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What Science Says to Do If Your Loved One Has an Opioid Addiction

anythingnonidin 9y ago
OP here. An interesting takeaway I had was the importance of community. Does anyone know any non-profits or startups working to increase people's sense of community at a mass scale? It seems this is missing from large parts of the western world and has many consequences.
- CodeCube 9y ago
  the cynical amongst us would respond that this need is being "filled" by FB and social media ... I for one hope that doesn't turn out to be true in the long term.
  - hasenj 9y ago
    This need is actually being exacerbated by the likes of FB.
    - emodendroket 9y ago
      Facebook can definitely be a complement to real-life associations; I've used it to find some real-life events.
  - saint_fiasco 9y ago
    Using social media to fill the need of community is like using heroin to fill the need of happiness. It provides a pale facsimile of the real thing at a terrible price.
  - emodendroket 9y ago
    I see people claiming this all the time (or even that somehow Reddit is the new version of it), but it's just not right... it's not the same kind of community at all.
- DougN7 9y ago
  > any non-profits ... working to increase people's sense of community at a mass scale You're describing most religions that I'm aware of. Say what you will about their beliefs, but most of them (definitely not all) work hard to have an inclusive and supportive community.
  - hasenj 9y ago
    > work hard to have an inclusive and supportive community. With the condition that you abide by the rules. It's the assurance that everyone adheres to more-or-less the same values that glues the community together. Also, if I may venture slightly off-topic, the modern western definition of "inclusive" seems to imply "without requiring people to adhere to anything", which is the opposite of what you need to build a community. No shared set of values ("do whatever you want" does not really count as a value) means less trust and more suspicion. Simplest example: group A values sexual restraint and have a philosophical framework that justifies why this value is necessary for the preservation of society, group B values sexual freedom and is dismissive of the philosophical framework of group A. Members of group A will be extremely weary of members of group B, and will be concerned about how they might start influencing their children, for example. So they will avoid them. Vice versa, members of group B will be suspicious of group A members, because when you see people being suspicious and avoidant towards you, you tend to become suspicious of them as well.
    - slv77 9y ago
      > With the condition that you abide by the rules. The rules are generally in place to protect the community from sociopaths and serve as the communities immune system.
      - astura 9y ago
        What!? Religious rules are not "to protect the community from sociopaths." For example, eating pork is not sociopathic behavior and yet a large part of the world's religions forbid pork eating. People who have problems with the religious community usually are for their arbitrary rules rather than they'd much rather be sociopaths. (I'd make the argument they aren't particularly good about keeping sociopaths out anyways but that's another topic)
- otakucode 9y ago
  It reminds me of things Mother Teresa (who was at times a horrendous person, her Nobel acceptance speech is pretty disturbing and cruel) said about American/western society. She remarked that although a person in India might be radically more poor, even if they were starving in the street, they knew people would reach out to them and cared for them. In America, no matter how rich you are, you feel far more alone than that.
  - gedy 9y ago
    > (who was at times a horrendous person, her Nobel acceptance speech is pretty disturbing and cruel) Wait what? Because she brought up abortion? https://www.nobelprize.org/nobel_prizes/peace/laureates/1979/teresa-acceptance_en.html https://www.nobelprize.org/nobel_prizes/peace/laureates/1979...
    - emodendroket 9y ago
      I don't know about the speech particularly, but I think Catholic notions about poverty and suffering bringing people closer to Christ rub some people the wrong way. At least that seems to be a lot of the motivation behind "Mother Teresa was awful" stuff I see.
  - hourislate 9y ago
    Mother Teresa didn't know much about America. She failed to realize that money might not buy happiness but it sure buys the kind of misery we all like.
  - TACIXAT 9y ago
    I don't think I've ever seen someone starving in the street in the US. I totally disagree with the sentiment that Americans wouldn't help each other. There is a lack of community here and that would be a nice problem to solve, but we aren't heartless.
- wu_tang_chris 9y ago
  Your comment reminds me of this video: https://www.youtube.com/watch?v=ao8L-0nSYzg https://www.youtube.com/watch?v=ao8L-0nSYzg
  - anythingnonidin 9y ago
    Thanks
- AndrewOMartin 9y ago
  I've seen a couple of documentaries where KKK members were interviewed and the sense of purpose and community seemed to be the main thing they were all getting out of it. I'm not saying the KKK is a good community group, but I will say there are a lot of people with less community than they offer.
  - anythingnonidin 9y ago
    Extremely interesting. Don't suppose you have a link?
    - KGIII 9y ago
      Even better, visit voat.co and read for a few weeks. The white nationalists are all about family, community, and a collective. Well, a specifically white collective. It's very important to them and a frequent topic. Of course, this means reading their posts which is not for the faint of heart. It's like most of them are missing something and are trying to find something to belong to. In a way, I feel more sorrow than anger towards them.
    - AndrewOMartin 9y ago
      See my response to nothingnonidin. https://news.ycombinator.com/item?id=15244420 https://news.ycombinator.com/item?id=15244420
      - anythingnonidin 9y ago
        Thanks
  - anythingnonidin 9y ago
    Was it http://www.npr.org/2017/08/13/543259499/a-reformed-white-nationalist-speaks-out-on-charlottesville http://www.npr.org/2017/08/13/543259499/a-reformed-white-nat... or something else?
    - AndrewOMartin 9y ago
- pjc50 9y ago
  > non-profits or startups working to increase people's sense of community This is non-profit territory, absolutely not startup territory. You can only build a classic VC-funded startup by promising that eventually you're going to extract value (usually monopoly profits!) from the community. "Sense of community" is one of those things that's traditionally ranked well below profits and been destroyed in the search for profit.
  - Bartweiss 9y ago
    Cynically: 'sense of community' gets destroyed in the search for profit when you're profiting from something else. If you're getting your profits from the community, you'll build it up just fine. Not necessarily in a healthy way, but at least in a persistent one. Hell, I think you could convincingly argue that opening a new pub counts as founding a startup aimed at increasing people's sense of community. It doesn't have the unlimited scale of a tech startup, but it is a company that profits from offering a 'third place'. For that matter, plenty of churches have been run more like businesses than non-profits while still creating strong communities. As long as the sense of community is profitable, it might do well with startups. That just hasn't been a common state of affairs lately.
    - closeparen 9y ago
      A pub is a small business. A startup is distinct from a small business in that it seeks outsized returns through economies of scale, efficiency, etc. The funding model and the set of behaviors which are adaptive for founding or working in these kinds of businesses don't have much in common. Much of the loss of community in America is small businesses getting destroyed in the market by successful startups (i.e. large corporations).
- emodendroket 9y ago
  Uh, well, maybe not a popular answer here, but that is one thing churches are really good at.
  - terminado 9y ago
    With churches, there are a few problems that are intellectually repellent, meaning they won't solve for certain personality types. Namely: 1. artificial social heirarchy 2. magical thinking 3. group think 4. rules without reason Part of religion is often about imposing order on the irrational aspects of experience and reality, but there's a lot of centuries-old cruft and inertia behind the ones that exist. When you take apart any given religion, and inspect individual parts, and place those parts within the context of a small, insular village, dispossessed of plumbing, medicine or indoor heating, any single part starts to make sense. But many are far, far away from that, and need not invest in superstition. Morality is great, but in some cases morality without purpose translates to overbearing fear imposed with motive. Mythology and folklore are good for illustrating practical principles and relationships between ideas, but some people refuse to consider whether the ant and the grasshopper never actually happened. All this taken together, often tips the scales toward cognitive dissonance for some who think too deeply about bald facts. I don't have a solution to fix this, but I've seen what happens when smart people try to reimagine a modern religion that might fit current scenarios, and it's usually equally terrible. Someone will eventually figure this modern community rationale problem out, but it's not something you can just fake or make up for its own sake. It's something that needs to (seem to) happen organically, on its own, and remain authentic. Sounds pretty difficult if you ask me.
    - snark42 9y ago
      > With churches, there are a few problems that are intellectually repellent, meaning they won't solve for certain personality types. Unitarian Universalist churches are good for community and avoid most of these negatives in my experience.
      - emodendroket 9y ago
        Yeah, that seems to be a popular choice for lapsed religious people.
- marojejian 9y ago
  Shameless plug: I've been working on a service (www.campfire.care) to build peer support groups for any focus. Groups of 5-10 people with the same issue meet regularly via video and stay connected via chat. The idea is that we are fundamentally social creatures, and struggling with a challenge alone is unhealthy. Campfire is not therapy or a replacement for therapy. But peer support can be powerful + inexpensive. And being part of a true peer group can provide a kind of value that professional mental health can't. You can't be friends with you therapist, and their job is not to truly empathize with you. Would love any thoughts / feedback!
  - anythingnonidin 9y ago
    Wonderful! What's the main challenge for you as it relates to the product? i.e. are you limited on needing more customers / stronger product market fit, do you have insane product market fit and limited on hiring, etc? Is this a for profit thing?
    - marojejian 9y ago
      Thanks! Generally, I think the challenge for us is going to be the same as for many other consumer-ish mental health startups. The experience is really effective, but most people aren't looking for this specific approach to solve their problem. So building awareness is super valuable. Our main goal is to help as many people as cost-effectively as we can. After thinking a lot about it, I think there's more evidence we can scale better as a for profit.
  - flatfilefan 9y ago
    Did you consider appointing (renting out) a community lead for those groups? Maybe something along the lines of Über driver system? If a group has a natural leader - perfect. If not they can "rent" one to keep the momentum of the group going.
    - marojejian 9y ago
      Yes - we've been trying a variety of different backgrounds for our "hosts." The most exciting approach is to level up our members to lead groups with their challenge. They truly empathize and care about the group, which can make them more effective than a whole bunch of training. Plus, it reinforces that this is not a case where you are being treated for a mental health problem. This is a tight-knit community helping each other.
kchoudhu 9y ago
Now that the opioid crisis is a problem for white people, science makes an appearance in the policy discussion. Contrast to the crack epidemic in the 80s: fuck'em, throw them all in prison. Edit to add: I wish the best of luck to those who have been caught up in this crisis: I'm rooting for you, and I hope every last one of you find the treatment you need. For those of us who aren't affected, it's time for some deep introspection about what we allow our politicians and (yes) our neighbors to get away with.
- TearsInTheRain 9y ago
  Imho i would guess it is more a markets thing than a racial thing. There probably wasn't a whole lot of money to be made in curing an epidemic to a poor minority in the 80s whereas the opioid crisis is hitting a larger middle class population
  - kchoudhu 9y ago
    I hope you see that this is a problem? Why is our society incapable of doing the right thing when there is a market failure?
    - ianai 9y ago
      Because the moneyed interests have altogether too much power.
  - ianai 9y ago
    That doesn't make it any better. It's also not a simple A/B. Maybe society had to drag it through the aforementioned stages to reach a point of consciousness. I don't really buy that though. Honestly, I think the problem is simply being on opioids for a week due to post surgery pain or similar is enough to hook people. My write in ballot would include various forms of legalization and treatment. I've heard DMT can make people quit heroin over night. While a little radical, that's better than the alternatives.
    - 9y ago
Justsignedup 9y ago
Interesting question: The replacing opioid addiction with maintenance drugs... I could understand that drug being an okay interim solution, but in the end the person still needs to go through withdrawal, the drug just replaces withdrawal with another drug. Withdrawal is hard. Yes. But at least the person is in the right mindset to go through it once they are off the compulsory addiction, even if it takes a year to get to that point. As kchoudhu points out and many have pointed out to me before this article, certainly once a bunch of white kids have this problem, suddenly they are "victims" not "criminals". Yet we have destroyed so many lives between the 80s and now, especially with the mandatory minimums and such.
- jtmcmc 9y ago
  Why? The problems with addiction - specifically opioid addiction - is that it causes negative, destructive behavior. This isn't a consequence of having a physical dependence we are all physically dependent on things after all.
  - otakucode 9y ago
    No, it does not cause negative, destructive behavior. It causes you to lie down and feel good. And it also causes constipation. And, if your supply is interrupted, withdrawal symptoms. The rest is caused primarily by the laws and social environment. Having to interact with criminals? Getting uncertain doses? Overdosing? Those things are because it is illegal, not because it's an opiate.
    - graphememes 9y ago
      The withdrawals do lead to destructive behavior.
    - jtmcmc 9y ago
      Addiction by definition does cause negative destructive behavior. That's part of the definition. What you're describing is a combination of the psychoactive effects of it and its withdrawal symptoms. I do agree with you, however. People become addicts due to how our society has criminalized and deregulated drug manufacture and sale and made it extremely hard to teach people how to do properly.
btmorex 9y ago
What science says nothing about because of the DEA's inane scheduling: hallucinogens.
- elchief 9y ago
  Yes, Ibogaine is literally 10x more effective than Methadone. It's risky if you've weakened your heart with stimulants though.
  - martinald 9y ago
    Source?
- VT_Drew 9y ago
  The "science" on treating Opioid addictions at this point would just be reaffirming what we already know with mountains of "anecdotal" evidence. You want to solve the Opoid problem? Legalize Ibogane, DMT, Psilocybin, and MDMA, it is that simple.
anythingnonidin 9y ago
Also interesting and related: https://news.ycombinator.com/item?id=15241874 https://news.ycombinator.com/item?id=15241874 "Psychedelics Help Reduce Opioid Addiction, According to New Study"
- spraak 9y ago
  Interesting, but I'm surprised it doesn't mention Iboga.
- taylorswift_ 9y ago
  Have you also read "Abstinence Helps Reduce Opioid Addiction, According to New Study"?
  - tree_of_item 9y ago
    No, I haven't read that one. Did you have some point to make by making up a fake study title?
  - pjc50 9y ago
    Oh, is this like the "abstinence based sex education" that increases teenage pregnancy and STD rates?
deleted 9y ago
[deleted]
sharpercoder 9y ago
An addiction tries to replace a void in someone's life. Chances are big the environment of the addicted played a role in cerating the void.
- betenoire 9y ago
  That's not helpful at all. Yes, addiction is "filling" "something" "broken". Now what?
  - otakucode 9y ago
    It is extremely helpful. It is very incovenient, to be sure, but it is very helpful. If you want people to not use drugs, then you have to provide them with a fulfilling life or the opportunity for such. If your desire is to operate a society that grinds people down, restricts them in ways that feel burdensome to them, insults them, and also does not have people using drugs? You might as well wish to fly. Because your wish is as realistic, and as worthy of ridicule. It comes down to whether you want to stop people using drugs because you don't like that they get happy so easy, or whether you want people to stop using drugs of their own accord and have happy lives. If it's the second - help.
    - ubernostrum 9y ago
      Never mind people who get addicted after being prescribed medication for an injury, then? Never mind that the new generations of opioids were marketed as safer/less addicting when they probably were more addicting, and thus prescribed even more out of perception of their safety?
      - zaroth 9y ago
        Althogh this has certainly become the narrative of late, TFA seems to discount this fairly strongly; "To that point, pain treatment is not the most significant risk factor for addiction. Far greater risk comes from simply being young and from using alcohol and other recreational drugs heavily. Ninety percent of all drug addictions start in the teens — and 75 percent of prescription opioid misuse begins when (mainly young) people get pills from friends, family or dealers — not doctors. Opioids are rarely the first drug people misuse."
otakucode 9y ago
Great article, but if your loved one has an opioid addiction and wants to quit without suffering the devastating withdrawal, I would strongly recommend investigating kratom. It is a non-opiate tree which grows primarily in Thailand and similar regions. It contains an alkaloid called mitragynine. This alkaloid is a selective opioid receptor agonist. Specifically, research shows that it is an agonist to several opioid receptors but particularly an antagonist of the receptor which causes respiratory system depression, and is thought responsible for the primary addictive nature of most opiates and synthetic opioids. It is legal in most of the US (I believe there are 1 or 2 states which have banned it, it has a long history by now in US law. A year or so ago the DEA announced to Congress the intention to schedule it (ban it) under their 'emergency' powers (which is bullshit since there are no deaths from it, and it remains mostly unknown, those 'emergency' powers are simply abused). After that announcement, they were required to consult research and doctors, along with opening a public comment period. Afterward they withdrew their intent to schedule it. So, for now, it remains legal. Its effect upon a person with no opioid dependence is at low doses similar to caffeine without the 'jittery' part and without the crash afterward. In larger doses it has mild analgesic and sedative properties. I've taken Vicodin after I had my wisdom teeth removed, and have also tried kratom, and not even in large amounts have I ever experienced it giving any sort of similar 'high'. It is mildly habit-forming of itself, but very mildly compared to opiates. Withdrawal after extensive use might consist of having the sniffles and feeling a bit restless for a day or two. With tapering dosages down rather than sudden cessation, nothing is likely to be noticed. Reportedly, kratom ameliorates most, if not all, withdrawal symptoms from things like Oxycontin, heroin, etc. Expecting people to go through withdrawal is inhumane and stupid. We can deal with it without the suffering. Kratom can be gotten online from multitudes of vendors. Please steer clear of the "legal high" and 'weed shop' variety of places. In addition to being radically overpriced, their association does active harm to the community of people who use kratom reasonably. Stay away from extracts and concentrated forms (although those seem to have mostly gone away from most outlets, they were big for awhile and were bordering on dangerous) and just get simple crushed leaves. If you or a loved one wants to quit, kratom will let you do so without ruining your life. If your loved one does not want to quit, because doing so would expose them to the full pain (emotional, physical, OR psychological) of a life they hate and which they feel traps them... your problem and theirs is not the drug.
intopieces 9y ago
If there were one article this year I could force my family to process adequately, it's this one. Addiction is still seen in our group as a failure of character -- not raised right, not religious enough, not following the right path. This kind of advice is seen as 'soft', and that's a shame.
- buxtehude 9y ago
  I would also recommend listening to an NPR podcast "The Fix" by RadioLab: http://www.radiolab.org/story/addiction/ http://www.radiolab.org/story/addiction/ While the description talks about taking a pill to solve your addiction problems (some very interesting insights into the latest research at that time 2015 and also many absurd regulatory hurdles), it's the interviews with researchers and addicts that are truly eye opening - and address many of the issues you mention. After listening to it I personally will never reduce someone who has an addiction to failure of character.
  - leggomylibro 9y ago
    In the words of Neal Stephenson, they are '[opiate]-seeky.' They have a tendency dug in at the neurological level to seek opiates, even if they aren't doing so at the moment. The distinction offered by Stephenson is that '*-seeky' is an adjective that modifies an individual, rather than a noun such as 'addict' which overshadows and eclipses an individual.
  - taxicabjesus 9y ago
    One of my passengers tried Naltrexone to get her drinking under control, maybe a dozen years ago. While on that drug, she couldn't drink enough to make all her problems go away so she discontinued it. I met her after her third DUI & almost 2 years in prison... Addiction is multi-faceted. Thx for the radiolab link.
biggerfisch 9y ago
I think the saddest part of this article is perhaps the glancing statement it makes about how prison isn't a place of recovery and rehabilitation. The prison system here really is too focused on punishment and locking people up forever rather than helping them get back on their feet and being productive members of society
- buxtehude 9y ago
  Unfortunately, the drug war and punishing users of non-sanctioned drugs is embedded deep in America's political and social DNA - but seeing how much has changed in some areas of drug policy especially with variations from state to state - I hold out some hope that we might see some changes there too - but I just wouldn't hold my breath.
  - billmalarky 9y ago
    It's not just America's DNA. Many countries around the world base their drug policy off of US drug policy.
- mrguyorama 9y ago
  The prison system is highly privatized. Prisons with more people in them make more money and have a higher return on investment. Prisons that have repeat visitors can out compete prisons that do not. Therefore, there is a selection towards not keeping an inmate out of prison in the future. I hate how tinfoil hat-y this sounds, and I'm certainly no expert, so feel free to offer alternatives
  - Notre1 9y ago
    The ACLU, using from the Bureau of Justice Statistics, says that "for-profit companies were responsible for approximately 7 percent of state prisoners and 18 percent of federal prisoners in 2015" I don't think that count's as "highly" privatized. I personally think the incentives involved in the private prison system present major ethical issues, but I think we need to look at the incentives involved with the our legal system and governmental prisons, also.
ringaroundthetx 9y ago
> evidence-based medicine non-evidence based medicine that uses the made-up-on-the-spot holistic approach is upheld by the idea that there is no scientific method available because it is about the body as a whole. I think that rebuttal is reductionist and that there could be a method that is applicable to that form of treatment. does anybody have thoughts on that?
- taylorswift_ 9y ago
  posting my response above but I am with you...
dogruck 9y ago
Annoying how this 538 article immediately bemoans the lack of regulation -- as if the only solution is to grow the government and pass more laws.
logfromblammo 9y ago
In short, the published science says to addict the patient to methadone or suboxone instead of whatever they are on, for a lifetime of perpetual treatment. Actual drug users are likely to recommend using kratom to alleviate withdrawal symptoms and ibogaine (or another powerful hallucinogen) to permanently remove the addiction. "Science" does not recommend this, because politics has made the hallucinogens--and research into their therapeutic uses--at least as illegal as the opioids that cause all the problems. As someone with an opioid addiction is likely already routinely breaking some rather serious laws, and frequently courting sudden death by overdoses or adulterants, it may be worth trying the single dose of ibogaine before choosing the lifelong maintenance therapy.
taylorswift_ 9y ago
I read this, as a recovering addict that went through my own hell mostly from alcoholism, and wondered where the "science" part was? For instance this sentence "More than 13 percent of its participants died after treatment,1 mainly of overdoses that could potentially have been prevented with evidence-based care." The argument is that they "could" have been prevented but how do they really know that? How many people in general die of an overdose after X number of stays in a rehab? Through my own experiences going to rehab, I have known of many people who die. The fact is you can't predict which people will "get" it any better than you can predict if it will rain next month. I also disagree with this notion that being on suboxone or methadone indefinitely is a legitimate solution. Like what? You're advocating to stay on a drug the rest of your life? That isn't recovery at all, it's a band-aid that will likely lead to relapse and promotes a perpetual notion of being sick. I also disagree that their supposed evidence that CRAFT gets twice as many people into rehab has much relevance. How many of those people relapsed? How many of the people that didn't go to rehab ended up overdosing OR recovering? We don't get the whole picture so the "evidence" is mute. They knock 12-step which is fine but it turns out that it works for millions of people. There is no silver bullet here. While I have mixed feeling about the "tough love" approach, I can tell you from personal experience that the only reason I'm not buried right now is because at a certain point the floor dropped out too low, my family and friends abandoned me, I lost everything for a moment, and the pain and horror reached a level that finally I had a change of psyche on my OWN and realized I wanted to get better. In my own humble opinion the only "science" that matters on this subject are the opinions of those whom have lived it and recovered. Go survey the opiate addicts that didn't end up dead and find out what worked for them.
- bsder 9y ago
  Alcohol != opioid. As I said in another comment, alcohol is an odd drug. It's mechanisms work very differently from opioids and needs very different behaviors and strategies to combat.
  - taylorswift_ 9y ago
    In my opinion you can't simply discard the debate as comparing apples to oranges... There are many similarities. It's a drug addiction at the end of the day.
wjossey 9y ago
I do not agree with much of what is stated in this article, nor do I feel that this article represents "what science says" should be done if a loved one has opioid addiction (although it really goes into addiction as a general topic). Treating someone with addiction is a remarkably nuanced and challenging situation, and the author tries to present certain treatment options as not worth doing based on science, when their own citations do not back up those claims. As someone who has had a loved one go through addiction, and ultimately die from that addiction, I find the binary nature of a lot of this self-described "evidence based guide" dangerously black and white. Proclaiming that abstinence based programs "have not been found to be effective" is total nonsense. What the study found in GB was that psychological only based treatment is less effective at preventing death than replacement therapy, on average. For many, replacement therapy may very well be the best option. For other, abstinence programs may give them an opportunity to fully reclaim their life. How about we empower medical professionals with the ability to treat the disease with a number of weapons, rather than creating this false dichotomy, which is not represented in the data. This guide would potentially discourage someone, or a family member, from choosing a very viable option for treatment, by overstating results. While I'm not a medical professional, the best example I can think of is with how we treat depression. For some people, active psychotherapy is the best treatment option. For others, a regime of anti-depressants is sufficient treatment. For others, a combination of both is the optimum treatment option. What we don't do, as scientists, is say, "Option 2 has a 30% better outcome, thus we only will treat depression with option 2." That's just absolute junk. What it means is that we will look at what cohorts tend to respond best to option 1, 2, and 3, and understand why, so we can choose a treatment option that makes sense for that individual, without having to try 1, 2, and 3. It doesn't mean that we just toss out the other options wholesale. The 538 politics podcast does a, "Good use of polling" and "bad use of polling" intro during many of their podcasts. This article would clearly fall under the category of "bad use of polling". I hope to see better out of 538 in the future on these topics.
warcher 9y ago
Fun fact: The current standard within the US is AA/NA. AA and NA are not only wholly unscientific, being invented of whole cloth by a layperson in the early 20th century (for context, lobotomy was a totally accepted psychological treatment for decades after 1935). There was no science whatsoever involved in AA, and indeed Alcoholics Anonymous actively resists any data collection about the efficacy of its techniques whatsoever. It's main advantages from a US perspective are a) it's free. The costs are borne mostly in the form of churches providing basements and meeting rooms. and b) it's super churchy. We love churchy stuff around here. So basically we kicked addiction under the rug for the entire 20th century in favor of religious hokum that refuses any objective evaluation of its efficacy, or changing its methods. I should say, for the record, that there's a lot of people that have been helped by AA and NA, and there's indisputably good work being done there. But it's not perfect and categorically refuses to get better, and its longevity is IMHO more a result of our collective refusal to take the problem of addiction seriously in the US than anything else.
- rajacombinator 9y ago
  Got any better suggestions? Genuinely interested, not sarcasm. (Mostly.)
  - milkytron 9y ago
    I've seen a lot of headlines about studies of psychedelic drugs and compounds having a positive impact on addicts. There are a ton of articles out there, most seem like clickbait, but there are studies that have been done such as this one [1] which say that LSD has had a positive impact on alcohol abuse. I'm not saying this is the cure, but I do think further studies could prove beneficial. Edit: Added pdf of paper [2]. [1] http://journals.sagepub.com/doi/abs/10.1177/0269881112439253 http://journals.sagepub.com/doi/abs/10.1177/0269881112439253 [2] https://www.ntnu.edu/documents/139226/8932977/JOP439253.pdf https://www.ntnu.edu/documents/139226/8932977/JOP439253.pdf
  - curun1r 9y ago
    Not the poster you're replying to, but I'd say mindfulness and meditation. Learning to look inward can be an incredibly powerful tool for dealing with issues like substance abuse.
stmfreak 9y ago
Sympathetic support I'd fine for people interested in kicking a habit. But when the addict doesn't want to quit? What then?
narrator 9y ago
Nothing about NAD therapy? Sadly, it's an underutilized treatment for opioid addiction.
mirimir 9y ago
> When a family member, spouse or other loved one develops an opioid addiction — whether to pain relievers like Vicodin or to heroin — few people know what to do. Faced with someone who appears to be driving heedlessly into the abyss, families often fight, freeze or flee, unable to figure out how to help. OK, if someone wants to be an opioid addict, why not just let them? The "driving heedlessly into the abyss" aspect seems mainly due to opioids being illegal and expensive. I mean, do we use such language about diabetics? Do we expect them to manage their diabetes through diet alone? I'm not aware of solid evidence for health risks associated with chronic opioid use alone. Excluding opioid addiction, I mean. But please do share.
- mattmanser 9y ago
  A lot of people are dying from overdoses. https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf https://www.asam.org/docs/default-source/advocacy/opioid-add...
  - mirimir 9y ago
    People are dying of overdoses because opioids aren't available legally, with regulated strength and purity, and at reasonable prices. If opiods with regulated strength and purity were as readily available as liquor, few people would be overdosing. In parts of the Middle East, where alcohol isn't available legally, methanol poisoning isn't uncommon.
CodeWriter23 9y ago
"Science"'s answer to opioid addiction: prescribe opioids, declare addict cured. PS I'm not an advocate of treatment because they also employ shortcuts to "recovery".
emodendroket 9y ago
> Consequently, do not try to use legal consequences as a way to help people you love, and if possible, bail them out if they get arrested for drug crimes. This doesn’t mean you shouldn’t hold them accountable, but do so in ways that are less likely to lead to lifelong problems. Meaningful employment is an important factor in recovery — and few things are more harmful to the chances of getting a good job than having a criminal record. This is one area that's crying out for some kind of reform.
- criddell 9y ago
  I've been thinking about similar things in the context of a basic income. If we were to just pass a law and guarantee a significant basic income I think it would have disastrous effects and fail miserably. A guaranteed income is a good goal, but before we do that we need to figure out how to replace meaningful employment with other meaningful activities. People need a purpose. If we can alter our culture and separate a person's purpose from their employment, then we might be able to get to a Star Trek future. If I can get anything I want from a replicator in the wall, what are my incentives to still better myself and work towards something?
  - emodendroket 9y ago
    > I've been thinking about similar things in the context of a basic income. If we were to just pass a law and guarantee a significant basic income I think it would have disastrous effects and fail miserably. A guaranteed income is a good goal, but before we do that we need to figure out how to replace meaningful employment with other meaningful activities. People need a purpose. I don't think so. I think people can find a purpose without us imposing one on them. > If I can get anything I want from a replicator in the wall, what are my incentives to still better myself and work towards something? Why do people get really good at chess when there is little extrinsic motivation in it? If some people just want to hang around, is that really a "problem" we need to address?
    - infinite8s 9y ago
      Does maintaining an opioid addiction count as a meaningful purpose? Who's to say it's not (as long as it doesn't harm anyone else)?
sizzle 9y ago
Hands down, Naltrexone is the only thing that helped my loved ones with alcohol addiction. Please look into it and watch "one pill" documentary. You have a choice other than AA meetings.
grzm 9y ago
(2016)

OP here. An interesting takeaway I had was the importance of community. Does anyone know any non-profits or startups working to increase people's sense of community at a mass scale? It seems this is missing from large parts of the western world and has many consequences.

CodeCube 9y ago
the cynical amongst us would respond that this need is being "filled" by FB and social media ... I for one hope that doesn't turn out to be true in the long term.
- hasenj 9y ago
  This need is actually being exacerbated by the likes of FB.
  - emodendroket 9y ago
    Facebook can definitely be a complement to real-life associations; I've used it to find some real-life events.
- saint_fiasco 9y ago
  Using social media to fill the need of community is like using heroin to fill the need of happiness. It provides a pale facsimile of the real thing at a terrible price.
- emodendroket 9y ago
  I see people claiming this all the time (or even that somehow Reddit is the new version of it), but it's just not right... it's not the same kind of community at all.
DougN7 9y ago
> any non-profits ... working to increase people's sense of community at a mass scale You're describing most religions that I'm aware of. Say what you will about their beliefs, but most of them (definitely not all) work hard to have an inclusive and supportive community.
- hasenj 9y ago
  > work hard to have an inclusive and supportive community. With the condition that you abide by the rules. It's the assurance that everyone adheres to more-or-less the same values that glues the community together. Also, if I may venture slightly off-topic, the modern western definition of "inclusive" seems to imply "without requiring people to adhere to anything", which is the opposite of what you need to build a community. No shared set of values ("do whatever you want" does not really count as a value) means less trust and more suspicion. Simplest example: group A values sexual restraint and have a philosophical framework that justifies why this value is necessary for the preservation of society, group B values sexual freedom and is dismissive of the philosophical framework of group A. Members of group A will be extremely weary of members of group B, and will be concerned about how they might start influencing their children, for example. So they will avoid them. Vice versa, members of group B will be suspicious of group A members, because when you see people being suspicious and avoidant towards you, you tend to become suspicious of them as well.
  - slv77 9y ago
    > With the condition that you abide by the rules. The rules are generally in place to protect the community from sociopaths and serve as the communities immune system.
    - astura 9y ago
      What!? Religious rules are not "to protect the community from sociopaths." For example, eating pork is not sociopathic behavior and yet a large part of the world's religions forbid pork eating. People who have problems with the religious community usually are for their arbitrary rules rather than they'd much rather be sociopaths. (I'd make the argument they aren't particularly good about keeping sociopaths out anyways but that's another topic)
otakucode 9y ago
It reminds me of things Mother Teresa (who was at times a horrendous person, her Nobel acceptance speech is pretty disturbing and cruel) said about American/western society. She remarked that although a person in India might be radically more poor, even if they were starving in the street, they knew people would reach out to them and cared for them. In America, no matter how rich you are, you feel far more alone than that.
- gedy 9y ago
  > (who was at times a horrendous person, her Nobel acceptance speech is pretty disturbing and cruel) Wait what? Because she brought up abortion? https://www.nobelprize.org/nobel_prizes/peace/laureates/1979/teresa-acceptance_en.html https://www.nobelprize.org/nobel_prizes/peace/laureates/1979...
  - emodendroket 9y ago
    I don't know about the speech particularly, but I think Catholic notions about poverty and suffering bringing people closer to Christ rub some people the wrong way. At least that seems to be a lot of the motivation behind "Mother Teresa was awful" stuff I see.
- hourislate 9y ago
  Mother Teresa didn't know much about America. She failed to realize that money might not buy happiness but it sure buys the kind of misery we all like.
- TACIXAT 9y ago
  I don't think I've ever seen someone starving in the street in the US. I totally disagree with the sentiment that Americans wouldn't help each other. There is a lack of community here and that would be a nice problem to solve, but we aren't heartless.
wu_tang_chris 9y ago
Your comment reminds me of this video: https://www.youtube.com/watch?v=ao8L-0nSYzg https://www.youtube.com/watch?v=ao8L-0nSYzg
- anythingnonidin 9y ago
  Thanks
AndrewOMartin 9y ago
I've seen a couple of documentaries where KKK members were interviewed and the sense of purpose and community seemed to be the main thing they were all getting out of it. I'm not saying the KKK is a good community group, but I will say there are a lot of people with less community than they offer.
- anythingnonidin 9y ago
  Extremely interesting. Don't suppose you have a link?
  - KGIII 9y ago
    Even better, visit voat.co and read for a few weeks. The white nationalists are all about family, community, and a collective. Well, a specifically white collective. It's very important to them and a frequent topic. Of course, this means reading their posts which is not for the faint of heart. It's like most of them are missing something and are trying to find something to belong to. In a way, I feel more sorrow than anger towards them.
  - AndrewOMartin 9y ago
    See my response to nothingnonidin. https://news.ycombinator.com/item?id=15244420 https://news.ycombinator.com/item?id=15244420
    - anythingnonidin 9y ago
      Thanks
- anythingnonidin 9y ago
  Was it http://www.npr.org/2017/08/13/543259499/a-reformed-white-nationalist-speaks-out-on-charlottesville http://www.npr.org/2017/08/13/543259499/a-reformed-white-nat... or something else?
  - AndrewOMartin 9y ago
pjc50 9y ago
> non-profits or startups working to increase people's sense of community This is non-profit territory, absolutely not startup territory. You can only build a classic VC-funded startup by promising that eventually you're going to extract value (usually monopoly profits!) from the community. "Sense of community" is one of those things that's traditionally ranked well below profits and been destroyed in the search for profit.
- Bartweiss 9y ago
  Cynically: 'sense of community' gets destroyed in the search for profit when you're profiting from something else. If you're getting your profits from the community, you'll build it up just fine. Not necessarily in a healthy way, but at least in a persistent one. Hell, I think you could convincingly argue that opening a new pub counts as founding a startup aimed at increasing people's sense of community. It doesn't have the unlimited scale of a tech startup, but it is a company that profits from offering a 'third place'. For that matter, plenty of churches have been run more like businesses than non-profits while still creating strong communities. As long as the sense of community is profitable, it might do well with startups. That just hasn't been a common state of affairs lately.
  - closeparen 9y ago
    A pub is a small business. A startup is distinct from a small business in that it seeks outsized returns through economies of scale, efficiency, etc. The funding model and the set of behaviors which are adaptive for founding or working in these kinds of businesses don't have much in common. Much of the loss of community in America is small businesses getting destroyed in the market by successful startups (i.e. large corporations).
emodendroket 9y ago
Uh, well, maybe not a popular answer here, but that is one thing churches are really good at.
- terminado 9y ago
  With churches, there are a few problems that are intellectually repellent, meaning they won't solve for certain personality types. Namely: 1. artificial social heirarchy 2. magical thinking 3. group think 4. rules without reason Part of religion is often about imposing order on the irrational aspects of experience and reality, but there's a lot of centuries-old cruft and inertia behind the ones that exist. When you take apart any given religion, and inspect individual parts, and place those parts within the context of a small, insular village, dispossessed of plumbing, medicine or indoor heating, any single part starts to make sense. But many are far, far away from that, and need not invest in superstition. Morality is great, but in some cases morality without purpose translates to overbearing fear imposed with motive. Mythology and folklore are good for illustrating practical principles and relationships between ideas, but some people refuse to consider whether the ant and the grasshopper never actually happened. All this taken together, often tips the scales toward cognitive dissonance for some who think too deeply about bald facts. I don't have a solution to fix this, but I've seen what happens when smart people try to reimagine a modern religion that might fit current scenarios, and it's usually equally terrible. Someone will eventually figure this modern community rationale problem out, but it's not something you can just fake or make up for its own sake. It's something that needs to (seem to) happen organically, on its own, and remain authentic. Sounds pretty difficult if you ask me.
  - snark42 9y ago
    > With churches, there are a few problems that are intellectually repellent, meaning they won't solve for certain personality types. Unitarian Universalist churches are good for community and avoid most of these negatives in my experience.
    - emodendroket 9y ago
      Yeah, that seems to be a popular choice for lapsed religious people.
marojejian 9y ago
Shameless plug: I've been working on a service (www.campfire.care) to build peer support groups for any focus. Groups of 5-10 people with the same issue meet regularly via video and stay connected via chat. The idea is that we are fundamentally social creatures, and struggling with a challenge alone is unhealthy. Campfire is not therapy or a replacement for therapy. But peer support can be powerful + inexpensive. And being part of a true peer group can provide a kind of value that professional mental health can't. You can't be friends with you therapist, and their job is not to truly empathize with you. Would love any thoughts / feedback!
- anythingnonidin 9y ago
  Wonderful! What's the main challenge for you as it relates to the product? i.e. are you limited on needing more customers / stronger product market fit, do you have insane product market fit and limited on hiring, etc? Is this a for profit thing?
  - marojejian 9y ago
    Thanks! Generally, I think the challenge for us is going to be the same as for many other consumer-ish mental health startups. The experience is really effective, but most people aren't looking for this specific approach to solve their problem. So building awareness is super valuable. Our main goal is to help as many people as cost-effectively as we can. After thinking a lot about it, I think there's more evidence we can scale better as a for profit.
- flatfilefan 9y ago
  Did you consider appointing (renting out) a community lead for those groups? Maybe something along the lines of Über driver system? If a group has a natural leader - perfect. If not they can "rent" one to keep the momentum of the group going.
  - marojejian 9y ago
    Yes - we've been trying a variety of different backgrounds for our "hosts." The most exciting approach is to level up our members to lead groups with their challenge. They truly empathize and care about the group, which can make them more effective than a whole bunch of training. Plus, it reinforces that this is not a case where you are being treated for a mental health problem. This is a tight-knit community helping each other.

kchoudhu 9y ago

Now that the opioid crisis is a problem for white people, science makes an appearance in the policy discussion. Contrast to the crack epidemic in the 80s: fuck'em, throw them all in prison. Edit to add: I wish the best of luck to those who have been caught up in this crisis: I'm rooting for you, and I hope every last one of you find the treatment you need. For those of us who aren't affected, it's time for some deep introspection about what we allow our politicians and (yes) our neighbors to get away with.

TearsInTheRain 9y ago
Imho i would guess it is more a markets thing than a racial thing. There probably wasn't a whole lot of money to be made in curing an epidemic to a poor minority in the 80s whereas the opioid crisis is hitting a larger middle class population
- kchoudhu 9y ago
  I hope you see that this is a problem? Why is our society incapable of doing the right thing when there is a market failure?
  - ianai 9y ago
    Because the moneyed interests have altogether too much power.
- ianai 9y ago
  That doesn't make it any better. It's also not a simple A/B. Maybe society had to drag it through the aforementioned stages to reach a point of consciousness. I don't really buy that though. Honestly, I think the problem is simply being on opioids for a week due to post surgery pain or similar is enough to hook people. My write in ballot would include various forms of legalization and treatment. I've heard DMT can make people quit heroin over night. While a little radical, that's better than the alternatives.
  - 9y ago

Justsignedup 9y ago

Interesting question: The replacing opioid addiction with maintenance drugs... I could understand that drug being an okay interim solution, but in the end the person still needs to go through withdrawal, the drug just replaces withdrawal with another drug. Withdrawal is hard. Yes. But at least the person is in the right mindset to go through it once they are off the compulsory addiction, even if it takes a year to get to that point. As kchoudhu points out and many have pointed out to me before this article, certainly once a bunch of white kids have this problem, suddenly they are "victims" not "criminals". Yet we have destroyed so many lives between the 80s and now, especially with the mandatory minimums and such.

jtmcmc 9y ago
Why? The problems with addiction - specifically opioid addiction - is that it causes negative, destructive behavior. This isn't a consequence of having a physical dependence we are all physically dependent on things after all.
- otakucode 9y ago
  No, it does not cause negative, destructive behavior. It causes you to lie down and feel good. And it also causes constipation. And, if your supply is interrupted, withdrawal symptoms. The rest is caused primarily by the laws and social environment. Having to interact with criminals? Getting uncertain doses? Overdosing? Those things are because it is illegal, not because it's an opiate.
  - graphememes 9y ago
    The withdrawals do lead to destructive behavior.
  - jtmcmc 9y ago
    Addiction by definition does cause negative destructive behavior. That's part of the definition. What you're describing is a combination of the psychoactive effects of it and its withdrawal symptoms. I do agree with you, however. People become addicts due to how our society has criminalized and deregulated drug manufacture and sale and made it extremely hard to teach people how to do properly.

btmorex 9y ago

What science says nothing about because of the DEA's inane scheduling: hallucinogens.

elchief 9y ago
Yes, Ibogaine is literally 10x more effective than Methadone. It's risky if you've weakened your heart with stimulants though.
- martinald 9y ago
  Source?
VT_Drew 9y ago
The "science" on treating Opioid addictions at this point would just be reaffirming what we already know with mountains of "anecdotal" evidence. You want to solve the Opoid problem? Legalize Ibogane, DMT, Psilocybin, and MDMA, it is that simple.

anythingnonidin 9y ago

Also interesting and related: https://news.ycombinator.com/item?id=15241874 https://news.ycombinator.com/item?id=15241874 "Psychedelics Help Reduce Opioid Addiction, According to New Study"

spraak 9y ago
Interesting, but I'm surprised it doesn't mention Iboga.
taylorswift_ 9y ago
Have you also read "Abstinence Helps Reduce Opioid Addiction, According to New Study"?
- tree_of_item 9y ago
  No, I haven't read that one. Did you have some point to make by making up a fake study title?
- pjc50 9y ago
  Oh, is this like the "abstinence based sex education" that increases teenage pregnancy and STD rates?

deleted 9y ago

[deleted]

sharpercoder 9y ago

An addiction tries to replace a void in someone's life. Chances are big the environment of the addicted played a role in cerating the void.

betenoire 9y ago
That's not helpful at all. Yes, addiction is "filling" "something" "broken". Now what?
- otakucode 9y ago
  It is extremely helpful. It is very incovenient, to be sure, but it is very helpful. If you want people to not use drugs, then you have to provide them with a fulfilling life or the opportunity for such. If your desire is to operate a society that grinds people down, restricts them in ways that feel burdensome to them, insults them, and also does not have people using drugs? You might as well wish to fly. Because your wish is as realistic, and as worthy of ridicule. It comes down to whether you want to stop people using drugs because you don't like that they get happy so easy, or whether you want people to stop using drugs of their own accord and have happy lives. If it's the second - help.
  - ubernostrum 9y ago
    Never mind people who get addicted after being prescribed medication for an injury, then? Never mind that the new generations of opioids were marketed as safer/less addicting when they probably were more addicting, and thus prescribed even more out of perception of their safety?
    - zaroth 9y ago
      Althogh this has certainly become the narrative of late, TFA seems to discount this fairly strongly; "To that point, pain treatment is not the most significant risk factor for addiction. Far greater risk comes from simply being young and from using alcohol and other recreational drugs heavily. Ninety percent of all drug addictions start in the teens — and 75 percent of prescription opioid misuse begins when (mainly young) people get pills from friends, family or dealers — not doctors. Opioids are rarely the first drug people misuse."

otakucode 9y ago

Great article, but if your loved one has an opioid addiction and wants to quit without suffering the devastating withdrawal, I would strongly recommend investigating kratom. It is a non-opiate tree which grows primarily in Thailand and similar regions. It contains an alkaloid called mitragynine. This alkaloid is a selective opioid receptor agonist. Specifically, research shows that it is an agonist to several opioid receptors but particularly an antagonist of the receptor which causes respiratory system depression, and is thought responsible for the primary addictive nature of most opiates and synthetic opioids. It is legal in most of the US (I believe there are 1 or 2 states which have banned it, it has a long history by now in US law. A year or so ago the DEA announced to Congress the intention to schedule it (ban it) under their 'emergency' powers (which is bullshit since there are no deaths from it, and it remains mostly unknown, those 'emergency' powers are simply abused). After that announcement, they were required to consult research and doctors, along with opening a public comment period. Afterward they withdrew their intent to schedule it. So, for now, it remains legal. Its effect upon a person with no opioid dependence is at low doses similar to caffeine without the 'jittery' part and without the crash afterward. In larger doses it has mild analgesic and sedative properties. I've taken Vicodin after I had my wisdom teeth removed, and have also tried kratom, and not even in large amounts have I ever experienced it giving any sort of similar 'high'. It is mildly habit-forming of itself, but very mildly compared to opiates. Withdrawal after extensive use might consist of having the sniffles and feeling a bit restless for a day or two. With tapering dosages down rather than sudden cessation, nothing is likely to be noticed. Reportedly, kratom ameliorates most, if not all, withdrawal symptoms from things like Oxycontin, heroin, etc. Expecting people to go through withdrawal is inhumane and stupid. We can deal with it without the suffering. Kratom can be gotten online from multitudes of vendors. Please steer clear of the "legal high" and 'weed shop' variety of places. In addition to being radically overpriced, their association does active harm to the community of people who use kratom reasonably. Stay away from extracts and concentrated forms (although those seem to have mostly gone away from most outlets, they were big for awhile and were bordering on dangerous) and just get simple crushed leaves. If you or a loved one wants to quit, kratom will let you do so without ruining your life. If your loved one does not want to quit, because doing so would expose them to the full pain (emotional, physical, OR psychological) of a life they hate and which they feel traps them... your problem and theirs is not the drug.

intopieces 9y ago

If there were one article this year I could force my family to process adequately, it's this one. Addiction is still seen in our group as a failure of character -- not raised right, not religious enough, not following the right path. This kind of advice is seen as 'soft', and that's a shame.

buxtehude 9y ago
I would also recommend listening to an NPR podcast "The Fix" by RadioLab: http://www.radiolab.org/story/addiction/ http://www.radiolab.org/story/addiction/ While the description talks about taking a pill to solve your addiction problems (some very interesting insights into the latest research at that time 2015 and also many absurd regulatory hurdles), it's the interviews with researchers and addicts that are truly eye opening - and address many of the issues you mention. After listening to it I personally will never reduce someone who has an addiction to failure of character.
- leggomylibro 9y ago
  In the words of Neal Stephenson, they are '[opiate]-seeky.' They have a tendency dug in at the neurological level to seek opiates, even if they aren't doing so at the moment. The distinction offered by Stephenson is that '*-seeky' is an adjective that modifies an individual, rather than a noun such as 'addict' which overshadows and eclipses an individual.
- taxicabjesus 9y ago
  One of my passengers tried Naltrexone to get her drinking under control, maybe a dozen years ago. While on that drug, she couldn't drink enough to make all her problems go away so she discontinued it. I met her after her third DUI & almost 2 years in prison... Addiction is multi-faceted. Thx for the radiolab link.

biggerfisch 9y ago

I think the saddest part of this article is perhaps the glancing statement it makes about how prison isn't a place of recovery and rehabilitation. The prison system here really is too focused on punishment and locking people up forever rather than helping them get back on their feet and being productive members of society

buxtehude 9y ago
Unfortunately, the drug war and punishing users of non-sanctioned drugs is embedded deep in America's political and social DNA - but seeing how much has changed in some areas of drug policy especially with variations from state to state - I hold out some hope that we might see some changes there too - but I just wouldn't hold my breath.
- billmalarky 9y ago
  It's not just America's DNA. Many countries around the world base their drug policy off of US drug policy.
mrguyorama 9y ago
The prison system is highly privatized. Prisons with more people in them make more money and have a higher return on investment. Prisons that have repeat visitors can out compete prisons that do not. Therefore, there is a selection towards not keeping an inmate out of prison in the future. I hate how tinfoil hat-y this sounds, and I'm certainly no expert, so feel free to offer alternatives
- Notre1 9y ago
  The ACLU, using from the Bureau of Justice Statistics, says that "for-profit companies were responsible for approximately 7 percent of state prisoners and 18 percent of federal prisoners in 2015" I don't think that count's as "highly" privatized. I personally think the incentives involved in the private prison system present major ethical issues, but I think we need to look at the incentives involved with the our legal system and governmental prisons, also.

ringaroundthetx 9y ago

> evidence-based medicine non-evidence based medicine that uses the made-up-on-the-spot holistic approach is upheld by the idea that there is no scientific method available because it is about the body as a whole. I think that rebuttal is reductionist and that there could be a method that is applicable to that form of treatment. does anybody have thoughts on that?

taylorswift_ 9y ago
posting my response above but I am with you...

dogruck 9y ago

Annoying how this 538 article immediately bemoans the lack of regulation -- as if the only solution is to grow the government and pass more laws.

logfromblammo 9y ago

In short, the published science says to addict the patient to methadone or suboxone instead of whatever they are on, for a lifetime of perpetual treatment. Actual drug users are likely to recommend using kratom to alleviate withdrawal symptoms and ibogaine (or another powerful hallucinogen) to permanently remove the addiction. "Science" does not recommend this, because politics has made the hallucinogens--and research into their therapeutic uses--at least as illegal as the opioids that cause all the problems. As someone with an opioid addiction is likely already routinely breaking some rather serious laws, and frequently courting sudden death by overdoses or adulterants, it may be worth trying the single dose of ibogaine before choosing the lifelong maintenance therapy.

taylorswift_ 9y ago

I read this, as a recovering addict that went through my own hell mostly from alcoholism, and wondered where the "science" part was? For instance this sentence "More than 13 percent of its participants died after treatment,1 mainly of overdoses that could potentially have been prevented with evidence-based care." The argument is that they "could" have been prevented but how do they really know that? How many people in general die of an overdose after X number of stays in a rehab? Through my own experiences going to rehab, I have known of many people who die. The fact is you can't predict which people will "get" it any better than you can predict if it will rain next month. I also disagree with this notion that being on suboxone or methadone indefinitely is a legitimate solution. Like what? You're advocating to stay on a drug the rest of your life? That isn't recovery at all, it's a band-aid that will likely lead to relapse and promotes a perpetual notion of being sick. I also disagree that their supposed evidence that CRAFT gets twice as many people into rehab has much relevance. How many of those people relapsed? How many of the people that didn't go to rehab ended up overdosing OR recovering? We don't get the whole picture so the "evidence" is mute. They knock 12-step which is fine but it turns out that it works for millions of people. There is no silver bullet here. While I have mixed feeling about the "tough love" approach, I can tell you from personal experience that the only reason I'm not buried right now is because at a certain point the floor dropped out too low, my family and friends abandoned me, I lost everything for a moment, and the pain and horror reached a level that finally I had a change of psyche on my OWN and realized I wanted to get better. In my own humble opinion the only "science" that matters on this subject are the opinions of those whom have lived it and recovered. Go survey the opiate addicts that didn't end up dead and find out what worked for them.

bsder 9y ago
Alcohol != opioid. As I said in another comment, alcohol is an odd drug. It's mechanisms work very differently from opioids and needs very different behaviors and strategies to combat.
- taylorswift_ 9y ago
  In my opinion you can't simply discard the debate as comparing apples to oranges... There are many similarities. It's a drug addiction at the end of the day.

wjossey 9y ago

I do not agree with much of what is stated in this article, nor do I feel that this article represents "what science says" should be done if a loved one has opioid addiction (although it really goes into addiction as a general topic). Treating someone with addiction is a remarkably nuanced and challenging situation, and the author tries to present certain treatment options as not worth doing based on science, when their own citations do not back up those claims. As someone who has had a loved one go through addiction, and ultimately die from that addiction, I find the binary nature of a lot of this self-described "evidence based guide" dangerously black and white. Proclaiming that abstinence based programs "have not been found to be effective" is total nonsense. What the study found in GB was that psychological only based treatment is less effective at preventing death than replacement therapy, on average. For many, replacement therapy may very well be the best option. For other, abstinence programs may give them an opportunity to fully reclaim their life. How about we empower medical professionals with the ability to treat the disease with a number of weapons, rather than creating this false dichotomy, which is not represented in the data. This guide would potentially discourage someone, or a family member, from choosing a very viable option for treatment, by overstating results. While I'm not a medical professional, the best example I can think of is with how we treat depression. For some people, active psychotherapy is the best treatment option. For others, a regime of anti-depressants is sufficient treatment. For others, a combination of both is the optimum treatment option. What we don't do, as scientists, is say, "Option 2 has a 30% better outcome, thus we only will treat depression with option 2." That's just absolute junk. What it means is that we will look at what cohorts tend to respond best to option 1, 2, and 3, and understand why, so we can choose a treatment option that makes sense for that individual, without having to try 1, 2, and 3. It doesn't mean that we just toss out the other options wholesale. The 538 politics podcast does a, "Good use of polling" and "bad use of polling" intro during many of their podcasts. This article would clearly fall under the category of "bad use of polling". I hope to see better out of 538 in the future on these topics.

warcher 9y ago

Fun fact: The current standard within the US is AA/NA. AA and NA are not only wholly unscientific, being invented of whole cloth by a layperson in the early 20th century (for context, lobotomy was a totally accepted psychological treatment for decades after 1935). There was no science whatsoever involved in AA, and indeed Alcoholics Anonymous actively resists any data collection about the efficacy of its techniques whatsoever. It's main advantages from a US perspective are a) it's free. The costs are borne mostly in the form of churches providing basements and meeting rooms. and b) it's super churchy. We love churchy stuff around here. So basically we kicked addiction under the rug for the entire 20th century in favor of religious hokum that refuses any objective evaluation of its efficacy, or changing its methods. I should say, for the record, that there's a lot of people that have been helped by AA and NA, and there's indisputably good work being done there. But it's not perfect and categorically refuses to get better, and its longevity is IMHO more a result of our collective refusal to take the problem of addiction seriously in the US than anything else.

rajacombinator 9y ago
Got any better suggestions? Genuinely interested, not sarcasm. (Mostly.)
- milkytron 9y ago
  I've seen a lot of headlines about studies of psychedelic drugs and compounds having a positive impact on addicts. There are a ton of articles out there, most seem like clickbait, but there are studies that have been done such as this one [1] which say that LSD has had a positive impact on alcohol abuse. I'm not saying this is the cure, but I do think further studies could prove beneficial. Edit: Added pdf of paper [2]. [1] http://journals.sagepub.com/doi/abs/10.1177/0269881112439253 http://journals.sagepub.com/doi/abs/10.1177/0269881112439253 [2] https://www.ntnu.edu/documents/139226/8932977/JOP439253.pdf https://www.ntnu.edu/documents/139226/8932977/JOP439253.pdf
- curun1r 9y ago
  Not the poster you're replying to, but I'd say mindfulness and meditation. Learning to look inward can be an incredibly powerful tool for dealing with issues like substance abuse.

stmfreak 9y ago

Sympathetic support I'd fine for people interested in kicking a habit. But when the addict doesn't want to quit? What then?

narrator 9y ago

Nothing about NAD therapy? Sadly, it's an underutilized treatment for opioid addiction.

mirimir 9y ago

> When a family member, spouse or other loved one develops an opioid addiction — whether to pain relievers like Vicodin or to heroin — few people know what to do. Faced with someone who appears to be driving heedlessly into the abyss, families often fight, freeze or flee, unable to figure out how to help. OK, if someone wants to be an opioid addict, why not just let them? The "driving heedlessly into the abyss" aspect seems mainly due to opioids being illegal and expensive. I mean, do we use such language about diabetics? Do we expect them to manage their diabetes through diet alone? I'm not aware of solid evidence for health risks associated with chronic opioid use alone. Excluding opioid addiction, I mean. But please do share.

mattmanser 9y ago
A lot of people are dying from overdoses. https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf https://www.asam.org/docs/default-source/advocacy/opioid-add...
- mirimir 9y ago
  People are dying of overdoses because opioids aren't available legally, with regulated strength and purity, and at reasonable prices. If opiods with regulated strength and purity were as readily available as liquor, few people would be overdosing. In parts of the Middle East, where alcohol isn't available legally, methanol poisoning isn't uncommon.

CodeWriter23 9y ago

"Science"'s answer to opioid addiction: prescribe opioids, declare addict cured. PS I'm not an advocate of treatment because they also employ shortcuts to "recovery".

emodendroket 9y ago

> Consequently, do not try to use legal consequences as a way to help people you love, and if possible, bail them out if they get arrested for drug crimes. This doesn’t mean you shouldn’t hold them accountable, but do so in ways that are less likely to lead to lifelong problems. Meaningful employment is an important factor in recovery — and few things are more harmful to the chances of getting a good job than having a criminal record. This is one area that's crying out for some kind of reform.

criddell 9y ago
I've been thinking about similar things in the context of a basic income. If we were to just pass a law and guarantee a significant basic income I think it would have disastrous effects and fail miserably. A guaranteed income is a good goal, but before we do that we need to figure out how to replace meaningful employment with other meaningful activities. People need a purpose. If we can alter our culture and separate a person's purpose from their employment, then we might be able to get to a Star Trek future. If I can get anything I want from a replicator in the wall, what are my incentives to still better myself and work towards something?
- emodendroket 9y ago
  > I've been thinking about similar things in the context of a basic income. If we were to just pass a law and guarantee a significant basic income I think it would have disastrous effects and fail miserably. A guaranteed income is a good goal, but before we do that we need to figure out how to replace meaningful employment with other meaningful activities. People need a purpose. I don't think so. I think people can find a purpose without us imposing one on them. > If I can get anything I want from a replicator in the wall, what are my incentives to still better myself and work towards something? Why do people get really good at chess when there is little extrinsic motivation in it? If some people just want to hang around, is that really a "problem" we need to address?
  - infinite8s 9y ago
    Does maintaining an opioid addiction count as a meaningful purpose? Who's to say it's not (as long as it doesn't harm anyone else)?

sizzle 9y ago

Hands down, Naltrexone is the only thing that helped my loved ones with alcohol addiction. Please look into it and watch "one pill" documentary. You have a choice other than AA meetings.

grzm 9y ago

(2016)