Thursday, January 22, 2015


 a bunch of people have now separately sent me this article and asked me what i thought.

i am so flattered.

*puts on professor doctor hat*

without having read a word of the article, i already thought its clickbait-y, jazzhand-y title was offputting and wrong. there is no one likely cause of addiction. addiction is a bio-psycho-social phenomenon, and no one component is any more important or right or "it" than the others. bio, psycho, and social all interact to create a particularly unfortunate set of circumstances that enable addiction. this isn't news. (or is it? i have so much work to do if it is.)  

as for the rest of the article: i was on board for the first bit (except maybe the drama queen tone). rat park is rad. here it is explained in cartoon form (also rad). but as the author went on to clarify his argument, i started to realize that he is just as sadly biased (manipulative?) as the lessons he's trying to debunk. just as the more common teachings leave out the overwhelming percentage of people who use drugs, sometimes regularly, and never get addicted, just sort of "grow out of it," this account leaves out those who DO. i bet you not ALL rats went back to "having a normal life" after being dropped off in rat park. i bet you some small percentage continued their heavy drug use. or maybe not - study rats are inbred. but if we extended this study to people with greater genetic variability or varied personalities, we'd probably arrive at that result. 

same with the argument about medical vs. street use of opiates. sure, your brain doesn't care if your opiate is "Rx" or "street," the pharmacology is the same, so something other than "chemical hooks" must be at play. but putting aside the differences in route of administration for a minute (street users tend to shoot or snort = faster more intense effects = more likely to result in compulsive use than hospital administration), i disagree with the idea that street users wind up hooked and patients do not b/c one is isolated and the other has a loving home. you'd be surprised what kind of well-adjusted highly-functional individuals come through my research program meeting full criteria for addiction. take the parkinson's patients for example. (hey check it out i just wrote a paper about this.) sweet, cared-for grandparents, all of them. except that some, as a side effect of their medications, developed impulse control disorders that included problem gambling, hypersexuality, and medication misuse. point being: something other than social environment must be at play, too. and if you want to keep talking about patients using opiate meds: this study tested attention to drug cues in well-behaved pain patients (11% of whom, btw, show signs of misuse), and showed that test scores predicted abuse of meds 3 months later. so 1. don't play like all patients are saints, and 2. attentional bias seems independent from social support so, again, consider other factors.

the thing about the nicotine patch? drug isn't the only thing that triggers craving/relapse. cues and stress do, too. you can't patch those out.

the thing about portugal? maybe decriminalization allowed more people better access to treatment programs.

don't get me wrong, i'm not trying to knock this guy's point. in fact i REALLY REALLY like and stand behind his ultimate message of compassion and connection. what rubs me the wrong way is how his "revelation" (*jazzhands*) about social determinants of addiction dismisses other explanations ("chemical hooks," if you will). in my opinion, the answer isn't in dismissing previously championed views, the answer is in integrating them -- including, yes, more attention to socio-economic environment as a legit driver of addiction.

it's like the story of the blind men each touching a different part of an elephant and thinking they can describe the essence of "elephant." this guy discovered "tail" in a world where most people have been taught "trunk." but neither revelation makes the thing we're talking about any less "elephant," y'know?