UKC

This explanation of addictions is really how we need to think about the issue. It is remarkable to think that we criminalise traumatized people and then wonder why we aren't successful in eliminating the problem:

youtube.com/watch?v=ys6TCO_olOc&

Sounds like common sense to me. I do think that the ground's shifting, slowly but surely, away from the idea that it's the person who's bad or weak, or that the cause of addiction is the drug itself - I don't think Mate even names a drug, because it's almost irrelevant. Exactly as he says, what matters is people's problems - why has their life gone that way?

Unfortunately, I think that the most likely "cure" for most drug addictions is having a job to take up your time, and genuine relationships with others (outside a drug scene) to give you some self-worth. Without those basic things holding your life together I think anyone could slither into some form of addiction, whether booze, drugs, gambling, whatever. Those activities allow you to live in the moment for a bit rather than dealing with what's going on inside your head. Much like climbing, which is generally not destructive, but I doubt most drug addicts would find it quite as instantly satisfying as getting high. In all seriousness though any sport/activity that delivers a buzz and has a social scene that doesn't revolve around getting high has potential to help someone who's gone off the rails, if they can overcome the hurdles to getting into it. Pure speculation about something I know nothing about, but maybe boxing/martial arts could serve this function quite well and be easier to get into than climbing for some? I guess some of those gyms have seen a few more recovering smackheads than the climbing walls have. But obviously not everyone's into vigorous exercise and for many it will be a non-starter, even with the support of someone pushing them along and paying for it.

It must be incredibly hard work trying to get people up that hill - where would we, as a society, get the resources from to put in that work? I can't see the justice system being equipped to help - that job is keeping others safe from the drug user's destructive behaviour, and courts and jail seem to be an incredibly expensive and ineffective way try to do that. I don't know how much resources go in, but I can imagine that drugs workers are looking at a problem of a scale which is overwhelming.

To say that a person or a drug is "bad" is such a cop-out. A problem is a problem, there's nothing to be gained by moralising.

There is clearly the issue of those who have an addiction problem and how we might deal with that. Decriminalizing is certainly a start and then changing behaviors so that criminal activity becomes unnecessary. Then perhaps, focusing on the trauma and how best to address it. We perhaps need to accept that this might not be a battle we will win but if we can hold the tide then that might be enough?

If you google "soft white underbelly" you will see interviews with many people with addiction issues. Almost always the opening line is "did you grow up with both your parents" and "tell me about your childhood" and almost always there is a history of broken homes, abuse and addictions in the parents. I doubt that anything I am going to hypothesis on, hasn't been thought of already, but if we can break the cycle of abuse and create a stable environment then we might have a chance. 

For me, this starts with decriminalising as it then allows people access to the help they need.

I don't for one minute think that there is a silver bullet answer but I do know that what we have now is not working. 

I'm pretty out of my depth on this aspect, but I'm not really sure what's meant by "addressing trauma" - sounds like psychotherapy I guess? I tend to think that the practical steps of getting a routine and building social connections are what I'd try to help someone with first off.

Exactly, I think the stable environment is crucial...

...and criminalising drug addicts militates against that.

The policy will change eventually - no one gains from prohibition. It's bad for the addict, and it's bad for everyone else, including the taxpayer.

It's marvellous for dealers, and fairly nifty for unscrupulous conservative politicians  who can offer voters a simple, strong (wrong) message. Unfortunately, evidence-based-policy is something that happens to other countries. 

Oh dear, I'm wading in on yet another thread. But I read a book called Chasing the Scream once about this subject. Interestingly animals too will take drugs if they're deprived of a natural life and will reject them if they have other stuff to occupy themselves with. Addiction is hardwired into the mammalian brain. Chasing the Scream by Johann Hari is an excellent read.

This little video from a favourite youtube channel of mine, based on Hari's stuff, was deleted (someone else has put it back up). Kurzgesagt thought they'd got it wrong and it wasn't objective enough for their channel.

https://www.youtube.com/watch?v=tdJAQZxJ6vY&ab_channel=ArunSharma

Good video, in part that it's been made to present to an engaged audience.

What comes to mind aside from the basic 'of course, this makes sense' stuff, is that much of the initial research into psychedelics was precisely into this element of resolving destructive behaviour imprints that manifest negatively later in life. Before guys like Tim Leary went off into their pop culture misadventures they were part of broad research based on Laing's ideas (primitive as they were for the 50's). Before anyone decides to knee-jerk to the predictable reaction of Leary's name being mentioned, I suggest looking into his Harvard years first so we can avoid the usual cliches that follow.

So, the idea of self-medicating for childhood trauma is not new, and what's both stunning and disturbing is how it's been buried under all the bullshit as mentioned in the linked video. I'm confident anyone who's been around anyone who has spiraled into destructive addiction can see the connection, it's almost a unifying theory. Fact is a large sector of society uses drugs/gambles etc, yet only a portion get on the train to hell with it - what separates them? I've tried a selection of things that for some can lead to a grim end, but always with the thought 'what have a got to lose by going further' that concludes it even coming close to happening - what switched off or reroutes that mechanism in some?

Recently I've been playing with a Turing Tumble with my kid (look it up if you don't know what it is, and be ready to buy one yourself) and we use it to simulate these sorts of scenarios. It's easy to demonstrate with simple logic how fundamental shifts in basic decisions early in the game go on to have dramatic, yet often predictable, outcomes later. The cases for the place in the video are well described, but one can also witness the birth of similar places in areas that shift into having the factors of instability, childhood trauma, criminal activity, reasonless lifestyles etc like Kabul, the Balkans, Somalia, North East China etc that show how predictable scenario is.

Beat me to it. Plenty of people have something to gain from the damage that goes with bad drug policy, from real estate companies and untaxed religious groups being paid to 'treat' addicts, to security organizations and the organized crime groups that use it as a perpetuator for tie-in activities like forced prostitution, extortion and black market goods.

Normally I find your robust style grates on me, so I disagree by default. But here I tend to agree.

I don’t know the answer. I suspect there isn’t one. Education possibly works to some extent, maybe with some youngsters. But it has a shelf life, and doesn’t endure into later life quite so successfully.  Drugs are rife, and the message amongst the young is that they’re ok, they’re cool and they do no damage; in fact an acceptance would be good for health and public revenue. 

Depends how you define 'working'. Avoid the predictable 'well it's working fine for the mafia', I do think things have come a long way re working better since about the 80's, with programs popping up that address things medically and socially rather than 'conservatively' (my term for all dysfunctional policy based on ignorant morality by disconnected lobbyists).

True, we still have scenarios like described in Vancouver, but we also have guys like Mate on the job where 30 years ago probably not. Some places now have decriminalized drug use, something that was fantasy when I was a teenager. Drugs are now getting discussed openly like this very thread and even on popular pod casts I hear, something that in the 80's would have got things shut down or investigated. The tide hasn't, society seems to produce addiction a bit faster than it deals with it, but for a fundamental problem it's being resolved better than say, guns or even literacy.

'Education' without further definition is one of the great straw men of the drug and other debates. Simply going to school till ones 17 possibly introduces as many to drugs as it as it does steers them from them and Oxford certainly didn't turn people of them. Likewise plateauing literacy hasn't been met with plateauing drug problems.

But if by 'education' one means it specifically to address fortifying ones choices when faced with pivotal life choices, some of which includes matters of STEM, then it's about the only system for inoculating against bad choices there is. Some years back I looked into it(so maybe things have changed) but it was shown then that the substance rehabilitation programs that had the most success two years later (the common extent of follow up) were the ones that educated in new vocational options, often outdoors type stuff, but also military and development work, noting these places had a success rate of about 40% compared to the regular institutional stuff that was about 15%. I seemed to me at the time the combination of focused education AND relocation was what worked, and that the former gave confidence for the latter. Having the knowledge to get the hell out and stay out even if it was just planting trees.

It had to happen one day.. a serious post with you I can agree with (potshot at Jon aside).

On a point above, I've known addicts who came from loving backgrounds and no trauma. Addiction usually results from a strong combined biochemical and psychological response and can be overwhelming for some people irrespective of background. Trauma just helps with the chances of getting involved.

From my teenages I saw no alternative to legalising drugs and found it weird few felt the same way.  The more 'serious' ones via prescription and safe injection. The damage done by criminal gangs is too large on its own: the moral choice of not giving money to fund the activities of seriously evil people for a 'high' seemed very clear. Public health impacts of safe drugs are bad enough, let alone the impact of uncontrolled content and delivery. Even with legalisation, things can go wrong: the US has a major drug use epidemic based on pain killer prescriptions.

I'm pretty sure recreational drug use could be cool and OK, with some strong provisos (alcohol is a drug that can be...and can also cause major health problems..., as can various home growns) but not from the current illegal supply lines with no pharmaceutical standards. 

All the 'wars on drugs' seem to have done is increase profit for criminals, increase corruption, and add risk to the addicted, all at great expense to the taxpayer and with massive collateral damage. Legalise it, control it under public health arrangements and make some money for the state from the taxation of recreational behaviour. Illegal supply will still occur but only by the smaller profit margins of undercutting tax (as for tobacco).

It is worth noting that Gabor's population is somewhat unusual in that it is a particularly disadvantaged one, often suffering from transgenerational trauma. However the basic premise is correct that many individuals with substance dependence have a history of trauma, and  not unusually of childhood abuse. 

His comments that addiction is not a brain disease are, I believe, important. They fly in the face of popular medical teaching (not mine though!) which adopted Alan Leshner's ``"addiction is a brain disease"  model in the 1970's. In a sense this fulfilled an important role (at that time) to try and move addiction into health and away from the moral weakness view. More modern thinking, informed by developments in neuroscience, has allowed for an alternative explanation such that addiction occurs as a consequence of the "hijacking" of necessary evolutionary brain responses to certain neurotransmitters. In the context of "distress"  the urge is to seek pleasure, or a release from distress, so leading to a powerful drive to continue using. Mark Lewis has written on this in 2 excellent books Memoirs of an addicted brain and The biology of desire.

I must make one request - please do not refer to addicts as smackheads/junkies (not you MS) or think of them as such. Such labelling informs the stigma that is so prevalent and harmful- just as the stigma  against people with mental illness was (and still is). Most of the substance users and addicts I treat are decent human beings who are suffering. A few are unpleasant. Many, once able to separate themselves from their addiction, are not just decent but reasonable, and often very normal.

As has been stated in this forum the key to recovery is developing meaning- through work, relationships, social engagement. The role of therapists/doctors is to keep the patient alive, and as healthy as possible,  for them to be able to recover. Some medical treatments have great value (methadone/buprenorphine in the case of opioid dependence and other drugs for alcohol or nicotine dependence). The mainstay of treatment is often helping the person address the underlying psychological issues, often in a solution-focused way. 

The whole prohibition debate and legal status of some drugs is a whole new topic but one which, of course, has led us to where we are (for which we in Australia and elsewhere can largely thank the good old USA). Don't get me started. Decriminalising drug users is essential but is not the solution which will be far more complex.

Thanks for the insight. To our enduring shame here in Canada, we have an identifiable minority indigenous population that carries a much higher burden of addiction than other sectors. Almost certainly as a result of intergenerational trauma begun by a cycle of racism and subsequent poverty that might be difficult to fully grasp.

If anyone can imagine their children being forcibly taken away from the family to attend a boarding school where they would be physically and sexually abused and have their cultural identity and language beaten out of them then that might give some insight into the issues these people face. And that was only a small part of their experience. 

The ability to break this cycle is clearly challenging but I think the first step is to change our own attitudes towards the problem. That certainly starts with humanizing the victims rather then demonizing them.

Are we missing the part where huge amounts of people take drugs without becoming addicts? 

No, I think that is exactly the point being made.

OK. But your OP talks about addiction. It just seems that every discussion about drugs has to come from the addiction angle. 

That's because the OP is about addiction and what causes it.

The thread title doesn't say that but OK. 

That's because the thread title is a follow on from a previous (now sadly deleted) thread called "Drugs". Sorry you missed it as the thread title and subsequent conversation might have made a little more sense,

Why is addiction always associated with trauma? I don't doubt it is a major aggravating factor, but ultimately all long-term addiction (i.e. non-chemically based) is down to reprogramming of the brain's pleasure centres (or whatever the biological terms is for the complex balance of hormones/stimulants we secrete) and the resulting semi-permanent imbalance generated. This happens slower/faster depending on the drug but spend enough time partying and you may well carve out a niche you wished you hadn't.

For instance, alcohol may not be highly chemically addictive like opiates, but it is is a slow burner and addiction can creep up insidiously over time.

spend enough time partying and you may well carve out a niche you wished you hadn't.

This was my experience. I wouldn't change any of my life, ecstasy and rave culture in particular were powerfully transformative for me in a very positive way, but I just carried on battering away at it long past the point where it was bringing anything useful or meaningful to me. I ended up a functioning alcoholic and fairly chaotic drug user, simply because I'd rewired my brain to associate being f*cked up with feeling normal/ok.

I think, like with all things, it is impossible to identify one single cause and perhaps trauma is too specific a word to describe what is going on. But there is a body of evidence out there that suggests that addiction is much less to do with the substance and much more to do with escaping a reality and that reality is often linked to trauma.

Many thousands of US servicemen took heroin during the Vietnam war but stopped once they returned to the US. Everyone thought that Heroin was a massively addictive substance but it turns out that it was the escape that was addictive.

I also wonder if the choice of drug is simply a result of chance? I know people who are addicted to cough medicine and I suspect they could get their escape from other drugs but landed on this because this is what made them feel better. This last point is simply a musing of mine and I'd love to hear more about this from those that might know.

Surely its still more likely to be the other way round and that escape/trauma is a common reason for taking drugs, but that the addiction is due to the substance. For instance I think animals given addictive substances can develop the symptoms of addiction, presumably without trying to escape reality.

I've personally little knowledge of drug addiction (apart from alcoholism).

No, I don't think so. I think this is the theme of the video link. That addiction is not an addiction to the substance but an addiction to the escape.

I think that doing drugs and booze in a particular way for Pleasure and escape at particular times in your life can also wire your brain to expect that same kinda feeling at similar times later in life. 

Are you an alcoholic? 

For sure. I quit drinking four years ago but I've found myself lingering in the booze aisle a few times since March.

Thanks for your honesty. 

the animal, mainly rat, models of addiction which helped give rise to Leshner's interpretation are flawed unless one understands the complexity of behaviour.  Put a rat, an inherently social animal, in a cage with nothing but food and water or a drug (alcohol, cocaine whatever) and it will express a preference for the drug. Put rat in a playpen for rats ("Rat Park") where it can eat, play, chat, fxxx, etc. and it will not show the preference for drugs.

in human terms having meaning and other ways to enjoy oneself will be protective against developing a drug dependence. BUT some people are genetically sensitive to the pleasurable effects of some substances- heroin for example. Manu people receive heroin (diamorphine) for treatment of pain- in some it works well with no unpleasant side-effects, apart from constipation, in others it is intensely rewarding (= reinforcing). This can be such that even though it causes nausea/vomiting the person likes the effect so much they keep on using it. Methamphetamine can be very very nice to take but in some people it causes anxiety.++/dysphoria, rather than euphoria.

in response to the question about drugs having differing addictive potential that is well described. Caffeine less addictive than methamphetamine, ecstacy being far less addictive than alcohol which is less addictive than heroin etc. However, the addictivity also depends on the host- genetically and psychologically.  in some people the effect of a drug is so intense compared to its effect in others that the decision to not use it again/as often is very different.  

No. That's why I used  the word knowledge rather than experience. I've known several alcoholics, some quite well, and I've often failed to realize the seriousness of their condition.

I agree with much that is in the link but it seems to state much that should already be obvious. The phrase "Driven to drink" is widespread and its often easy to see why taking a drug is an escape eg  a wife with no family whose husband has been severely affected by a stroke, or a single father on low income bringing up a child after his wife has left. The trauma does cause the person to take drugs and become addicted, but the addiction itself is surely usually the effect of the substance. That doesn't mean drug addiction can be successfully treated without treating the cause. 

Again I've little personal knowledge. My rather conservative view on legalizing drugs is that there are good arguments and evidence for it but there are a lot of substances out there that I'm not convinced should be legally, and thus more easily, available. Alcohol is legal and controlled yet it still causes more damage to our society than other drugs, and indeed there is still a significant market for illegal drink. Edit: And I enjoy alcohol myself.

I wasn't intending to give reasons for developing addiction but trying to say that in humans the actual addiction is an unintended end result and due to the substance itself. I was suggesting the example of experiments with animals  just to illustrate that a substance causes effects of addiction but not discussing reasons for taking the substance and developing the addiction in the first place.

Again, no, that isn't the current evidence. The old way of thinking was that the substance was addictive but the evidence of heroin use during the Vietnam war proves this to largely be a false assumption. 

I've googled a little and seen claims that Rat Park was based on rather poorly designed experiments that have not been successfully replicated. The Kurzgesagt video appeared to me rather like something I'd expect from anti-vaxxers and their Trumpian ilk (I'm not necessarily correct though).. Below I've copied in a concluding paragraph from the following site which may be a more balanced view

https://theoutline.com/post/2205/this-38-year-old-study-is-still-spreading-...

"The point that Rat Park is used to underscore is true. Environment often plays a role in a person developing an addiction and the War on Drugs does nothing to address that. In fact, the War on Drugs has done tremendous harm by ignoring the sociological factors that contribute to addiction and focusing exclusively on criminalization. Alexander and Hari argue that we need a more humane approach to drug policy, a belief that is widely shared. But ignoring the greater body of addiction science in favor of a neat narrative is the kind of thinking that fueled the War on Drugs. It’s precisely because this is such an important fight that we should make sure our arguments, and the evidence we use to support them, are sound."

However I have no idea about the reliability of the sources I looked at, including the above. I know almost nil about the subject myself. Incidentally is anyone claiming that that an otherwise untraumatized human forcibly and frequently injected with heroin would definitely not become an addict?

Edit: developing is my boldening

Yes, as with all things there is complexity. When I wrote this: 

"Again, no, that isn't the current evidence. The old way of thinking was that the substance was addictive but the evidence of heroin use during the Vietnam war proves this to largely be a false assumption".

I was aware that this might be an oversimplification. Clearly the idea that drugs like heroin, crystal meth, crack cocaine etc. aren't harmful and don't have addictive properties isn't correct but nor is the "if you take one hit of heroin you will be hooked for life" school of thought that I grew up believing. 

We know that alcohol can lead to addiction and yet millions of us take it every day without becoming alcoholic. So we really need to understand the mechanism of addiction in order for us to address the problem and so far we seem to have failed. This is what the linked video is trying to explore.

The old saying 'no one becomes a heroin addict by accident' rings true in that anyone picking up the needle knows where things can lead and at some point is ok with it. I think that's the crux issue here; something affects the switch in the head that says don't take the next step. This may be neurological, ie a feedback loop from trauma, or environmental, ie being in a scenario where permissiveness and availability make the choice ok. Probably an equilibrium of both. Addressing only the individuals hardwiring can only be half the solution

I think something being overlooked is the simplified use of the term 'addiction'. Addiction, dependence and habitual describe significantly different ways of being in the drug loop, including habitual use of drugs that have no addictive properties. It's all different dependent on availability and environment.

There's a popular interview with Lemmy, a man famous for his alcoholism and drug tolerance, where he mentions heroin. He says he's never tried it because it killed some of his friends, but that it must be the best hit on earth because people are willing to die for it.

Yes, I think this is important. There is an old theory that once an alcoholic, always an alcoholic but I think that view has changed. Can we still class someone who has been sober for 20 years as an alcoholic? And what about those of us who habitually use alcohol but aren't defined as alcoholic. Clearly there is the distinction between need and want but again, the lines are blurry.

I have a feeling I've seen these distinctions defined somewhere but it eludes me right now. A quick look shows distinctions between any two terms but I've seen all three. I worked briefly in a substance rehab and detox 20 years ago, mostly cowboy stuff, but some theory in use that used the distinctions and seemed to work.

The destructive stuff as per Rat Town looks like an overlap of the three broad factors, with people having just one or two factors present or manageable meaning they can function more in 'normal' society. The substance itself appears to have a lot of leverage in how those factors overlap, ie I have a raging coffee addiction, my life revolves around it both consuming and procuring, I have anxiety with the thought of not getting it and it affects others - but availability and acceptability mean I can still tick the boxes of normal societal function (even as a barely literate migrant). Swap the coffee for speed or even booze and that paradigm goes south fast. Swap it for fat or refined sugar and we probably wouldn't even label it addiction.

The heroin - methadone process is interesting as it swaps out a drug with a more damaging cycle due to it's illicitness, with one that has some of the bad elements removed. Dependency seems unchanged, but the habits and addictive drive become less damaging. Decades of established use in society appear to show positive results.

re your reference to alcoholism; 20 years sober, alcoholic maybe not, but addict maybe yes. They may not be in the firing line of alcohol itself as a substance, but may still very well be in the sphere of influence of addictive/habitual/dependent behaviours. Not wanting it and not getting it are two different states to be in obviously.

And here in lies the conundrum. We are all possibly addicted to something but for the most part we remain functional. It is only the addictions where we become dysfunctional that challenge our sensibilities and lead us to prohibition, criminalization and exclusion. 

And perhaps the exclusion is borne for our own fears of who we really are or what we might become because, in the end, it is our own frailty that we see within the addict. 

I don't think that's a fair generalisation - my impression is that drugs are less popular now than 20 years ago when I was a nipper and doing party drugs and smoking weed all the time. 

I doubt many young people think that heroin, crack cocaine and crystal meth are cool and safe. But many probably think that smoking weed is fine (give or take the lung cancer); that psychedelics are cool and safe; and that party drugs like MDMA, ketamine, powder cocaine and mephedrone are alright so long as you don't overdo it.

The addicts referred to in the clip were most likely heroin/opiate, crystal meth, or alcohol addicts. They tend to be the drugs that cause severe dependency problems (although cocaine can, but that's an odd one).

Heroin/opiates (and other sedative drugs like benzos and alcohol once addicted) have a very different mechanism of addiction than stimulants like crystal meth, cocaine, etc. Withdrawal from heroin etc. involves horrible symptoms that the drug will immediately alleviate - and that withdrawal takes weeks rather than hours. It takes a fair bit of use of any drug to develop that physical addiction, and in general, you're only going to take a drug like that every day and develop a physical addiction if you've got nothing else to do. If you've got a job and a family that you want to keep hold of, it's extremely unlikely, no matter how much you enjoyed taking heroin, that you'd develop an addiction.

Addiction to stimulants like crystal meth or cocaine is very different, because once you've come down off the drug, you feel tired but you don't go into withdrawal. You just need a good night's sleep and some food and you're back to normal. The reason people get addicted to these things is either that can get away with it (functioning coke addicts with a job etc.) or they've got nothing to lose (crystal meth addicts who binge for days at a time without sleep or food, eventually crash, then wake up and start over). 

If you've got a job and whatnot, you could take heroin or crystal meth for fun on a weekend and hold your life together, if you wanted to (although these would be bad drug choices IMO). It would be facts about your life that made you use the drugs during the week when you should be doing something else, and get physically addicted (heroin) or keep going back for more (stimulants), not the drugs themselves. 

Alcohol becomes very physically addictive if you use so much/frequently that you never sober up. Again, this takes making some fairly drastic decisions e.g. drinking at work, to take hold, and is only going to happen if your life is going down the pan already. Getting pissed every night, having a hangover every morning is usually more "problematic alcohol use" than "alcoholism" (physical addiction, drinking early to avoid withdrawal).