Drug Addiction Dualism is Harmful, Not Just an Interesting Philosophical Navel-Inspection

Jan 05 2009 Published by under Drug Abuse Science

A recent post from PalMD notes that discontinuation from clinical treatment with modern anti-depressant drugs such as the Selective* Serotonin Reuptake-Inhibitors (SSRIs; Prozac/fluoxetine and the like) can result in unpleasant effects.

When many of the newer classes of antidepressants are abruptly discontinued, there is a constellation of symptoms that many patients experience, including headache, dizziness, muscle aches, and nausea. This isn't one of those "iffy" adverse drug events, for example when a patient treated with a statin complains of a backache and blames the drug. This is a predictable reaction to stopping or skipping a dose of medication.

PalMD then asks a question that is most fascinating to YHN.

In other words, stopping these medications can cause a withdrawal syndrome. Why don't we just call it that? What's with this "discontinuation syndrome" thing?

It all comes back to the stigma associated with dependence on recreational drugs and a persistent misconception that it is all merely "psychological" in nature. The overwhelming connotation of "psychological" in the context of substance dependence is a dualist connotation. In this case the notion expressed quite widely from the average layperson to the medical doctor to certain lay areas of substance dependence treatment (AA for example) that substance dependence is a matter of personal willpower or morality. It follows that all that is wrong with the substance dependent person is a deficit of will or morals and that the solution is to support will-power and moral rectitude.
This is pernicious and harmful nonsense.


scicurious posted an excellent analysis of how we should think about deciding whether or not to call SSRI discontinuation syndromes "addiction" or "withdrawal". It is her usual excellent communication of brain pharmacology. (Which one would think I would be able to do but consistently fail at. Go figure.) While I disagree with her fundamental conclusion, vis a vis PalMDs post/question

Just because there is a "discontinuation syndrome" associated with a drug does not mean that it is "addictive" in the common sense

this may have to wait for another post. What really (really, really) got me exercised was her expression of the classic physiological/psychological dualist distinction.
Long term readers will recall that I've had a go or two at the topic in the past. So I'm kinda primed already, perhaps explaining an impression of being "over the top" on this issue. And I am not really busting on scicurious as hard as she thinks:

Drugmonkey is absolutely right, and Sci considers herself justifiably spanked. So I'm feeling sheepish, and I think I need to try and rectify this situation, and get myself all better in the eyes of Drugmonkey, so I don't have to cower in his presence the next time I see him

Ha! Hardly. It is really hard to write about this stuff in a way that avoids geekery, leverages the existing knowledge base and yet (gently) corrects misunderstandings of the science. For some reason when it comes to behavioral and so-called psychological phenomena everyone is an expert and feels quite free to aggressively challenge scientific findings in a way only cranks would challenge, say, stem-cell findings. Drug abuse seems to feature this in spades, most usually because of an underlying desire to A) personally use recreational drugs, B) deny there could ever be any harm from same and C) rail about supposedly silly and unjustified legal prohibitions. So it's difficult to walk an informative line when blogging sciC, I get it.
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return to hunt
Nevertheless, supporting or continuing the convenient shorthand distinction physiological/psychological to describe lasting consequences of sustained drug (recreational or clinical) exposure has negative consequences when it comes to avoiding or treating those medically, personally and socially significant symptoms. A comment from D. C. Sessions gives us a start:

It took me freaking forever to figure out that those miserable days-long headaches were the result of caffeine withdrawal. The coffee didn't do anything for me except taste good, you see, but if I went without I was wide-awake but the day after I did without coffee I had a killer headache.

Yeah. Except coffee doesn't even taste good, my friend. Coffee and beer objectively taste terrible and smell bad to boot. You have learned to associate those bad tastes and smells with a highly desirable subjective drug effect. This is why you think coffee and beer taste really great, my friends! The brain is really quite a fascinating organ.
Drug addiction dualism poses a problem at the outset in getting the individual simply to recognize that problems that are causing them distress may indeed stem from neurological alterations that are a direct result of their drug exposure. If they do not recognize this, they go for years continuing to use without recognizing that they are drug dependent. They may try to reduce their use or stop altogether without success, leading to feeling dismal about personal failings of will. Family members may reinforce these notions of personal failings and disappointment if they fail to see a substance dependence problem for what it is. It may occasionally be the case that collective ignorance about drug dependence and neuronal plasticity has the most tragic of consequences.
Now, don't get me wrong. I'm not a complete drug-science-Nazi. There are very, very good reasons for the state of common, layperson understanding of dependence. Starting with the central fact that it is only a minority of individuals who sample a given drug that will go on to develop dependence. Reinforced by the fact that some people who consume enough drug over long enough periods of time to cause dependence in majority fractions of the subpopulation (probably) may NOT develop a clinically significant dependence. And cemented by the fact that a dependence problem and withdrawal/craving symptoms not at all obvious to the external observer leading to a lot of denial of the seriousness of the dependence among friends and acquaintances.
The less obvious the symptoms of the characteristic withdrawal syndrome, the less likely a drug is to be taken seriously as causing addiction. This can be because the symptoms are almost entirely covert (limited to subjective craving) or because continued use is cheap, easy and socially encouraged (see caffeine). Despite these facts, dependence on these substances is still a significant lifestyle or health issue for some users of which some fraction can be helped with clinical (not necessarily pharmaceutical) intervention.
There is a familiar and tired history to this which is perhaps not obvious to all. Caffeine and cannabis are addictive substances that cause brain and other changes that result in adverse symptoms when acutely discontinued. Withdrawal symptoms. Remember the seventies and eighties? People thought cocaine wasn't "physically addictive". Harder for me to draw population level descriptions but probably through the fifties, ditto for cigarettes. Patent medicine era of the late nineteenth century? You bet. So for those of you who think that, duh, of course heroin and cigarettes produce dependence of a physiological and medical nature but aren't so sure about the caffeine and cannabis....well, check your history lessons along with the current science.

So what?

Back to the essential point in my objection to drug abuse dualism there are four obvious problems.
First, people who are uninformed about dependence risk/potential will not modulate their exposure so as to minimize dependence in the first place. Here you can think about the sordid history of cigarette dependence. Those of us raised post-sixties scoff about how anyone could have failed to recognize that cigarettes were addictive (particularly when reading the "I didn't know" testimony in those big tort cases of the eighties and nineties) but this is naive. They really didn't know. Lots of people now are unaware that cannabis and caffeine are addictive, the comparison may be helpful.
Second, people who are dependent will not seek out available treatment options. Instead they will try to exert willpower to cut down or quit, only to fail repeatedly. Thereby feeling depressed and helpless and generally bad about themselves....guess what makes 'em feel better?
Third, that people who do attempt to seek care may not be taken seriously by their medical care provider. If such a person believes that the lack of directly observable symptoms like seizure, vomiting, shaking or the like excludes the complaint from further consideration, well, that doctor is not going to be all that up on current pharmacotherapy and behavioral/talk therapy options, now, is s/he?
Fourth, medical insurance will not cover such treatments if it is not commonly accepted that dependence is 1) a medically treatable problem and 2) should receive care like any other** acquired medical problem.
Of course this latter requires legislation to insist that insurance companies comport with logic and science when it comes to parity of coverage for the so-called behavioral and mental disorders. Legislation, of course, requires very overt understanding on the part of the relevant legislators to overcome insurance industry and morality-warrior lobbying. Understanding which is greatly assisted by general understanding of the constituents in that legislator's district. Which means the general public.
This is the very long answer to commenter joe over at Neurotopia :

What barrier to getting "medical help" does making the distinction between 2 different classes of effects, one on the reward centers vs. one that just trashes your body for a time?

UPDATE 1/06/09: leigh has quite a nice description of pharmacological mechanisms that are related to much of the neural alterations associated with chronic drug exposure.
__
*That is a relative concept since almost all compounds which interact with any of the dopaminergic, serotonergic or noradrenergic re-uptake mechanisms ("transporters") have the capability of interacting with all three. The relative affinity and activity to inhibit (or reverse) the function can differ to the extent that we consider the activity of the drug to be "selective" even though it really is not totally exclusive.
**Does the medical care insurance industry refuse to cover traumatic accident care even though we choose voluntarily to put ourselves at risk with recreational vehicles or other pursuits?

64 responses so far

  • scicurious says:

    I love this post, Drugmonkey. And really, it wasn't that I felt YOU spanked me, it's that I read what you said and wanted to bang my head against the desk, because I realized the wrongness of what I said, and realized I should have known this when I wrote it the first time. Dualism is really an old idea, especially since we now know that "psychological" addiction is physical in origin. And I wanted to clear it up because I don't want to perpetuate the old stereotypes of "failure of will", as you pointed out.
    I still say SSRIs are not "addictive" in the traditional sense, but that may be the rats-pressing-levers half of my brain speaking. I feel like there should be a "high" associated with a drug, giving it enough "positive reinforcement" to encourage further use, with "negative reinforcement" from withdrawal driving the furtherance of the cycle. I feel like drugs such as SSRIs give the withdrawal symptoms, but not the rush associated with further seeking. Most people don't notice the drug taking effect at all, and have to be encouraged to continue taking it through the first few weeks until effects are achieved.
    I also want to point out that coffee smells DELICIOUS. I thought this for many long years before I ever drank coffee, and for a long time wondered (and still do), why coffee doesn't taste like it smells. πŸ™‚

  • It took me freaking forever to figure out that those miserable days-long headaches were the result of caffeine withdrawal.

    The last time I quit drinking coffee, I literally felt like I was dying.

  • D. C. Sessions says:

    Except coffee doesn't even taste good, my friend. Coffee and beer objectively taste terrible and smell bad to boot. You have learned to associate those bad tastes and smells with a highly desirable subjective drug effect. This is why you think coffee and beer taste really great, my friends! The brain is really quite a fascinating organ.

    If you say so -- but do bear in mind that there are a lot of different reward mechanisms in addition to "hardwired" preferences for certain stimuli. The attraction of alcohol may (emphasis, may) be related to the fact that a lot of fruits peak their nutritional value at the time they start to ferment. Or not -- but the mechanism would be valid if so.
    In my case, believe or not as you will, I never had any use for the stimulant effect (being a rather extreme "lark") and only learned to drink coffee in specific combinations with certain foods. My totally irregular consumption (plus the fact that the latency from last coffee to headache is about 36 hours) made the connection far from obvious.
    Once I made the connection between caffeine and sleep disturbances and headaches, I switched to decaf. Not missing anything, although there's an annoying tendency for roasters to confuse "decaffeinated" with "light roast," which is bass ackward.
    Bottom line: there is learned behavior based on reward mechanisms other than direct [1] stimulation of brain biochemistry -- the writing and reading of this blog being an example. Referring to those behaviors in terms of "psychology" is a convenient abstraction, just as chemistry is a convenient abstraction for quantum mechanics. It doesn't have to involve dualistic woo.
    The distinction is functionally important, though, because it makes a huge difference in the learning curve. Learned behaviors depend enormously on temporal proximity, so rapid-effect drugs like the amphetamines (and esp. via rapid delivery such as inhalation or injection) are much more readily learned. Conversely, slow-response drugs such as the SSRIs are less readily learned. This shows up in the nontrivial matter of compliance.
    Having children who routinely forgot to take amphetamines may have made me a bit more aware of how complex this can be.
    Everything should be as simple as possible -- but no simpler. Let's not trivialize the relationship between drugs and behavior.
    [1] Again, emphasis. Of course it eventually gets to the biochemistry, but if the chain is long enough it's desirable to abstract it.

  • D. C. Sessions says:

    The last time I quit drinking coffee, I literally felt like I was dying.

    You were. This is Hell, and you're condemned to eternally read Sol's posts.

  • Becca says:

    Sci- I wouldn't be so sure there isn't a rush associated with further seeking (at least with Wellbutrin, which isn't really fair since it's it's playing with norepenephrine and seems to have noticeable effects faster than the straightup SSRIs).
    Anyone who doesn't think caffeine is addictive lives in a very strange world.
    DM- oh it's almost like you're doing it on purpose!
    1) You say "Those of us raised post-sixties scoff about how anyone could have failed to recognize that cigarettes were addictive (particularly when reading the "I didn't know" testimony in those big tort cases of the eighties and nineties) but this is naive. They really didn't know." I don't think this is a legitimate argument. It is obvious smoking is harmful (see below), so to indulge in it at all means you seek it in the face of consequences- one aspect of addiction.
    I refer you (again?) to the words of James I on tobacco smoking: "A custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black, stinking fume thereof, nearest resembling the horrible Stygian smoke of the pit that is bottomless." (emphasis added).
    (He wrote in 1604)
    2) " Coffee and beer objectively taste terrible and smell bad to boot. " I've already heckled you about this before. I'm happy to grant that "we have to learn to interpert coffee and beer to taste good"... but heck, we have to learn to interpert lots of things. Like cheese. Or broccoli. Perhaps everything to some degree (sure, I think chocolate "objectively tastes wonderful", but there are actually differences of opinion on that front [albeit only from sad, twisted souls]).
    My quibbles with these assertions aside, I don't know that, even if we can totally change the meaning of "addiction" we necessarily should do so. I mean, I'm totally in favor of destigmatizing it enough so that everybody gets the treatment they need (and avoids potentially dangerous things). But do a detoxing heroin junkie and a gambling addict need the same treatment?
    More importantly, I'm more afraid that if we totally remove the criteria of "pursuit in the face of consequences to one's live" that we render the word "addiction" totally meaningless. "Like,OMGIluvtxting!itsSOOOadditive!!11" *shudder*.
    I'm not a fan of arbitrary unjustified dualism, and biochemical mechanisms are certainly integrated with behavioral ones. But trying to use addiction in the linguistically lazy catch-all sense may not be helpful at all.

  • Stephanie Z says:

    DM, I'll heartily second everything here except the taste issue (for me). Some of us just like bitter, right down to things like red food dye. Weird, yes, but true.
    Of course, if you can tell me what drug effects I associate with red food dye or unsweetened cardamom, I might change my mind on that.

  • natural cynic says:

    Except coffee doesn't even taste good, my friend. Coffee and beer objectively taste terrible and smell bad to boot. You have learned to associate those bad tastes and smells with a highly desirable subjective drug effect. This is why you think coffee and beer taste really great, my friends! The brain is really quite a fascinating organ.

    Hmmmm, I must be missing something. To me, coffee smells good and tastes bad :
    The withdrawal from SSRIs is sometimes called "brain shivers" and I have encountered the phenomenon more than once. The subjective feelings are momentary nausea and a very distracting feeling that the brain is shape-shifting - as if it were shaking or resizing. Not pleasant. This is accompanied by a dull sensation that is sometimes similar to the first inklings of the flu - faintly achy and definitely not feeling at my best.

  • juniorprof says:

    This is a fantastic and important post, DM. Make sure to get it into compilations for the coming year.
    That is a relative concept since almost all compounds which interact with any of the dopaminergic, serotonergic or noradrenergic re-uptake mechanisms ("transporters") have the capability of interacting with all three. The relative affinity and activity to inhibit (or reverse) the function can differ to the extent that we consider the activity of the drug to be "selective" even though it really is not totally exclusive.
    One of my favorite things to tell students about pharmacology is that drug selectivity is inversely proportional to the number of publications on a given compound. One small quibble though, I think by activity you may mean efficacy (which is completely different from potency).

  • whimple says:

    Except coffee doesn't even taste good...
    This means you've never had quality coffee the way it's supposed to be prepared.

  • tbell says:

    beer, coffee objectively taste bitter. So do many cheeses, and perfectly lovely vegetables. Bitter is only "bad" if your palate is stuck on sugar and sweets.
    Of course I understand that a preference for sweet exists, and engages the reward system when an energy rich food source (nice ripe fruit) has been identified. I also understand that aversion to bitter is an adaptation to avoid certain toxins. But still, the adult palate moves beyond the sweet pretty easily. And I'm guessing there's more addiction to sugary food than there is to broccoli, or aged cheddar.

  • DrugMonkey says:

    I think by activity you may mean efficacy (which is completely different from potency).
    ha, I thought sciC would jump all over me for that. yeah, it's hard to do the colloquial or lay-speak when essentially all the obvious words are used technically as well. any suggestions when one doesn't care to get into efficacy, affinity, potency and all that crap?
    But do a detoxing heroin junkie and a gambling addict need the same treatment?
    The acute withdrawal effects are the most likely to be substance-dependent and therefore no, treatment during detox is going to be very different. Of course, when it comes to drugs we have pretty decent hypotheses about the primary mechanisms. When it comes to pathological gambling addiction? Not as obvious yet.
    It is the long-term aspects of addictive disorders that are most likely to be shared because of lasting disruptions of what seems to be common mechanisms of reinforcement and affect. Who knows? At some point we may actually differentiate addictive disorders on the basis of particular changes in final common reward (or anxiety or ...) pathways.

  • scicurious says:

    Hi Becca! I personally think Welbutrin is an exception, it's an "atypical" antidepressant, and is more of an SNRI (AND it hits dopamine!). And there is indeed a rush associated with it. But I don't know that there is one with a drug like Prozac. I think the onset of effects is so slow that drug seeking and feeling better won't necessarily form a strong connection like with cocaine.
    And yeah, caffeine is TOTALLY addictive. I'm now a decaf girl except for binges at conferences and dissertation writing.
    And Drugmonkey, I just wanted to say this:

    It is her usual excellent communication of brain pharmacology.

    is STILL making me blush! You are awesome!

  • Left_Wing_Fox says:

    But do a detoxing heroin junkie and a gambling addict need the same treatment?
    But that's something we can test for isn't it? If we toss dualism, then the question is whether the biochemical manifestation of addiction is identical between drug addicts and stimulus addicts.
    It's possible that addiction might just be an evolutionary "bug" in our reward system, and the only difference between the rewards from stimuli (gambling, gaming, sex) and drugs is that drugs are much more intense and immediate, and thus more likely to trigger that latent dependency tendency. If that's true, then perhaps the same methods for treating cocaine and Warcraft addicts are identical, after all. It might also be that everything pleasurable is potentially addictive.
    The other option, of course is that there are multiple changes happening in drug addicts that share similarities to stimuli addictions, and the physical symptoms are a different biochemical interaction than the cravings.
    I should look up the state of that sort of research, once I get some time...

  • leigh says:

    a cuppa joe just brought me back to life after a very long day to (wake up and drive home- um i mean-) read this post, DM! at that point i don't care wtf it tastes like.
    man. after all this discussion i feel the urge to write a basic receptor pharmacology post... my most absolutely adored subject! i needed a good stimulus to put up something more sciencey. i'll get on that tonight after i crank out some more of my own science.

  • Hector M says:

    I vehemently disagree with the notion that cannabis is an addictive substance. I have smoked marijuana daily for months and quit cold turkey for at least a month with no withdrawal symptoms whatsoever, in stark contrast to my experiences with caffeine and nicotine. All of my close cannabis using friends report similar experiences. You could argue that this is anecdotal experience, but I have never heard of withdrawal symptoms from pot in real-life experience. Of course, one can become psychologically addicted to cannabis, but this is is the same kind of addiction one can get to TV, food, sex, work, etc. In reality, the human brain can become psychologically addicted to absolutely anything. But as far as chemical dependence and withdrawal symptoms, cannabis is not addictive.

  • bill says:

    Coffee and beer objectively taste terrible and smell bad to boot.
    You have reviled my gods and are dead to me, you worthless heathen sack of meat.
    As per comments above, I don't buy this. Not that the drug-reward doesn't contribute to our liking for these things, but there's no rush from stinky cheese or brussel sprouts and I like them too.

  • PennyBright says:

    Speaking as a user of an SSRI (Lexapro, escitalopram), I've never heard anyone except my MD say 'discontinuation syndrome'. Everyone I was in hospital with, and in group, and in my online support groups calls it withdrawal. Even my shrink called it withdrawal. And it sucks royally. Almost as bad as starting the stuff.

  • Jameson smells and tastes objectively delicious!!!!!!!!!!!!!

  • PalMD says:

    Oh, Hector...you are about to get spanked...and with good reason. Independent of whether or not cannabis is addictive (it is---i've recently delved into the literature), your argument from personal experience is very unconvincing. As DM pointed out, not everyone who uses an addictive substance becomes dependent.
    And just because one can become dependent doesn't mean they or the substance is evil---it's just a fact. You can throw whatever judgment you wish to on it.

  • NJS says:

    I'm trying to keep some level of caffeine tolerance so Excedrine doesn't make me shaky when I take it for headaches. Otherwise I'd only consume minimal amounts in the occasional mug of tea.
    Oh, and coffee smells good but tastes horrible. Beer is yucky altogether. Tea has become an acquired taste, but only for some kinds of tea.

  • D. C. Sessions says:

    Jameson smells and tastes objectively delicious!!!!!!!!!!!!!

    That's exactly what some of my friends used to say about bongwater. Never underestimate the power of human self-deception.
    Now, I don't really object to Jameson. All in all it tastes about like Jack Daniels, although it costs several times as much. If I'm feeling like paying that much for whiskey I'll have an Islay, preferably Ardbeg.

  • PalMD says:

    I don't do well with alcohol...too sleepy and itchy. But i do like to drink a little beer to enjoy the flavor, just not enough to feel tired.
    Coffee is more important than oxygen, and anyone who says otherwise it itchin' for a fight.

  • Speaking as a user of an SSRI (Lexapro, escitalopram), I've never heard anyone except my MD say 'discontinuation syndrome'. Everyone I was in hospital with, and in group, and in my online support groups calls it withdrawal. Even my shrink called it withdrawal.

    I have had the opposite experience. Whenever I abruptly stopped taking my antidepressants, I understood many of my symptoms as withdrawal. When I wasn't on a dopamine-reuptake inhibitor, and I quit drinking coffee, I called the ensuing misery withdrawal. Additionally, I call all drugs "drugs"-- antidepressants, cough syrup, alcohol, marijuana, nicotine, whatever drug it is we're talking about. And I've had doctors and social workers and friends get all up in my face about my not using euphemisms like "discontinuation syndrome", or my calling pot or vodka a drug.
    I'm not qualified to weigh in on "what we should be calling it", but I want to say that I wish more people would agree that deciding not to call some more socially acceptable substance a drug does NOT magically render it impossible to abuse. It also doesn't magically empower random people to infallibly predict the effects of x substance on x person's body. It's just like DM wrote:

    For some reason when it comes to behavioral and so-called psychological phenomena everyone is an expert and feels quite free to aggressively challenge scientific findings in a way only cranks would challenge, say, stem-cell findings.

    I have no idea why my pharmacologically-illiterate ass bluntly calling substances "drugs" precisely because I'm aware of my ignorance and I appreciate their consequences is somehow worse than equally ignorant people confidently assuring their friend at a party that they can ignore the "don't drink alcohol" labels on their antidepressant bottles, or people telling their friends rapturously about the psychologist who "spiritually healed" them by giving them ecstasy during a session. Just my anecdotal two-cents' worth.
    I like this post, DrugMonkey. Thanks.

  • All in all [Jameson] tastes about like Jack Daniels

    Dude, Jameson tastes nothing at all like Jack Daniels. Not even close.

  • Stephanie Z says:

    Hector, when a bunch of my friends were working hard to quit smoking, I gave someone my lighter and walked away from cigarettes without a twitch. We have plenty of evidence that cigarettes are addictive, including your experience. My experience says much more about me than it does about cigarettes. Ditto yours and pot.
    Uh, Pal, have you considered getting a good night's sleep once in a while?

  • D. C. Sessions says:

    Dude, Jameson tastes nothing at all like Jack Daniels. Not even close.

    I was trying to be considerate of your easily-bruised feelings.

  • HolfordWatch says:

    In the UK there are many nutritionists who are attempting to convince people that they are addicted to sugar, to carbohydrates etc. and that these addictions are every bit as serious as addiction to heroin and need comparable detox and rehab interventions. We even have an article in a very popular tabloid-y newspaper that claims authority for carb addiction from a recent item in Medical Hypotheses.

    'Heavily processed carbohydrates such as cornflakes, sweets and croissants quickly raise the amount of sugar in your blood,' explains lead researcher Dr Simon Thornley, a registrar with the Auckland Regional Public Health Service.
    'This rush of sugar stimulates the same areas of the brain that are involved with addiction to nicotine and other drugs.'
    In other words, some of us may be piling on the pounds not just because we are greedy but because we are addicted.
    If Dr Thornley's claim is supported, that would open up new ways of dealing with the obesity crisis, including a food version of the nicotine patch used to help smokers quit.
    'Drug addicts have to keep taking larger amounts of their chemical of choice. They find it difficult to stop, they keep doing it despite negative consequences and they feel depressed if they do stop,' says Thornley, whose paper was published in the journal Medical Hypotheses. 'People do all those things around refined carbohydrates.'

    Loopiness aside (although, is it just me who finds the idea of something like a vanilla sugar patch quite alluring) - what would be the correct way to describe this? I find it very difficult to believe that it is an addiction but, meh, what do I know.

  • DuWayne says:

    I was actually well on my way to writing a response to Pal's post, when I realized that it was far too personal information about someone who isn't me. Suffice to say that if ever this duality issue is truly dangerous poison, it's in the context of SSRIs and other neuro-drugs.
    But do a detoxing heroin junkie and a gambling addict need the same treatment?
    You're actually asking an apples and oranges kind of question here. Detox is different than dealing with addiction. Gambling addiction is not and never can be a chemical dependency. Likewise, it is very possible, if not also very uncommon, for someone to become chemically dependent on heroin, without becoming an addict persay. I.e. once they are detoxed, they don't feel the slightest compulsion to go out and get high on heroin.
    But once we are beyond the detox, then yes, I would argue that the treatment is likely to be very similar. Because ultimately, you are really dealing with very much the same thing - addiction.
    Take it with a grain of salt though. I'm a high school drop-out and it will be several years before I become a reasonably credible voice in this. I am however a freshly minted college student and am studying psych with the intention of studying neuropsych and plan on focusing on addiction and addiction research. I really doubt there is a difference in the parts of the brain that give one the propensity to become a gambling addict and that which creates the propensity for one to become a heroin junkie.
    I'm going to school so I can do research to either prove that or show it to be completely incorrect.

  • DrugMonkey says:

    I am however a freshly minted college student and am studying psych with the intention of studying neuropsych and plan on focusing on addiction and addiction research.
    DuWayne, this is freakin' fantastic news! Good on ya.

  • D says:

    Except coffee doesn't even taste good, my friend. Coffee and beer objectively taste terrible and smell bad to boot. You have learned to associate those bad tastes and smells with a highly desirable subjective drug effect. This is why you think coffee and beer taste really great, my friends!
    Ah so tastinos, the elementary particles of taste the tongue detects when it enjoys things that objectively taste good, have been discovered at last? Good thing that, proponents of mSUGAR models were starting to get worried πŸ™‚

  • agoodman says:

    Thank you so much for this article. I synchronistically stumbled across this as I lay in bed this morning pondering my own addiction issue. I've spent many years self-medicating with GHB. It's my anti-depressant, compensating for deficiencies in dopamine and GABA. It revolutionised my life, freeing me to express my authentic self which is normally held back somewhat by subconscious limiting beliefs generated by a whole lifetime of specific personal experiences, mostly programmed in during childhood. The measure of how it's helped me is in the depth and extent of my relationships. I've created a wide and deeply loving circle of friends out of the heart opening effects of this tremendous anxiolytic.
    I know myself very well and have explored and exercised many psychological and spiritual techniques for self-improvement, but I know now that my psychology is a product of my physiology which is a product of my psychology... Mmmmm! No wonder there's so much confusion on this whole issue. I've spend the last 14 weeks without GHB and life has been relatively dull and boring and I've been socially withdrawn, but only to the extent that I used to be before I discovered, at age 34, what is to me a spiritual molecule. No other compound holds me to an addictive pattern, and I've tried them all. It seems it is just my particular bio-chemistry that accepts the GHB molecule like a perfectly fitting key.
    You wrote:
    "In this case the notion expressed quite widely from the average layperson to the medical doctor to certain lay areas of substance dependence treatment (AA for example) that substance dependence is a matter of personal willpower or morality. It follows that all that is wrong with the substance dependent person is a deficit of will or morals and that the solution is to support will-power and moral rectitude.
    This is pernicious and harmful nonsense."
    Absolutely, and it was this "pernicious and harmful nonsense" that resulted in the recent death of a friend who was trying, unsuccessfully, to 'stay clean' from GHB. Indeed it was his own misunderstanding of this issue that led to his death thru the denial of his own bio-chemical needs, a misunderstanding supported by all those around him, who he sought approval from.
    I do recognise that GHB is not a long term solution to my physio-psycho deficiencies, but it is a low cost solution in my journey to greater well-being. Managed well it still serves me, and very importantly, everybody else whose life I'm able to touch in extraordinary ways.

  • D. C. Sessions says:

    Detox is different than dealing with addiction. Gambling addiction is not and never can be a chemical dependency. Likewise, it is very possible, if not also very uncommon, for someone to become chemically dependent on heroin, without becoming an addict persay. I.e. once they are detoxed, they don't feel the slightest compulsion to go out and get high on heroin.

    It's this contrast between learned behavior and physiological effects unmoderated by learned behavior that, as I read it, DM is objecting to as "dualism."
    Perhaps I misread. DM, if you could clarify?

  • scicurious says:

    DuWayne: go you! Now be a good scientist and take your chemistry, please. For the good of all of us. I can't even tell you what a difference it will make. I completely loathed chem, but it's been really important. And I don't know if pysch always requires it.
    Welcome to addiction research!! We need all the people we can get.

  • pinus says:

    Great post and subsequent comments (except for the marijuana denialist...why does that drug draw out so many..so strange)
    I recall seeing some interesting rodent data that suggested that they prefer self administering how an intensely sweet saccharin solution to cocaine (found it: http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0000698 )...rather than this being a sweeping statement..OMG SWEETS ARE WORSE THAN COCAINE!! I think it speaks to the incredibly complicated and interesting biology involved in compulsive and consumatory behaviors.
    This is why it is so critical to destigmatize addictive (and other psychiatric) disorders. There could be a million drugmonkeys working in a million labs*, but if the will-power mindset doesn't change, what gains have we really made?
    who am I kidding...there can be only 1 drugmonkey!

  • PalMD says:

    Take it with a grain of salt though. I'm a high school drop-out and it will be several years before I become a reasonably credible voice in this.

    You're being a HS dropout no more disqualifies you than Gary Null's PhD qualifies him.
    Self-esteem---U CAN HAZ IT cuz you rock.

  • DrugMonkey says:

    pinus @#35:
    http://scienceblogs.com/bushwells/2007/08/is_sugar_more_addictive_than_c.php
    http://scienceblogs.com/purepedantry/2008/12/sugar_is_an_addictive_drug_ehs.php
    http://scienceblogs.com/bushwells/2008/12/annual_pointing_out_of_the_add.php
    http://scienceblogs.com/neurotopia/2008/09/reward_prediction_and_dopamine.php
    DC@#33: I think you have it right. I am objecting to the notion that changes in behavior through "experience", i.e., learning, is not a fundamentally physical phenomenon related to alterations in the structure and function of that wonderful organ the brain. (yes, yes, there can be non-brain physical mediators elsewhere in the body of things that qualify as learning).

  • Adubs says:

    But do a detoxing heroin junkie and a gambling addict need the same treatment?
    Absolutely. A thousand times yes. There is no difference in the craving -- both are seeking the same 'hit' of dopamine. They are just using different avenues to get there.

  • pinus says:

    Adubs,
    I venture to say that you are incorrect.
    Acute withdrawal is a beast that has many faces, all of which are different depending on the mechanism of the drug. Alcohol withdrawal, while simliar to opiate withdrawal, is different. Detox = acute withdrawal.
    The LONG TERM alterations, including the rise in negative affect, and the engagement of endogenous stress systems, are far more likely to be consistent across a broad range of abused drugs (lots of data showing this), and who knows...potentially some of these compulsive behaviors (no data that I know of, but I don't think it is a stretch to hypothesize that it could happen). And for the record, I think it has WAY more to it than just dopamine.

  • pinus says:

    DM,
    thanks for the links. I need to go read them. Although, the titles (SUGAR is addictive) are troubling to me, as from my cursory look at the paper in question, they used sacharin, which is NOT sugar...it has no caloric value..it is just sweet.

  • DrugMonkey says:

    yeah but isn't the whole point of using saccharin in rats is that it supposedly has the same triggers for the stimulus properties of sugar while avoiding the caloric contribution? the thought being that they are being signaled "sugar" without actually getting sugar...
    for the peanut gallery, this is important because rats have been shown to be exquisitely sensitive to the caloric and macronutrient content of foodstuffs that are offered to them.

  • pinus says:

    That is true, hadn't considered that point.

  • DrugMonkey says:

    I think a lot of this was hashed out in the (eighties?) rat alcohol self-admin lit. Again, for the peanut gallery, rats are too smart to drink alcohol so the usual technique was to use wine coolers. sweetened/flavored alcohol preps. Then the "fade" procedure was developed in which you would initially start with low or zero alcohol in the drinking solution, gradually over days increasing the alcohol. eventually the flavorant/sweetener would be diluted out until rats were drinking alcohol diluted only with tap water.
    anyway, a big part of that issue was the debate over whether rats were merely seeking the calories (of alcohol or the flavorant) or the acute subjective effects that we associate with being drunk or buzzed. anyway, there's some arguments and data in that literature concerning the caloric-sensitivity of rats and how to control for this.

  • Jenn says:

    This discussion takes me back to my favorite behavioral pharmacology class I took as a fledgling scientist. There are a coupla things that piqued my nostalgia. First, there are some elegant animal studies that threw a wrench in the whole debate about physiological vs "psychological" dependence, if you will. A number of drugs, not all of which are considered reinforcing by the purest terms, can induce a state which has best been described as "behavioral dependence" for the very good reason that when a chronic treatment is stopped, the behavior baseline becomes disrupted. Second, operant behavior provides a very sensitive measure when physical dependence is even very subtle or non-existent by typical terms. This has been demonstrated with cocaine and THC, and believe it or not, antidepressants.

  • D. C. Sessions says:

    I am objecting to the notion that changes in behavior through "experience", i.e., learning, is not a fundamentally physical phenomenon related to alterations in the structure and function of that wonderful organ the brain. (yes, yes, there can be non-brain physical mediators elsewhere in the body of things that qualify as learning).

    OK, we're on the same page so far. "Learning," we agree, is a high-level abstraction for underlying physical phenomena.
    Where you and I appear to part is in application of that principle. I argue that "learned behavior" is sufficiently different from "direct physiological response [1]" that we need to have separate terms and strategies for dealing with them. I don't disagree that this has unfortunate PR consequences, but as others have noted our primary responsibility is to the scientific truth rather than the political marketing.
    DrugMonkey Appreciation Moment: this is working out to be a fruitful discussion, and I thank you for hosting it.
    [1] e.g. decongestants, prednisone, etc. and their tolerance/rebound effects, but also from the rather crude rebiasing resulting from dopaminergic drugs (e.g. amphetamines.)

  • Coriolis says:

    I'm also going to have to object to the claim that no one likes bitter foods without some type of addictive property. That's sugarism!
    Many people love blue cheese (which smells way, way worse than any beer you could ever imagine), or broccoli, etc. When it comes to coffee, I personally don't drink it (and never have), but I do like the smell. And have you ever heard of kimchi? Now that's some horribly smelling (but friggin awesome) rotten cabbage with various spices. And you'd be hard-pressed to find a Korean who doesn't like it. From what I'm told they make it ferment by throwing in a little bit of rotten dead fishes.
    Not to mention that spicy food in general is very much of an acquired taste, and yet it certainly can't make you high.
    It seems to me that there has to be another reason why these types are so popular. No clue what it is though.

  • D. C. Sessions says:

    It seems to me that there has to be another reason why these types are so popular. No clue what it is though.

    Social reinforcement [1] goes a long way. Kimchi, for instance, is one of the best available ways in a Korean climate to preserve a food rich in vitamin C into the winter. Like saurkraut, it may be objectively noxious but cultures which adopt it are healthier and outcompete their neighbors, so social reinforcement ensures that people eat the stuff. Capsicum is also, BTW, a great source of ascorbic acid and its ability to make us sweat may be Good For Us; there is active research on that, also oriented towards social reinforcement.
    This gets back to the point that there are a whole host of mechanisms leading up to the subtle neurological phenomena of acquired behavior. Effective attempts to alter those behaviors will necessarily take the different reinforcement mechanisms into account.
    [1] And, yes, social reinforcement is actually a gross simplifying abstraction for quantum mechanics.

  • And have you ever heard of kimchi? Now that's some horribly smelling (but friggin awesome) rotten cabbage with various spices. And you'd be hard-pressed to find a Korean who doesn't like it. From what I'm told they make it ferment by throwing in a little bit of rotten dead fishes.

    Usually shrimp juice. Doesn't have to be spoiled when it goes in.

  • I think a lot of this was hashed out in the (eighties?) rat alcohol self-admin lit. Again, for the peanut gallery, rats are too smart to drink alcohol so the usual technique was to use wine coolers.

    My friend had a golden retriever who would lap up whiskey if you accidentally left your glass within her reach.

  • Coriolis says:

    Thanks for the correction Juniper, perhaps what I was told was somewhat more old fashioned or inaccurate.
    And I'm not sure that evolutionary competitiveness and is all that relevant D.C.. Primarily because of how quickly changes towards certain types of food can happen.
    In the particular case of Korea and spicy food for example, perhaps the most iconic spice they use is red pepper paste, which made it's way to Korea in the 1700, i.e. pretty recently (it came first to Japan around 1600, but apparently didn't catch on). Before that there was no great propensity for spicy food in Korea, and now it's ubiquitous.
    Now perhaps Korea is just an odd case for this, but it is a pretty quick change.

  • DuWayne says:

    DC @33 -
    I think you're misunderstanding me. I'm not disagreeing with DM, rather I have exactly the same issues with people creating this dichotomy.
    At the same time, it is also important to recognize the difference between addiction and chemical dependence. The comparison of gambling addiction treatment, to heroin detox attempts to ignore that difference - the two are not the same. Though the underlying addiction to heroin beyond the overt chemical dependence really is. I will try to explain using my own addiction issues - bear with me.
    I have severe ADHD and I am also bipolar. Bottom line, I have an innate propensity for substance abuse and addiction. One of the neurological functions of ADHD, is lower levels of dopamine. I have spent most of my life unmedicated for ADHD and as such have sought out methods of self-medicating. What follows is a list of addictions that have helped fulfill this need - all of which have contributed to higher levels of dopamine.
    Coffee, marijuana, LSD (and many other hallucinogens), cigarettes, alcohol, cocaine, amphetamines, opiates and benzos. This is pretty straight forward fare thus far, but is only a small part of the story.
    I have also dealt with addictions to these; Hiking, rock climbing, cycling, playing and writing music, producing awesome feats of craftsmanship, religious faith, leadership in the church, writing worship music and leading worship in church, getting into blog discussions that fill me with valid, selfrighteous anger and helping others in a great variety of ways.
    You will note that included on the first list, are several substances that commonly lead to overt chemical dependency. Here's the thing - excepting the cigarettes, I have never once struggled with overt chemical dependence. Not once. And I suspect that my problems with the cigarettes have little to do with nicotine and more to do with underlying situational factors.
    So here's the other end - there is very little difference in what I get out of any of the addictions I listed. Every one of them produce dopamine spikes. And to really try to blow your mind, the most effective sources, in order of efficacy are writing music, writing religious music, playing music in front of a crowd and leading worship. Nothing spikes my dopamine, like effecting the emotions of others. The more pronounced the effect, the better the spike and the emotions people attach to their faith are profound indeed. Unfortunately, from the perspective of getting my fix, but fortunately all around, recognizing what my faith really meant was the last straw holding it all together.
    I am interested though, to see how attending a worship service that is going to be primarily made up of my music is going to feel. I have to admit that I'm looking forward to it tomorrow evening. But back on track here.....
    The thing that is absolutely critical to realize, is that the underlying addiction, is in itself a chemical dependency. It is a very different chemical dependency to that of, say, cocaine, but it is chemical dependency nonetheless. I would also argue that it is also much more profound. It is the dependency that makes people who have avoided having a drink in five years, fall to pieces with the first sip. That first sip doesn't throw them into DTs, it's far more insidious than that. That first sip reminds their brain of the way it wants to feel again - has never stopped wanting to feel.
    And I don't think that DM has ever failed to recognize the distinction we're talking about here. As I've always read it, the false dichotomy that he is decrying, is the one that seeks to separate the "psychological" from the physical. And the more I have come to see the power of the psychological in my own life, the more important it has become to recognize the psychologicals physiological nature.
    I would finish by pointing out that eliminating this false dichotomy is even more critical when we're talking about SSRIs and other psych meds. These are profoundly powerful drugs and it is important that we recognize that. I really don't feel comfortable going into details, because it is a very personal issue affecting someone else. Suffice to say that this issue has had a very profound effect on the life of my partner and by default on the lives of our children and I. And the effect has been uniformly negative, the results of it all, problems that will take years to sort out.

  • DuWayne says:

    scicurious -
    Believe it, I find chemistry extremely sexy.
    DM -
    Thanks, I'm actually very excited at the notion of getting the edumacation.....
    Pal -
    Honestly, I have never had problems with low self esteem. Quite the opposite, I have a tendency towards being an arrogant bastard. But when I get out of my comfort zone, such as getting into academic discussions involving people with stronger backgrounds in the topic at hand, I find that being a little humble saves me the embarrassment of getting spanked...
    Now you want to see me get "self confident," try arguing with me about the best solution to a particular home repair issue. Trust me, I am adept at eviscerating people who make such foolish attempts.

  • slow-ber says:

    In this case the notion expressed quite widely from the average layperson to the medical doctor to certain lay areas of substance dependence treatment (AA for example) that substance dependence is a matter of personal willpower or morality. It follows that all that is wrong with the substance dependent person is a deficit of will or morals and that the solution is to support will-power and moral rectitude.
    Weeeelllll, let me just derail for a hot minute. I take issue with AA being lumped together with groups that attribute addiction to a weakness in morals or willpower. There are many examples in their books where they describe addiction as a physical problem/disease or allergy, totally separate from morality and willpower. I just wanted to submit that for the record.
    That is all, carry on!

  • D. C. Sessions says:

    And I'm not sure that evolutionary competitiveness and is all that relevant D.C.. Primarily because of how quickly changes towards certain types of food can happen.

    To be clear: I was referring to social adaptation, not phenotypical adaptation.

  • Becca says:

    " getting into blog discussions that fill me with valid, selfrighteous anger and helping others in a great variety of ways."
    Wait, darnit- these are addictions?
    Wow, I'm totally screwed then.
    "is it just me who finds the idea of something like a vanilla sugar patch quite alluring" Definitely not just you. Actually, if we could invent a small, non-invasive (or at least painfree) way to monitor blood sugar and simultaneously inject a small amount of sugar as needed to keep it steady, we'd have 1) a highly marketable product for helping diabetics and 2) much better science
    (note: 2) follows from the fact that grad students in labs think better with proper blood sugar, and often forget to eat... or maybe this is just my issue...)

  • Kalirren says:

    #46-48:
    Kimchi can be vegetarian. That's the way my maternal-line-Korean girlfriend makes it, because she hates the fish and the shrimp - she likes her kimchi to have a more transparent taste.
    As I'm given to understand, it's primarily a Lactobacillus fermentation, and kimchi can apparently be made without a culture inoculum. Admittedly my girlfriend took her first culture inoculum from a non-vegetarian source, but all of the batches we've made since the first have been vegetarian.

  • In the particular case of Korea and spicy food for example, perhaps the most iconic spice they use is red pepper paste, which made it's way to Korea in the 1700, i.e. pretty recently (it came first to Japan around 1600, but apparently didn't catch on).

    We are all about the red pepper paste. In fact, we are all about making almost any food as spectacularly spicy as possible to withstand, while Japanese food features sweet tastes. (Yeah. I'm aware "spicy" isn't technically a "taste". You know what I mean.) But I had no idea when the red pepper paste arrived at the Hermit Kingdom! Cool.

    Now perhaps Korea is just an odd case for this, but it is a pretty quick change.

    Why is this an odd case? Cultural evolution, while obviously not measured the same way that scientists measure biological evolution, still occurs at myriad different rates and levels as biological evolution does. People introduced red pepper paste to Koreans and Japanese around the same time, and it "succeeded" in Korea but didn't in Japan, and at this time scientists can't provide a scientific explanation, first because there is no scientific theory of cultural evolution. Meanwhile, this kind of thing happens all the time, in terms of the popularity of other foods, fashions, songs, literature genres, etc. in given populations. It has since time immemorial.

  • #46-48:
    Kimchi can be vegetarian. That's the way my maternal-line-Korean girlfriend makes it, because she hates the fish and the shrimp - she likes her kimchi to have a more transparent taste.

    You're totally right. Thanks for catching that.

  • JLK says:

    Dammit, I am always late to the party and by the time I go to say something, it's already been said. Screw it, I'm gonna do it anyway.
    Du wayne said:
    "Gambling addiction is not and never can be a chemical dependency."
    Oh, but it is. Every addiction is a chemical addiction. It's just that the chemicals in question are neurotransmitters rather than foreign substances.
    Several other people have echoed this similarly since the initial comment, but I wanted to participate. πŸ™‚

  • DuWayne says:

    JLK -
    Sorry, I really wasn't being very clear. I actually clarified that in my subsequent comment. It's not that I don't think that the gambling addiction isn't chemical dependency, it's just a very different sort. One that I believe is far more nefarious.
    Cocain, heroin, alcohol - you can detox and get through that aspect of the addiction fairly quickly and without too many complications. Dealing with neurotransmitters is a whole different ballgame. After several years without a drop of alcohol, an alcoholic is not going to go through DTs because they have one drink. But that one drink does remind their brain what they were missing and usually leads to many more drinks.

  • Simon says:

    Now that I've read your actual analysis of the issues at hand, rather than your somewhat snarky comments on the Nature Neuroscience blog, I have to say I agree with many of your points. The media's current perception of the importance of "psychological" addiction is highly flawed, and particularly that medical insurance ought to cover treatment for drug dependence. There is a great deal of sense in this post.
    With that said, however, I still think that painting the controversial topic as "Drug Addiction Dualism" is a misleading. It's true that, if the definitions are taken literally and we assume that mental states are physically determined,† "psychological" addiction has physical causes. However, it's not as if the distinction in use is at all unclear. "Psychological" addiction refers to effects on volition, and "physical" addiction refers to effects on everything else. The importance of "psychological" addiction is certainly misunderstood by many non-scientists, but the concept itself is useful and meaningful. There is no more dualism here than in the idea that the brain can experience, believe, interpret, decide, etc.* Throwing out the concept is, in my opinion, an overreaction. If this is "Drug Addiction Dualism," then your position might be labeled "Drug Addiction Behaviorism."
    Perhaps a change in terminology is in order, for all of the reasons you've stated above. However, I don't think that drawing a distinction is essentially a bad thing. Volitional and non-volitional effects of drug addiction are, in fact, very different phenomena, and the public deserves to know that. If I hadn't been fed so much blatantly false information about drugs as a child, perhaps I actually would have stayed away from them.
    †This is a bit of a non sequitur, but this condition actually only rules out Cartesian dualism and other forms of interactionist dualism. Property dualism, and its cousin monism, coexist perfectly well with a physically determined world, and I know several well-respected neuroscientists who hold these positions. So don't go around giving dualism a bad name! πŸ™‚
    *Since the strict definitions of these terms apply only to an entire being, literally applying them to the brain implies that the brain is itself a being, resurrecting Descartes' homunculus. This is a point that Bennett and Hacker make in Philosophical Foundations of Neuroscience. They argue that here, too, a terminology change is in order, but I remain unconvinced that this actually leads to significant misunderstandings.

  • Pi Guy says:

    Yeah. Except coffee doesn't even taste good, my friend. Coffee and beer objectively taste terrible and smell bad to boot. You have learned to associate those bad tastes and smells with a highly desirable subjective drug effect. This is why you think coffee and beer taste really great, my friends! The brain is really quite a fascinating organ.

    I don't deny that I like the feeling that results from drinking both coffee and alcohol. However, I don't agree that that is the only thing drives my desire to consume either. I won't just drink any coffee nor any alcohol. I like Guinness Stout and am a big fan of pale ales and IPAs but do not like white beers, such as Celis, and think that Budweiser sucks donkey balls. And, to me, tequila is liquid dust. Though I like the effect of alcohol, I won't drink just to achieve that feeling.
    Likewise for coffee. I like many, but certainly not all, of Starbucks flavors but have also stopped on a number of late nights for a coffee that was so bad that I just threw it out. Again, despite the fact that I was tired and wanted a pick-me-up, I just won't consume it merely for effect. Can you explain this in terms of your assertion that they "...objectively taste terrible and smell bad to boot." (And, while not quite in the same ballpark, I'll have to be the hungriest man alive to willingly consume liver. And, yet, I like the feeling of having my hunger satisfied.)
    I do not question in the least your conclusions about addiction. I'm no expert and have know some people who'll drink anything just to get drunk. And while I don't doubt that I've associated with the smell and taste of those drinks with a feeling that I like - and I acknowledge that that Pavlov guy was certainly on to something! - I suspect that you've expressed a personal subjective conclusion that's not completely fact-based.
    The brain truly is, as you say, a fascinating organ!

  • Kat says:

    Would love to see you elaborate on how coffee and beer taste bad. I've always felt they taste bad- subjectively, but how can a test be conducted to say that they OBJECTIVELY taste bad?

  • DrugMonkey says:

    Taste is subjective and there do appear to be people who are either insensitive to or actually prefer tastes that the majority find unpleasant.
    I use this line to get people really thinking about their history with beer and coffee.

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