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Once an Addict, Always an Addict?

188 points by vitabenes 5y ago

SargeZT 5y ago
For anyone who wants a more evidence-based approach to addiction than 12-step programs, SMART recovery might do the trick for you. It helped me greatly with my alcohol addiction, and it doesn't treat addiction as a forever thing. I've been sober for 6 years or so now, and I haven't needed to attend a meeting since I beat the addiction. Meetings are free, there are online sessions all the time, and it's just a great community overall.
- vitabenes 5y ago
  Interesting, I'll take a look at that. Congrats!
- toyg 5y ago
  What is your experience about the following paragraph? > you can go from being addicted to alcohol, to having a social drink once a week. That goes against pretty much everything I've ever been told by addicts to alcohol and drugs. Once you've been "in the tunnel", there just isn't "a social drink" - even a drop will get you off the wagon for good.
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  - runawaybottle 5y ago
    That’s not 100% true. Exhaustion is real. Can you watch the same Marvel super hero movie for the n-th time, even though you loved the first few? You can’t, you just get tired. Burn out is real even amongst addicts. You literally get tired of this shit. Before I became an addict, another legitimate addict told me why he stopped - he just got tired. I’m talking years of daily drinking, and all the consequences that come with it (every bridge burnt, every path destroyed, credentialed as a true fuck-up). Exhausted. That’s the thing about abuse. If you took one hit of cocaine, and you die, that’s the end of your abuse. Addicts can take hit after hit after hit, and still live. That’s scarier than death, and extremely tiring. I am tired of it, pure exhaustion is a way out. The implication of that is that you yourself are such a piece of shit that you didn’t quit until you yourself got tired. It’s shameful.
    - sethjgore 5y ago
      Check out the Sinclair method.
      - BayAreaEscapee 5y ago
        I'm going to second the Sinclair method, which involves taking naltrexone or nalmefene. I started with the Sinclair method at the same time I started participating in SMART recovery online meetings. I only drink alcohol about once a week now and only in moderate quantities. Here are some links for anyone interested: https://www.amazon.com/Cure-Alcoholism-Medically-Eliminate-Addiction-ebook/dp/B009G1TID4 https://www.amazon.com/Cure-Alcoholism-Medically-Eliminate-A... https://www.youtube.com/watch?v=6EghiY_s2ts https://www.youtube.com/watch?v=6EghiY_s2ts
  - SargeZT 5y ago
    For alcohol that may be true, but the ultimate goal of SMART is sobriety. There is another (smaller) branch of REBT drug-based therapy called 'Rational Recovery' that uses naltrexone (an opiate blocker) before drinking to reduce the pleasurable feeling associated with drinking. I tried it, but it didn't work for me. It certainly makes drinking less pleasurable, but I was using it as a coping mechanism for my anxiety. I think for some people, that approach might work. Also, if a person solves their underlying psychological problem which led to the need of alcohol for a coping mechanism, I think it might work as well. I'm probably saddled with anxiety for life, but I've learned healthy coping mechanisms. Besides the taste of a cold beer after mowing the lawn, I don't miss it in the slightest.
  - retrac 5y ago
    It's not my experience. I do believe it's riskier than simply abstaining long-term. You are, in fact, reminding yourself of something you found so compelling once that it derailed your life. But personally, I have been addicted to amphetamine and alcohol/benzodiazepines badly enough in the past, that I could not discontinue them suddenly due to the severity of the withdrawal. Yet in recent years I have felt able to get drunk at a party for example, without serious cravings in the weeks that follow. And I'm back on amphetamines for ADHD which I take to schedule. I won't lie though; the thought of taking two pills instead of one does occur to me not infrequently. The temptation is probably always there once you know what it's like. But my experience is that no, it doesn't automatically derail necessarily.
- throwawaylinux 5y ago
  What evidence is it based on? When you say evidence-based, do you mean the initial development of the program, or its ongoing claim to efficacy in light of the results? There is evidence supporting AA as a treatment for alcoholism. https://pubmed.ncbi.nlm.nih.gov/29606223/ https://pubmed.ncbi.nlm.nih.gov/29606223/ https://pubmed.ncbi.nlm.nih.gov/32159228/ https://pubmed.ncbi.nlm.nih.gov/32159228/ It's great there are alternatives, and I'm sure different treatments will work best for different people, but it is for that reason you shouldn't imply other programs are not an evidence-based treatment (at least of similar quality).
ChemSpider 5y ago
Just the other week I read in a medical textbook: If you are overweight (obese) at age 18, there is only a 15%(!) chance that you will manage to have a more healthy weight during your adult life. I found that number utterly depressing and shockingly low.
- maccard 5y ago
  That lines up with intuition; if you are obede at 18, chances are your parents have not prioritized a healthy relationship with food, meaning it has never been a priority for you or your family, and you are unlikely to change those entrenched habits.
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  - dathinab 5y ago
    That might depend a lot on the country you are in/from. The huge majority of (similar aged) people I had meet between 16-20 which had been obese where so because of "health issues" not directly related to them eating unhealthy being lazy. As such it's not surprising if you have problems changing it because "just" eating healthy and doing sports is far from enough to fix it. And trying to fix it with that is often a task needing far more discipline and self control then the large majority of humans (independent of weight) have. I mean let's be honest the difficulty many of this people face is way higher then the difficulty for a young(1) health male to get a black belt in Judo, Karate or similar. (1): Start training with ~14 or earlier, through not necessary with high commitment, then at some point later (e.g. 16,18,20) added commitment trying to get a black belt.
    - maccard 5y ago
      Are health issues unrelated to obesity the primary cause of obesity in under 18s? Also, I specifically never called anyone out as lazy. The majority of obesity is overeating (a single Starbucks muffin is a 10k run). Yes there are people with imbalances/medication that are outliers but most people aren't outliers. I specifically called out a relationship with food being something that's carried into adulthood as the cause of the relationship between those figures. An obese 14 year old may have some underlying health condition but is more likely to be a victim of socioeconomic problems; lack of access to healthier and more balanced foods, or to have obese parents (which appears to be a good indicator for childhood obesity). Neither of these are easy solves, and the blame doesn't lie with an individual, but it does explain that someone who is obese as a child is more likely to be obese as an adult.
fitba72 5y ago
The disease model of addiction is still hotly debated in the USA. It has been widely discredited and thrown out in other western nations. What's the difference in these nations? These other nations have some form of socialized medicine so you don't have to have a medical illness to have your treatment costs covered. On the contrary, the only way to get treatment costs paid for addictive behaviours in the USA, by a medical insurance company, is if you have a disease. Try asking your medical insurance to pay to stop you making bad choices or changing your habits. The work of Stanton Peele is seminal in this field for anyone interested. Also check out The Freedom Model. Completely heretical to AA types but to rational thinkers struggling with an addictive behaviour, it could be life changing.
- MattGaiser 5y ago
  > Try asking your medical insurance to pay to stop you making bad choices or changing your habits. If they found a way to scale monitoring to prove you changed, they absolutely would. The challenge is proving it.
- refurb 5y ago
  This clearly isn’t true since plenty of people get access to psychotherapy who have public and private insurance without being diagnosed with a specific illness.
  - amanaplanacanal 5y ago
    Will insurance really cover a psychiatrist without a diagnosis? I always assumed the doctor was reporting a diagnosis to the insurance company even if they weren't telling the patient.
  - chillwaves 5y ago
    Every time I look at a therapist while seeking treatment, they always put a disclaimer on their insurance page that a diagnosis is required to be paid for claims. Maybe it's just my state.
- wintermutestwin 5y ago
float4 5y ago
> Your brain can start functioning normally again in a span of a few months. It doesn’t have to be the same, but it should work just fine. The two articles linked to at the bottom talk about multiple years, the third link points to a news article that refers to some research that uses one year as a minimum. This feels more believable than "a few months". My flat mate has ADD and has phases during which he's clearly addicted to alcohol. At one point he stopped drinking completely for over 6 months, but drank a small amount once and things spiralled out of control again. He does view addiction as a personality trait (in part because he knows that people with ADD develop addictions more often), and that attitue actually seems to help him. These days he abstains from addictive things because he "knows" that he'll get addicted to them once he starts. I believe in the thesis of this blogpost (that addiction is in fact an emotion regulation problem, and that it can therefore be cured), but the approach my flat mate takes these days works pretty well, at least for the first year.
- loa_in_ 5y ago
  Alcohol is a depressant - it gradually wanes your higher cognitive skills over the course of hours. Very convenient when one's thoughts are racing. I believe there's no causation in "drinking once" -> "drinking more". I believe there's causation in "trying to self medicate" -> "drinking".
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  - bserge 5y ago
    being forced to self medicate by the healthcare industry
- donatzsky 5y ago
  Notice that they said can, not will start functioning normally in a few months. Basically it's a lower bound, and elsewhere they do say it can take years.
- sethjgore 5y ago
  I suggest you mention the Sinclair Method to him. It has worked wonders for thousands who were addicted to alcohol. It is a cheap prescription that you take before drinking and over time people actually drink normally again since the brain is rearranged (the medicine takes away pleasure from the drinking). It might save his life or reduce his cravings.
123pie123 5y ago
I would probably class myself as someone with an addictive personality. not with drugs (except alcohol), but with anything - if I like something, I find it very hard to not have more, wether it's good or bad. eg going to the gym 6x week or getting takeaways every day I've analsysed this for sometime and the best (for me) way of dealing with it is to keep track of every thing I do or I like. "The power of habit" book helped a lot with my ability to control my addictions
- axiosgunnar 5y ago
  Note that you could probably „weaponize“ this addictive personality to achieve what normal people cannot (eg dedicate an extreme amount of time to a difficult task and achieve it)
  - curiousllama 5y ago
    I'm not who you're responding to, but I very much identify with what they wrote. I once accidentally trained for a marathon. Weaponizing this is unhealthy. It doesn't end well. The reason normal people can't do X and an addict can is because an addict is making egregious trade-offs. "I know I'm going to mess up my shoulder for the rest of my life, but I'm going to bench heavy anyway" "I know I haven't seen my kids in a month, but I'm going to shut myself away and work on my side business anyway" It's collapsing your entire life into a single, simplistic max/min function. It's a quick path to misery.
    - ThrowawayR2 5y ago
      I'm reminded of a quote from J. M. Barrie, the author of Peter Pan: "You can have anything in life if you will sacrifice everything else for it." I once thought it was, and have often seen it used as, an inspirational quote until I later read another opinion that it was a warning of the dangers of being too single focused.
      - kmmlng 5y ago
        I simply take it as a description of reality. As a child, you are nothing yet, but you have the potential to become almost anything. As you get older, you trade in that potential for something specific. It's up to you to choose. You can trade all your potential for one thing only or you can divide it up to become multiple things. The right balance is debatable. The real danger lies in taking it to the limit. If you try to become everything, you divide your potential up into infinitesimal pieces and end up remaining nothing at all, a child. In any case, there is some real wisdom in Peter Pan, but it was completely lost on me as a child.
trabant00 5y ago
All the feel good theories in the world can't contradict the numerous examples of addicts who relapse after trying to moderate what they previosly used in excess. The article is basically a hook for buying the course. They can't accept the once always theory because it would make their product not attractive.
- dillondoyle 5y ago
  I also thought their 2 ways only characterization was contrived. And I don't buy stock into the way they are founding their arguments on their definition of the word 'disease.' But I guess it's a good point that harm reduction is good and abstinence is not the goal for everyone.
- vitabenes 5y ago
  As the saying goes: all models are false, but some are useful. Every theory has its limits, but that doesn't mean it can't be helpful. The opinion that once-always theory can be damaging is rejected by many people in the field, not just us. We're simply presenting it in a digestible format (without the need to dive into the sources for hours and hours). See the rest of the series for a better understanding of the subject matter. And yes, our blog is a part of our marketing, but that doesn't mean that we "just" want to make money from it. The aim of the whole project is to help people, in a sustainable way, with some free and some paid resources.
- balfirevic 5y ago
  > All the feel good theories in the world can't contradict the numerous examples of addicts who relapse after trying to moderate what they previosly used in excess How does it compare to the number of addicts who relapse after striving to be 100% clean?
awaaythroow 5y ago
The author states that thinking that you have an addictive personality is unhelpful. Articulated that way, it could be true, but understanding that there is a predisposition towards addiction[1] is helpful to overcome it, and does not contradict the fact that one can recover from addiction. From Overcoming Sex Addiction by Thaddeus Birchard [2]: “A predisposition towards addiction, be it genetic or a legacy from the historic family dynamic, is important to understand. It reduces shame to know that you are vulnerable to sexual addiction not because you are morally deficient but because you are predisposed towards addiction either through genetic inheritance or though interfamilial patterns. The more that shame is reduced, the more that the drive to act out sexually is lessened.” “Once you understand that this dysfunctional regulation was set up in childhood, there is a reduction in shame because you are not responsible for having the problem. However, you are responsible for what you do about it.” [1] For example, because of childhood trauma. See https://youtube.com/watch?v=_-APGWvYupU https://youtube.com/watch?v=_-APGWvYupU and https://newyorkpathways.com/sexually-acting-out-as-response-to-childhood-trauma/ https://newyorkpathways.com/sexually-acting-out-as-response-... [2] I'm halfway through this book and found it very helpful. I recommend it for anyone dealing with addiction.
YarickR2 5y ago
Well, quit smoking cold turkey after doing so for 10 years. No addiction. Quit eating lots of sugar, after doing so for 30 years, replaces with fruits and nuts. No addiction. Can't stop reading books, doing so for 40+ years; addictive as hell. I know iv drug users , they quit and do not look back, so , oaaa does not hold true in general
lookalike74 5y ago
> "Opinion A can make people feel powerless. I’m an addict and I’ll be that way forever- it creates feelings of shame and being a victim. It also creates a stigma in society that addicts are somewhat broken and can’t be fixed. Opinion A seems a little bit outdated. Abstinence isn’t necessarily the goal." This isn't a very informed argument at all. One, abstinence isn't the goal of AA or 12-step ; recovery is the goal, and it starts with abstinence. Two, addiction is best defined as having lost the power of choice. So not only does this opinion ignore that, it propagates the very stigma it intends to diminish.
- sneak 5y ago
  Reminder: AA and 12 step are faith-based, and aren't very effective when actually measured (roughly equal to the effectiveness of not using AA/12-step).
  - lookalike74 5y ago
    Sorry, there are untold (but not unknown) millions more people around the world who've recovered from addiction with 12-step than anything medical. AA was founded in part by a doctor (himself an alcoholic) who recognized that medical science had no solution to alcoholism. Fast-forward to now and the 'medical solution' to addiction is usually another addictive substance. Can those help? Sure, and they do. But I don't think there's been any significant studies confirming medical science has a better solution than 12-step. If you have evidence that relapse rates are lower outside of 12-step than within, please share because I've never heard of it.
    - lotophage 5y ago
      Here's an article from The Atlantic that you might want to read. > Its faith-based 12-step program dominates treatment in the United States. But researchers have debunked central tenets of AA doctrine and found dozens of other treatments more effective. https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/ https://www.theatlantic.com/magazine/archive/2015/04/the-irr...
    - 5y ago
scandox 5y ago
> This has some merit, for example, when it comes to alcohol - you can go from being addicted to alcohol, to having a social drink once a week. To anyone who has experience of alcoholism from any angle...this is absurd.
- vitabenes 5y ago
  First, can is the important word here. The point is that if the rest of your life is okay, there's no need to run away by drinking yourself under the table. You seem to be implying that there are no people on Earth who went from addiction to moderation. There's nuance to it. To be fair, however, we're not encouraging people who've struggled with alcoholism (esp. severe) to have a drink.
  - toyg 5y ago
    > if the rest of your life is okay, there's no need to run away by drinking yourself under the table. That's... not how it works. One might have become an alcoholic because the rest of their life was shit; but remaining an alcoholic is another matter. Highly-functioning addicts are still addicts. A lot of neurochemical processes don't care for the social or psychological situation. It's a bit like saying that "people can sail the Atlantic in a kayak"; a few might make it, but the overwhelming majority will die under the waves, and telling them they can do it is just Bad.
    - vitabenes 5y ago
      Fair enough, given that the rest of the series is more about behavioral addictions that substance addictions, it might make sense to change that passage. Thank you for the feedback.
  - deleted 5y ago
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- bunnyfoofoo 5y ago
  Agreed, if you're in recovery, do not attempt moderation. That normalizes the behavior and is a slippery slope. Seriously thinking this may work for you is a probable sign you should talk to your sponsor or attend an AA meeting.
the-dude 5y ago
I have always believed there must exist a reason I had addictions. Somehow after about 2 decades, a midlife crisis and starting all over again, and then some years : I seem to have come to terms with these reasons. I seem to understand them, and accept them and therefore accept myself. And then the urges just disappeared. I tapered off the substances and am clean for over a year now. Fingers crossed. YMMV.
- toyg 5y ago
  Clarity of purpose makes all the difference for me. The periods where I know what I want and what to do, I have no need for any addiction. When that feeling of purpose and control goes away, I become a slave to them. In some perverse way, they make life endurable when my brain says it shouldn't be.
  - rakejake 5y ago
    This x1000. I wouldn't qualify as an "addict" by clinical definitions, but I have a set of bad habits. Over the last year or so I have been making journal entries . The journal entries made me realize exactly what you said - the odds of falling into bad habits multiply several fold during periods where I don't know what I should do. I realize now that maintaining a journal is a very important and fruitful habit. It is a valuable exercise to record your feelings and state of mind at regular intervals. It will help you figure out your failure modes and patterns (if any) to your successes and failures.
- vitabenes 5y ago
  Congrats! Hm, why do you think the urges disappeared? Does it coincide with getting your life in order or not?
  - the-dude 5y ago
    Not so much life in order, still working on that. The internal discrepancies, finally understanding why and what. Finding peace.
polote 5y ago
To me, a lot of time addiction is a choice. I'm not saying all the time, but very often still. I've tried helping different people overcome an addiction, and even though at first they want to stop it, when they start to think more about it they don't really want it to stop. If you are not entirely convinced that the addiction is doing more harm than good, it is much more difficult to overcome it. Trying to think rationally is not going to be very helpful, most of people are not able to think that way, emotions and perceptions are much more important. I often say, life is much much easier when you are a rationalist
- EdwardDiego 5y ago
  Genuine question, have you ever recovered from addiction yourself? Because that phrasing is a bit odd, IMO. No-one chooses to become dependent, and there's a lot of optimism bias/hubris when people start dabbling in addictive substances - I won't get addicted like _those_ people, I'm different... But the hard bit, as you've noted, is making the choice to end your dependence. The choice to face whatever in life your vice of choice was numbing you to, to face it naked and vulnerable. ...that takes a lot of guts. And a lot of repeated attempts. And you're right about the need for intrinsic instead of external motivation.
- omnicognate 5y ago
  I agree that it is, or can be, a matter of "choice", but that's a subtle thing. What does it mean to "choose" or "want" something when you have conflicting motives, when you both enjoy and hate the same thing, even at the same time? I think a large part of reaching emotional maturity (for some people at least, me included) is about resolving those conflicts and achieving a sort of unity of self. This often involves letting some parts of yourself go, deciding not to be a particular person any more, which the "addiction" may only be one aspect of. In my case I finally succeeded in quitting smoking, after 9 years of 20-30 a day and innumerable failed attempts to stop, just after I got married, 18 years ago. It was easy.
- balfirevic 5y ago
  > To me, a lot of time addiction is a choice. What does "to me" mean here? Do you mean that's how you perceived it in your own addiction?
aaron695 5y ago
This article is not a good summary on addiction and current understanding. It jumps around a lot between ideas that should not be linked and is factually wrong often. RE title - "Once an Addict, Always an Addict" This doesn't rule out moderation, and it is well known you don't use this wording or idea on some people. Addiction treatments fail around 90%+ of the time. That's why there are so many around, different ideas work on different people, and probably so people don't get bored or despondent as the churn through them multiple times. "Once an Addict, Always an Addict" might be someones win, someone else might just randomly stop.
chiefalchemist 5y ago
A or B? Why does it have to be binary? It seems that a spectrum is in order. Our brains are all not exactly the same. So there's a case for A. Our lives are all not exactly the same.So there's a case for B. The best answer might be C, a spectrum. A spectrum that considers both and some combination of A and B.
fxtentacle 5y ago
This article seems weird to me, because I view non-substance addictions as a way of procrastination, which in turn is a way to fix a bad emotional state. When your environment is hostile and depressing, and it certainly is for many people now thanks to covid and the faceless megacorps we have to deal with to get through daily life, then it kind of makes sense to disassociate from reality and get lost in a good video game.
satellite2 5y ago
What can really help getting addictions under control is understanding how it is expressed in the brain. Delta FOSB seems to be associated with addiction https://en.m.wikipedia.org/wiki/FOSB#Delta_FosB https://en.m.wikipedia.org/wiki/FOSB#Delta_FosB. And having a simple model of how it works helps in dealing with it. Contrary to popular depictions addiction is not bolean, it's a unbounded scale. And roughly each consumption of an addictive substance increase addiction and for each substance some time is required to go back to baseline. And if another take occurs before this period, then the addiction will grow. As a very simple model it's ovmbviously wrong but it's a very helpful proxy. Another euristic that is helpful in dealing with addiction is to avoid repeated use before 6-7 times the halflife of the substance. Such that > 99% of it has been eliminated. Finally looking for "harm reduction techniques" when dealing with a substance provides many helpful tips. I believe those advice can probably be translated in the case of an addictive behaviour instead of a substance but will obviously yield less precise recommendations.
throwawaycvid 5y ago
Really funny thing happened to me last year. I got COVID, luckily fairly mild but with some long lasting symptoms. The odd thing is that I no longer have appetite for drink or opiates/cocaine (on top of my maintenance medication) Surprising as I’ve been on that path for 15+ years. It’s not much but at least something good has come out of (having) COVID…
- evv555 5y ago
  Dr. Drew had the opposite reaction where he started drinking wine and smoking cannabis. He compares the symptoms to suffering from head trauma.
DoreenMichele 5y ago
I hate this idea that addiction is someone just getting high so they don't have to feel bad feelings, which seems to be the underlying assumption of most discussions. My dad drank heavily for a lot of years. I grew up hearing tales of his legendary drinking. Mom would buy him a case of beer on Sunday and if he ran out mid-week, he would drunkenly accuse her of drinking his beer -- which makes no sense because mom is a tea totaller. He would go on a bar crawl on nickel night and hit dozens of bars with his buddies. Etc. He was in the army and he fought in the front lines of two wars, WWII and Vietnam. He retired when I was three and apparently began tapering off. I don't recall him having the DTs. I don't recall him drinking heavy in my lifetime. I recall him having a beer as part of dinner when I was four or five. When I was seven, he was diagnosed with a heart condition. He blamed it on the alcohol and never touched the stuff again (except for a few sips when my brother hit drinking age while talking to him about what made for a good beer, I think). By then, he had been out of the army for four years or so. He had time to taper off for a few years before making his dramatic announcement that he wasn't drinking again. I think he drank to suppress his nightmares from serving in two wars. I think he didn't need to actively suppress his nightmares anymore after he dropped his retirement papers and no longer had to live in fear of being sent back. I think people drink and drug for a reason. We just mostly don't bother to try to figure out what the reason is for this specific person and we just act like "You are a badly behaved child who needs a spanking and you need to just try harder." And then blame them when that stupid idea consistently fails to be an effective solution to their problem. Edited. Cuz typos and auto-corrupt.
- runawaybottle 5y ago
  I think he drank from the pressure of having children and a family. Think about the reasons why he quit, his family, and he never showed much of it to his children. The reasons for quitting are often the reasons for starting. Sorry for getting all Freudian.
  - DoreenMichele 5y ago
    I think the opinion of a random stranger who never met my late father likely has less merit than my own.
harlanji 5y ago
Being an addict seems more social than anything. It’s possible to go through a party phase and then years later go through an unrelated tough patch, having not touched drugs for years, and then hear whispers of addiction to explain the unrelated issue. Nobody dares broach the subject, and so a person clean for years and never really an addict can have their life ruined by others calling them one. Maybe they have real pictures from the phase or similar to circulate. It is slander even if the photos are real, and there’s no recourse. That can happen to a non-addict who experimented; can only imagine how likely a true addict would be to relapse in such a hopeless situation. Addiction is a destructive habit or system that needs to be replaced.
imvetri 5y ago
"you are an addict, be addicted to something else" - movie quote
runawaybottle 5y ago
It’s very hard to understand addiction. I know I had two distinct addictions for wildly different reasons. With certain games or porn, it’s just, I loved it too much. Later, with alcohol and prescription meds, it just made me feel less shitty. The former I just enjoyed it too much, and the latter, I never found a better substitute for anxiety and self hatred. One was truly an insatiable desire, the other was truly self medication. If you suffered from this, it’s very hard not to think you were born this way.
ransom1538 5y ago
If you are out there struggling with addiction I would checkout: Naltrexone. Naltrexone binds to the endorphin receptors in the body, and blocks the effects and feelings of alcohol. IMHO: The addict brain needs to be reprogrammed with chemicals - not just 'understanding why' or making macaroni necklaces in rehab. Naltrexone can be used with both opioid and alcohol dependence and is extremely cheap. Once on Naltrexone you can still drink/opioid and you wont get the high. Drinking a beer would be like drinking a Coke on Naltrexone. Pounding down two liters of Coke is gross - and your brain will start to associate that drinking is terrible.
- cupcake-unicorn 5y ago
  Low Dose Naltrexone is also a super interesting modality that's gaining more traction. The idea is that at low doses you are training your body to reset and produce its own endogenous opioids.
tomhoward 5y ago
At least twice, I had doctors describe me as having an "addictive personality", and saying things like "that's just how you're wired". I never went back to those doctors, as I refused to accept that's what I was stuck with being. I'd been an excessive drinker from my late teens through to my early 30s. "Alcoholic", I'm not sure about; I've seen others who were formally diagnosed alcoholic, including one friend who ultimately died of it, and I wasn't that bad, but I was at least very socially dependent. I also smoked tobacco heavily and dabbled in some substances - not the most addictive ones, but it could have gone down that path if I hadn't seen the warning signs. At 33 I stopped drinking and smoking completely (I'd quit smoking a few years earlier but had started again that year). For two whole years I didn't have a drop or puff, and focused on eating a very healthy diet, cleaning up my body and getting my career and relationships in better shape. Along the way I found some deep emotional healing techniques. I started doing them regularly, and have continued doing them consistently for nearly 10 years since. These days I can drink regularly for pleasure, and I never have a problem with it. I barely ever get drunk unless it's a major celebration, but if I do, I bounce back fine and have no temptation to do it again any time soon. And I'm never remotely tempted to smoke or use other substances when drinking, even when around others who are. One of those doctors expressed shock that I'd gone to all the trouble of quitting my old ways, only to start drinking again. He couldn't believe that it would be possible to go from the way I was to having a healthy relationship with alcohol. The most significant factor that's made the difference has been the emotional healing work I've been doing. It's a practice that methodically finds and enables releasing all traumas, complexes and sabotaging beliefs/patterns from the earliest times in life. So maybe it's valid to say one can have an "addictive personality" and that I was one of those people. But we assume that "addictive personality" equals "hard wired", without realising that personality is very alterable if you work at it consistently over a long enough period of time, with a focus on the deep subconscious/unconscious aspects of personality. I think organisations like AA do great harm when they tell their patients that you're an "addict for life". It's such a disempowering belief to have about one's self, and it's little surprise that people relapse when they're given no hope of ever being completely free of their addiction and able to live like other healthy people. These days, I have a young child, a great relationship with my partner, family members and friends, my career is going fine, and my physiological health continues to improve. The doctor I see these days, on the infrequent occasions I need to see him, says "whatever you're doing, keep doing it".
post_break 5y ago
I look at someone like Steve-o and say nah, people can change. If someone as addicted as him can pull out of the spiral, then no you can break the cycle. But not everyone can do that.
Osmose 5y ago
The premise of this article (that "Once an addict always an addict" is false when evaluated from a rational, scientific standpoint) is flawed from the start because the phrase isn't _meant_ to be a rational, scientific claim. The phrase is a contextual, emotional expression. Sometimes it's used to express frustration that even after years of work and/or progress, an addict might still _feel_ urges and have to deploy coping mechanisms against them. Other times it's a way of empathizing with someone who is a victim of a relapsed addict's maladaptive behavior. Still other times it's a mantra for recovered addicts to stay vigilant. The repeated references to "victimization" are a red flag to me that anything this author has to say about addiction isn't inclusive of everyone's (e.g. my own) lived experience of addiction. Admitting the difficulty and struggle of being an addict does not weaken me and prevent me from working towards recovery.
zafka 5y ago
Pretty much yes from my experience. Both personal and by observation of others. That being said I know many addicts/alcoholics who live happy productive lives- they avoid the chemicals that suck them in.
ddtaylor 5y ago
Thats an ad.
ChrisMarshallNY 5y ago
I have opinions and...more importantly...skin in the game, here. It's been my experience that most of this stuff is written by folks, to whom addiction is an intellectual exercise. Maybe they know someone that may or may not be an addict, and the chances are good, that what happens to that person won't really be life-changing to the person writing about their pet theory. Things are quite different, when it's your ass, or someone that you really care about, experiencing it. There's also a great deal of money to be made. Desperate people are easy marks. That's all I'll say.
- teach 5y ago
  Agreed. This article, while interesting enough, is clearly written by someone who is not an addict and does not have close/intimate relationships with any addicts. "In theory there is no difference between theory and practice, while in practice there is." - Benjamin Brewster
  - SV_BubbleTime 5y ago
    > clearly written by someone who is not an addict and does not have close/intimate relationships with any addicts I have a disproportionately large number of addicts in my family as a percentage. I grew up around this. This article is written by someone working completely in theory. There is nuance in everything, and many people may actually beat addiction - but from what I’ve seen, to some degree it’s always there somewhere, forever dormant or just napping, just takes the right conditions to come back.
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- moonshinefe 5y ago
  "to whom addiction is an intellectual exercise. Maybe they know someone that may or may not be an addict, and the chances are good, that what happens to that person won't really be life-changing to the person writing about their pet theory." Spot on. I also got a massive armchair amateurish feel reading it. They feel very comfortable emphasizing that certain lucky addicts can seem to recover and moderate, but don't really seem to put nearly as much emphasis on addicts that might die or ruin their lives if they read that advice and think they can moderate before relapsing again. No mention in the article about %s of addicts these facts apply to, no mention of the author's name or credentials. Just a crappy article that doesn't help the situation at all really.
max_ 5y ago
What exactly is an addiction? Am I a Hacker News addict?
Dumblydorr 5y ago
There's physiological addiction, withdrawal alleviation, and psychological addiction too, to games or habits or anything. Then, I find where you live, who you know, and how you use drugs in patterns while also living in those patterns, this makes it harder to quit. Finally, there's the coping, the escapism, the alternate forms of consciousness, which help us get through the suffering of daily life. For me, only using legal "softcore" stuff, I have to think in terms of delay and moderation. I am fortunate, as Lincoln once said, to not have the urge and scourge of strong addiction to alcohol. I can't claim some magical fortitude or moral superiority, I was lucky enough to have a safe life and a "meh" feeling about alcohol and nicotine.
reducesuffering 5y ago
I’ve perused Hacker News almost every single day for 5 years. How do I break that addiction?
moonshinefe 5y ago
"If enough time passes, you can start engaging in the behavior in a healthy way once again." Spoken like the author has never had someone close with addiction, imo. You'll notice that actual medical professionals never are like "oh just quit your massively health-ruining addiction for several years then you're good to go potentially! Happens all the time, look at these studies." It's because such advice or facts--while technically true in a % of cases--downplay how devastating the next relapse might be for the addict (often it means death, or at the very least, their life ruined). Framing these things to addicts and individuals properly given their situations is very important, but has been totally bypassed by this author "helpfully." They present the article without mentioning their intentions or target audience too, which hardly helps. "So I dove deep into the topic and looked at what science says about it." So what credentials if any do they have at evaluating scientific consensus on addiction? Oddly enough the article includes some sources but makes no mention of who the author is from what I can see. Is this some high schooler's opinion after Googling around for an evening? We can't be sure. "This has some merit, for example, when it comes to alcohol - you can go from being addicted to alcohol, to having a social drink once a week." "However, that doesn’t mean you need to avoid the behavior forever." This author needs to like stop repeatedly emphasizing this stuff and muddying the waters--it HIGHLY depends. Again, this is spoken like someone who has never seen someone kill themselves young after that "one last relapse" because they thought they could control it finally. So this article comes off very poorly and I'm disappointed it got upvoted to be honest. Like, the lucky few addicts who recover and can moderate (& their loved ones) probably won't need this article. To the rest of the addicts and people who may be giving them advice, it seems to be a pretty irresponsible article to me.
- MrStonedOne 5y ago
  > So what credentials if any do they have at evaluating scientific consensus on addiction This is an ad-hom attack, and not productive.
  - j0057 5y ago
    'Consider the source' is not the same as an ad hominem: 'The source is unreliable therefore we should distrust the information' vs 'The information is false because the source has bad credentials'.
dalu 5y ago
I quit nicotine. Because I had to. My lungs hurt. I tried to quit before but something always brought me back. Nicotine is the most addictive substance I ever took. I did take a lot of drugs. Different drugs. This article for me is just another on the trash heap. You have to differentiate. There is mental and body addiction. There are so many reasons. I know people who quit heroin. It's not all the same. Overcoming something is "easy" just stop taking it anymore and find other things to do instead.
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kelnos 5y ago
I really want to believe this, because "once an addict, always an addict" has always sounded like an unsupported, junk-science, catchy thing to say, and not something based in reality. And I don't really want to believe (yes, I know this is an emotional take), that some people's brains are just fundamentally "broken" in a way that means they can't enjoy some nice things without destroying their health and relationships. I think also the idea of addiction (or an "addictive personality") as this inherent, unchangeable thing just doesn't pass the smell test for me. Our understanding of the human brain is still pretty limited, and making a blanket statement like that just doesn't make sense. I can certainly understand this attitude for practical reasons: if you can get an alcoholic to stop drinking, and stay sober for the rest of their life, yes, you've certainly solved that problem. But I also suspect you haven't solved some of the underlying issues (e.g. around anxiety, dealing with emotion, etc.) that probably led them to drink excessively and uncontrollably in the first place. But I know very few people who have (to my knowledge) gone through this sort of thing, so while I can intellectually spout off what I believe to be true, it's not coming from a position of experience. The only real data point I have that perhaps aligns with this article is my father, and this is only from what I was told (by him, decades later). In his teens and early 20s, he drank heavily (to the point of doing some pretty unsafe things), nearly every night of the week; he was friends with the bartenders at many of the local bars, and would stay after closing to continue drinking. But during my childhood, I'd only known him to have a beer or two at a family get-together or neighborhood block party, so I asked him what changed. He said that he wanted to marry my mom, and that required him to put all that behind him. She was ok with the occasional social drink, but binge drinking or any kind of drunkenness was not kosher. He told me all this when I was in my late 20s, while we were having dinner at a brewery... drinking beer, of course.
rvn1045 5y ago
Here is what helped me kick two major addictions in my life: I smoked 3 packs of cigarettes a day for 6 years straight. It started to take a huge hit on my health and I quit. I smoked marijuana every night for 4 years then quit and have just smoked it occasionally. I started doing vipassana several years ago, everyday a little bit of a good chemical balance accumulates in my brain and body to the point where a lot of cravings start to disappear and you feel good in your head and body even without drugs like caffeine. I wouldn’t say I’ve beat all my cravings but they’re 90% better ..
locusofself 5y ago
I have some strong, perhaps knee jerk feelings about the idea that addicts can come around to become healthy social drinkers, smokers, etc. I feel like some probably can, but most probably can't. As someone who had major addiction issues for about a decade and has been clean for 12 years, I have no desire to test those waters, and feel a bit offended at the notion that my life would be better if I figured out how to be a functional user. I have everything to lose and very little to gain.
- jkhdigital 5y ago
  I know, right? My wife basically never drinks, and she’s doing just fine. I’m really not missing anything by abstaining from alcohol for the rest of my life.
- MrStonedOne 5y ago
  I have the same but reverse knee jerk feelings towards AA. The entire idea that i should treat something other people can manage as if it were some forbidden fruit just doesn't sit with me. That doesn't mean I've solved any issue, It just means i've figured out a way to avoid it. > and feel a bit offended at the notion that my life would be better if I figured out how to be a functional user. Lets try to reframe that then: given that conventional AA is basically the only game in town, do you think that there are people who have either failed to take to its abstinence only system that might be successful at a different approach or is somebody who flat out refuse to seek help from an AA style system for the reason i laid out, such as myself, who could use access to a different approach?
  - locusofself 5y ago
    I actually agree that it's a shame that AA is the only game in town and I think its effectiveness is vastly overestimated. It's also seriously dogmatic about way more than just complete abstinence (I mean it's 12 steps, meetings every week or every day, etc). I prefer to keep my past far in the rear view mirror instead of continually drudging it up. I am just very dubious that people who have shown they have the capacity to fuck up their lives with drinking/drugs, especially for an extended period of time, are going to reprogram themselves successfully to become casual users. I don't know how black and white it is. But I count my lucky stars for the last 12 years of life compared the 10 before that.
rhyn00 5y ago
Marc Lewis, a neuroscientist has a nice book on the topic, which to me makes complete sense (and is grounded in sound science). His view on the topic is that addiction is nothing special, just a learned behavior. Hebbian learning states that neurons that fire together wire together (corollary: neurons that don't, the connection weakens). The neurons in the limbic system control emotions, attention, desire, and fear. The prefrontal cortex (PFC) controls planning, expectation, and long term planning. We are motivated to do things that we desire, or avoid things we fear, which is controlled by the limbic system (also involving dopamine release). Let's take drugs for an example but this can apply to other behaviors like internet usage, eating, falling in love, becoming obsessed with a hobby, or cronic anxiety toward something (avoiding fear). When we take a drug (or do xyz behavior ) it gives us a positive feeling (pleasure, or comfort in avoiding fear) and probably a favorable outcome occurred, so we are likely to engage in the behavior again. Each time we engage in the behavior the connection between the limbic system and the stimulus that triggers it, strengthen. When the trigger happens the limbic system lights up and triggers the PFC to create a plan and imagine how good it will be (then a positive feedback will occur - this is craving). Over time more and more stimuli will become triggers. Also, if you don't use it you lose it, and the neurons responsible for long term planning will weaken their connection to the limbic system (also, shown in brain scans), making it harder for you to assert self control. However, your brain is plastic, and you can also unlearn the behavior over time (studies also support this). Meditation can help because you can stimulate these neural pathways in a controlled environment. For example you can imagine how a trigger leads to drugs, then you can imagine how drugs leads to bad things while meditating - over time you can strengthen the connection from the trigger to the emotion and imagery of bad things happening. Ofcourse meditation is not the only thing that can help, but the main idea is that you want to make your brain associate the bad behavior with bad outcome, and strengthen the association of good outcomes with fear/desire circuit. Book: The Biology of Desire: Why Addiction Is Not a Disease - https://www.amazon.com/Biology-Desire-Why-Addiction-Disease/dp/1610397126 https://www.amazon.com/Biology-Desire-Why-Addiction-Disease/... Youtube: The Neuroscience of addiction - https://www.youtube.com/watch?v=aOSD9rTVuWc https://www.youtube.com/watch?v=aOSD9rTVuWc Edit: typos
cupcake-unicorn 5y ago
Honestly I don't think putting it into sharp categories like A or B are useful. I don't have addiction but I suffer from chronic mental illness. Strangely despite being diagnosed at a young age and having dealt with it all through college and into my mid 20s people were still treating me like it was just something I could "get over". So I guess this is more in the B camp. For me this wasn't helpful and I felt just as helpless because the problems didn't go away. Now I embrace the fact that I have a chronic mental illness that is NOT going to go away. This is more in the A camp. But once you embrace that at least for me I felt less helpless. I knew it wasn't going away and I worked to put up supports because it wasn't just a passing thing. It never will be for me. You can change your response to things and that's maybe the "neuroplasticity" he's talking about? But your brain actually isn't that plastic after childhood. If addiction is anything like my mental illness you'll always have the same response in a situation. You can have years of learned behaviors and coping mechanisms but that doesn't mean that it doesn't destroy you initially when you run into a rough situation. It's accepting that and how to deal with it and the aftermath that you can change.
peter-m80 5y ago
I quit smoking 10 years ago. I still notice the addiction and I think it will never go away.
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throwawayapatra 5y ago
I smoked meth almost everyday for a few years, abruptly quit, and never relapsed. I've been trying to quit diet soda for more than a decade and I can't go longer than a week ..
cratermoon 5y ago
Addiction is a brain disease, and it matters: https://pubmed.ncbi.nlm.nih.gov/9311924/ https://pubmed.ncbi.nlm.nih.gov/9311924/
golemiprague 5y ago
I think the main way people get into some addictive behaviour is the social norm around them, if everybody around you are doing drugs or smoking or eating sugars or gambling there are good chances you will also do it, it has nothing to do with personal traumas. Maybe sometimes a certain personality traits can enhance the addiction but you don't always need those amplifiers to get addicted. It's true also for other bad behaviours which are not necessarily addictive, like getting knocked up in an early age for example. The interesting thing is that many people do overcome those addictions but many other struggle, so maybe we shouldn't try to figure out what caused it since it is not that relevant to rehabilitation but focus more on why some people succeed and try to replicate it. I know it is not a simple task as the diet industry shows very clearly, but some people do become thin, so what makes them do the switch and can it be replicated? this is the interesting question.
jl2718 5y ago
“There are people who went through AA, recovered from their alcohol addiction, and are able to drink moderately.” There are also people who have survived skydives without a parachute. This article seems like some kind of self-justification for returning to destructive behavior. I imagine their codependent somewhere rolling their eyes again at this mental gymnastics routine. Here we go again….
treebot 5y ago
I have been around addicts my whole life (drugs and alcohol), I've known many people who died from their addiction, and I've struggled with addiction myself at times (drugs and alcohol). I have a few issues with this article. 1. Behavioral addictions are not comparable to a serious chemical addiction. The person who can't stop watching Netflix or can't get off Facebook is not the same as someone who can't stop sticking needles in their arm (heroin) and is flirting with death everyday. I've had behavioral addictions and chemical addictions, and I can tell you first hand that a chemical addiction is a different monster. You start to feel physically and mentally ill when you can't get your fix for a chemical addiction. Flu like symptoms, you can even die from withdrawal from some things. Comparing that to something like video game addiction is a huge stretch and somewhat offensive. 2. Saying that an addictive personality is really just deep seated emotional issues is not really changing much. Deep seated emotional issues are very hard to change. We try and some do, but a lot of us only make minor progress or don't change at all. Especially the people whose emotional issues have led them to a serious drug or alcohol addiction. Sometimes the best they can do is just abstain and use something healthier to cope. The whole article feels like the author is engaging with the issue on an intellectual level. Sure, there are addicts who can recover and then even use their substance without relapsing. But there are many addicts who relapse and die, or ruin their lives. It makes sense then to err on the side of caution. For most addicts, there's more to lose than to gain, and it's hard enough fighting addiction that I don't think we should encourage addicts to push their boundaries. I've just known many people first hand that truly embody the phrase "Once an addict, always an addict." Sure, maybe it's not true for some people, but it's true for a lot of people, especially the addicts that have it really bad.
denton-scratch 5y ago
As usual, the term "addiction" is being used in the article (and in the comments, unfortunately) to refer to two quite different things. Addiction to something like Oxycontin is a physical addiction; the symptoms of withdrawal can be severe enough to kill you. Addiction to something like Twitter may involve dopamine pathways, or not; but withdrawal isn't going to result in serious physical symptoms. Consider nicotine. Withdrawal from even a serious habit takes no more than about 72 hours. The habit of having a ciggie between your fingers is another matter; habits are really hard to shift. I think it's a mistake to subsume habitual behaviours under the handle "addiction". There are two different things going on here, and it's useful to have two words, with distinct meanings, so that we can distinguish them in discourse.
tacocataco 5y ago
Anyone know of secular support groups for addiction? I've been abused growing up because of religion and the people that's worked for it. I don't think I need a higher power in my support groups. the reason I started using was the trauma caused by faith based organizations. You may as well have a rapist host a support group for battered women IMO. I apologize for the emotional comment.
InfiniteRand 5y ago
A lot can be said about this article, but just to pick on one thing. It can be useful to think of yourself as having an "addictive personality" if it helps you make smarter life decisions about avoiding situations where addiction is a possibility. "Discretion is the better part of valor". It is possible to recognize certain paths in life will put you under greater stress and do some cost benefit analysis of that, to do an accurate cost benefit analysis you must have a realistic idea of how you deal with stress and how likely serious issues might arise.
lcall 5y ago
FWIW, my church has an excellent 12-step program also, free, with online materials (ducuments, videos), and meetings (including phone/video), for individuals, affected spouses & families: https://addictionrecovery.churchofjesuschrist.org/ https://addictionrecovery.churchofjesuschrist.org/ (There are also very good materials on general self-reliance (being stable and better able to go forward), including improving employment, self-employment, family finances, preparedness, general family welfare, forgiveness, and other topics, at ProvidentLiving.org.)

188 points by vitabenes 5y ago

For anyone who wants a more evidence-based approach to addiction than 12-step programs, SMART recovery might do the trick for you. It helped me greatly with my alcohol addiction, and it doesn't treat addiction as a forever thing. I've been sober for 6 years or so now, and I haven't needed to attend a meeting since I beat the addiction. Meetings are free, there are online sessions all the time, and it's just a great community overall.

vitabenes 5y ago
Interesting, I'll take a look at that. Congrats!
toyg 5y ago
What is your experience about the following paragraph? > you can go from being addicted to alcohol, to having a social drink once a week. That goes against pretty much everything I've ever been told by addicts to alcohol and drugs. Once you've been "in the tunnel", there just isn't "a social drink" - even a drop will get you off the wagon for good.
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- runawaybottle 5y ago
  That’s not 100% true. Exhaustion is real. Can you watch the same Marvel super hero movie for the n-th time, even though you loved the first few? You can’t, you just get tired. Burn out is real even amongst addicts. You literally get tired of this shit. Before I became an addict, another legitimate addict told me why he stopped - he just got tired. I’m talking years of daily drinking, and all the consequences that come with it (every bridge burnt, every path destroyed, credentialed as a true fuck-up). Exhausted. That’s the thing about abuse. If you took one hit of cocaine, and you die, that’s the end of your abuse. Addicts can take hit after hit after hit, and still live. That’s scarier than death, and extremely tiring. I am tired of it, pure exhaustion is a way out. The implication of that is that you yourself are such a piece of shit that you didn’t quit until you yourself got tired. It’s shameful.
  - sethjgore 5y ago
    Check out the Sinclair method.
    - BayAreaEscapee 5y ago
      I'm going to second the Sinclair method, which involves taking naltrexone or nalmefene. I started with the Sinclair method at the same time I started participating in SMART recovery online meetings. I only drink alcohol about once a week now and only in moderate quantities. Here are some links for anyone interested: https://www.amazon.com/Cure-Alcoholism-Medically-Eliminate-Addiction-ebook/dp/B009G1TID4 https://www.amazon.com/Cure-Alcoholism-Medically-Eliminate-A... https://www.youtube.com/watch?v=6EghiY_s2ts https://www.youtube.com/watch?v=6EghiY_s2ts
- SargeZT 5y ago
  For alcohol that may be true, but the ultimate goal of SMART is sobriety. There is another (smaller) branch of REBT drug-based therapy called 'Rational Recovery' that uses naltrexone (an opiate blocker) before drinking to reduce the pleasurable feeling associated with drinking. I tried it, but it didn't work for me. It certainly makes drinking less pleasurable, but I was using it as a coping mechanism for my anxiety. I think for some people, that approach might work. Also, if a person solves their underlying psychological problem which led to the need of alcohol for a coping mechanism, I think it might work as well. I'm probably saddled with anxiety for life, but I've learned healthy coping mechanisms. Besides the taste of a cold beer after mowing the lawn, I don't miss it in the slightest.
- retrac 5y ago
  It's not my experience. I do believe it's riskier than simply abstaining long-term. You are, in fact, reminding yourself of something you found so compelling once that it derailed your life. But personally, I have been addicted to amphetamine and alcohol/benzodiazepines badly enough in the past, that I could not discontinue them suddenly due to the severity of the withdrawal. Yet in recent years I have felt able to get drunk at a party for example, without serious cravings in the weeks that follow. And I'm back on amphetamines for ADHD which I take to schedule. I won't lie though; the thought of taking two pills instead of one does occur to me not infrequently. The temptation is probably always there once you know what it's like. But my experience is that no, it doesn't automatically derail necessarily.
throwawaylinux 5y ago
What evidence is it based on? When you say evidence-based, do you mean the initial development of the program, or its ongoing claim to efficacy in light of the results? There is evidence supporting AA as a treatment for alcoholism. https://pubmed.ncbi.nlm.nih.gov/29606223/ https://pubmed.ncbi.nlm.nih.gov/29606223/ https://pubmed.ncbi.nlm.nih.gov/32159228/ https://pubmed.ncbi.nlm.nih.gov/32159228/ It's great there are alternatives, and I'm sure different treatments will work best for different people, but it is for that reason you shouldn't imply other programs are not an evidence-based treatment (at least of similar quality).

ChemSpider 5y ago

Just the other week I read in a medical textbook: If you are overweight (obese) at age 18, there is only a 15%(!) chance that you will manage to have a more healthy weight during your adult life. I found that number utterly depressing and shockingly low.

maccard 5y ago
That lines up with intuition; if you are obede at 18, chances are your parents have not prioritized a healthy relationship with food, meaning it has never been a priority for you or your family, and you are unlikely to change those entrenched habits.
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- dathinab 5y ago
  That might depend a lot on the country you are in/from. The huge majority of (similar aged) people I had meet between 16-20 which had been obese where so because of "health issues" not directly related to them eating unhealthy being lazy. As such it's not surprising if you have problems changing it because "just" eating healthy and doing sports is far from enough to fix it. And trying to fix it with that is often a task needing far more discipline and self control then the large majority of humans (independent of weight) have. I mean let's be honest the difficulty many of this people face is way higher then the difficulty for a young(1) health male to get a black belt in Judo, Karate or similar. (1): Start training with ~14 or earlier, through not necessary with high commitment, then at some point later (e.g. 16,18,20) added commitment trying to get a black belt.
  - maccard 5y ago
    Are health issues unrelated to obesity the primary cause of obesity in under 18s? Also, I specifically never called anyone out as lazy. The majority of obesity is overeating (a single Starbucks muffin is a 10k run). Yes there are people with imbalances/medication that are outliers but most people aren't outliers. I specifically called out a relationship with food being something that's carried into adulthood as the cause of the relationship between those figures. An obese 14 year old may have some underlying health condition but is more likely to be a victim of socioeconomic problems; lack of access to healthier and more balanced foods, or to have obese parents (which appears to be a good indicator for childhood obesity). Neither of these are easy solves, and the blame doesn't lie with an individual, but it does explain that someone who is obese as a child is more likely to be obese as an adult.

fitba72 5y ago

The disease model of addiction is still hotly debated in the USA. It has been widely discredited and thrown out in other western nations. What's the difference in these nations? These other nations have some form of socialized medicine so you don't have to have a medical illness to have your treatment costs covered. On the contrary, the only way to get treatment costs paid for addictive behaviours in the USA, by a medical insurance company, is if you have a disease. Try asking your medical insurance to pay to stop you making bad choices or changing your habits. The work of Stanton Peele is seminal in this field for anyone interested. Also check out The Freedom Model. Completely heretical to AA types but to rational thinkers struggling with an addictive behaviour, it could be life changing.

MattGaiser 5y ago
> Try asking your medical insurance to pay to stop you making bad choices or changing your habits. If they found a way to scale monitoring to prove you changed, they absolutely would. The challenge is proving it.
refurb 5y ago
This clearly isn’t true since plenty of people get access to psychotherapy who have public and private insurance without being diagnosed with a specific illness.
- amanaplanacanal 5y ago
  Will insurance really cover a psychiatrist without a diagnosis? I always assumed the doctor was reporting a diagnosis to the insurance company even if they weren't telling the patient.
- chillwaves 5y ago
  Every time I look at a therapist while seeking treatment, they always put a disclaimer on their insurance page that a diagnosis is required to be paid for claims. Maybe it's just my state.
wintermutestwin 5y ago

float4 5y ago

> Your brain can start functioning normally again in a span of a few months. It doesn’t have to be the same, but it should work just fine. The two articles linked to at the bottom talk about multiple years, the third link points to a news article that refers to some research that uses one year as a minimum. This feels more believable than "a few months". My flat mate has ADD and has phases during which he's clearly addicted to alcohol. At one point he stopped drinking completely for over 6 months, but drank a small amount once and things spiralled out of control again. He does view addiction as a personality trait (in part because he knows that people with ADD develop addictions more often), and that attitue actually seems to help him. These days he abstains from addictive things because he "knows" that he'll get addicted to them once he starts. I believe in the thesis of this blogpost (that addiction is in fact an emotion regulation problem, and that it can therefore be cured), but the approach my flat mate takes these days works pretty well, at least for the first year.

loa_in_ 5y ago
Alcohol is a depressant - it gradually wanes your higher cognitive skills over the course of hours. Very convenient when one's thoughts are racing. I believe there's no causation in "drinking once" -> "drinking more". I believe there's causation in "trying to self medicate" -> "drinking".
- deleted 5y ago
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- bserge 5y ago
  being forced to self medicate by the healthcare industry
donatzsky 5y ago
Notice that they said can, not will start functioning normally in a few months. Basically it's a lower bound, and elsewhere they do say it can take years.
sethjgore 5y ago
I suggest you mention the Sinclair Method to him. It has worked wonders for thousands who were addicted to alcohol. It is a cheap prescription that you take before drinking and over time people actually drink normally again since the brain is rearranged (the medicine takes away pleasure from the drinking). It might save his life or reduce his cravings.

123pie123 5y ago

I would probably class myself as someone with an addictive personality. not with drugs (except alcohol), but with anything - if I like something, I find it very hard to not have more, wether it's good or bad. eg going to the gym 6x week or getting takeaways every day I've analsysed this for sometime and the best (for me) way of dealing with it is to keep track of every thing I do or I like. "The power of habit" book helped a lot with my ability to control my addictions

axiosgunnar 5y ago
Note that you could probably „weaponize“ this addictive personality to achieve what normal people cannot (eg dedicate an extreme amount of time to a difficult task and achieve it)
- curiousllama 5y ago
  I'm not who you're responding to, but I very much identify with what they wrote. I once accidentally trained for a marathon. Weaponizing this is unhealthy. It doesn't end well. The reason normal people can't do X and an addict can is because an addict is making egregious trade-offs. "I know I'm going to mess up my shoulder for the rest of my life, but I'm going to bench heavy anyway" "I know I haven't seen my kids in a month, but I'm going to shut myself away and work on my side business anyway" It's collapsing your entire life into a single, simplistic max/min function. It's a quick path to misery.
  - ThrowawayR2 5y ago
    I'm reminded of a quote from J. M. Barrie, the author of Peter Pan: "You can have anything in life if you will sacrifice everything else for it." I once thought it was, and have often seen it used as, an inspirational quote until I later read another opinion that it was a warning of the dangers of being too single focused.
    - kmmlng 5y ago
      I simply take it as a description of reality. As a child, you are nothing yet, but you have the potential to become almost anything. As you get older, you trade in that potential for something specific. It's up to you to choose. You can trade all your potential for one thing only or you can divide it up to become multiple things. The right balance is debatable. The real danger lies in taking it to the limit. If you try to become everything, you divide your potential up into infinitesimal pieces and end up remaining nothing at all, a child. In any case, there is some real wisdom in Peter Pan, but it was completely lost on me as a child.

trabant00 5y ago

All the feel good theories in the world can't contradict the numerous examples of addicts who relapse after trying to moderate what they previosly used in excess. The article is basically a hook for buying the course. They can't accept the once always theory because it would make their product not attractive.

dillondoyle 5y ago
I also thought their 2 ways only characterization was contrived. And I don't buy stock into the way they are founding their arguments on their definition of the word 'disease.' But I guess it's a good point that harm reduction is good and abstinence is not the goal for everyone.
vitabenes 5y ago
As the saying goes: all models are false, but some are useful. Every theory has its limits, but that doesn't mean it can't be helpful. The opinion that once-always theory can be damaging is rejected by many people in the field, not just us. We're simply presenting it in a digestible format (without the need to dive into the sources for hours and hours). See the rest of the series for a better understanding of the subject matter. And yes, our blog is a part of our marketing, but that doesn't mean that we "just" want to make money from it. The aim of the whole project is to help people, in a sustainable way, with some free and some paid resources.
balfirevic 5y ago
> All the feel good theories in the world can't contradict the numerous examples of addicts who relapse after trying to moderate what they previosly used in excess How does it compare to the number of addicts who relapse after striving to be 100% clean?

awaaythroow 5y ago

The author states that thinking that you have an addictive personality is unhelpful. Articulated that way, it could be true, but understanding that there is a predisposition towards addiction[1] is helpful to overcome it, and does not contradict the fact that one can recover from addiction. From Overcoming Sex Addiction by Thaddeus Birchard [2]: “A predisposition towards addiction, be it genetic or a legacy from the historic family dynamic, is important to understand. It reduces shame to know that you are vulnerable to sexual addiction not because you are morally deficient but because you are predisposed towards addiction either through genetic inheritance or though interfamilial patterns. The more that shame is reduced, the more that the drive to act out sexually is lessened.” “Once you understand that this dysfunctional regulation was set up in childhood, there is a reduction in shame because you are not responsible for having the problem. However, you are responsible for what you do about it.” [1] For example, because of childhood trauma. See https://youtube.com/watch?v=_-APGWvYupU https://youtube.com/watch?v=_-APGWvYupU and https://newyorkpathways.com/sexually-acting-out-as-response-to-childhood-trauma/ https://newyorkpathways.com/sexually-acting-out-as-response-... [2] I'm halfway through this book and found it very helpful. I recommend it for anyone dealing with addiction.

YarickR2 5y ago

Well, quit smoking cold turkey after doing so for 10 years. No addiction. Quit eating lots of sugar, after doing so for 30 years, replaces with fruits and nuts. No addiction. Can't stop reading books, doing so for 40+ years; addictive as hell. I know iv drug users , they quit and do not look back, so , oaaa does not hold true in general

lookalike74 5y ago

> "Opinion A can make people feel powerless. I’m an addict and I’ll be that way forever- it creates feelings of shame and being a victim. It also creates a stigma in society that addicts are somewhat broken and can’t be fixed. Opinion A seems a little bit outdated. Abstinence isn’t necessarily the goal." This isn't a very informed argument at all. One, abstinence isn't the goal of AA or 12-step ; recovery is the goal, and it starts with abstinence. Two, addiction is best defined as having lost the power of choice. So not only does this opinion ignore that, it propagates the very stigma it intends to diminish.

sneak 5y ago
Reminder: AA and 12 step are faith-based, and aren't very effective when actually measured (roughly equal to the effectiveness of not using AA/12-step).
- lookalike74 5y ago
  Sorry, there are untold (but not unknown) millions more people around the world who've recovered from addiction with 12-step than anything medical. AA was founded in part by a doctor (himself an alcoholic) who recognized that medical science had no solution to alcoholism. Fast-forward to now and the 'medical solution' to addiction is usually another addictive substance. Can those help? Sure, and they do. But I don't think there's been any significant studies confirming medical science has a better solution than 12-step. If you have evidence that relapse rates are lower outside of 12-step than within, please share because I've never heard of it.
  - lotophage 5y ago
    Here's an article from The Atlantic that you might want to read. > Its faith-based 12-step program dominates treatment in the United States. But researchers have debunked central tenets of AA doctrine and found dozens of other treatments more effective. https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/ https://www.theatlantic.com/magazine/archive/2015/04/the-irr...
  - 5y ago

scandox 5y ago

> This has some merit, for example, when it comes to alcohol - you can go from being addicted to alcohol, to having a social drink once a week. To anyone who has experience of alcoholism from any angle...this is absurd.

vitabenes 5y ago
First, can is the important word here. The point is that if the rest of your life is okay, there's no need to run away by drinking yourself under the table. You seem to be implying that there are no people on Earth who went from addiction to moderation. There's nuance to it. To be fair, however, we're not encouraging people who've struggled with alcoholism (esp. severe) to have a drink.
- toyg 5y ago
  > if the rest of your life is okay, there's no need to run away by drinking yourself under the table. That's... not how it works. One might have become an alcoholic because the rest of their life was shit; but remaining an alcoholic is another matter. Highly-functioning addicts are still addicts. A lot of neurochemical processes don't care for the social or psychological situation. It's a bit like saying that "people can sail the Atlantic in a kayak"; a few might make it, but the overwhelming majority will die under the waves, and telling them they can do it is just Bad.
  - vitabenes 5y ago
    Fair enough, given that the rest of the series is more about behavioral addictions that substance addictions, it might make sense to change that passage. Thank you for the feedback.
- deleted 5y ago
  [deleted]
bunnyfoofoo 5y ago
Agreed, if you're in recovery, do not attempt moderation. That normalizes the behavior and is a slippery slope. Seriously thinking this may work for you is a probable sign you should talk to your sponsor or attend an AA meeting.

the-dude 5y ago

I have always believed there must exist a reason I had addictions. Somehow after about 2 decades, a midlife crisis and starting all over again, and then some years : I seem to have come to terms with these reasons. I seem to understand them, and accept them and therefore accept myself. And then the urges just disappeared. I tapered off the substances and am clean for over a year now. Fingers crossed. YMMV.

toyg 5y ago
Clarity of purpose makes all the difference for me. The periods where I know what I want and what to do, I have no need for any addiction. When that feeling of purpose and control goes away, I become a slave to them. In some perverse way, they make life endurable when my brain says it shouldn't be.
- rakejake 5y ago
  This x1000. I wouldn't qualify as an "addict" by clinical definitions, but I have a set of bad habits. Over the last year or so I have been making journal entries . The journal entries made me realize exactly what you said - the odds of falling into bad habits multiply several fold during periods where I don't know what I should do. I realize now that maintaining a journal is a very important and fruitful habit. It is a valuable exercise to record your feelings and state of mind at regular intervals. It will help you figure out your failure modes and patterns (if any) to your successes and failures.
vitabenes 5y ago
Congrats! Hm, why do you think the urges disappeared? Does it coincide with getting your life in order or not?
- the-dude 5y ago
  Not so much life in order, still working on that. The internal discrepancies, finally understanding why and what. Finding peace.

polote 5y ago

To me, a lot of time addiction is a choice. I'm not saying all the time, but very often still. I've tried helping different people overcome an addiction, and even though at first they want to stop it, when they start to think more about it they don't really want it to stop. If you are not entirely convinced that the addiction is doing more harm than good, it is much more difficult to overcome it. Trying to think rationally is not going to be very helpful, most of people are not able to think that way, emotions and perceptions are much more important. I often say, life is much much easier when you are a rationalist

EdwardDiego 5y ago
Genuine question, have you ever recovered from addiction yourself? Because that phrasing is a bit odd, IMO. No-one chooses to become dependent, and there's a lot of optimism bias/hubris when people start dabbling in addictive substances - I won't get addicted like _those_ people, I'm different... But the hard bit, as you've noted, is making the choice to end your dependence. The choice to face whatever in life your vice of choice was numbing you to, to face it naked and vulnerable. ...that takes a lot of guts. And a lot of repeated attempts. And you're right about the need for intrinsic instead of external motivation.
omnicognate 5y ago
I agree that it is, or can be, a matter of "choice", but that's a subtle thing. What does it mean to "choose" or "want" something when you have conflicting motives, when you both enjoy and hate the same thing, even at the same time? I think a large part of reaching emotional maturity (for some people at least, me included) is about resolving those conflicts and achieving a sort of unity of self. This often involves letting some parts of yourself go, deciding not to be a particular person any more, which the "addiction" may only be one aspect of. In my case I finally succeeded in quitting smoking, after 9 years of 20-30 a day and innumerable failed attempts to stop, just after I got married, 18 years ago. It was easy.
balfirevic 5y ago
> To me, a lot of time addiction is a choice. What does "to me" mean here? Do you mean that's how you perceived it in your own addiction?

aaron695 5y ago

This article is not a good summary on addiction and current understanding. It jumps around a lot between ideas that should not be linked and is factually wrong often. RE title - "Once an Addict, Always an Addict" This doesn't rule out moderation, and it is well known you don't use this wording or idea on some people. Addiction treatments fail around 90%+ of the time. That's why there are so many around, different ideas work on different people, and probably so people don't get bored or despondent as the churn through them multiple times. "Once an Addict, Always an Addict" might be someones win, someone else might just randomly stop.

chiefalchemist 5y ago

A or B? Why does it have to be binary? It seems that a spectrum is in order. Our brains are all not exactly the same. So there's a case for A. Our lives are all not exactly the same.So there's a case for B. The best answer might be C, a spectrum. A spectrum that considers both and some combination of A and B.

fxtentacle 5y ago

This article seems weird to me, because I view non-substance addictions as a way of procrastination, which in turn is a way to fix a bad emotional state. When your environment is hostile and depressing, and it certainly is for many people now thanks to covid and the faceless megacorps we have to deal with to get through daily life, then it kind of makes sense to disassociate from reality and get lost in a good video game.

satellite2 5y ago

What can really help getting addictions under control is understanding how it is expressed in the brain. Delta FOSB seems to be associated with addiction https://en.m.wikipedia.org/wiki/FOSB#Delta_FosB https://en.m.wikipedia.org/wiki/FOSB#Delta_FosB. And having a simple model of how it works helps in dealing with it. Contrary to popular depictions addiction is not bolean, it's a unbounded scale. And roughly each consumption of an addictive substance increase addiction and for each substance some time is required to go back to baseline. And if another take occurs before this period, then the addiction will grow. As a very simple model it's ovmbviously wrong but it's a very helpful proxy. Another euristic that is helpful in dealing with addiction is to avoid repeated use before 6-7 times the halflife of the substance. Such that > 99% of it has been eliminated. Finally looking for "harm reduction techniques" when dealing with a substance provides many helpful tips. I believe those advice can probably be translated in the case of an addictive behaviour instead of a substance but will obviously yield less precise recommendations.

throwawaycvid 5y ago

Really funny thing happened to me last year. I got COVID, luckily fairly mild but with some long lasting symptoms. The odd thing is that I no longer have appetite for drink or opiates/cocaine (on top of my maintenance medication) Surprising as I’ve been on that path for 15+ years. It’s not much but at least something good has come out of (having) COVID…

evv555 5y ago
Dr. Drew had the opposite reaction where he started drinking wine and smoking cannabis. He compares the symptoms to suffering from head trauma.

DoreenMichele 5y ago

I hate this idea that addiction is someone just getting high so they don't have to feel bad feelings, which seems to be the underlying assumption of most discussions. My dad drank heavily for a lot of years. I grew up hearing tales of his legendary drinking. Mom would buy him a case of beer on Sunday and if he ran out mid-week, he would drunkenly accuse her of drinking his beer -- which makes no sense because mom is a tea totaller. He would go on a bar crawl on nickel night and hit dozens of bars with his buddies. Etc. He was in the army and he fought in the front lines of two wars, WWII and Vietnam. He retired when I was three and apparently began tapering off. I don't recall him having the DTs. I don't recall him drinking heavy in my lifetime. I recall him having a beer as part of dinner when I was four or five. When I was seven, he was diagnosed with a heart condition. He blamed it on the alcohol and never touched the stuff again (except for a few sips when my brother hit drinking age while talking to him about what made for a good beer, I think). By then, he had been out of the army for four years or so. He had time to taper off for a few years before making his dramatic announcement that he wasn't drinking again. I think he drank to suppress his nightmares from serving in two wars. I think he didn't need to actively suppress his nightmares anymore after he dropped his retirement papers and no longer had to live in fear of being sent back. I think people drink and drug for a reason. We just mostly don't bother to try to figure out what the reason is for this specific person and we just act like "You are a badly behaved child who needs a spanking and you need to just try harder." And then blame them when that stupid idea consistently fails to be an effective solution to their problem. Edited. Cuz typos and auto-corrupt.

runawaybottle 5y ago
I think he drank from the pressure of having children and a family. Think about the reasons why he quit, his family, and he never showed much of it to his children. The reasons for quitting are often the reasons for starting. Sorry for getting all Freudian.
- DoreenMichele 5y ago
  I think the opinion of a random stranger who never met my late father likely has less merit than my own.

harlanji 5y ago

Being an addict seems more social than anything. It’s possible to go through a party phase and then years later go through an unrelated tough patch, having not touched drugs for years, and then hear whispers of addiction to explain the unrelated issue. Nobody dares broach the subject, and so a person clean for years and never really an addict can have their life ruined by others calling them one. Maybe they have real pictures from the phase or similar to circulate. It is slander even if the photos are real, and there’s no recourse. That can happen to a non-addict who experimented; can only imagine how likely a true addict would be to relapse in such a hopeless situation. Addiction is a destructive habit or system that needs to be replaced.

imvetri 5y ago

"you are an addict, be addicted to something else" - movie quote

runawaybottle 5y ago

It’s very hard to understand addiction. I know I had two distinct addictions for wildly different reasons. With certain games or porn, it’s just, I loved it too much. Later, with alcohol and prescription meds, it just made me feel less shitty. The former I just enjoyed it too much, and the latter, I never found a better substitute for anxiety and self hatred. One was truly an insatiable desire, the other was truly self medication. If you suffered from this, it’s very hard not to think you were born this way.

ransom1538 5y ago

If you are out there struggling with addiction I would checkout: Naltrexone. Naltrexone binds to the endorphin receptors in the body, and blocks the effects and feelings of alcohol. IMHO: The addict brain needs to be reprogrammed with chemicals - not just 'understanding why' or making macaroni necklaces in rehab. Naltrexone can be used with both opioid and alcohol dependence and is extremely cheap. Once on Naltrexone you can still drink/opioid and you wont get the high. Drinking a beer would be like drinking a Coke on Naltrexone. Pounding down two liters of Coke is gross - and your brain will start to associate that drinking is terrible.

cupcake-unicorn 5y ago
Low Dose Naltrexone is also a super interesting modality that's gaining more traction. The idea is that at low doses you are training your body to reset and produce its own endogenous opioids.

tomhoward 5y ago

At least twice, I had doctors describe me as having an "addictive personality", and saying things like "that's just how you're wired". I never went back to those doctors, as I refused to accept that's what I was stuck with being. I'd been an excessive drinker from my late teens through to my early 30s. "Alcoholic", I'm not sure about; I've seen others who were formally diagnosed alcoholic, including one friend who ultimately died of it, and I wasn't that bad, but I was at least very socially dependent. I also smoked tobacco heavily and dabbled in some substances - not the most addictive ones, but it could have gone down that path if I hadn't seen the warning signs. At 33 I stopped drinking and smoking completely (I'd quit smoking a few years earlier but had started again that year). For two whole years I didn't have a drop or puff, and focused on eating a very healthy diet, cleaning up my body and getting my career and relationships in better shape. Along the way I found some deep emotional healing techniques. I started doing them regularly, and have continued doing them consistently for nearly 10 years since. These days I can drink regularly for pleasure, and I never have a problem with it. I barely ever get drunk unless it's a major celebration, but if I do, I bounce back fine and have no temptation to do it again any time soon. And I'm never remotely tempted to smoke or use other substances when drinking, even when around others who are. One of those doctors expressed shock that I'd gone to all the trouble of quitting my old ways, only to start drinking again. He couldn't believe that it would be possible to go from the way I was to having a healthy relationship with alcohol. The most significant factor that's made the difference has been the emotional healing work I've been doing. It's a practice that methodically finds and enables releasing all traumas, complexes and sabotaging beliefs/patterns from the earliest times in life. So maybe it's valid to say one can have an "addictive personality" and that I was one of those people. But we assume that "addictive personality" equals "hard wired", without realising that personality is very alterable if you work at it consistently over a long enough period of time, with a focus on the deep subconscious/unconscious aspects of personality. I think organisations like AA do great harm when they tell their patients that you're an "addict for life". It's such a disempowering belief to have about one's self, and it's little surprise that people relapse when they're given no hope of ever being completely free of their addiction and able to live like other healthy people. These days, I have a young child, a great relationship with my partner, family members and friends, my career is going fine, and my physiological health continues to improve. The doctor I see these days, on the infrequent occasions I need to see him, says "whatever you're doing, keep doing it".

post_break 5y ago

I look at someone like Steve-o and say nah, people can change. If someone as addicted as him can pull out of the spiral, then no you can break the cycle. But not everyone can do that.

Osmose 5y ago

The premise of this article (that "Once an addict always an addict" is false when evaluated from a rational, scientific standpoint) is flawed from the start because the phrase isn't _meant_ to be a rational, scientific claim. The phrase is a contextual, emotional expression. Sometimes it's used to express frustration that even after years of work and/or progress, an addict might still _feel_ urges and have to deploy coping mechanisms against them. Other times it's a way of empathizing with someone who is a victim of a relapsed addict's maladaptive behavior. Still other times it's a mantra for recovered addicts to stay vigilant. The repeated references to "victimization" are a red flag to me that anything this author has to say about addiction isn't inclusive of everyone's (e.g. my own) lived experience of addiction. Admitting the difficulty and struggle of being an addict does not weaken me and prevent me from working towards recovery.

zafka 5y ago

Pretty much yes from my experience. Both personal and by observation of others. That being said I know many addicts/alcoholics who live happy productive lives- they avoid the chemicals that suck them in.

ddtaylor 5y ago

Thats an ad.

ChrisMarshallNY 5y ago

I have opinions and...more importantly...skin in the game, here. It's been my experience that most of this stuff is written by folks, to whom addiction is an intellectual exercise. Maybe they know someone that may or may not be an addict, and the chances are good, that what happens to that person won't really be life-changing to the person writing about their pet theory. Things are quite different, when it's your ass, or someone that you really care about, experiencing it. There's also a great deal of money to be made. Desperate people are easy marks. That's all I'll say.

teach 5y ago
Agreed. This article, while interesting enough, is clearly written by someone who is not an addict and does not have close/intimate relationships with any addicts. "In theory there is no difference between theory and practice, while in practice there is." - Benjamin Brewster
- SV_BubbleTime 5y ago
  > clearly written by someone who is not an addict and does not have close/intimate relationships with any addicts I have a disproportionately large number of addicts in my family as a percentage. I grew up around this. This article is written by someone working completely in theory. There is nuance in everything, and many people may actually beat addiction - but from what I’ve seen, to some degree it’s always there somewhere, forever dormant or just napping, just takes the right conditions to come back.
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moonshinefe 5y ago
"to whom addiction is an intellectual exercise. Maybe they know someone that may or may not be an addict, and the chances are good, that what happens to that person won't really be life-changing to the person writing about their pet theory." Spot on. I also got a massive armchair amateurish feel reading it. They feel very comfortable emphasizing that certain lucky addicts can seem to recover and moderate, but don't really seem to put nearly as much emphasis on addicts that might die or ruin their lives if they read that advice and think they can moderate before relapsing again. No mention in the article about %s of addicts these facts apply to, no mention of the author's name or credentials. Just a crappy article that doesn't help the situation at all really.

max_ 5y ago

What exactly is an addiction? Am I a Hacker News addict?

Dumblydorr 5y ago

There's physiological addiction, withdrawal alleviation, and psychological addiction too, to games or habits or anything. Then, I find where you live, who you know, and how you use drugs in patterns while also living in those patterns, this makes it harder to quit. Finally, there's the coping, the escapism, the alternate forms of consciousness, which help us get through the suffering of daily life. For me, only using legal "softcore" stuff, I have to think in terms of delay and moderation. I am fortunate, as Lincoln once said, to not have the urge and scourge of strong addiction to alcohol. I can't claim some magical fortitude or moral superiority, I was lucky enough to have a safe life and a "meh" feeling about alcohol and nicotine.

reducesuffering 5y ago

I’ve perused Hacker News almost every single day for 5 years. How do I break that addiction?

moonshinefe 5y ago

"If enough time passes, you can start engaging in the behavior in a healthy way once again." Spoken like the author has never had someone close with addiction, imo. You'll notice that actual medical professionals never are like "oh just quit your massively health-ruining addiction for several years then you're good to go potentially! Happens all the time, look at these studies." It's because such advice or facts--while technically true in a % of cases--downplay how devastating the next relapse might be for the addict (often it means death, or at the very least, their life ruined). Framing these things to addicts and individuals properly given their situations is very important, but has been totally bypassed by this author "helpfully." They present the article without mentioning their intentions or target audience too, which hardly helps. "So I dove deep into the topic and looked at what science says about it." So what credentials if any do they have at evaluating scientific consensus on addiction? Oddly enough the article includes some sources but makes no mention of who the author is from what I can see. Is this some high schooler's opinion after Googling around for an evening? We can't be sure. "This has some merit, for example, when it comes to alcohol - you can go from being addicted to alcohol, to having a social drink once a week." "However, that doesn’t mean you need to avoid the behavior forever." This author needs to like stop repeatedly emphasizing this stuff and muddying the waters--it HIGHLY depends. Again, this is spoken like someone who has never seen someone kill themselves young after that "one last relapse" because they thought they could control it finally. So this article comes off very poorly and I'm disappointed it got upvoted to be honest. Like, the lucky few addicts who recover and can moderate (& their loved ones) probably won't need this article. To the rest of the addicts and people who may be giving them advice, it seems to be a pretty irresponsible article to me.

MrStonedOne 5y ago
> So what credentials if any do they have at evaluating scientific consensus on addiction This is an ad-hom attack, and not productive.
- j0057 5y ago
  'Consider the source' is not the same as an ad hominem: 'The source is unreliable therefore we should distrust the information' vs 'The information is false because the source has bad credentials'.

dalu 5y ago

I quit nicotine. Because I had to. My lungs hurt. I tried to quit before but something always brought me back. Nicotine is the most addictive substance I ever took. I did take a lot of drugs. Different drugs. This article for me is just another on the trash heap. You have to differentiate. There is mental and body addiction. There are so many reasons. I know people who quit heroin. It's not all the same. Overcoming something is "easy" just stop taking it anymore and find other things to do instead.

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kelnos 5y ago

I really want to believe this, because "once an addict, always an addict" has always sounded like an unsupported, junk-science, catchy thing to say, and not something based in reality. And I don't really want to believe (yes, I know this is an emotional take), that some people's brains are just fundamentally "broken" in a way that means they can't enjoy some nice things without destroying their health and relationships. I think also the idea of addiction (or an "addictive personality") as this inherent, unchangeable thing just doesn't pass the smell test for me. Our understanding of the human brain is still pretty limited, and making a blanket statement like that just doesn't make sense. I can certainly understand this attitude for practical reasons: if you can get an alcoholic to stop drinking, and stay sober for the rest of their life, yes, you've certainly solved that problem. But I also suspect you haven't solved some of the underlying issues (e.g. around anxiety, dealing with emotion, etc.) that probably led them to drink excessively and uncontrollably in the first place. But I know very few people who have (to my knowledge) gone through this sort of thing, so while I can intellectually spout off what I believe to be true, it's not coming from a position of experience. The only real data point I have that perhaps aligns with this article is my father, and this is only from what I was told (by him, decades later). In his teens and early 20s, he drank heavily (to the point of doing some pretty unsafe things), nearly every night of the week; he was friends with the bartenders at many of the local bars, and would stay after closing to continue drinking. But during my childhood, I'd only known him to have a beer or two at a family get-together or neighborhood block party, so I asked him what changed. He said that he wanted to marry my mom, and that required him to put all that behind him. She was ok with the occasional social drink, but binge drinking or any kind of drunkenness was not kosher. He told me all this when I was in my late 20s, while we were having dinner at a brewery... drinking beer, of course.

rvn1045 5y ago

Here is what helped me kick two major addictions in my life: I smoked 3 packs of cigarettes a day for 6 years straight. It started to take a huge hit on my health and I quit. I smoked marijuana every night for 4 years then quit and have just smoked it occasionally. I started doing vipassana several years ago, everyday a little bit of a good chemical balance accumulates in my brain and body to the point where a lot of cravings start to disappear and you feel good in your head and body even without drugs like caffeine. I wouldn’t say I’ve beat all my cravings but they’re 90% better ..

locusofself 5y ago

I have some strong, perhaps knee jerk feelings about the idea that addicts can come around to become healthy social drinkers, smokers, etc. I feel like some probably can, but most probably can't. As someone who had major addiction issues for about a decade and has been clean for 12 years, I have no desire to test those waters, and feel a bit offended at the notion that my life would be better if I figured out how to be a functional user. I have everything to lose and very little to gain.

jkhdigital 5y ago
I know, right? My wife basically never drinks, and she’s doing just fine. I’m really not missing anything by abstaining from alcohol for the rest of my life.
MrStonedOne 5y ago
I have the same but reverse knee jerk feelings towards AA. The entire idea that i should treat something other people can manage as if it were some forbidden fruit just doesn't sit with me. That doesn't mean I've solved any issue, It just means i've figured out a way to avoid it. > and feel a bit offended at the notion that my life would be better if I figured out how to be a functional user. Lets try to reframe that then: given that conventional AA is basically the only game in town, do you think that there are people who have either failed to take to its abstinence only system that might be successful at a different approach or is somebody who flat out refuse to seek help from an AA style system for the reason i laid out, such as myself, who could use access to a different approach?
- locusofself 5y ago
  I actually agree that it's a shame that AA is the only game in town and I think its effectiveness is vastly overestimated. It's also seriously dogmatic about way more than just complete abstinence (I mean it's 12 steps, meetings every week or every day, etc). I prefer to keep my past far in the rear view mirror instead of continually drudging it up. I am just very dubious that people who have shown they have the capacity to fuck up their lives with drinking/drugs, especially for an extended period of time, are going to reprogram themselves successfully to become casual users. I don't know how black and white it is. But I count my lucky stars for the last 12 years of life compared the 10 before that.

rhyn00 5y ago

Marc Lewis, a neuroscientist has a nice book on the topic, which to me makes complete sense (and is grounded in sound science). His view on the topic is that addiction is nothing special, just a learned behavior. Hebbian learning states that neurons that fire together wire together (corollary: neurons that don't, the connection weakens). The neurons in the limbic system control emotions, attention, desire, and fear. The prefrontal cortex (PFC) controls planning, expectation, and long term planning. We are motivated to do things that we desire, or avoid things we fear, which is controlled by the limbic system (also involving dopamine release). Let's take drugs for an example but this can apply to other behaviors like internet usage, eating, falling in love, becoming obsessed with a hobby, or cronic anxiety toward something (avoiding fear). When we take a drug (or do xyz behavior ) it gives us a positive feeling (pleasure, or comfort in avoiding fear) and probably a favorable outcome occurred, so we are likely to engage in the behavior again. Each time we engage in the behavior the connection between the limbic system and the stimulus that triggers it, strengthen. When the trigger happens the limbic system lights up and triggers the PFC to create a plan and imagine how good it will be (then a positive feedback will occur - this is craving). Over time more and more stimuli will become triggers. Also, if you don't use it you lose it, and the neurons responsible for long term planning will weaken their connection to the limbic system (also, shown in brain scans), making it harder for you to assert self control. However, your brain is plastic, and you can also unlearn the behavior over time (studies also support this). Meditation can help because you can stimulate these neural pathways in a controlled environment. For example you can imagine how a trigger leads to drugs, then you can imagine how drugs leads to bad things while meditating - over time you can strengthen the connection from the trigger to the emotion and imagery of bad things happening. Ofcourse meditation is not the only thing that can help, but the main idea is that you want to make your brain associate the bad behavior with bad outcome, and strengthen the association of good outcomes with fear/desire circuit. Book: The Biology of Desire: Why Addiction Is Not a Disease - https://www.amazon.com/Biology-Desire-Why-Addiction-Disease/dp/1610397126 https://www.amazon.com/Biology-Desire-Why-Addiction-Disease/... Youtube: The Neuroscience of addiction - https://www.youtube.com/watch?v=aOSD9rTVuWc https://www.youtube.com/watch?v=aOSD9rTVuWc Edit: typos

cupcake-unicorn 5y ago

Honestly I don't think putting it into sharp categories like A or B are useful. I don't have addiction but I suffer from chronic mental illness. Strangely despite being diagnosed at a young age and having dealt with it all through college and into my mid 20s people were still treating me like it was just something I could "get over". So I guess this is more in the B camp. For me this wasn't helpful and I felt just as helpless because the problems didn't go away. Now I embrace the fact that I have a chronic mental illness that is NOT going to go away. This is more in the A camp. But once you embrace that at least for me I felt less helpless. I knew it wasn't going away and I worked to put up supports because it wasn't just a passing thing. It never will be for me. You can change your response to things and that's maybe the "neuroplasticity" he's talking about? But your brain actually isn't that plastic after childhood. If addiction is anything like my mental illness you'll always have the same response in a situation. You can have years of learned behaviors and coping mechanisms but that doesn't mean that it doesn't destroy you initially when you run into a rough situation. It's accepting that and how to deal with it and the aftermath that you can change.

peter-m80 5y ago

I quit smoking 10 years ago. I still notice the addiction and I think it will never go away.

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throwawayapatra 5y ago

I smoked meth almost everyday for a few years, abruptly quit, and never relapsed. I've been trying to quit diet soda for more than a decade and I can't go longer than a week ..

cratermoon 5y ago

Addiction is a brain disease, and it matters: https://pubmed.ncbi.nlm.nih.gov/9311924/ https://pubmed.ncbi.nlm.nih.gov/9311924/

golemiprague 5y ago

I think the main way people get into some addictive behaviour is the social norm around them, if everybody around you are doing drugs or smoking or eating sugars or gambling there are good chances you will also do it, it has nothing to do with personal traumas. Maybe sometimes a certain personality traits can enhance the addiction but you don't always need those amplifiers to get addicted. It's true also for other bad behaviours which are not necessarily addictive, like getting knocked up in an early age for example. The interesting thing is that many people do overcome those addictions but many other struggle, so maybe we shouldn't try to figure out what caused it since it is not that relevant to rehabilitation but focus more on why some people succeed and try to replicate it. I know it is not a simple task as the diet industry shows very clearly, but some people do become thin, so what makes them do the switch and can it be replicated? this is the interesting question.

jl2718 5y ago

“There are people who went through AA, recovered from their alcohol addiction, and are able to drink moderately.” There are also people who have survived skydives without a parachute. This article seems like some kind of self-justification for returning to destructive behavior. I imagine their codependent somewhere rolling their eyes again at this mental gymnastics routine. Here we go again….

treebot 5y ago

I have been around addicts my whole life (drugs and alcohol), I've known many people who died from their addiction, and I've struggled with addiction myself at times (drugs and alcohol). I have a few issues with this article. 1. Behavioral addictions are not comparable to a serious chemical addiction. The person who can't stop watching Netflix or can't get off Facebook is not the same as someone who can't stop sticking needles in their arm (heroin) and is flirting with death everyday. I've had behavioral addictions and chemical addictions, and I can tell you first hand that a chemical addiction is a different monster. You start to feel physically and mentally ill when you can't get your fix for a chemical addiction. Flu like symptoms, you can even die from withdrawal from some things. Comparing that to something like video game addiction is a huge stretch and somewhat offensive. 2. Saying that an addictive personality is really just deep seated emotional issues is not really changing much. Deep seated emotional issues are very hard to change. We try and some do, but a lot of us only make minor progress or don't change at all. Especially the people whose emotional issues have led them to a serious drug or alcohol addiction. Sometimes the best they can do is just abstain and use something healthier to cope. The whole article feels like the author is engaging with the issue on an intellectual level. Sure, there are addicts who can recover and then even use their substance without relapsing. But there are many addicts who relapse and die, or ruin their lives. It makes sense then to err on the side of caution. For most addicts, there's more to lose than to gain, and it's hard enough fighting addiction that I don't think we should encourage addicts to push their boundaries. I've just known many people first hand that truly embody the phrase "Once an addict, always an addict." Sure, maybe it's not true for some people, but it's true for a lot of people, especially the addicts that have it really bad.

denton-scratch 5y ago

As usual, the term "addiction" is being used in the article (and in the comments, unfortunately) to refer to two quite different things. Addiction to something like Oxycontin is a physical addiction; the symptoms of withdrawal can be severe enough to kill you. Addiction to something like Twitter may involve dopamine pathways, or not; but withdrawal isn't going to result in serious physical symptoms. Consider nicotine. Withdrawal from even a serious habit takes no more than about 72 hours. The habit of having a ciggie between your fingers is another matter; habits are really hard to shift. I think it's a mistake to subsume habitual behaviours under the handle "addiction". There are two different things going on here, and it's useful to have two words, with distinct meanings, so that we can distinguish them in discourse.

tacocataco 5y ago

Anyone know of secular support groups for addiction? I've been abused growing up because of religion and the people that's worked for it. I don't think I need a higher power in my support groups. the reason I started using was the trauma caused by faith based organizations. You may as well have a rapist host a support group for battered women IMO. I apologize for the emotional comment.

InfiniteRand 5y ago

A lot can be said about this article, but just to pick on one thing. It can be useful to think of yourself as having an "addictive personality" if it helps you make smarter life decisions about avoiding situations where addiction is a possibility. "Discretion is the better part of valor". It is possible to recognize certain paths in life will put you under greater stress and do some cost benefit analysis of that, to do an accurate cost benefit analysis you must have a realistic idea of how you deal with stress and how likely serious issues might arise.

lcall 5y ago

FWIW, my church has an excellent 12-step program also, free, with online materials (ducuments, videos), and meetings (including phone/video), for individuals, affected spouses & families: https://addictionrecovery.churchofjesuschrist.org/ https://addictionrecovery.churchofjesuschrist.org/ (There are also very good materials on general self-reliance (being stable and better able to go forward), including improving employment, self-employment, family finances, preparedness, general family welfare, forgiveness, and other topics, at ProvidentLiving.org.)