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I think it's probably still useful to distinguish addictions with hardcore substance related barriers to quitting (think withdrawals) from addictions where the

I think it's probably still useful to distinguish addictions with hardcore substance related barriers to quitting (think withdrawals) from addictions where the barrier is a lack of dopamine or serotonin or simple habituation. For people with normal executive function, the second category of problems should be fairly tractable to overcome, whereas the first is still quite difficult. The second only really becomes an issue when you have a bit of executive dysfunction. Maybe that distinction is important and one merits the term addiction while the other doesn't? Though both categories seem to be relatively treatable with drugs that massively improve executive function, so the parallels are pretty glaring.

hamdingers 1y ago
The distinction you're reaching for is addiction vs dependance.
- intrasight 1y ago
  For clinician, this might be an important distinction. But for a layperson, the distinction is not very clear.
hyghjiyhu 1y ago
Idk I think the importance given to withdrawals is overrated. Dealing with withdrawals is just matter of gradually lowering the dose. The lifelong craving is the bigger issue.
normie3000 1y ago
How is a lack of dopamine different from "withdrawals"?
- Aurornis 1y ago
  “Lack of dopamine” isn’t an accurate description. It’s a reductionist pop culture metaphor that feels scientific but it’s not really accurate. Drugs of abuse involve multiple systems including opioid receptors, which modulate reward. There is much more going on than simple levels of a single neurotransmitter, which can actually be completely normal relative to non-addicts. Dopaminergic systems are actually involved in driving certain addictive and craving mechanisms, which should be a hint that it’s not as simple as “lack of dopamine”. In fact, the side effects of certain drugs that directly increase dopamine levels (L-DOPA) or drugs that directly stimulate dopamine receptors (dopamine agonists like bromocriptine) include a risk of compulsive gambling, shopping, and risky behaviors. Ironically it’s more accurate to simply say “withdrawals” than to try to inject reductionist neurotransmitter speak.
vintermann 1y ago
Most of the addiction literature I've read says that physical addiction is overestimated: even heroin addicts regularly go through physical addiction, either involuntarily because they can't get it, or voluntarily (through treatment efforts, or simply deciding to sober up for e.g. a wedding or other important event). What makes them addicts isn't that they can't stop, it's that they start up again. Conversely, people hospitalized for something acutely painful often get addicting (or, withdrawal causing) painkillers in amounts and at purities street users can only dream of. And once it's over, they go through withdrawal, and it's deeply unpleasant, and they never want to do it again. People going through something like that aren't more likely to become opioid addicts than anyone else, according to old study results (I may be able to dig them up if you're interested). It's of course different for chronic pain. But then, the reason for people wanting to start up again is pretty obvious.
- galagawinkle489 1y ago
  I think I have heard the same. People whose lives are hopeless are much more likely to get addicted. The addiction then makes their life worse which causes this downward spiral of despair. People with physical addictions can choose not to use drugs etc. Smokers can take 12 hour flights and they don't involuntarily take out a lighter and cigarette and smoke half way through. It is about self control.
  - falcor84 1y ago
    With my limited second-hand experience, I tend to think it's less about self-control and more about the hopelessness you mentioned earlier - addicts seem to be exactly the people who for various reasons attach very little value to "being a healthy and productive member of society".
    - Aurornis 1y ago
      > addicts seem to be exactly the people who for various reasons attach very little value to "being a healthy and productive member of society". These are just the people you notice and see because they don’t care that you see them that way. My friend worked in the rehab industry. The people who attended rehab came from all different walks of life. Many of them had everything going for them and great lives. It was common for people doing well in work and their social life to think that they could abuse drugs because they could handle it better than “those people” and they wouldn’t allow their use to get out of control. The idea that addiction is only ever a response to life circumstances is a myth. Lots of people get tangled up with drugs simply because they’re seeking some extra recreational value or euphoria and don’t think the addiction part will apply to them. In fact, I think the idea that addiction only happens to people who aren’t good members of society is a contributor to many of these people dabbling with drug abuse: They’ve heard so much about addiction only happening to people of poor morale character or who are victims of their circumstances that they think they’re not at risk for addiction because they don’t fit that description.

hamdingers 1y ago

The distinction you're reaching for is addiction vs dependance.

intrasight 1y ago
For clinician, this might be an important distinction. But for a layperson, the distinction is not very clear.

hyghjiyhu 1y ago

Idk I think the importance given to withdrawals is overrated. Dealing with withdrawals is just matter of gradually lowering the dose. The lifelong craving is the bigger issue.

normie3000 1y ago

How is a lack of dopamine different from "withdrawals"?

Aurornis 1y ago
“Lack of dopamine” isn’t an accurate description. It’s a reductionist pop culture metaphor that feels scientific but it’s not really accurate. Drugs of abuse involve multiple systems including opioid receptors, which modulate reward. There is much more going on than simple levels of a single neurotransmitter, which can actually be completely normal relative to non-addicts. Dopaminergic systems are actually involved in driving certain addictive and craving mechanisms, which should be a hint that it’s not as simple as “lack of dopamine”. In fact, the side effects of certain drugs that directly increase dopamine levels (L-DOPA) or drugs that directly stimulate dopamine receptors (dopamine agonists like bromocriptine) include a risk of compulsive gambling, shopping, and risky behaviors. Ironically it’s more accurate to simply say “withdrawals” than to try to inject reductionist neurotransmitter speak.

vintermann 1y ago

Most of the addiction literature I've read says that physical addiction is overestimated: even heroin addicts regularly go through physical addiction, either involuntarily because they can't get it, or voluntarily (through treatment efforts, or simply deciding to sober up for e.g. a wedding or other important event). What makes them addicts isn't that they can't stop, it's that they start up again. Conversely, people hospitalized for something acutely painful often get addicting (or, withdrawal causing) painkillers in amounts and at purities street users can only dream of. And once it's over, they go through withdrawal, and it's deeply unpleasant, and they never want to do it again. People going through something like that aren't more likely to become opioid addicts than anyone else, according to old study results (I may be able to dig them up if you're interested). It's of course different for chronic pain. But then, the reason for people wanting to start up again is pretty obvious.

galagawinkle489 1y ago
I think I have heard the same. People whose lives are hopeless are much more likely to get addicted. The addiction then makes their life worse which causes this downward spiral of despair. People with physical addictions can choose not to use drugs etc. Smokers can take 12 hour flights and they don't involuntarily take out a lighter and cigarette and smoke half way through. It is about self control.
- falcor84 1y ago
  With my limited second-hand experience, I tend to think it's less about self-control and more about the hopelessness you mentioned earlier - addicts seem to be exactly the people who for various reasons attach very little value to "being a healthy and productive member of society".
  - Aurornis 1y ago
    > addicts seem to be exactly the people who for various reasons attach very little value to "being a healthy and productive member of society". These are just the people you notice and see because they don’t care that you see them that way. My friend worked in the rehab industry. The people who attended rehab came from all different walks of life. Many of them had everything going for them and great lives. It was common for people doing well in work and their social life to think that they could abuse drugs because they could handle it better than “those people” and they wouldn’t allow their use to get out of control. The idea that addiction is only ever a response to life circumstances is a myth. Lots of people get tangled up with drugs simply because they’re seeking some extra recreational value or euphoria and don’t think the addiction part will apply to them. In fact, I think the idea that addiction only happens to people who aren’t good members of society is a contributor to many of these people dabbling with drug abuse: They’ve heard so much about addiction only happening to people of poor morale character or who are victims of their circumstances that they think they’re not at risk for addiction because they don’t fit that description.