Drug addiction: The great American relapse

There is a difference: alcohol can kill you in various ways, both acute and long term. Heroin can too, but by knowing what you're getting and your own tolerance you can avoid overdoses and then the side effects are pretty mild (constipation).

A quote I like to fall back on is the one from Portugal, which no longer has (edited) criminalized substances.

"If you realize addiction is simply a symptom of a deeper underlying mental illness. Treat the illness, you solve the addiction."

But yes there will be addicts.

The critical point in my suggestion above is that heroin at any rate is not legalised in general. It is only made legal for it to be supplied to support addicts at registered non profit treatment centres. This is actually pretty much the law at the moment in the UK - heroin can be prescribed legally by doctors, but there are still issues in getting it done. The alternate policy of tolerating illegal heroin use such as practiced in Amsterdam at times has many problems - you get the criminal dealers, the parks full of junkies who steal stuff to buy the drugs and so on.

What's interesting is that the USA has very high rates of drug abuse, illegal and prescription drug abuse, despite having very strict laws and harsh punishments for drugs (it varies by state, but generally).

The lesson is that the harsh punishments don't solve the problem.

Drug addictions should not be blamed on the addict, there is still a huge problem here. I think they can be treated if they are accepted, the addiction approached like a mental disease, with counseling and honesty.

But legal alcohol did work to make it far less dangerous and remove the organized crime effect

If misery causes drug abuse, like it seems to do, then obviously making misery more rare is the solution. Legality is one easy step towards that goal, other steps include societal acceptance (i.e. drug users not immediately being regarded as worse people) and increased wealth.

> However, I don't think this is a "fix" any more than legal alcohol is a fix for alcoholism.

Is it too much of a stretch to suggest that legal alcohol IS a fix for alcoholism, at least if you're speaking of the sort of alcoholism that might exist is a world where alcoholics are all destitute and social pariahs? I think we live in a world where many functional alcoholics exist, for better or for worse. But I would rather have more functional alcoholism and legality, than live in a society that views alcoholics as criminals and condemns them to destitution.

In the same way, while i dont necessarily want more heroin addicts, i think i want to live in society where functional heroin addicts can lead the semblance of a normal life as we coolectively sort out how to help them recover.

Don't forget Canada.

I've thought similar things but came to a slightly different conclusion.

Let people buy and use heroin legally, but make the process like the DMV or a welfare office. That is to say, it takes hours, it's boring and uncomfortable, you can't play on your phone, and is so lacking in romance or mystique that it could be a synonym for mundane inanity. Plus they can only get a limited amount at a time and there is a cooldown period.

I've had leftover opioid painkillers from surgeries and I can see how easily this could turn into a gateway. I often feel simply lucky that oxy et al wasn't prevalent when I was 16-24yrs old, as I'm sure I would have encountered it. And as a new father I am also worried what kids will be up to in 10-15 years if we can't learn from experiences like yours. So again, thank you - I really appreciate your story.

The point on stigma is a hard one.

On one hand, I see your point. There's a lot of merit in allowing various mental and emotional illnesses to be treated as illnesses rather than moral failings.

On the other, this seems orthogonal to the AA/NA approach. "I am an addict. I am no different from other addicts." Own the problem. Make it your primary mission. Many members give "recovering addict" a very central place in their identity.

Do you think it's better to encourage addicts embrace the label or allow them to wear it lightly?

Also, regarding the "drug culture." I don't know much about the heroin culture but the prescription painkiller culture seems to be very different. Recreational users seem to treat it like a party drug. A lot of addicts seem to treat it like medicine. There's an obvious compulsiveness to it, but it's not incompatible with a normal life the way heroine seems to be. I don't know if it's mostly stigma and culture or properties of the actual substance, but using heroin and going to work and then picking up the kids seems like a total contradiction.

I know as a smoker that smoking and exorcise (and healthy eating) feel incompatible. If you do this self destructive thing 10-20 time a day, going into a gym or playing soccer seems ridiculous. This is something that changed over the last generation. In the 50s, you could see professional athletes take smoke breaks between training sessions. But now, with the current cultural treatment of cigarettes, relapsing on smoking usually means relapsing on exercise too.

Again, I think there's a contradiction between AA/NA approach and another approach. One is to encourage the oxy culture in heroin. Shooting heroin doesn't mean your whole life is derelict. The NA/AA approach is the other way, oxy addicts need to see that they're addicts just like the bum with a needle in his arm. Thoughts?

> Social stigma is a huge problem. The people who won't get help because "A bum sitting under a bridge with a needle in his arm, robbing houses to feed his addiction," c.f. the article, is what people think of when they think of heroin. There are people who won't seek help out of fear they will be thrown away by society.

True, and as a side point it's sad that people are willing to discard the person under the bridge any more than the person in their middle-class neighborhood. The person under the bridge is far more vulnerable and more likely to need help.

> Don't care whether they live or die? Kind of moralizing a bit there.

I mean if you look at the research, it's the same childhood factors that predict both drug abuse and suicide, e.g. the Adverse Childhood Experience study.

Not really, but it depends on your definition of alcoholism a lot. For example, if you treat every alcoholic as "alcoholic for life, with some of them sober" it makes sense.

Yes, Opiates can, amongst other things, Make you feel strong and confident, a state of mind free of social phobia. Opiates can also have quite a lot of side effects, such as a drunken, drowsy feeling, nausea etc.

There are drugs that may what you want. MDMA in particular can really reduce social phobia significantly. In some cases MDMA can even cure social Phobia. It does have side effects too. Amphetamines also lower inhibitions, as well as stimulate dialogue.

I believe addiction potential is more closely related to your reason for doing the drug and your economic status. If you are doing a drug to escape from a bad situation for example, you are likely to become dependent.

heya, just as a personal message, and not knowing your situation at all, I just want to encourage you to be creative and practice going from social anxiety to typical amounts of social comfort without meds... There are dozens of techniques out there, so give them all a try, from meditation to exercise, encouraging youtube videos, to diet changes, etc. Above all, don't be afraid to make mistakes... it's rather a trap for many of us to cease taking the small risks that lead to mistakes once we attain a niveau of success, but small mistakes are the propulsion that maintains that success.

For example, I've been huffing and puffing about learning Javascript since it first came out, mocking it, only seeing the bad sides. Then I got stuck in the loop of hoping it would go away and trying to rationalize not knowing it. When I started to come around, I felt embarrassed because I knew my code would be baby code and I would do lots of dumb things. But I'm pressing forward, trying to modify mapHighlight to do what I need it to do and I no longer give a shit about haters.

Yes, maybe someday people will make fun of me, but by that time, I'll be skilled enough that I'll have thicker skin. When you take the long view, you see that people mocking you is just a test to see where you are. In the case of bullying, it goes too far, but in general, testing one another to see if we're still emotionally sensitive to our failures from long ago is part of how human social bonding works. And fear of not being able to stand up to the test can motivate us to take those chances, write that crappy JS code, embarrass ourselves a little bit in front of our co-workers or potential mates.

And finally, most people are astonishingly forgiving and forgetful. Much more than we deserve. Every now and then you'll have that psycho (a trope the media and movies love to push to keep everyone in fear and anxiety) who remembers some slight for his entire life and uses it to levy revenge on someone, but in actual life, no one simply has the energy and desire to sustain a revenge campaign. They're too busy living their own lives. No one cares if I wrote some sloppy C code in 2004 and in 2024, no one will care if my JS is crummy now. And even if someone says anything to me then, it will just be a big joke in the past to me.

So that's my spiel, friend. If you want any more encouragement, it's $400/hour :)

>Huh. I've tried quite a few different meds in the search for a chemical cure for social phobia, and always, somebody eventually suggests opiates as the only thing that will truly act as an "off" switch. (Accompanied by the usual dire warnings.)

I've gone from mild social anxiety to serene confidence in social settings. No drugs.

What helped was treating it as a skill like any other. I was anxious because frankly, I sucked at social interactions. I didn't know how to make small talk, eye contact, and the very fact that I worried about how I was doing made people enjoy talking with me less.

So one by one I identified skills I lacked, and worked to acquire them in small, incremental steps.

For instance, talking to strangers. Start by asking a stranger the time. Then do it a few times. Notice that everything goes well. Once you've done that a few times, you've now got that as a skill.

Interacting with strangers. When you're at a store, make a comment to the cashier about something in the environment. They'll respond. Then you respond with something. Note how they react. Do this a bunch of times and it'll become natural.

Etc, etc. Look at people who are good at social interactions. What are they doing differently? What skills can be isolated and learned?

Anxiety itself can be approached laterally, with meditation. I don't recommend this route, but what worked for me was a major health crisis that forced me to confront death and loss. After that, social difficulties paled in comparison, and I'm not afraid of any social interactions anymore. Mindfulness was what let me get through that time of trouble by growing, rather than shrinking into misery.

What's good about social difficulties is that they are very easy to practice. All around you every day are thousands of opportunities to interact with others. If a skill can be practice, and you can get feedback, then that skill can be learned.

I read a series of anecdotal reports about someone who tried to treat his social anxiety by misting an aqueous solution of oxytocin into his nasal cavity.

Reportedly, it worked beyond expectations once the effective dose was found, but it only lasted for about 10-15 minutes. So he used it before entering a social situation, it lasted long enough to break the ice, and then it stopped working.

While the experiment was to test a single drug, if the initial spray of oxytocin were combined with MDMA, the guy probably could have felt almost like a normal person for the whole evening.