UKH

https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_a...

A fascinating lecture on the nature and solution to addiction, in this case drug addiction. The speaker's thesis is that addiction is not caused by biochemistry but by loneliness and boredom and its cure is providing an addict with a purpose in life. I have always been in favour of the legalisation of non addictive drugs but hesitated for practical reasons to advocate the legalisation of addictive drugs despite my philosophical belief that what you decide to put in your body is no one else's business. However exactly this policy has been in place in Portugal for nearly fifteen years and has proved a success.

Perhaps it's time to legalise all drugs?

I recently read Skagboys by Irvine Welsh, which is a prequel to Trainspotting. It's a long novel which details their descent into heroin addiction as a result of the Thatcher administration, when no one could get a job, and no one had anything to do. They had no purpose and they were bored. I found it especially fascinating because this era was an important time in the UK climbing culture, and a lot of the folk in the 80's scene came from deprived areas which probably had similar drug problems to Edinburgh. Difference being is climbing provides a sense of community, a sense of purpose, and it is certainly not boring. I lived through a few years of depression myself and became quite isolated, and used a lot of drugs (though never heroin/crack/meth) as a means of escape, and I maintain that climbing saved me for the reasons listed above.

As for legalising - the Portugal model of decriminalisation rather than legalisation seems to work well and I'm all up for it. And legalising them properly so they could be produced and sold by legal businesses would take a lot of money out of the hands of some very nasty people. But we would also need a much better education about drug use. Ultimately though, I don't really buy any of the so called logic used to support the war on drugs.

Yes it is.

He makes a good case, and I think he's fundamentally correct, but I also think it's a little over-egged and distorted. For example, the difference between being a smackhead and being treated medically with diamorphine is that in one situation you're trying deliberately to get high, so you're taking the drug in a manner than achieves that, i.e. getting a lot in one go and enjoying the ride. In a medical setting, your dosage is carefully controlled to be effective at relieving pain while minimising the "side effect" of euphoria.

I don't think it's remotely mysterious that hospital patients don't come away with smack addictions, because the context and control is so radically different - the danger of addiction is managed by a team of professionals, not snorted at (pun intended) by a person with nothing to lose, hell bent on getting as f*cked up as they can. While the drug might be the same, the situations aren't remotely comparable in basic practical terms as well as the psychological ones that Hari presents as the be-all-and-end-all of addiction.

I think cocaine and sometimes cannabis addiction presents a fascinating paradox here because these drugs are often used not to replace social connections, but to enable them. Yes, some people use these drugs alone, but a lot of people are addicted to using them socially - they rely on the connections with the people and the drugs together, intertwined. 

In general, discussions about the problem of "drugs" or "addiction" fail to understand that a heroin user who has no friends and whose family has abandoned them just isn't the same problem as the teenager who throws away all their academic prospects in favour of taking mephedrone and ketamine until the sun comes up several times every week because they find the experience more compelling and gratifying than being a good boy or girl and doing their homework and turning up for lessons after a good nights sleep. Or the coked-up socialite who prides themselves on being the more "connected" than anyone...or the benzodiazepine-reliant panic attack sufferer who's been off work with stress on and off for years.

All these social problems involve drugs, but they're not linked by common causes nor do they call for a common solution. Yes, let's decriminalise drug use, but let's not tell an oversimplified story that paints all addicts as suffering from some single social malaise that can be overcome with just being nice. Unless you're doing a TED talk, in which case, "let's just be nice" is the inevitable conclusion that will solve the world's problems.

I agree with everything you've said, but on this point, it's worth saying that this is more or less how it started with me. I found drugs exciting (at least in part because of the illegal status), and as a highly introverted youth they did help me to communicate. Where it becomes interesting though is the point at which the connection morphs into disconnection. You reach a point where you take drugs so you don't have to communicate properly, because you haven't learned how to, which is a stepping stone to self isolation and self hatred, which is a stepping stone to a worse addiction. The reason I got out was I found a way of connecting with both people and the world again. 

I think it's dangerous to devalue the mess a student, for example, gets into just because they did it to themselves.

I guess my point being its still worth looking at why one student descends into a mess of addiction whilst another does drugs for a bit of occassional fun alongside a normal life.

Also this - I don't know if its the case here but certainly in the US morphine addiction post treatment is a huge problem. A friend of mine who got cancer in his twenties had a morphine addiction for years following his recession.

Sorry for posting loads but I've been thinking about this and possibly one reason why some students do wind up going down a rabbit hole of drug taking is it is the first time they have been alone in the world. They've just left home and the support network of family and old friends suddenly isn't there any more. Most people make friends quite quickly, but if you're struggling to do so it wouldn't be hard to imagine getting really isolated. 

Completely agree with your post. Addiction is mostly a personality and life issue, rather than a chemical one.

I got an insight into this while spending a week on morphine. I was lying in bed barely able to move with a button that gave me a shot when I pressed it. I've always enjoyed experimenting and I had nothing better to do, so I pressed this button as often as I could. It was limited, so I had to wait for the green light to come on after each go. It seemed to take longer and longer for the light to come on. I don't know if this was programmed, or a shift in my sense of time. In the end the best I managed was four hits before losing track of where I was.

Anyway, after a few days of this I wanted to return to the real world. I got told off for not doing enough morphine when I admitted that I'd stop using it when visiting time was approaching. The point is that while going off into that other space was great, I really wanted my experience and people in the real world too. On the other hand, there were people on the ward with nothing and no one in the real world - so why would they ever want to come back?

I'm assuming that's the same Johann Hari who resigned from the Independent a few years back after admitting to, ahem, tidying up quotes from people he'd interviewed. Was wondering if he'd pop up again.

That's the man. Interesting Guardian piece about his book on depression here - 

https://www.theguardian.com/science/brain-flapping/2018/jan/08/is-everythin...

"Let’s address the elephant in the room: Johann Hari does not have a flawless reputation. He has been absent from the spotlight for many years following a plagiarism scandal, compounded by less-than-dignified behaviour towards his critics. Admittedly, he has since shown remorse and contrition over the whole affair, but even a cursory glance online reveals he’s a long way from universal forgiveness. Logically, someone with a reputation for making false claims should be the last person making high-profile, controversial, sweeping statements about something as sensitive as mental health. And yet, here we are. It’s 2018 after all."

Interesting approach, and probably very useful in some contexts, but my understanding is that there are multiple factors behind addiction. This article looks at a good range of them:

https://www.psychologytoday.com/gb/blog/science-choice/201711/7-common-reas...

I agree that some form of legalisation is the only way to manage drug use. It's not going to go away and the object should be harm reduction, individually and socially.

I think that article pretty much nails it. We're struggling enough being subjected to political populism at the moment, without lurching towards medical populism as well.

Interesting footnote saying that a complaint had been received over the Guardian's coverage of the book, but essentially not upheld.

Yep, I remember his downfall for copying - he had been an interesting voice in the circles I used to follow talking about multiculturalism, radicalism, extremism, anti-war politics, anti-immigrant politics etc. so I had read a lot of his stuff. Interesting that he's making something of a comeback.

There was a science writer in the US around the same time who was caught doing similar - he used to be a regular on the excellent podcast/radio show "Radio Lab", then there was the journalist who did the big take down of Apple's manufacturing plants in China, mainly for the show/podcast This American Life, who was also found to have been doing some manufacturing of his own.

Interesting little diversions from frenetic highway of "public debate".

I couldn't really tell what the complaint was, but it looked like someone objected to the way the article might encourage people to come off anti-depressants without medical advice. 

Yes, there's been quite a bit of it over the years. Seems to pale into insignificance alongside the current 'fake news' epidemic.

Read the book. 

It isn't really about legalising drugs.

And it unfortunately descends into a slightly political left wing rant (I don't really see why the political spectrum should come into this, addiction doesn't discriminate.)

However the broad swathes of his ideas seem good.

Very insightful, thanks for posting this candidly. You don't have to answer, but would you describe your experience as "addiction" or would "problematic recreational use" be more accurate? Perhaps it doesn't matter - but I think there are clear differences between drugs that people use constantly to avoid withdrawal symptoms (opiates, benzos, alcohol), and drugs like cocaine that people use for completely different reasons.

Sorry if that's how it came across, that's not what I intended. I'm saying that it's unhelpful to talk about "drugs" and "addiction" in general terms because the actual actual problems that fall under that category are diverse. They have different causes and different solutions: for example, opiate addiction should IMO be medicalised (heroin should not be available without prescription), whereas other drugs should be legalised and regulated for recreational use. If there is a general solution to drug problems, then it's finding something else to do instead, and that might mean breaking a load of social connections before new ones are developed. Easier said than done, of course.

I'm trying to encourage better clarity on what the different problems actually are, rather than supporting the blanket thesis that "drug addiction" is caused by social isolation rather our physiological responses to drugs. 

As I understand it, the opioid crisis in the states is a lot to do with the way they're prescribed. I think it gets pretty dark if you follow the money.

Kind of sensationalist bollocks really - there are plenty of high-functioning addicts and alcoholics in society. The US seems to be in the grip of a prescription-drug epidemic (so already legal), a lot of illegal drugs are used by non-addicts, and lots of drugs have very well documented physical effects, so not all in the mind. Instead of making drugs legal, why not just have armies of 'befrienders' that'll sort the lonley junkies right out...

Have you read his book on depression and mental health? It makes some well researched arguments for a different approach. It might not be the whole answer but he convinced me it is a path that should be developed more.

While agree that a change in drug policy is overdue, and the ideology driven war on drugs was one of the greatest disasters of the 20th century, I think this claim is misguided and counterproductive.

Our mental state IS biochemistry, and addiction is simply a specific type of biochemistry or neurophysiology. To deny that there exist "mechanistically simple" types of addiction that involve feedback loops involving the reward centres of our brains, especially with opioid drugs, does not help with devising treatment or prevention strategies. 

Of course, loneliness, boredom, and depression will all increase the likelihood of trying drugs in he first place and becoming addicted afterwards.

CB

How does one explain an addiction to gambling?

I do think it's complex with both physiological and psychological factors and I doubt the speaker explains the whole story.

I am reminded though of what two people have told me at different times, kne zn ex junky and the other someone who worked with people with addictions. They both said that if you've got no job, no qualifications, live in a shithole with no prospect of getting out at least as an addiction gives you a purpose in life. Something to get up for in the morning.

Yes, but psychology is physiology is biochemistry....

Gambling and opioids will interfere with our normal reward or pleasure circuits by different triggers, but in the end will establish similar self stabilizing feedback processes.

CB

We have much the same drugs available for prescription in the UK as the US sometimes they are sold under different names.  There are a few drugs that used in the UK for palliative care and little else,  In the US the same drugs were been used for back ache etc.  This led to huge addiction issues.  Drugs are marketed very differently in the US. 

By "addiction" we mean, a condition in which a person engages in use of a substance or in a behavior for which the rewarding effects provide a compelling incentive to repeatedly pursue the behavior despite detrimental consequences. (https://www.psychologytoday.com/gb/basics/addiction)

So any behaviour that encourages you to repeat it by giving a short-term reward, but causes harm in the longer term is something you can get addicted to. Neuroscientists are rapidly learning more and more about the structures in the brain that mediate this (e.g. the nucleus accumbens is often referred to as the brain's "pleasure centre" presumably after fMRI studies showed it activating when subjects reported experiencing pleasure - beware duff simplistic waffle on this subject, there is a lot around). So, you might stimulate those bits of the brain by chemically mucking around with the neurotransmitters, e.g. by snorting cocaine; or you could activate the same brain pathways with some other behaviour that gives an intense short term reward like gambling or sex with a new partner, or whatever. There are lots of ways you can create a pattern of destructive behaviour and it seems that whether it's with drugs or something else, the same neurobiology is at work: those bits of the brain that were designed by evolution to make us repeat useful behaviours (useful to our genes) like eating highly calorific foods, vanquishing a rival or having sex. 

As CB says, you can't separate psychological from physiological factors. Psychology is what brain physiology feels like from the inside.

I've not read it no. I don't think you'd find anyone who'd argue against more research into mental health provided there's real value in what's being researched. The writer of the Guardian response to the initial article says that these areas are already being looked into and that Hari is mischaracterising current mental health treatment as only offering drugs as a viable option. Knowing a few people currently undergoing treatment of varying kinds for depression (and having been in the doctors' with a certain friend almost literally begging for medication), I'd say that it's a fair criticism of Hari's position. Cards on the table, knowing what Hari did as a journalist, his book on this (or any) subject would be way down on my list of ones to read, even more so buy. Credibility is hard won and easily lost.

At first it was problematic recreation definitely, but that is a stepping stone and when you can't stop recreating it isn't really recreation any more. Ketamine I think is a really scary one because it's an accepted party drug but it's a sensory anaesthetic rather than a stimulant so if you get too into it, and start taking it in the evenings with a few reefers, it soon gets hard to face the world without just a little bit at least, you know, to take the edge off. And that's just when you leave the house. I was lucky in two ways, first it actually started making me really sick, and I couldn't take it any more. And then I discovered climbing and moved to Sheffield with the amazing community it has, before finding an alternative drug to use.

Yep agree with all this. I think the thing that is most daft about criminalisation is the money it puts in some horrible bastards' pockets. Medicalisation would go some way to helping that. Agree on the breaking social connections bit. When I moved to Sheffield climbing provided an alternative to actual addiction but the problematic recreation side of things continued. The solution was to throw myself more and more fully into climbing and then going on trips meant that I didn't want to spend my money on getting f*cked up. Lost a few friends and fell out of touch with some good ones, but after a few years away from all that I have a much better relationship with it all, and am building those old friendships up again.

I agree totally with this. There shouldn't be a blanket thesis. But obviously social isolation is a pretty good starting point for addiction, whether the substance is physically addictive or not

It does indeed - particularly Perdue Pharma and Oxycontin, gobsmacking levels of cynicism in the pursuit of profit. If anyone is interested in the US opioid epidemic but doesn't know much about it there is a Louis Theroux documentary on iPlayer currently about just one town (out of thousands) where people are dropping like flies from ODing, that gives a very sad insight into what an utter mess it is.

Or read the article in last weekends FT which sums up the corporate side rather well.

https://www.ft.com/content/46ff5632-b1bd-11e8-99ca-68cf89602132  (paywall but you can read a few articles for free)