4 ms·

>If a user is in control then there is no problem The argument you’re making is flawed because it’s based on the users perception of a problem and not the stan

by bumby 4y ago

>If a user is in control then there is no problem The argument you’re making is flawed because it’s based on the users perception of a problem and not the standardized clinical definition. People (especially addicts) are not wholly rational. People will rationalize away a problem to suit their irrational biases. If a substance is detrimental to my health and I say “well, I don’t care. I could quit if I wanted to” it doesn’t negate the fact that it’s still detrimental to one’s health. It’s still a substance abuse problem by the clinical definition even if I’m claiming to be “in control”. If your doctor diagnoses you with obesity and you claim you can diet if you wanted to, it doesn’t make your obesity diagnosis moot. Your perception of self control doesn’t impact the objective diagnosis. Your take is a bit like the way people say the best way to solve the problems with illegal drugs is to make drug use legal. (And FWIW I’m pretty libertarian on this issue) Sure, by definition it’s no longer a legal problem but it’s a bit of a hand wavy effort that leaves most of the residual problems intact. It just reframes it in a way that ignores them. It’s also one of the problems with modern debate in that anyone can “do their own research” (which often means just reading an abstract that suits their confirmation bias without a grounded understanding of the full context). It devolves into rules-lawyering where people argue about what the definition of “is” is. We have standardized definitions for a reason.

brigandish 4y ago
You've assumed it's the user making the decision as to whether they are in control (or that I've assumed that, which I haven't), which makes that whole argument moot. It's a very strange assumption to make given we're discussing clinical diagnosis. Surely the most usual set of circumstances is that a user seeks help because they have (or perceive) a problem and a clinician diagnoses them. There certainly can be others that include self-diagnosis but you should really start from the usual, especially if you're going to avoid unintentionally building straw men.
- bumby 4y ago
  I think you're missing the actual point just to argue. u/brigandish doesn't need to come up with their own definition of abuse because there is a already a clinical definition of abuse. It doesn't matter who's making the decision about control. Even if a doctor thinks you're capable of controlling your diet, it doesn't make their clinical diagnosis of obesity go away. It takes more than control to alleviate the problem (e.g., knowledge about diet, access to healthy food, motivation etc. are also necessary). Either you meet the clinical definition or not. If you have the utmost ability to control your diet but still have a BMI of 60 because you lack those other factors, guess what, you've still got an obesity problem. That's why the clinical definition has multiple diagnostic factors. The point is clinical definitions matter. If you don't think so, try to get an insurance company to pay for rehab based on your personal definition without having a clinical diagnosis of substance abuse.
  - brigandish 4y ago
    I provided the definition, and I also provided a paper by professors of psychiatry and neuroscience that point out the critical parts of the definition. All except one (and even that one is arguable) take the user's state of mind and perception about their own life into account, and their lack of control. The practitioners even mention this in the abstract of that paper: > A definitive diagnosis entails confirming the presence of addictive behavior by identifying a preoccupation, compulsivity and relapse relative to the drug Preoccupation is a lack of control. Compulsivity(sic) is a lack of control. Relapse is a lack of control. In fact, the authors of that paper wrote a book about alcohol abuse[1] that is littered with quotes about control, like “These criteria reflect the loss of control over alcohol that is central to the diagnosis of alcoholism” or “The loss of control over the self and the alcoholic is present in the enabler as it is present in the alcoholic”, or my favourite: > The behavioral criteria describe the loss of control over alcohol that leads to the adverse consequences As to this claim by you: > Even if a doctor thinks you're capable of controlling your diet, it doesn't make their clinical diagnosis of obesity go away" They're not (or haven't been) capable of controlling their diet, that's why they're obese, and that's why they're getting help from a professional, but regardless, you've chosen a poor analogy. Someone with an addiction to eating or sugar would be much better, as obesity is a consequence of their actions, just as "Not managing to do what you should at work, home, or school because of substance use" would be an possible consequence of marijuana dependency. [1] https://books.google.com.au/books?id=NrHzBwAAQBAJ&q=control#v=snippet&q=control&f=false https://books.google.com.au/books?id=NrHzBwAAQBAJ&q=control#...
    - bumby 4y ago
      I think you are just confirming my suspicion about arguing for its own sake. >I provided the definition, and I also provided a paper Yes, but did you notice that the paper you cited is from 1989? And that I cited the more modern DSM V, which did not exist when that paper was published? Also note that you keep using the term "dependence" and I'm using "substance use". This is because the terminology was deliberately changed in the DSM V. It was updated to combine both "use" and "dependence" and merged them into a the category of "substance use". This includes the criteria that are not specifically related to the locus of control. This is what I mean about drawing strong conclusions from a paper when you don't know the fuller context. I don't think you're understanding my point about control so I'll try one last time. I've already agreed that control is part of the definition; so I don't think we disagree there. But I am saying the definition goes beyond just the idea of control. I get the impression you also agree here because you’re couching your statements to now include the “critical” (I.e., non-exhaustive) elements. It's possible to have the capability of control, but not exercise that control or not have the other elements to get a specific outcome. That doesn't make the clinical diagnosis go away. Keeping with the obesity analogy, consider a sumo wrestler who is, by clinical definition, morbidly obese. They could very well have phenomenal willpower to control their diet, but choose not to because their chosen profession gets a benefit from being larger than their opponent. In some sense, they choose to be obese. A clinician will still say they have an obesity problem. (It seems like you're assuming that, by the nature of their diagnosis, they are trying to fix it. i.e. 'trying to get help from a doctor'. That's assumption is not included in the distinction I'm making.) Now transfer that to an addict. Many choose to chase a high at the cost of their family, career, and/or health. To them, it's a worthy tradeoff. And the way substances affect/change the manner that we decide those tradeoffs is very real. Even if they could stop cold-turkey, they still have a clinical substance abuse problem. Your assumption is that they want to stop because of those ramifications and can't. I'm saying that they may not want to stop. They're still addicts. That's the pernicious part of your definition; just because they're doing it willfully doesn't make the problem go away any more than legalizing drugs makes society's drug problems magically go away.

by bumby 4y ago

brigandish 4y ago

You've assumed it's the user making the decision as to whether they are in control (or that I've assumed that, which I haven't), which makes that whole argument moot. It's a very strange assumption to make given we're discussing clinical diagnosis. Surely the most usual set of circumstances is that a user seeks help because they have (or perceive) a problem and a clinician diagnoses them. There certainly can be others that include self-diagnosis but you should really start from the usual, especially if you're going to avoid unintentionally building straw men.

bumby 4y ago
I think you're missing the actual point just to argue. u/brigandish doesn't need to come up with their own definition of abuse because there is a already a clinical definition of abuse. It doesn't matter who's making the decision about control. Even if a doctor thinks you're capable of controlling your diet, it doesn't make their clinical diagnosis of obesity go away. It takes more than control to alleviate the problem (e.g., knowledge about diet, access to healthy food, motivation etc. are also necessary). Either you meet the clinical definition or not. If you have the utmost ability to control your diet but still have a BMI of 60 because you lack those other factors, guess what, you've still got an obesity problem. That's why the clinical definition has multiple diagnostic factors. The point is clinical definitions matter. If you don't think so, try to get an insurance company to pay for rehab based on your personal definition without having a clinical diagnosis of substance abuse.
- brigandish 4y ago
  I provided the definition, and I also provided a paper by professors of psychiatry and neuroscience that point out the critical parts of the definition. All except one (and even that one is arguable) take the user's state of mind and perception about their own life into account, and their lack of control. The practitioners even mention this in the abstract of that paper: > A definitive diagnosis entails confirming the presence of addictive behavior by identifying a preoccupation, compulsivity and relapse relative to the drug Preoccupation is a lack of control. Compulsivity(sic) is a lack of control. Relapse is a lack of control. In fact, the authors of that paper wrote a book about alcohol abuse[1] that is littered with quotes about control, like “These criteria reflect the loss of control over alcohol that is central to the diagnosis of alcoholism” or “The loss of control over the self and the alcoholic is present in the enabler as it is present in the alcoholic”, or my favourite: > The behavioral criteria describe the loss of control over alcohol that leads to the adverse consequences As to this claim by you: > Even if a doctor thinks you're capable of controlling your diet, it doesn't make their clinical diagnosis of obesity go away" They're not (or haven't been) capable of controlling their diet, that's why they're obese, and that's why they're getting help from a professional, but regardless, you've chosen a poor analogy. Someone with an addiction to eating or sugar would be much better, as obesity is a consequence of their actions, just as "Not managing to do what you should at work, home, or school because of substance use" would be an possible consequence of marijuana dependency. [1] https://books.google.com.au/books?id=NrHzBwAAQBAJ&q=control#v=snippet&q=control&f=false https://books.google.com.au/books?id=NrHzBwAAQBAJ&q=control#...
  - bumby 4y ago
    I think you are just confirming my suspicion about arguing for its own sake. >I provided the definition, and I also provided a paper Yes, but did you notice that the paper you cited is from 1989? And that I cited the more modern DSM V, which did not exist when that paper was published? Also note that you keep using the term "dependence" and I'm using "substance use". This is because the terminology was deliberately changed in the DSM V. It was updated to combine both "use" and "dependence" and merged them into a the category of "substance use". This includes the criteria that are not specifically related to the locus of control. This is what I mean about drawing strong conclusions from a paper when you don't know the fuller context. I don't think you're understanding my point about control so I'll try one last time. I've already agreed that control is part of the definition; so I don't think we disagree there. But I am saying the definition goes beyond just the idea of control. I get the impression you also agree here because you’re couching your statements to now include the “critical” (I.e., non-exhaustive) elements. It's possible to have the capability of control, but not exercise that control or not have the other elements to get a specific outcome. That doesn't make the clinical diagnosis go away. Keeping with the obesity analogy, consider a sumo wrestler who is, by clinical definition, morbidly obese. They could very well have phenomenal willpower to control their diet, but choose not to because their chosen profession gets a benefit from being larger than their opponent. In some sense, they choose to be obese. A clinician will still say they have an obesity problem. (It seems like you're assuming that, by the nature of their diagnosis, they are trying to fix it. i.e. 'trying to get help from a doctor'. That's assumption is not included in the distinction I'm making.) Now transfer that to an addict. Many choose to chase a high at the cost of their family, career, and/or health. To them, it's a worthy tradeoff. And the way substances affect/change the manner that we decide those tradeoffs is very real. Even if they could stop cold-turkey, they still have a clinical substance abuse problem. Your assumption is that they want to stop because of those ramifications and can't. I'm saying that they may not want to stop. They're still addicts. That's the pernicious part of your definition; just because they're doing it willfully doesn't make the problem go away any more than legalizing drugs makes society's drug problems magically go away.