribe. To feel constant guilt is to not just make mistakes, but to also be wrong fundamentally, as we know one must not feel it constantly. What is one to think when they are convinced by others that they, completely freely, constantly make bad choices? That's a hell of a cross to bear. Little surprise is it, then, that many people decide that they don't want any of that agency if it comes at the price of constant pain and living life at the lead of someone else. We want to avoid pain, not experience it. They either deny the choices themselves, or deny that they made them, or deny that the choices existed. Anything else leads to pain. They are not allowed to merely banish guilt and shame and reclaim their agency due to the philosophy of total free will, so they just banish all of their agency all together.
MarkPNeyer 10y ago
There's a huge difference between illness and injury. A broken leg isn't a disease, it's an injury. You treat the injury - avoid the situations which lead to it - and things are fine. Moralizing is destructive, but so is saying "now it's not your fault that you went skiing without knowing how." I think the best way of looking at lots of mental health issues is through the lens of _injury_, not illness. More on this: https://markpneyer.wordpress.com/2015/06/01/broken-leg-disorder/ https://markpneyer.wordpress.com/2015/06/01/broken-leg-disor...
LordHumungous 10y ago
>This marks, by the way, a difference between addiction and chronic diseases like diabetes, with which the surgeon general compares it. Both diabetes and alcohol or drug addiction have life style components. Bad diet and low levels of exercise trigger type 2 diabetes in those prone to the disease. In a similar way, drug abuse causes addiction. But diabetes comes down, finally, to a difficulty managing glucose levels in the blood. You can't say that addiction boils down to something straightforwardly physiological in the same sort of way Is diabetes really that straightforward? Diabetes and heart disease are linked to obesity which is linked to diet and exercise. Most people who are pre-diabetic or hypertensive can reverse their condition through lifestyle changes, yet most fail to do so. And I would disagree that addiction lacks a physiological component in its later stages. Withdrawals are absolutely a physiological phenomenon and a big reason why people continue to use.

I believe the reporter is still trying to place blame. This is both counter-productive from a treatment standpoint, and also probably in direct conflict with what the /lead/ for experts in the US has stated is the case. That once addiction has set in, it is every bit as much a disease that requires external intervention and treatment to correct the imbalance as the other conditions.

pg_is_a_butt 10y ago
until we realize that addiction to living is the only thing keeping us going. you're all idiots.
twblalock 10y ago
The author is arguing that the reduction of addiction to a neurological concept ignores a long list of other components to addiction, some of which are moral, some of which are environmental, and others. The author further argues that people make this reduction because they think it prevents addicts from being blamed for their addiction, and that doesn't make sense because when you talk about what is going on in someone's brain, you are talking about most of what you consider to be the person, including that person's personality, beliefs, thoughts, feelings, etc. So, it's not an attempt to blame anyone. It's an argument that the mechanisms people use to deflect blame don't make sense. In other words, people who blame addicts for their addiction have no reason to stop blaming them if addiction is reduced to a neurological pathology, and people who don't blame addicts have no reason to start blaming them if addiction is reduced to a neurological pathology. The neurological pathology thing doesn't make a difference.

md224 10y ago

"Addiction" is a very tricky concept... Wikipedia defines it as "compulsive engagement in rewarding stimuli, despite adverse consequences". But what if the person engaging in the behavior doesn't mind the adverse consequences? What if the only adverse consequence is a slight decrease in life expectancy? How bad do the consequences have to be before a behavior becomes pathological? The line we draw here seems rooted in personal values, not an objective standard. What if someone uses amphetamines daily and really doesn't want to give them up. Are they addicted? What if they later learn they have ADHD and they've just been self-medicating? What if they don't have ADHD but the drug just improves their life? What if their name happens to be Paul Erdős? If someone suffers depression from opiate withdrawal, we call them an addict. If someone suffers depression from going through a breakup, it's just par for the course. And yet both scenarios are withdrawal from a pleasurable stimulus. Why is one acceptable and the other not?

concinds 10y ago
> But what if the person engaging in the behavior doesn't mind the adverse consequences? Addiction is by definition not something that is indulged in voluntarily by carefully weighing the consequences. I recommend you familiarize yourself with the Jellinek Curve, which accurately describes the guilt and shame that results from addiction. > What if the only adverse consequence is a slight decrease in life expectancy? Addiction itself not only has much worse consequences than that, but you're omitting the fact that addiction is present for a reason. Addiction is self-medication of excessive pain, and that excessive pain has deep, significant adverse effects. There is a reason that addiction is often comorbid with family dysfunction; addiction is a response to pain, not just a cause of pain. "Curing" an addiction involves reducing this pain to remove the need for self-medication. > The line we draw here seems rooted in personal values, not an objective standard. We need to recognize that subjectivity when we discuss addiction. The line is very clear. If you compulsively use, in a way that harms you, to relieve inner pain, it's addiction. Treating addiction as a "subjective" thing just ignores the pain-dimension which drives people to addiction in the first place, to run away from their pain. Society's focus should be on becoming more nurturing and cohesive, which'll hopefully result in fewer people being in so much pain that they'll destroy their lives and relationships just to feel remotely human.
- md224 10y ago
  > Addiction is self-medication of excessive pain Well if you're going through excessive pain, self-medication sounds like a pretty reasonable response. What are you going to do, just suffer it? Therapy is nice but it doesn't solve everything. Would it be better if you took the "self" out of the equation and were supervised by a professional? > If you compulsively use, in a way that harms you, to relieve inner pain, it's addiction. So this requires all 3 parts though, right? If you compulsively use to relieve inner pain but without harm, that's okay, right? How much harm is allowed before it's addiction?
  - concinds 10y ago
    > Well if you're going through excessive pain, self-medication sounds like a pretty reasonable response No, it's a survival mechanism. It only reduces the pain superficially and temporarily. It's like giving an adrenaline shot to Atlas instead of getting the Globe off his back. >So this requires all 3 parts though, right? If you compulsively use to relieve inner pain but without harm, that's okay, right? How much harm is allowed before it's addiction? It's all motivation. Addictions are a way to deal with deep-seated and excessive shame, guilt, fears, hopelessness, despair, and loneliness. If that's why you take a drug, you're only hurting yourself by not seeking help for the aforementioned problems. If you're taking a drug just for fun, that's fine. Note that many addicts will lie to themselves and pretend the latter applies to them.

deleted 10y ago

[deleted]

concinds 10y ago

95% of the article explains how addiction isn't just a disease of the brain. The conclusion is a non-sequitur claiming that people only have compassion for addicts because they view addiction as a "brain disease". Am I misunderstanding this? For reference, he's the NPR article on the SG's report on addiction[0]. All the Surgeon General is trying to do it to shift addiction from an issue of personal blame that's widespread in the culture ("he's just an alcoholic!") and make people view it as a complex pathology that we need to address. The SG also proposes school programs to teach about substance misuse, and stress-management, as stress obviously contributes to addiction. What's unreasonable about any of this? The article in OP seems impossibly nitpicky. [0]: http://www.npr.org/sections/health-shots/2016/11/17/502402409/surgeon-general-murthy-wants-america-to-face-up-to-addiction http://www.npr.org/sections/health-shots/2016/11/17/50240240...

JacksonGariety 10y ago
The author is a philosopher. He's raising the question of why we seemingly need to reduce people's behavior to their neurology in order to have compassion for them. It's a philosophical question.
- concinds 10y ago
  I missed that he was a philosopher. Still underwhelmed by the article. He's raising the question, but doesn't even attempt to answer it. And he doesn't even demonstrate that we even feel a "need" to do this to feel compassion. That's why it feels like a non-sequitur. The article is more quip than demonstration.
  - JacksonGariety 10y ago
    Philosophers aren't in the business of pretending to have answers. By "need" I just meant that it was a matter of course that the surgeon general said it.
- ths 10y ago
  We have an easier time categorising a disorder as a disease rather than a moral failure when we see clear neurobiological correlates. But as we know (or at least currently believe), the separation of disorders into "hardware" (non-moral/impersonal) and "software" (moral/personal) is ultimately an illusion: The material substrate for our personality is precisely our neurobiology. For example, ΔFosB overexpression in the Nucleus Accumbens following repeated reward stimulus is "the most significant biomolecular mechanism in addiction since its viral or genetic overexpression (through chronic addictive drug use) in D1-type medium spiny neurons in the nucleus accumbens is necessary and sufficient for many of the neural adaptations and behavioral effects (e.g., expression-dependent increases in self-administration and reward sensitization) seen in drug addiction" (https://en.wikipedia.org/wiki/FOSB#Role_in_addiction https://en.wikipedia.org/wiki/FOSB#Role_in_addiction) If we reach a point where we also find sufficiently convincing neural correlates for the more "high-level" aspects of addictive psychology and personality, wouldn't that eventually lead to us treating the whole complex in non-moral terms? My feeling is that we intuitively choose the conceptual structure that we feel is most functional, given our state of knowledge. Morality is just another model for predicting and interacting with the behaviour in question, albeit less formal and more heuristic-based.

benevol 10y ago

PSA: There have been lots of reports of people getting rid of their addiction or obsessive-compulsive disorder (OCD), as a byproduct of their experience with LSD or psilocybin (the active substance contained in "magic mushrooms").

panglott 10y ago

This is the problem with "mental health" as a metaphor from bodily health. It's better than simply moralizing about addiction, sure, but leaves people with very muddled thinking about the topic through taking the metaphor too literally. So much of these debates seem like there's a confusion of causes and symptoms. Childhood trauma is as predictive of addiction in adulthood as obesity is of heart disease. Loneliess and personal trauma are just enormously corrosive to a person's mental well-being, but it seems like the mental health frame rarely attempts to deal with problems like that.

concinds 10y ago
> it seems like the mental health frame rarely attempts to deal with problems like that. I think viewing mental health as similar to physical health is useful (since, in mental as in physical health, lack of symptoms does not indicate good health). It's that we have no clue how to bring people from low psychological health to solid psychological health. For physical health, you need a good diet, exercise, and sleep. What do you need for mental health? Meditation? Even then, doctors have never told patients to "meditate more", whereas they do tell obese patients to eat less and exercise more. I know meditation isn't effective at solving pathologies, but it's telling that we as a culture have no clue what causes and promotes pathology in the first place.
- crawfordcomeaux 10y ago
  For the past two weeks, I've starting developing/discovering a testable theory for how the mind/body/brain work together by viewing the brain as a neural-network-based machine that can rewire itself, the mind as a VM that runs programs in a well-typed functional language w/effects & coeffects. All 3 are inputs/outputs and the body is the only one able to carry out effects on the external environment. I've been able to dramatically reduce my daily anxiety without medication in a matter of minutes. I'm finding the model directly implies things we already know, such as why first impressions are important & how to overcome bad ones, as well as aspects of how bad first impressions are related to trauma in some ways. Using the model, I came up with a technique to drastically improve the rigid action in my left pinky for 30 mins to the point that it moved almost as smoothly as my right pinky. 10 years of playing piano and/or sax when growing up didn't help it at all, but 2-3 mins of a simple exercise practically cured the issue. I'm currently looking for experts to help me flesh out what I believe to be a new approach to mental health that's more effective & can more easily be specifically tuned for individual problems. What I need are category/type theorists to help w/the mathematical model, neuroscientists for the brain stuff, and anyone else willing to explore/play with the ideas. I could also use help figuring out a way to develop an open source science experiment that anyone can participate in & that produces scientifically legit data.

deleted 10y ago

[deleted]

projektir 10y ago

> The slogan that addiction is a chronic disease of the brain is meant to put the addict beyond the reach of moral reproach — and addiction itself squarely into the domain of the medical rather than the moral. > Now, I agree that addicts should be treated with love and compassion instead of judgment and punishment. But what does it say about us if the only way we can muster compassion and love for those among us with substance abuse problems is by suggesting that they are solely bystanders unjustly afflicted by mechanisms in their brains? This is a recurring problem that I think is only going to get worse once we get more knowledgeable about many things. Genetics, mental processes, ethics. I believe it's tightly coupled to the idea of total free will, and as long as that idea is the dominant philosophy of a society, it cannot have compassion for these people as it perceives them as acting freely. This leads to the just world hypothesis. We feel compassionate about injustice; negative outcomes coming from free will are, by definition, not unjust. Among those whose desire to have compassion is great enough, they have to say that the people in question are dealing with a physical problem, as physical causes are the only things that are perceived as capable of encroaching on total free will. In reality, there is no problem. A person may have a mental model that leads them to addiction. That mental model, most likely, makes sense to them and in their circumstance. Note that mental problems are not fully logical - we're not solving the framing problem. Genetics and environment are pieces here. Given this model, they choose addiction, because in their model, it makes sense. It turns out (we think, md224 has some interesting comments on that part of the equation) that their model is somewhat faulty, and now in addition to having a faulty model and knowing that it's faulty somewhere, they have the expected effects of physical addiction to deal with. Just reading this paragraph shouldn't lead anyone to believe that it will be straightforward for them to suddenly develop a perfect mental model to deal with the addiction from this situation, even if such a thing is possible. The person has made a choice, but it doesn't really matter that they did, and the choices they continue to make, may, again, not matter. There's nothing magical about choices, they're still limited by one's mental model and therefore will never be truly free. They may find a way through to a good model. Or maybe some good people will help them make their way there. Or perhaps a physical intervention will accomplish the same even faster. Feeling compassion towards someone trying to navigate this complex world? Easy. Just get rid of the idea that we're all sitting in front of two nicely presented plates where one clearly has good choices on it and the other clearly has bad choices on it. That's not how it works. But we can't think like this. The philosophy of total free will does not allow it. A person either has free will or they don't. Therefore the plates must clearly be there, and any good person will choose things from the right plate. Therefore, any person choosing addiction is fully aware of the outcome and expects exactly the same thing that we expect, so if it happens to them, we get to blame them and put the full weight of the responsibility that free will implies upon them. And from there comes pain. The terms we use when we talk about agency: attitude, personal responsibility, consequences. These terms became steeped in guilt and shame and authority. Because that is the price we put on agency: if you want to have it, you must feel constant guilt and shame, over any decision you make that we didn't want you to make that has a negative outcome. These are not light emotions, and especially those raised to be good and conscientious will be rather vulnerable to them. These inform of one's status and worthiness and acceptance in the tribe. To feel constant guilt is to not just make mistakes, but to also be wrong fundamentally, as we know one must not feel it constantly. What is one to think when they are convinced by others that they, completely freely, constantly make bad choices? That's a hell of a cross to bear. Little surprise is it, then, that many people decide that they don't want any of that agency if it comes at the price of constant pain and living life at the lead of someone else. We want to avoid pain, not experience it. They either deny the choices themselves, or deny that they made them, or deny that the choices existed. Anything else leads to pain. They are not allowed to merely banish guilt and shame and reclaim their agency due to the philosophy of total free will, so they just banish all of their agency all together.

MarkPNeyer 10y ago

There's a huge difference between illness and injury. A broken leg isn't a disease, it's an injury. You treat the injury - avoid the situations which lead to it - and things are fine. Moralizing is destructive, but so is saying "now it's not your fault that you went skiing without knowing how." I think the best way of looking at lots of mental health issues is through the lens of _injury_, not illness. More on this: https://markpneyer.wordpress.com/2015/06/01/broken-leg-disorder/ https://markpneyer.wordpress.com/2015/06/01/broken-leg-disor...

LordHumungous 10y ago

>This marks, by the way, a difference between addiction and chronic diseases like diabetes, with which the surgeon general compares it. Both diabetes and alcohol or drug addiction have life style components. Bad diet and low levels of exercise trigger type 2 diabetes in those prone to the disease. In a similar way, drug abuse causes addiction. But diabetes comes down, finally, to a difficulty managing glucose levels in the blood. You can't say that addiction boils down to something straightforwardly physiological in the same sort of way Is diabetes really that straightforward? Diabetes and heart disease are linked to obesity which is linked to diet and exercise. Most people who are pre-diabetic or hypertensive can reverse their condition through lifestyle changes, yet most fail to do so. And I would disagree that addiction lacks a physiological component in its later stages. Withdrawals are absolutely a physiological phenomenon and a big reason why people continue to use.