Most People With Addiction Simply Grow Out of It
October 1, 2014 4:57 AM   Subscribe

According to the American Society of Addiction Medicine, addiction is “a primary, chronic disease of brain reward, motivation, memory and related circuitry.” However, that’s not what the epidemiology of the disorder suggests. By age 35, half of all people who qualified for active alcoholism or addiction diagnoses during their teens and 20s no longer do, according to a study of over 42,000 Americans in a sample designed to represent the adult population.
Only a quarter of people who recover have ever sought assistance in doing so (including via 12-step programs). This actually makes addictions the psychiatric disorder with the highest odds of recovery.
Metafilter's own maias on myths surrounding the disease(?) of substance addiction, and their impact on medicine and policy.
posted by grobstein (84 comments total) 80 users marked this as a favorite
 
from an earlier maias article from July...

Addiction is a learning disorder, a condition where a system designed to motivate us to engage in activities helpful to survival and reproduction develops abnormally and goes awry.
posted by mikelieman at 5:05 AM on October 1, 2014 [9 favorites]


AA more or less saved my uncle's life, and he has since gone on to save dozens of lives as an AA sponsor. That said, it makes perfect sense to me that he's an example of a far extreme, and that there's a huge shadow constituency of naturally-recovered addicts that are simply absent from the data. Between that and the fact that basically all recovery programs have more or less the same success rate, there are a lot of things we need to fix in how we think about drugs and addiction.
posted by cthuljew at 5:09 AM on October 1, 2014 [5 favorites]


Unfortunately the ones that don't naturally recover have a myriad of health problems and have very decreased lifespans. The costs and impacts on their life's and the people around them are extremely high.
posted by AlexiaSky at 5:23 AM on October 1, 2014 [1 favorite]


I think that motivational interviewing pretty much is a treatment technique that follows this model. And people do up and decide to quit. It's awesome when they do.
posted by AlexiaSky at 5:33 AM on October 1, 2014 [2 favorites]


Based on my observations, I'll bet that addiction is a complex suite of conditions, each arising from a complex stew of physical, metal, and social factors and further complicated by other conditions the addict may have, so any "one size fits all" approach is likely to fail. The bizarre and punitive aspects of most legal codes concerning many addictive substances doesn't help people deal with the multi-sided problem either.
posted by GenjiandProust at 5:46 AM on October 1, 2014 [37 favorites]


At the bottom of the article linked in the post was another Maias wrote entitled "Here’s What I’ve Finally Concluded About 12-Step Programs". I just wanted to mention one thing that struck me from that:

"Less extreme but still troubling are cases where young people meet dealers or new running buddies at meetings—particularly when their initial drug of choice was marijuana and alcohol and they get introduced to cocaine and heroin. This 'deviancy training' risk is especially strong at meetings where many people are forced to attend and are not actively seeking to be abstinent. These issues, of course, can arise at any type of group that brings addicts together—and for that reason I believe that young people should generally be treated individually, not in groups like AA."

A very, very similar dynamic occurs in group treatment of eating disorders. It makes me wonder how similar the causes and treatments are between the two problems, and whether more of Maias' comments might also apply to both.
posted by kyrademon at 5:47 AM on October 1, 2014 [33 favorites]


So this is one more damn thing that we have to wait for the prefrontal cortex to finishing growing to be done with, like youthful impulsivity and bad judgement? *sigh*
posted by wenestvedt at 5:47 AM on October 1, 2014 [4 favorites]


I'd be curious to know (I didn't RTFA) how many people who grow out of their addictions to negatively-reinforcing activities (e.g. alcohol, drugs) have shifted those addictive tendencies to either less detrimental activities or positively-reinforcing ones (e.g. exercise, social activities). The addictive habit remains but is being channeled into less harmful/more beneficial action.
posted by kokaku at 5:48 AM on October 1, 2014 [7 favorites]


Simply grow out of it? This guy says the same and has some other interesting points:

Love and Addiction 3. A General Theory of Addiction


Alcoholism. The National Institute on Alcohol Abuse and Alcoholism made a starling declaration at its Web site in 2010: “Alcoholism isn’t what it used to be.” The agency based this on the repeated finding – which Stanton has pointed out for decades – that most people overcome alcoholism without treatment and do so without ceasing drinking. For the most part, alcoholism (like drug addiction) is connected with specific periods of people’s lives, and the large majority move beyond this point as they mature and experience other developments in their lives.

more:
In 2010, the U.S. Dietary Guidelines noted for the first time that: "results from large epidemiological studies consistently show that alcohol has a favorable association with total mortality especially among middle age and older men and women." The 2010 Guidelines also begin to build on Stanton's finding a decade earlier that moderate drinkers maintain better cognitive functioning with age, to wit: "Moderate evidence suggests that compared to non-drinkers, individuals who drink moderately have a slower cognitive decline with age."

My favorite hangover cure (seems not to be available anymore).

Also:

"Ohhh, never thought of this hypothesis: that the act of getting drunk together might be a social technology that helps us verify the trustworthiness of others by inhibiting their higher cognitive functions and thus making it harder to consciously fake things. That would make sense."

Living in Asia, the last hypothesis makes a lot of sense to me if I observe the business practices here.
posted by yoyo_nyc at 5:48 AM on October 1, 2014 [12 favorites]


So this is one more damn thing that we have to wait for the prefrontal cortex to finishing growing to be done with, like youthful impulsivity and bad judgement? *sigh*

Soon, medical science will fins a way to culture mature, even aged, prefrontal cortices, and the we can graft them into young people's noggings. They will look a bit odd for a while, but eventually their skulls will adapt.

Op-eds will become a thing of memory, as there will no longer be anyone to get off of anyone else's lawn.
posted by GenjiandProust at 5:51 AM on October 1, 2014 [11 favorites]


Until now, there tends to be two models for addiction: the Disease model and the Choice Model. The disease model says the person addicted has a mental disease and is helpless. The Choice model says essentially the opposite : that the addicted person has chosen this lifestyle. Neither seems satisfactory.

If you've ever seen an alcoholic sitting in their own piss and shit in a cold doorway, it is difficult to think that they have made a conscious choice to live that way.

At the end of the Vietnam War, it was estimated that up to 10% of US soldiers were addicted to heroin, maybe 100,000 people. The army were never going to bring back that many addicts to the US so soldiers were tested and told they weren't getting on a C130 until they were clean. The vast majority did pass, and when they arrived back in the States, the recidivism rate was 16%, a historically low figure for this narcotic. It seems that a strong incentive to stop, plus removing the person from the environment where they developed the addiction could prove a successful cure in a lot of cases. Note that the same course of action doesn't work with patients with Alzheimer's. If addiction is a disease, it doesn't share many characteristics with other brain diseases.

A new model is needed to understand addiction, and this theory is as promising as any I have seen.
posted by devious truculent and unreliable at 6:16 AM on October 1, 2014 [26 favorites]


I was struck by the differences between alcohol and heroin, which take about 15 years to resolve on average, and cocaine, pot, and prescription opioids which resolve in 4-6 years on average. So much can happen in 15 years.
posted by Area Man at 6:21 AM on October 1, 2014 [1 favorite]


These issues, of course, can arise at any type of group that brings addicts together—and for that reason I believe that young people should generally be treated individually, not in groups like AA.

I find this deeply troubling. I understand and mostly agree with the concerns underlying it, but the slash-and-burn solution of refusing someone suffering from addiction a community of support from people who live and understand their problems in a way that outsiders never can strikes me as horrifying.
posted by middleclasstool at 6:24 AM on October 1, 2014 [1 favorite]


A new model is needed to understand addiction

How about this one?
posted by Obscure Reference at 6:29 AM on October 1, 2014 [37 favorites]


middleclasstool: I don't think anyone is refusing anyone access to AA meetings, only making a recommendation about a general plan of treatment.
posted by Juffo-Wup at 6:31 AM on October 1, 2014 [8 favorites]


The disease model says the person addicted has a mental disease and is helpless. The Choice model says essentially the opposite : that the addicted person has chosen this lifestyle. Neither seems satisfactory.

Fortunately, few scientists buy into either absolute. In fact, not even the DSM buys this kind of absolutist bullshit -- talking instead of substance use disorders of varying severities, with a complex and intersecting range of causes.

I'm not sure I've read anyone other than Jeffrey Schaler who argues that the most severe and self-destructive behaviour we associate with addiction is a pure choice. People get confused because the desire to use drugs or to embrace recovery can seem like free choices. Once you look at things like the distribution of addiction problems by race and class, the impact of a high incidence of adverse childhood incidents and the recovery outcomes for a group like doctors when compared with the long term unemployed, it kind of makes a mockery out of the arguments for a pure free will model for addiction.
posted by PeterMcDermott at 6:32 AM on October 1, 2014 [14 favorites]


I guess everyone has their own story, but my experience is that just as a particular set of circumstances can lead to addiction, another set can lead to falling out of addiction. After a few tries at it, what finally got me off nicotine was an infected tooth which was treated with the wrong antibiotic leading to my neck swelling up like a balloon and the loss of the tooth before I got proper treatment. This meant ciggies were not an option for a while and was just enough of a push in the right direction that I haven't had one since.
posted by drnick at 6:34 AM on October 1, 2014 [1 favorite]


Also: when I very first met maias, some 20 years ago, she was arguing for the disease model of addiction, and I was arguing a free will model.

We live and learn.
posted by PeterMcDermott at 6:35 AM on October 1, 2014 [10 favorites]


it kind of makes a mockery out of the arguments for a pure free will model for addiction.

Exactly, As Marx said "People make their own history, but not in circumstances of their own making." Claiming that people make free and rational choices, except in very particular circumstances, is pernicious in all sorts of ways. Even people who seem to be relatively free to choose to use or not (say because of social and/or economic privilege) can be driven by all sorts of factors to make unfree choices from a banquet of bad options.
posted by GenjiandProust at 6:38 AM on October 1, 2014 [16 favorites]


To be fair, AA is rather cult-like in that they label and indoctrinate members to think of themselves as "addicts" for the rest of their lives. Doesn't matter that you don't even drink anymore, you're still an addict. It doesn't matter that you once had impulse control problems, and you've seen the problems. You're not allowed to choose to imbibe a little bit. It's all or nothing, a drink or two is a "relapse," because you're an addict.
posted by explosion at 6:44 AM on October 1, 2014 [12 favorites]


A big problem with thinking about addictions is addictions treatment. I'm a psychotherapist, with a long history of treating people with addictions and other mental disorders with talk therapy. For the past year I have been spending many hours per week (8-10) rewriting the regulations regarding substance use disorder treatment in my jurisdiction (think a state level agency). The thinking about how to appropriately treat people with addictions, as brought to the table by the addictions treatment "subject matter experts," is draconian at best. Among the regulations I've sought to get changed, without success: one can be kicked out of treatment for using. Now, I'm no fan of the disease model, but these experts are. Think about the kind of mental gymnastics involved in believing that addiction is a disease and that the proper way to treat that disease is to deny treatment when the patient is symptomatic. "I'm sorry, you appear to have symptoms of pneumonia. We hope that resolves for you. Please return to the clinic so that we can treat your pneumonia after the symptoms have resolved."

Just yesterday I was trying to push back on the notion that drug testing SUD treatment clients all the time was an appropriate way to promote a therapeutic environment. No one can provide a good justification for it, so I thought I'd look around at other guidelines. Great, I thought, when I found these nice guidelines from Mass.[pdf] They get it. There is no treatment justification for ongoing drug testing. Ok, but wait, what does ASAM say? Oh. "Arbitrary restrictions on drug testing jeopardize these efforts and create a barrier to engaging patients into cost effective and beneficial treatment." There must be clinical justification provided? Nope, nope there is not.

Addiction is awful, and I've known personally and worked professionally with a lot of people completely sidelined by addiction. They did not have their issues resolve as they aged. But the way we think about and treat addiction is ass-backward, and really damaging. Some people are helped, but that's true of almost anything, and the amount of autonomy and self-definition that they have to give up to get that treatment can be really damaging (even if not as damaging as addiction.) (BTW, I'm speaking here of treatment, not supportive therapy like 12-step groups.)
posted by OmieWise at 6:45 AM on October 1, 2014 [40 favorites]


Glad to see more and better approaches to all learning disabilities. Even more happy to see more and better diagnoses. Some of what looks like addiction on the outside is often poorly applied self-medication for another ailment entirely. Once that is fixed, the crutches are laid down without much fuss. I've seen this pattern with persons having ADHD, anxiety, food insecurity, financial insecurity, abuse, etc.

I don't think that disproves other pathways to addictive behavior and relief.

All I can say is witnessing the recovery and failure of various folks, "best practices" in maias and AA seem to converge. From what I gather, AA guys spend a lot of time on what looks like cognitive therapy - "Insanity is doing a thing over and over expecting a different result" etc. It works when the person finds that community helpful with underlying cognitive issues, and it fails when the community offerings are not to taste, or overmatched. The folks whom I know in recovery are quite clear on this and have been for decades.

To friends that are actively stuck, I encourage trying AA in conjunction with proper healthcare and self-care. I also feel that every American should live in NYC for a year to desensitize them from fear of "other people". So you can all breathe easy knowing I will never ever be in a position to dole out official therapeutic advice.
posted by drowsy at 6:53 AM on October 1, 2014 [2 favorites]


As a callow youth, lo these many years ago now, I read a straightforwardly-titled book called "The Case For Legalizing Drugs." And this - the idea that many bouts of addiction are ended by the addict independently, either by choice or by aging out - was one of its main points.

I came away from that book unsure if the most troublesome drugs should really be legal, but thoroughly convinced that most of the "facts" about drugs we hear from the authorities can't be trusted at all. And that those "facts" inform our war on some drugs in a way that deemphasizes harm reduction, which is madness.
posted by Western Infidels at 7:07 AM on October 1, 2014 [3 favorites]


Anecdotal; I never really decided to stop drinking; I just kinda did. I was probably an alcoholic; at the very least I was a significantly heavy binge drinker. And then one day, it was like a switch in my brain; and I just didn't want a drink. I think I drink maybe 5-6 glass of wine a year now, usually at holidays or birthdays or whatever. I have a fully stocked wet bar for guests, and I'm more likely to raid the halloween candy stash than I am the 40 year old scotch. For me, it's just not a big deal.

My sister, on the other hand, still struggles. She can't keep alcohol in the house. She can't have an occasional drink. She has a binary relationship with it; drunk or sober, there is no happy middle. She misses drinking. She stays sober, but that switch, it just never got triggered.

By the same token, I've failed at quitting smoking more times than Miley Cyrus has licked things in public.


As an aside, is the font on the OP really weird/blurry for anyone else, or have I screwed up my graphic settings somewhere? It was headache inducing to read the page, I had to copy/paste it into notepad. But maybe I did something weird when I installed new video drivers.
posted by dejah420 at 7:10 AM on October 1, 2014 [9 favorites]


The effectiveness if AA seems to be impossible to determine, perhaps because it is ineffective for most people and complicates the issue.

Lance Dodes, former director of substance abuse treatment at Harvard’s McLean Hospital and assistant clinical professor of psychiatry at Harvard Medical School, says Alcoholics Anonymous helps between 5 percent and 10 percent of its participants. Dodes also believes A.A. harms 90 percent of participants because of the perception that "If you fail in A.A., it's you that's failed" and not A.A.[15]

What is more troubling is the fact that AA began after a hallucinogenic trial with the atropine found in Belladonna, which altered the founder's viewpoint, perhaps indicating that his addiction was simply a thinking error. This approach was deemed quackery and socially awkward at the time and replaced with a spiritualized higher power, which also serves as a mystical bulwark against criticism because all higher powers are culturally defined as never responsible for any failure (because higher powers must have a higher reason for letting you fail). LSD and similar substances are currently considered an effective treatment for addiction, but mostly ignored or suppressed.
posted by Brian B. at 7:15 AM on October 1, 2014 [7 favorites]


Based on my observations, I'll bet that addiction is a complex suite of conditions, each arising from a complex stew of physical, metal, and social factors and further complicated by other conditions the addict may have, so any "one size fits all" approach is likely to fail. The bizarre and punitive aspects of most legal codes concerning many addictive substances doesn't help people deal with the multi-sided problem either.

You're almost defining Social-Cognitive Theory, or Social Learning Theory, which describes how environment, cognition, and behavior all contribute to what people learn and do - and that those three factors (environment, cognition, and behavior) all wind up affecting each other in complex ways.

SCT/SLT is often used to inform and design interventions to help people move toward healthier behaviors. It often suggests the need for broad, varied, and environmental changes to help people move toward healthier behaviors - with the understanding that there is no silver bullet. Most people will need a combination of many factors, in part because any single factor is unlikely to work for all that many people.
posted by entropone at 7:15 AM on October 1, 2014 [3 favorites]


Interesting article. Though it focuses only on people who develop addictions at a relatively young age, and changes in the brain and lifestyle seem to result in many people dropping their drug habits.

What would the stats be for people who have developed a serious alcohol addiction in their late 20s or their 30s? I imagine that numbers would be different, and that we couldn't say that "most simply grow out of it". I'm just guessing here.

Perhaps alcoholism is more of a "learning of developmental disorder" in young people, as the author believes, but that it's not really true for older people? It just seems to me that some alcoholics definitely have NO chance of growing out of their addiction.
posted by beau jackson at 7:33 AM on October 1, 2014 [6 favorites]


This is one of those things that you read and almost get a neckache from nodding so frequently. I'm usually all about celebrate uniqueness, especially my own, but sometimes it's just so comforting to hear your lived experience is more statistically normal than you might have expected.

Thank you for sharing it here, and even if I've said this 100 times before it hasn't been enough, thank you maias for the work you are doing.
posted by MCMikeNamara at 7:42 AM on October 1, 2014 [5 favorites]


one can be kicked out of treatment for using.

This is the most mindbogglingly stupid thing about treatment ever. It comes from the same school of thought that suspends kids from school for skipping class. It's a punitive model that doesn't actually believe alcoholism is a disease, no matter what they say; the only possible reason for ceasing treatment because of use is a belief that one chose to use and wasn't compelled. If you're depressed, in treatment, and have a relapse leading to a suicide attempt it's not like your treatment team is going to say "Oh, well you're out of treatment now." Indeed, they'll redouble efforts up to and including forced institutionalization. There is no good reason at all for substance use disorder treatment to be any different.

A friend of mine quit drinking a few years ago. Without going into huge detail, they did something pretty monumentally stupid under the influence and sought treatment. Happily, they went to CAMH (Centre for Addiction and Mental Health, major Canadian psychiatric hospital), whose approach to substance use disorders is one of harm reduction, not the cult model of AA.

Essentially, the way they look at treatment is this: "You love $_substance. How do we work together to give $_substance a healthy place in your life?" For my friend, healthy meant excising alcohol, for now. They're getting to a point where they think it's probably reasonable to have the odd glass of wine from time to time, and they're detail-oriented enough to be strict about it.

I've believed for a while that the AA model ranges between not very effective and actively harmful. Some people, yes, need to never have another drink in their lives because one is the pebble that starts the avalanche. For most, I think, it's simply about figuring out that drinking self-destructively isn't just about lighting up the pleasure centres of the brain, there's a reason they drink that heavily, and addressing that reason will help develop a much healthier relationship.

It seems clear, also, that addiction follows different pathways with different substances. There are lots of casual drinkers and pot smokers and nicotine smokers, for that matter. Not that many casual heroin users, or meth users. What I'm saying is some substances, I think, drive a hook into your brain on an organic level, and for those, total abstinence seems to be the only reasonable treatment option. For some people, alcohol is that kind of substance, but for most it's probably not.

All that being said, it seems like the best treatment model is to remove it from your life completely first, work out issues, and then slowly reintegrate--if you want to--to healthy levels. Which seems to be how things work for a lot of potentially self-destructive behaviours. And that being said, there's no silver bullet; our propensity for wanting simple solutions to complex problems needs to be seriously quashed, because there are no simple solutions.

And the whole idea of court-mandated substance use treatment needs to be erased. Whatever else AA gets wrong, they are right that nobody will get better until they want to. A judge ordering you into treatment is like parents forcing children to say sorry when they don't want to: it's completely meaningless, no feelings get changed, and more importantly behaviours won't change except in response to fear that they'll be forced to again.
posted by feckless fecal fear mongering at 7:47 AM on October 1, 2014 [11 favorites]


Maias is great. Hi Maias! You’re great! I work with many people who have decades of chronic substance use and I'm going to send this article to my coworkers. It's a good starting point for reframing a lot of our thinking.

In one of the linked articles, I did find an idea that stuck in my craw a bit. you have to repeatedly take the drug for emotional relief to the point where it feels as though you can’t live without it. That doesn’t happen when you take a drug as prescribed in a regular pattern—it can only happen when you start taking doses early or take extra when you feel a need to deal with issues other than pain.

As a nurse, I totally get the way that pain meds are kept from people because providers fear "causing" addiction, and that's fucked up. On the other hand, I know people personally, and professionally, who developed addictions to their pain medications. Additionally, chronic pain is a very complex phenomenon that can't be decoupled from emotion. Saying that you can't become addicted to a drug if you take it as prescribed is just not true. Yes, at some point when you are addicted you likely start taking it NOT as prescribed, but it seems kind of like a circular argument to say that as long as you're taking a drug as prescribed then you're not addicted. I mean, there’s some kind of mushy middle ground when you start craving the drug more than prescribed, and then you’re taking it more than prescribed, so at what point are you calling that person addicted? Opiates just feel damned good, right? So most people enjoy them. While taking a strictly physical approach is obviously wrong, taking a strictly emotional approach doesn’t resonate for me either. If you do something every day that feels physically great and provides emotional relief, and you have done it for enough days that it is part of your routine, it’s going to be appealing to keep doing that thing every day. Add to that the way that people adjust to increased opiate dosing. I don’t know…
posted by latkes at 7:51 AM on October 1, 2014 [1 favorite]


I wonder, latkes, if part of the problem is that prescription meds are an all-or-nothing approach? I mean, you're in severe pain, right? So your doctor prescribes NoPainHappyPill to be taken four times a day for ten days. Except... the pain (depending on the condition obviously) dissipates. But when the pain has dwindled to a 2 from a 10, you're still taking the meds at the same level, where you're going to get more of the happy effects than the painkilling effects. Dwindling prescriptions would seem, I think, to make sense with pain meds (for non-chronic conditions). Take four pills today and tomorrow, then take three for two days, etc.
posted by feckless fecal fear mongering at 8:01 AM on October 1, 2014


explosion, one of my dad's old friends was addicted to heroin, alcohol, and cigarettes. He eventually got off of all of them, but when asked which was hardest to quit, he said that "heroin was easiest, AA was hardest."
posted by tavella at 8:16 AM on October 1, 2014 [1 favorite]


I know so many women who didn't start drinking abusively til their 40s.
posted by small_ruminant at 8:22 AM on October 1, 2014 [3 favorites]


Probably half the people who “qualify” for alcoholism or addiction before the age of 35 weren’t really addicts or alcoholics, to begin with…the ones who stick with it, are the addicts.
posted by littlejohnnyjewel at 8:22 AM on October 1, 2014 [5 favorites]


That's kind of saying anyone who breaks an addiction isn't an addict?
posted by feckless fecal fear mongering at 8:30 AM on October 1, 2014 [5 favorites]


This was my question as well. According to qualifications, I'd say 1/2 to 2/3 of the people I know in NYC would "qualify" as alcoholics based on the amount and way that they drink. But if removed from this social environment, at least half of them would probably never drink again.
posted by the jam at 8:30 AM on October 1, 2014


Slightly tangentially, I was having a discussion with patients at an eating disorder clinic I worked at over the similarities and differences between substance abuse and eating disorders. A large proportion of our ED patients had a history of substance abuse, and a lot of them saw it as just another coping strategy. Others insisted they were different (perhaps they had a fear of being lumped in with substance abusers?). At one point I asked a patient who had experienced both which was harder to recover from. Her answer was that no question - it was the eating disorder.
posted by antinomia at 8:34 AM on October 1, 2014


I very definitely was an alcoholic and prescription drug abuser for a couple years in my twenties, from age 25 to 27 or so. And then... one day I just wasn't. It wasn't fun anymore. I also stopped smoking at the same time. This article is very interesting to me.
posted by rabbitrabbit at 8:40 AM on October 1, 2014


I used drugs (and a lot of different ones) basically every weekend from the age of 24 till the age of about 30. I kept semi-regularly binge drinking for a couple of years beyond that. Somewhere around age 33, I just stopped. Moved to a new city, didn't drink at all for about 18 months, now, several years later, I *might* drink an entire beer a couple of times a month. It's rare that I even finish a beer if I order one.

Didn't go to AA, there was no intervention. My life situation just changed and drinking and doing drugs became less important to me than other things. I have lots and lots of friends from that era with similar histories. Started families, got careers that they cared about, etc. I think most people who drink too much or do too many drugs eventually back off.

That is, if they don't die first.

The real question is if they do something horrendously stupid before that happens like kill someone in a car accident, get fired, overdose, go to jail, etc. I'm pretty lucky that none of the above happened to me. Quite a few of my friends were not that lucky.
posted by empath at 8:44 AM on October 1, 2014 [7 favorites]


To be fair, empath, you live at least part-time in a world where you get to see the effects of substance abuse on a regular basis. I did too (ask me why I don't do E or put anything up my nose anymore), and I think being faced with that sort of thing helps to just stop like that. Not criticizing you in case this comes across that way.
posted by feckless fecal fear mongering at 8:48 AM on October 1, 2014 [1 favorite]


cthuljew, color me thoroughly impressed. Someone you clearly care about was saved by AA, and yet you recognize the validity of other paths, and the limits of AA path as a generic path.
posted by IAmBroom at 9:03 AM on October 1, 2014


I'm also confused about how to define addiction period. If someone is a daily alcohol user or daily pot smoker, but are not using to a level that significantly impact their physical health or ability to keep a job, should they be defined as addicts?

I know people who drink daily and to me that is an alcoholic. That person literally cannot emotionally tolerate going a day without alcohol. I have met plenty of pot smokers like this too.

I shy away from pathologizing a behavior that isn't causing measurable harm. On the other hand, a daily requirement to use a substance sounds like dependency to me. And having close relationships with folks who fit this description, I feel pretty convinced that daily substance use does retard people's emotional development. My experience is these folks have a more limited range of emotional coping strategies and that can cause problems in interpersonal relationships at the least. But perhaps that's my confirmation bias talking.
posted by latkes at 9:07 AM on October 1, 2014 [1 favorite]


kyrademon: "Less extreme but still troubling are cases where young people meet dealers or new running buddies at meetings—particularly when their initial drug of choice was marijuana and alcohol and they get introduced to cocaine and heroin.
An ex-girlfriend assured me that a woman attending her first NA meeting, or to a lesser extend AA meeting, is going to be hit on by multiple guys immediately afterwards under the guise of "offering advice/help/themselves as sponsor", because they know the woman is especially vulnerable at that moment, and furthermore unguarded (since she's never been in this situation before).

Now I have to go wash.
posted by IAmBroom at 9:07 AM on October 1, 2014 [4 favorites]


I've spoken elsewhere on Mefi about my struggles so I won't go into too many details, but a big part of recovery from certain types/levels of addiction is damage control from the wrecking ball of a life you once led. The longer someone is using the more difficult it is to grow out of one's addiction. It's also the love affair that keeps on taking for a long, long time after you've broken things off. Even if you outgrow your addictions you can't really outgrow the story you've written for yourself - all you can do is keep writing.

I'm clean today but I've been having a shitload of troubles lately that I probably wouldn't be having if I hadn't spent somewhere in the neighborhood of two decades getting fucked up. The situation I'm currently in, financially and otherwise, brings me in contact with elements of society that're a quick nudge or wink away from supplying me with a fresh route back into my own hell. This is a volatile thing for someone like me (and like a lot of other addicts) who's dealing with a dual diagnosis of mental health issues on top of the addictions. Some days it still seems like giving in to my demons will fix everything and this is something I have to be constantly vigilant about.

Having a scarlet A branded onto my forehead makes people I've known for a long time second guess why I am where I am today (and with good reason, of course). As I said, I've little doubt that had I been doing something other than getting high during those years I'd be somewhere else instead of worrying about being homeless and struggling through the system to help maintain my mental health. What I'm afraid a lot of people don't realize is that when you spent so little time building a safety net you're going to fall a lot further when you're knocked down by life's shit. In my case the spiral started when I lost my insurance while working an unpaid internship earlier this year but it could really be anything. I take full responsibility for where I am and how I got here, but it's definitely more difficult to rebuild when your foundation is made from very little.

It's interesting to look at my friends who I was using hard drugs with say 15 years ago, where they are today. Some replaced heavy drug use with heavy drinking. Some continued to use and are in a constant battle with the getting clean/relapsing/getting clean/relapsing loop. Some are dead. Some definitely grew out of it, letting other aspects of their existence push out and replace the drugs in their lives. Some got clean with the help of treatment programs and/or 12 step systems. And of course I have no idea where some are today.
posted by item at 9:15 AM on October 1, 2014 [12 favorites]


That person literally cannot emotionally tolerate going a day without alcohol. I have met plenty of pot smokers like this too.

i used to be one of those pot smokers - then, at 38, i got married to someone who wasn't about to tolerate being around that, so i quit, without assistance and have stayed there, even though i've been divorced for 10 years

kind of odd, seeing i was a heavy dope smoker for 20 years, but, that's how it is - aside from getting married, the other motivation for me is that i just seemed to be thinking clearer and got to where i preferred that
posted by pyramid termite at 9:19 AM on October 1, 2014


That's kind of saying anyone who breaks an addiction isn't an addict?

Not at all. It's saying that not everyone who abuses drugs or alcohol is an "alcoholic" or "addict".
posted by thelonius at 9:30 AM on October 1, 2014 [2 favorites]


The idea that it is a learning/development disorder is interesting; people that I know that continue to display addictive behaviour in their thirties and forties often display other maladaptive "immature" behaviour in relationships, responsibilities, and work ethic, along with difficulty in long-term planning/delayed gratification. I don't mean in the sense that ALL of their life revolves around scoring the next hit, but that choices they make are, for lack of a better word, not methodical. As item points out, the support network for a twenty year old "screw-up" is generally more robust than a fifty year old that has a never stayed in a job more than six months and caused so much heartbreak to the people that love(d) them. I hope you, item, find some support to get your feet back under you and I wish the US offered support to help people help themselves.
posted by saucysault at 9:58 AM on October 1, 2014 [3 favorites]


Not really, no, thelonius. "the ones who stick with it, are the addicts" is saying that if you quit, you weren't an addict. Which is tautological at best.
posted by feckless fecal fear mongering at 10:03 AM on October 1, 2014 [1 favorite]


people that I know that continue to display addictive behaviour in their thirties and forties often display other maladaptive "immature" behaviour in relationships, responsibilities, and work ethic, along with difficulty in long-term planning/delayed gratification.

There's a bit of a chicken and egg question here. Do people who are more challenged around emotional development seek out drugs to help ease that discomfort, or do people who take a lot of drugs never build these skills?
posted by latkes at 10:08 AM on October 1, 2014 [1 favorite]




I'm excited to read this because I think this field is fascinating. I'd heard about the idea that one can grow out of addiction before and that a lot of addiction is environmental, with the example of the soldiers in Vietnam who became addicted to opium but were fine when they returned to the U.S. even though people consider heroin addiction to be especially difficult to escape.

There are so many things we think we know about addiction. I watched the show Intervention and the premise was that people need to hit rock bottom so the interventionists would bring the bottom to the addicts. But if addiction is a disease, why would you wait until it had progressed significantly before doing something about it? That's not how we treat other diseases.
posted by kat518 at 10:20 AM on October 1, 2014


A friend posted the following on Facebook:
This is one reason why the narratives people construct about their own lives can be misleading. Many people who did dangerous things (stealing, drugs) in their youth attribute their turnaround to a very specific thing that happened to them, including being in an institution like the military or prison. They might be right about their own lives, of course. But there is an interesting disconnect between that kind of individual account and the fact that *most* people engaged in those behaviors will age out of them in due time.
posted by grobstein at 10:26 AM on October 1, 2014 [2 favorites]


I shy away from pathologizing a behavior that isn't causing measurable harm. On the other hand, a daily requirement to use a substance sounds like dependency to me.

Continuing action in the face of increasingly negative consequences is the definition I've heard. A professional poker player that makes a living doing it is not a gambling addict.
posted by empath at 10:39 AM on October 1, 2014 [4 favorites]



What would the stats be for people who have developed a serious alcohol addiction in their late 20s or their 30s? I imagine that numbers would be different, and that we couldn't say that "most simply grow out of it". I'm just guessing here.

Perhaps alcoholism is more of a "learning of developmental disorder" in young people, as the author believes, but that it's not really true for older people? It just seems to me that some alcoholics definitely have NO chance of growing out of their addiction.



First, thanks for making an FPP from my article!!!

Just wanted to note this here. Very few people develop an addiction "de novo" in their 30s and 40s or later (and overwhelmingly, addictions that develop during the 20s start in the teens) . If you look at the history of people who *appear* to become addicted without having had a problem during adolescence and early adulthood, whether with pain meds or with alcohol or benzos, you'll generally see that this pattern didn't just occur for the first time at this age, in about 99% of cases. Addiction is so heterogeneous that, of course, it does occur sometimes.

But mostly, it doesn't happen for the first time late in life because by that stage of life, if you *haven't* previously escaped your problems via addictive behavior, you have alternative ways of coping and you have learned to use them and so even when you are faced with a very pleasurable option and the rest of your life isn't so hot, you don't develop that compulsion around it.

As you get older, learning new things—including addiction— is just harder to do. Doesn't mean it can't happen, but it's rare. If you have a past addiction, however, and you fall onto hard time and haven't been able to develop real alternative ways of taking care of yourself, you are definitely at risk.

And yeah, best definition of addiction is compulsive use despite negative consequences: physical dependence is neither necessary (doesn't occur with cocaine: you don't get sick if you quit, you just crave it a lot) nor sufficient (you can be physically dependent on food, air, pain meds, antidepressants, blood pressure meds and not be an addict ever).
posted by Maias at 10:51 AM on October 1, 2014 [26 favorites]


people that I know that continue to display addictive behaviour in their thirties and forties often display other maladaptive "immature" behaviour in relationships, responsibilities, and work ethic, along with difficulty in long-term planning/delayed gratification.

I agree with this observation - it tallies with my own experiences. I have known some people - mostly women - who developed drinking problems in their 30's and older, never having been problem drinkers before. Almost all have been married with kids. They were unhappy in their marriages and/or with being mothers, but "didn't believe in" or "didn't think they needed" therapy, medication, or even better coping mechanisms. Everything was the fault of their awful husbands, terrible jobs, or naughty/disappointing/overly demanding kids. So they crawled into a bottle to escape.

Of course, some of them WERE married to assholes, were stuck in bad jobs in order to pay the bills, or had challenging children. But the methods chosen to deal with this were, to say the least, ineffective and damaging to themselves and their families.

I believe that they had dysfunctional coping mechanisms to begin with - denial being a major one - but when they were single, it didn't matter as much and/or they had fewer stressors. But when marriage and, especially, children, came along, they found themselves trapped in situations that called for a much higher level of responsibility, maturity, and functional coping strategies than they had developed; and they couldn't or wouldn't seek help from professionals or develop more functional ways of dealing with their lives.
posted by Rosie M. Banks at 10:58 AM on October 1, 2014 [2 favorites]


maias: As you get older, learning new things—including addiction— is just harder to do.

Finally -- my loss of brain plasticity has a silver lining!
posted by wenestvedt at 11:03 AM on October 1, 2014 [5 favorites]


I am really glad to see this, because I am not a fan of the AA type ideas about addiction. But I think viewing it as a developmental disorder misses a few things. I don't think it is flat out wrong, but I does seem to oversimplify it as "you were just immature and that's why you did this bad thing." I don't want to pull out a bunch of quotes, so I will just go with this one here:
But if addiction is seen as a disorder of development, its association with age makes a great deal more sense. The most common years for full onset of addiction are 19 and 20, which coincides with late adolescence, before cortical development is complete.
So, in other words, you hit legal adulthood at age 18. A lot of kids get little or no opportunity to really practice the kind of decision-making you need to do as an adult. Problems with the parents of some sort are all too common. I think this hypothesis kind of misses the fact that for many people, turning 18 is the point at which they have the opportunity to exercise enough free will to do something really screwy. It also isn't uncommon for people to, say, go off to college at age 18, have no idea how to self manage because mom and dad dictated so many things, and they eat crappy diets and they have terrible sleep habits and, unsurprisingly, they make terrible grades their first semester or first year on their own.

My dad drank heavily when he was career military. He swore off alcohol about 4 years after he left the military. I was seven when that happened. I do not remember ever seeing him drink to the alcoholic levels that family stories describe over and over again. He fought in the front lines of two wars. I think he drank to help him sleep at night because it helps suppress dreams (in his case, nightmares). I think after he left the army, he tapered off without really planning on it. By the time he decided to blame his health problems on alcohol, I think he wasn't drinking all that much anymore. I remember him having beer with dinner when I was around 4 years old or something but I don't remember there being beer in the house just all the damn time when I was around 6 or so. But family stories indicate my mom bought him a case of beer every weekend at some point in time and if he ran out of beer on Wednesday night, he accused her of drinking his beer -- which is ridiculous because my mom throws up if she drinks alcohol. She never touches the stuff.

I also recall reading an article about a young man whose brother was murdered or died in a gruesome car wreck. He was about 16 when this terrible thing happened and he began drinking heavily. Then when he was 18 or 19, he sought help for his drinking. Everyone was saying he was an alcoholic and that is the identity he went with. It seems to me he was horribly traumatized and then, two or three years later when the hurt was not so fresh, he was ready to try to sleep without needing alcohol to suppress his nightmares.

Those are just two examples that I know of. I think there can be reasons other than psychological trauma. I have also read that some people drink less as they get older because it just doesn't have the same payoff as when they were younger. So I think there is a physiological component as well.

Anyway, nice work. I am not a fan of the disease model of addiction. But I also would hate to see it oversimplified in some other direction. So I am hoping I just didn't get the full picture because it's just on article, apparently out of a body of work.
posted by Michele in California at 11:37 AM on October 1, 2014


Maias: very interesting point about addiction being harder to learn as an older person.

I'm curious since we have you here: I work with long-time (decades) users who do have a chronic presentation around substance abuse/use. What is the interesting research and analysis I can read about this population?
posted by latkes at 11:42 AM on October 1, 2014


Re the definition of addiction, there's still a ton of subjectivity here. Many users would state there is no harm from their behavior while outside observers might disagree. To me there's just a wide, wide gray area.
posted by latkes at 11:47 AM on October 1, 2014 [1 favorite]


Not really, no, thelonius. "the ones who stick with it, are the addicts" is saying that if you quit, you weren't an addict. Which is tautological at best.

I mainly do not believe that "half of all people who qualified for active alcoholism or addiction diagnoses during their teens and 20s no longer do", is meaningful. Plenty of treatment types consider high school or college binge drinking, for example, to be enough for an "addiction diagnosis". I really think a lot of non-addicted people get lumped in to these statistics.
posted by thelonius at 11:55 AM on October 1, 2014 [1 favorite]


Hi, my name is theinsectsarewaiting and I am an alcoholic. I've been in AA for three years. No relapses. I know that if I drink or use again it's going to take me a long time to come back. If I come back at all. It's not a cure, it's a treatment.

I was a classic binge drinker in my teens and 20s. I'd drink until there was nothing left. I was never able to completely quit drinking for more than 3 months. I once drank until I threw up blood. Then when I was 29 I decided to quit for good. Sort of. I'd just smoke weed, because how much trouble can you get in smoking weed?

Turns out an untreated alcoholic can get themselves in quite a bit of trouble. There are a lot of ways to die in this world. When you smoke every chance you get, every day, you can eventually die a spiritual death. I was never able to stop smoking for more than a couple of months, and I was only able to do that once in 8 years. It was an addiction, plane and simple. I'm an addict. I was going to get addicted to something.

So, when I'd finally had enough I walked through the doors of AA.

I've heard all this before: it's a cult, it doesn't work, it's ideas are flawed. But it works for me. And a lot of people who were a lot worse off than me.

I am never going to grow out of my addiction. Not ever.

If you can, fantastic. More power to you.
posted by theinsectsarewaiting at 12:28 PM on October 1, 2014 [7 favorites]


I really think a lot of non-addicted people get lumped in to these statistics.

How do you distinguish between a college kid that binge drinks multiple times a week and eventually stops from one who doesn't, before one of them quits drinking?
posted by empath at 12:36 PM on October 1, 2014 [3 favorites]


I think a mistake a lot of people make about a lot of psychological diagnoses is that they think that the diagnosis is an inherent property of the individual, rather than a description of their behavior at some point in time. An addict is a person that engages in addictive behavior at some point in time. If they stop addictive behavior, they're no longer an addict, even if they were at some point in time.
posted by empath at 12:42 PM on October 1, 2014 [4 favorites]


empath - of course there is no way to distinguish that. I'm getting more and more skeptical that any research like this produces really reliable knowledge. There is just so much cultural pressure to promote vague findings to the category of science. If I knew how to do better, I wouldn't be typing here, probably: I'd be working on research.

Looking a little deeper, it seems that what they relied on here was the DSM-IV. If people fit at least 3 of these 7 categories, they were diagnosable as alcoholics or addicts:


Dependence or significant impairment or distress, as manifested by 3 or more of the following during a 12 month period:

Tolerance or markedly increased amounts of the substance to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount of substance

Tolerance or markedly increased amounts of the substance to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount of substance

Withdrawal symptoms or the use of certain substances to avoid withdrawal symptoms

Use of a substance in larger amounts or over a longer period than was intended

persistent desire or unsuccessful efforts to cut down or control substance use

Involvement in chronic behavior to obtain the substance, use the substance, or recover from its effects

Reduction or abandonment of social, occupational or recreational activities because of substance use

Use of substances even though there is a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

source

That is more solid sounding than what I was imagining, which is, for example, considering anyone who has ever, say, been arrested for underage drinking to be an alcoholic. But I'd still like to know more. Of the spontaneously improving population, how many categories did they meet? Which ones? Are there differences between those people's diagnostic profile, and the people who didn't improve?
posted by thelonius at 1:04 PM on October 1, 2014 [1 favorite]


So this is one more damn thing that we have to wait for the prefrontal cortex to finishing growing to be done with, like youthful impulsivity and bad judgement? *sigh*

But I need it now

slams three tequila shots in quick succession
posted by kagredon at 1:58 PM on October 1, 2014


I find the popularity of AA in the US quite interesting, it is nowhere near so popular elsewhere in the world. For example, here in Australia it exists, and there is awareness of it, but I don't think anyone would recommend as a default to an alcoholic, if at all - and we have an alcohol problem as a nation. People here would recommend doctors, counselling, treatment centers.

I can't help feeling part of this is the difference between having a functioning welfare state with support networks and having a grim charade, but I also feel there's something more to it as well.

I wonder if part of it is America's general championing of the "self made man" myth, that individuals should help themselves, coupled with a history of scepticism of the state and state interventions and a higher religiosity in the population. I definitely think there's a cultural aspect to it, something about AA resonates with Americans, that's for sure
posted by smoke at 4:28 PM on October 1, 2014 [3 favorites]


On further reflection perhaps it is also to do with the perception of alcoholism as a medical problem vs a character problem or trait. A category thing where a non medical, non expert setting would be viewed as inappropriate.

Many in our society, as ever, are of course trying to reframe addiction as a moral and character issue rather than a medical one, but thankfully their impact on policy is usually more in favour of an uneasy detente between research/experts and public expectations around "punishment".
posted by smoke at 4:35 PM on October 1, 2014


smoke, it might also have to do with the history of America as a place for people who wanted religious freedom. Australia started as a penal colony. People didn't go there to pursue their faith without persecution. As I understand it, America is fairly religious compared to a lot of countries. Also, as I understand it, AA was originally started by a small group of folks who were literally hospitalized because alcoholism was killing them and they just could not stop and, for them, giving it up to god worked where nothing else had. But these were people who had been drinking heavily for decades.

So I think the AA model started as a religious model and America is a fairly religious country (as far as I know, Australia is not). There are no doubt a lot of other factors but I think that's most likely one of them.
posted by Michele in California at 4:48 PM on October 1, 2014 [2 favorites]


I stopped drinking when I was 22, 41 years ago. And I don't see any particular reason why I should drink again. What's the point? To somehow prove that I'm not addicted, I suppose, but to whom for what reason? And I rather like AA, which isn't particularly religious where I am and is full of entertaining characters who are all fumbling along getting through life. It seems to work just fine if that's what floats your boat, at least from the evidence of all the people who've been around and not drinking for a decade or two. I'm always rather amused by the people who declare that AA is this or that or believes this or that. Go to a different meeting a few blocks away and you'll find something rather different.

I stopped going to meetings for a long while because I got busy (work, family, taking care of a dying mother, traveling), but last year I was feeling itchy and wondering what hobby I should take up that would get me around other people outside my sport and my work. And there it was.

Honestly, I'm not sure my addiction would have gone away by itself soon enough for me to survive, and I'm still the kind of person who gets addicted fast. I'd rather be addicted to QuizUp or oatmeal raisin cookies because I kept getting in trouble when I was drunk but cookies just feed my spare tire. And at least in QuizUp, I can improve my knowledge of useless trivia.
posted by Peach at 5:19 PM on October 1, 2014 [1 favorite]


While one person dabbles in drugs with few ill-effects, another will become a chronic addict. What's the difference?

"What I began to realise was that most chronic addicts are not just addicts. They also suffer from other psychiatric disorders and come from backgrounds of adversity and deprivation, both economic and emotional. We need to think seriously about what drugs and alcohol do for people who find themselves in these circumstances.

The majority of addicts can control their use when they have a powerful enough reason, and are able to choose to quit if they want to. It’s only a small minority for whom addiction is a chronic condition — something they never overcome, and might even ultimately die from.

Who is this minority? Strikingly, they are usually people like Sarah, who suffer not only from addiction, but also from additional psychiatric disorders; in particular, anxiety, mood and personality disorders. These disorders all involve living with intense, enduring negative emotions and moods, alongside other forms of extreme psychological distress. Moreover, these disorders are in turn also associated with various forms of adversity, in particular low socio-economic status, childhood physical and sexual abuse, emotional neglect, poverty, parental mental illness and parental death, institutional care, war and migration. There are, of course, individual exceptions to these large-scale generalisations. Yet the minority who never overcome addiction typically suffer from additional psychiatric disorders and come from a background of adversity and poor opportunity. They are unlikely — even if they were to overcome their addiction — to live a happy, flourishing life, where they can feel at peace with themselves and with others.

Caged, isolated rats, when addicted to cocaine, morphine, heroin and other drugs, will self-administer in very high doses, foregoing food and water, sometimes to the point of death. But when placed in a spacious, comfortable, naturalistic setting, where both sexes can co-habit, nest and reproduce, these rats forego drugs and opt instead for food and water, even when they experience withdrawal symptoms. Recent well-controlled experiments support this early finding. The majority of addicted rats will choose not to self-administer drugs if provided with alternative goods. In other words, if we give addicted rats the option of a happy, flourishing rat lifestyle, they take it.

But the minority of addicts for whom addiction is a chronic condition are not given the option of a happy, flourishing human life just because they stop using. In the meantime, using drugs or alcohol might offer some relief from life’s miseries. This function is common parlance in our culture: we ‘reach for the bottle’, ‘drown our sorrows’ or get ‘Dutch courage’ when in need. For addicts who suffer from additional psychiatric disorders, drugs and alcohol offer a way of coping with the extreme psychological distress, as well as an escape from the broader hardship of life. And of course, distress, and hardship are made worse by the addition of addiction to their list of struggles. Yet without any real hope for a better future, there is unlikely to be any genuine long-term incentive to give up the short-term relief on offer through using drugs. To return to Sarah’s story, imagine what her life would look like without heroin — the emotions and moods she must live with, the loneliness and anger, the self-harm, the problematic relationships, the utter lack of any self-esteem or hope for the future. Does this life give her any reason to quit?"

posted by jenfullmoon at 10:26 PM on October 1, 2014 [7 favorites]



I mainly do not believe that "half of all people who qualified for active alcoholism or addiction diagnoses during their teens and 20s no longer do", is meaningful. Plenty of treatment types consider high school or college binge drinking, for example, to be enough for an "addiction diagnosis". I really think a lot of non-addicted people get lumped in to these statistics.
posted by thelonius at 11:55 AM on October 1 [1 favorite +] [!]


Nope, because this was a *community* sample and the diagnoses were done by trained interviewers using DSM criteria— not by treatment providers, who, as you say, will often diagnose anyone who meets the wallet biopsy criteria [AKA can pay for treatment somehow].

Regarding the role of trauma and circumstance, I absolutely believe that early life trauma and environmental social conditions (as in Rat Park, which I have written about numerous times) play important roles. But they do so in a developmental context: people who get traumatized as adults without prior childhood trauma or prior addiction rarely become addicts as a result. The role of development is crucial both in the effects of trauma and the ways people cope with it. If you get traumatized as an adult and have developed coping skills earlier in life, it's a very different thing from if you get traumatized as a child and then start self medicating.
posted by Maias at 7:09 AM on October 2, 2014 [2 favorites]


Btw, for those who want to know what I think about AA, I've just written about it here.

TLDR, it's great for those who find it great, should never be forced on people or sold to people as treatment.
posted by Maias at 7:12 AM on October 2, 2014


Maias,

What coping skills do non-addicts have that addicts lack?
posted by nooneyouknow at 7:17 AM on October 2, 2014


You know, I have to say that this thread, and discovering maias' articles are very happymaking. I feel a lot more hopeful about a future where executive function disorder diagnoses, coupled with occupational therapies and a healthy approach to meds, could save HUGE numbers of developing adults from decades of self-organized hell.
posted by drowsy at 10:03 AM on October 2, 2014 [4 favorites]


Nooneyouknow, that's a great question. I think it varies depending on the developmental path to addiction, of which there are at least four major ones. One is primarily via childhood trauma, the other is through psychiatric disorders and the third is through impulsivity and personality disorders. Another is probably via poverty and obviously, some people have more than one major contributor to their addiction.

So, if you have trauma, you need to learn how to cope with emotional pain. If you have anxiety, depression or other psychiatric disorders, you need to manage those symptoms. If you are impulsive or have antisocial personality disorder, you need to manage that and if you are poor, you need to either find a way out or a way of making meaning without drugs in that situation.

Everyone doesn't need all of these skills because everyone doesn't have all of these problems— so you need the ones in the area of your greatest weaknesses, basically. I am compulsive, not impulsive, for example— so training me on getting thrills in different ways wouldn't have been much good. But I definitely could have used cognitive behavioral techniques to avoid rumination and self hatred. And there are now prevention programs that aim to give these skills to exactly the kids who need them by basing their approach on the kids' personality traits.

The most important coping skills I think everyone needs are those involved in managing relationships because strong relationships are the best antidote to most mental health problems (though some will require medication as well).
posted by Maias at 2:28 PM on October 2, 2014 [6 favorites]


Why would poverty matter so much? I feel like I know as many (or more) well-to-do addicts as poor ones. They just don't end up in the court rooms and their addictions are often expensive (liquors, wines) and/or doctor-prescribed.
posted by small_ruminant at 3:05 PM on October 2, 2014


Maias,

Are you an alcoholic or an addict yourself? In other words, do you have any personal experience with alcoholism or drug addiction?
posted by strelitzia at 3:46 PM on October 2, 2014


Did you read the article?
posted by empath at 3:49 PM on October 2, 2014


Just realized she was talking about herself at the beginning, instead of someone else. My mistake. However, her experience is different than other people's.

My issue is that to make a blanket statement saying that it is not harder to stop using as you get older (disputing the progressive nature of alcoholism) is only her opinion based on her experience. It is not everyone's experience. People die every day from alcoholism and drug addiction because it is harder to stop as time goes on and as the individual gets older. That has been my experience and the experience of a lot of other people.

Not trying to be contrary, just sharing my experience. If maias has a different story, then so be it. But it doesn't make it the only truth.
posted by strelitzia at 3:59 PM on October 2, 2014


Maias doesn't have a different story, though - she has a massive piece of research, and the good grace not to forget outliers. For what it's worth, my experience is that it becomes easier to become reflexive about and redesign self-abusive habits as time passes. My experience is largely about booze, dope and nicotine, though.
posted by holist at 11:17 PM on October 2, 2014 [1 favorite]


Atrelitizia, read the links for the citations!!! The data says that on average, the same proportion of people with addictions quit in any given year. That means that it doesn't get harder over time— otherwise, you would see a smaller percent quit in latter years of addiction.

So, no, nothing in that piece is my opinion based simply on my experience. It's my opinion based on a 25 year immersion in the data as well as my own personal experience and interviews with hundreds of people with addiction. If I were to base the article on my experience alone, I would have been making a disease model/treatment is necessary argument, in fact ;-)

Oh, and regarding the earlier question about poverty, poverty matters enormously because it is hugely linked with high risk for early childhood trauma and massive exposure to status stress. Status stress, which is linked to being on the bottom of a hierarchy in a hierarchical species, increases risk for virtually all mental and physical illness, including addictions, because stress increases inflammation and lowers immunity. Only exceptions I know of are some cancers like breast and prostate cancers, which hit rich and poor equally or may even be higher in rich. No one knows why— work of Michael Marmot, Bruce McEwen and Robert Sapolsky is the basis for the status stress stuff for those who are interested.

Inequality increases addiction risk and lowers public health in general by magnifying status stress. I wrote a little about it here, and there's a whole chapter in my book Born for Love: Why Empathy Is Essential— and Endangered on this.

That said, the *extremely* rich seem to have a higher risk than the middle class for addiction and it may be as high as for the poor in some cases. This is because work and structure give a lot of people meaning in life and having everything you want and no structure can be as divorced from meaning and purpose as being able to get nothing and having no structure. Of course, for the rich it is a lot easier to recover, because they have more resources and options— and the middle class obviously have this advantage over the poor as well. Recovery rates are strongly linked with employment and education.
posted by Maias at 6:04 AM on October 3, 2014 [4 favorites]


(disputing the progressive nature of alcoholism)

What does this mean? It certainly causes progressive damage to your body, mind, relationships, etc, if you don't quit, but the evidence seems to be people do quit, for the most part. I think you're basically looking at survivorship bias here, where people think that alcoholism inevitably leads to an early death by cirrhosis and endless relapses, because the alcoholics that everyone notices are the ones that don't quit.

I think the take away here is that there are a lot more addicts out there than people realize and that the vast majority of them eventually quit on their own, without intervention.
posted by empath at 6:34 AM on October 3, 2014 [1 favorite]


In my own observations, personality disorders and childhood trauma seem to be key in why some people never outgrow their addictions, and why there are some people who seem to fall into addiction in their 30's and older. Every single person I've known who has not outgrown addictions has had those factors - always a personality disorder, and usually childhood trauma as well.

The people I have known who "suddenly" become alcoholics in their 30's had arranged their lives so that their anxiety/depression/etc. was kept in check - usually through structure, order, and ample sleep, leisure, and "me" time. And those coping skills worked fine as a single or a childless couple. But when these people had babies - no more tranquil, orderly adult life with lots of leisure and fewer expenses. The parents could not cope with the stressors inherent in having kids, and out came the bottle. Therapy and/or medication that could have taught the parent(s) to cope in a constructive way was either not available at the time (pre-90s) or Out Of The Question, Not An Option, My Life Sucks And My Kid Is A Brat And So I Need A Drink Or Six. Honestly, I don't think these people should have had kids without going into therapy and/or seeing a p-doc for meds - but then, everyone is supposed to want kids, and kids make everything better, or so the culture tells us. I think a lot of people are not well-prepared for what having kids is really like - but most parents adjust. Unfortunately, some just can't (or, worse, won't).

In my experience, people can jury-rig coping skills and create a functional life - as long as it's not upended by more intense demands (such as what kids create). But when that life is up-ended the jury-rigged coping falls completely apart and the addictions spiral out of control.

the *extremely* rich seem to have a higher risk than the middle class for addiction and it may be as high as for the poor in some cases. This is because work and structure give a lot of people meaning in life and having everything you want and no structure can be as divorced from meaning and purpose as being able to get nothing and having no structure.

I wonder if there's a sense of impunity contributing as well - "I don't HAVE to give up my addiction because my wealth and power will smooth the way for me no matter what." I surmise this might be the case with some non-wealthy addicts too - they are so enabled by families and friends, or they just plain do not CARE how much anguish it causes their families. This would fall under the "personality disorder" umbrella.
posted by Rosie M. Banks at 11:44 AM on October 3, 2014 [1 favorite]


I gave up being an alcoholic, it was surprisingly easy. You just kind of...stop drinking so much. Now it's a couple of beers a month at the absolute max (which usually means six beers once every three months).
posted by turbid dahlia at 4:50 PM on October 6, 2014


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