Personal anecdotes in substance dependence

I wanted to get this somewhat more serious discussion off the prior post for reasons that should be obvious. SouthernFriedSkeptic was apparently responding to my linkage of a post on some papers which attempted to compare symptoms of drug abstinence in cannabis and tobacco smokers. S/he noted:

Being someone who has in the past used both nicotine and marijuana (although at separate times in the past) I have to disagree with your comparison. I know it is a data point of one, anecdotal, and all that, but when I was young I went through a phase where I smoked marijuana several times a week, in the evenings, and mainly because I didn't like hangovers. As I got older, and took on more responsibilities, I quit. Not consciously, but just sort of got busy with life, started a family, career, etc... and didn't even really notice that several years had passed since I smoked it. Haven't had an urge to do so again, and besides, wouldn't compromise the aforesaid family and career.
I also quit smoking. It turned be into a liar, almost cost me my job and one was by far one of the most difficult things I have ever done. I become depressed and irritable, and though chemically I should be free, I still get occasional urges for a cigarette that are barely resistable. I don't even think of marijuana unless the conversation is brough up. I quit without even realizing it.
Hard to imagine they are similar.

The arrogance of the personal anecdote is worth discussing in this context.


Of course, this commenter is far from unique. If you look through the comments on that prior discussion you will see many similar observations. You will also notice the odd comment which identifies people who find cannabis discontinuation to be unpleasant. I responded to SFS:

And do you realize that it is hard for those who are not addicted to such obviously harmful drugs as nicotine to imagine why on earth any sensible person wouldn't just quit taking drugs? And hard for those who have had transient depression to understand why those with major depression can't just sack up and snap out of it?
It is this generic inability to get past the arrogance of our personal experiences that causes such demonstrable harm in getting parity for the so-called mental and behavioral health disorders.

Yup. This is really an issue that transcends drug abuse. It bleeds over into depression, ADHD and Autism Spectrum Disorders. What is disordered and in need of treatment? What is just feeling kinda sad for a while, an exuberant child or a smart, geeky eccentric?
The point is that there are ways to deal with this scientifically by identifying patterns and symptoms that are common and tend to cluster with each other. This is the basic idea of clinical diagnostic structures like the DSM. To make informed judgments that an essentially artificial threshold drawn across a distribution of personal traits can be useful. All the while maintaining the understanding that we need to know more about these thresholds. Also while recognizing that additional studies of representative samples (drawn from much larger populations, of course) can help us to understand more about potential biological markers of what are frequently subjective or behavioral symptoms.
All of this scientific structure is relatively available to the general public. There are many websites dealing with each behavioral condition and it takes only a cursory set of searches to come into contact with the relevant scientific ways to grapple with the disorders.
And yet for some reason whenever I post on dependence issues related to cannabis, the science denialist cannabis fans come out of the woodwork screaming about how their anecdote of one contradicts all the representative-sample science conducted in many different populations across the US and indeed worldwide. They completely fail to grapple with my points about the likely minority of drug users who will go on to develop serious problems with the substance- if 9 out of 10 cannabis smokers don't develop dependence issues, somehow this is supposed to prove that the 1 out of 10 can't possibly have a dependence issue.
Would these people argue that the majority of those who have ever felt sad and don't go on to suffer from Major Depression falsify this diagnosis? Do the people who do not get cancer prove that cancer is a sham? Of course not.
So what is it with you people? Seriously, I want to know. Are you just so enraged by the fact that your chosen recreational pursuit is a criminal act in the US that this blinds you to any rational discussion of the science?

52 responses so far

  • Mike says:

    Awesome post, DrugMonkey. It may be human nature to assume that everyone else has the same inner life as we do. I think that one sign of maturity is the understanding that not everyone is like you - whether it is in response to drugs, values, etc.

  • becca says:

    I don't know that it's "irrational" or evidence of "arrogance" to point out that the ostensibly prevailing (not necessarily DM-endorsed) view* in our society, i.e. that marijuana is worse than nicotine, does not square with one's experiential reality.
    Look, if one has been through ADHD and depression, and one feels depression is much worse, that's a valid perspective (as would be the inverse, though as a hunch that'd be less common).
    If one further extends that to a policy position (say for example that we need to medicate fewer kids for ADHD and find more effective drugs for depression in teenagers), based on said personal experience, I don't see that as being irrational or arrogantly self-centered... I see that as a very natural extension of one's personal concerns. Someone getting ideas based on personal experience is how most issues historically came to the attention of policymakers, afterall- it's not as good as comprehensibly obtained quantitative data, but it's better than just assuming your experiences are your own and never thinking about how to apply them to better society.
    Now, if one's personal experiential reality has almost nothing in common with that of others, and what one is asking for comes at significant cost, then one has to be mature enough to accept society isn't going to change on that kind of issue. But I'm not at all sure that applies here. I think the "nicotine is worse than marijuana" is actually a rather common experiential reality that policymakers ought not to ignore.
    All that said, if there was actual insulting minimization of any other individual's issues with cannabis dependence (outside of the fairly neutrally worded quote you supplied), I could definitely get on board with *that* being arrogant (and rude, to boot).
    *I say "ostensibly prevailing" because I have no actual quantitative data on public opinion here; but if this is truly not the general opinion, then the laws really are as irrational as the marijuana legalization crowd opines.

  • MattK says:

    My experiences would match the "arrogant" poster as well although I wouldn't presume to doubt the existence of THC addiction if there is evidence to support it.
    I wonder how internet pornography compares to mary jane wrt addictive potential...

  • Matthew Platte says:

    Make sadness a crime, then see who comes out of the woodwork.

  • ari says:

    I am one of the 9 out of 10. I used to smoke a great deal, and now I smoke maybe once yearly, without noticing the passage of time.
    I certainly acknowledge that pot can have serious consequences for some people, and more minor ones for others.
    What angers me about the debate is the need to make the drug illegal for everyone even though only some have problems with it.
    Alcohol can have very dangerous consequences for many, and serious addictions for others, yet it is still legal.
    Should we ban fast food because some people can't control their desire for it?
    Pot should be legal (hopefully with a far lower THC content than what is currently available).

  • Droogs says:

    DM, I thought the whole reason why marijuana was included in the initial legislature banning it was due to that one guy's excessive lobbying. Once it became law, it became extremely hard to change. Kind of like Giuliani banning pet ferrets in NYC except druggy.

  • anonymous says:

    I would say a sample of 12 highly unusual individuals (addicted to both cigarettes and weed) is only slightly smarter than a sample of 1. In fact, there are more plots and derived values than people. Of course, a bootstrap or jackknife error analysis would demonstrate the study is mostly pure crap.
    Having said that DrugMonkey, no one can argue with the fact that pot-heads get down right irritable and aggressive when confronted with negative evidence about weed.

  • anonymous says:

    @MattK:
    quote: I wonder how internet pornography compares to mary jane wrt addictive potential...
    As someone formerly addicted to the latter, and still addicted to the former, my personal anecdote is that the former is MUCH harder to break. Part of the issue is that pot is illegal. I am married, and have two kids, and cannot risk jail time (though when around people who I know have access to pot, I do get a bit defensive and jittery).
    No doubt some of you are saying "if you're married, why do you risk it? Why not just stop?". My reply is that if you are asking me that, you truly do not understand addiction. For every waking moment (but a few), I fight and rationalize, and resolve, and promise, and then I "wake up" and say "WTF?" and realize I have acted out again....
    Therapy helps, but it is not an easy battle...

  • DuWayne says:

    I think it's important to recognize and distinguish between the two issues being discussed here. One is the notion of legalization, the other the issue of the addictive potential of cannabis and the evidence for it. It is also where I tend to see a huge fail on the part of legalization advocates.
    The bottom line is, it does have addictive potential and for some people it is much more egregious than it is for most. That certain legal alternatives are far worse is irrelevant. In the minds of a lot of the diehard anti-legalization critics I've run across, all that is is an argument for alcohol and for some, tobacco prohibitions.
    And DM is making a really important point here. Anecdote is not evidence and it is incredibly arrogant to assume otherwise.
    That said, the post DM links at the head of this one, was one of the motivating factors that has pushed me in the direction of addiction - though I am finding that I probably have a lot more to contribute to research at the treatment end, than to lab end.
    The DSM is seriously and significantly fucked, when it comes to addiction and dependence. The more I research, the more I read and the more I communicate with psychotherapists who actually treat addiction, the more I am convinced of that. The notion that cannabis dependence is anything close to tobacco dependence is patently absurd. That according to DSM standards one can draw that conclusion is evidence that the DSM is fucked, not that there is actually a correlation to be drawn.
    It's all fine and good to bemoan anecdote over evidence, but we're not just talking about the anecdotes of a few old hippies.
    DM, I would seriously and respectfully suggest that you contact some addiction therapists and run this by them. I can even give you some names and emails if you like, but choosing them yourself would ensure you get a random sampling. See what they have to say about the notion of cannabis versus nicotine/tobacco. For that matter, see what they have to say about the DSM standards for addiction and dependence.
    Hell, talk to some folks involved in NA - trust me, they are no fans of the cannabis.
    I'm sorry DM, but in real world terms, there is simply no comparison.

  • PalMD says:

    So what is it with you people? Seriously, I want to know. Are you just so enraged by the fact that your chosen recreational pursuit is a criminal act in the US that this blinds you to any rational discussion of the science?

    Dude, aren't you an addiction expert of sorts? No one likes being told that their addiction is "bad", whether bad means illegal, immoral, smelly, or whatever. It always feels better to the addict if their addiction is in some way sanctioned.

  • DuWayne says:

    I fight and rationalize, and resolve, and promise, and then I "wake up" and say "WTF?" and realize I have acted out again....
    Would you do me the favor of clicking on my name and either emailing me, or, if you are concerned about remaining anon (though I would keep you in confidence) pick an old post at random and leave me a comment. I would really appreciate it - I would love to have the opportunity to ask you a few questions.

  • DrugMonkey says:

    Well no Pal, I'm not an addiction expert in the sense you seem to mean- and as DuWayne nicely identified (although I might admit to a certain didactic strategy that may not fully present the nuances of my understanding at times!). And actually I tend to assume the most strident critics of the science are indeed those that have the least personal familiarity with addiction.

  • DuWayne says:

    Pal -
    Actually, like DM, I tend to assume that most of the people who get up in arms about the notion of cannabis addiction haven't experienced addiction. Yes, there are certainly those out there who are simply in denial about it (I know several personally), but for the most part we're talking about people who once were recreational tokers and either quit, or only use cannabis once in a while.
    Honestly, I think that there are a lot of cannabis addicts out there who recognize full well their addiction and either just remain quiet in conversations like this or actually argue that it is addictive. Because while I know a lot of cannabis addicts who are in denial, I know just as many who will give the one in denial a big "whatever," often right after they expel the smoke from their lungs.
    Of course that's all purely anecdotal...

  • blogger who studies thc says:

    the wave of personal anecdotes is why i choose not to blog about my research specifically. i think i have some cool things to say (not published yet, still working on the slam-dunk which is looking beautiful so far), yet i don't really feel like handling the onslaught of denialists who claim that THEY don't experience effects x, y, or z and therefore the science is bunk.
    well, shit. if only i had known before throwing 5 years of my life away studying it. screw statistics, i'm just going to start asking people about their SUBJECTIVE experiences rather than collect data in controlled experiments.
    that totally sounds like a better way to go, if you believe the anecdotes.

  • Alex says:

    Personal anecdotes are certainly not science, but neither is the message often sent to the public by policymakers, that certain substances are going to condemn all users to addiction and thus anybody who tries these things is in need of immediate intervention. The importance of the personal anecdotes is to show that the official message is wrong, and then you can start to search somewhere in the middle and see where the science takes you (which I'm guessing probably shows that addiction is very real for many users but certainly not for all).

  • DrugMonkey says:

    Personal anecdotes are certainly not science, but neither is the message often sent to the public by policymakers, that certain substances are going to condemn all users to addiction
    I very much doubt you will find me advancing any such message. I find it just as abusive of the available scientific knowledge as the denialist pro-drug position. I think I've mentioned my views on this repeatedly. I put it under the 'conditional probability of dependence' issue.
    so there is no need to act as a counter to that particular message here.
    which I'm guessing probably shows that addiction is very real for many users but certainly not for all
    This is certainly my read of the evidence.

  • blogger who studies thc says:

    looking at the nsduh numbers, i would be inclined to think that thc abuse/dependence is not at all prevalent in the lifetime use/currently using population. but i don't know their criteria for dependence. of course use is greater in teens/early 20s age group, and they are the age groups with higher dependence numbers as well. there are many biological reasons that could be behind that.
    tolerance/dependence/withdrawal and addiction are, of course, very different things.
    that does not mean we should ignore the small percentages, either. clearly if some people are having a problem with it, we should work to better understand why and how to handle it.

  • PalMD says:

    Well, cannabis supporters tend to fall into all sorts of categories, you're right. There are libertarians, users, addicts, etc.
    I wonder now about addicts and legalization. As I think about it more, many addicts I've treated have abused legal and illegal substances and didn't seem to care about the legal status as much as getting some.

  • Pot should be legal (hopefully with a far lower THC content than what is currently available).

    Far lower!? Are you fucking high? What's the use of legalizing pot and then only making available fucking ditchweed?

  • DuWayne says:

    Pal -
    Very few addicts could care any less about the legal status and honestly, legal status quite often just gets in the way.
    First and foremost, we are throwing away a lot of resources that could be going to help actual addicts on people who are forced into to treatment because they got busted, not because they're addicts. Not only is it a waste, but it often interferes with the effective treatment of actual addicts. Nothing chills an AA or NA meeting, like having some asshole who doesn't want or need to be there around. It also tends to jade counselors, therapists and other addiction workers to effectively helping people who want and need help - hard to really care much, when half or more of the clients coming through are only there because they got popped with a dime bag. Whether they are an addict or not, no treatment is going to help someone who doesn't want to quit.
    Second, it makes it harder to convince people to seek help, even if they are aware they have a problem and want to quit. The bottom line is that heavy users are often quite paranoid about it, because they know it's illegal and they don't want to get busted.
    Third, when treatment is coming from a psycho-therapeutic approach, there are significant ethical dilemmas, that stem from legal status. On the one hand, it is highly unethical for a therapist to encourage a patient to do anything that's illegal. On the other, a psychotherapist has a responsibility to do and say what they believe is best for the patient. And whether or not the actual goal is abstinence from psychoactive substances, a great many therapists recognize that this is unlikely to happen over night.
    There are a lot of therapists who, when the addictive substance is alcohol, will encourage their client to take small steps towards quitting. They will tell them not to just try to quit altogether right now. Rather, they will encourage them when they are able to quit waking up to a shot of whiskey and wait until after lunch to have a drink. One case study I read, the therapist simply encouraged him to crack a low alcohol content beer, in place of his morning shot and got him to slowly taper off his alcohol intake, by drinking lower content drinks.
    And there are therapists who just eschew the ethical considerations of encouraging patients to do something illegal and take the same tact with illicit drugs. Others will encourage someone who uses heroin, to detox from the heroin and even while they are detoxing, encourage them to smoke pot instead.
    Or there are the drug treatment MDs who would like to look into the effectiveness of using actual heroin or morphine to maintain and taper off heroin addicts, instead of methadone. Because methadone isn't without it's problems and mainly becomes a traded addiction. There are a lot of junkies who just say fuck that, and keep on using or try to taper off the actual heroin themselves.
    And that comes to the final problem. There is increasing evidence that the taper off tactic that many harm reductionists support, seems to be a rather effective way to encourage people with substance abuse issues to actually agree to even try to deal with it. It is a lot less intimidating when your therapist tells you "you don't have to quit right now, maybe not at all. Lets just start with the goal of reducing the negative impact of your current use."
    That tactic often leads to complete abstinence, or a recognition that abstinence is really going to be important when we get to that point. Sometimes it doesn't. What it really does, is get the ball rolling in the right direction. It starts the process and in the short term, usually manages to reduce the harm of that persons substance abuse and puts them in a place where they can assess their life and their relationship with their substance of abuse, outside the fog of the high it provides them with.

  • Isabel says:

    "Pot should be legal (hopefully with a far lower THC content than what is currently available)."
    That would mean more smoking of plant material.

  • Martijn says:

    Are you just so enraged by the fact that your chosen recreational pursuit is a criminal act in the US that this blinds you to any rational discussion of the science?

    As a Dutchman I would say the answer to that is "Yes". Over here the debate is much less polarized and very pro-legalization advocates will take the absurd "Pot is not only not addictive, it's actually good for you" stance that so often turns up in the US.

  • Dunc says:

    As both a current and former addict (or at least, habitual dependant user) of a wide range of drugs, both legal and illegal, I could not agree with DuWayne more on this matter.
    And once again, I would like to point out that there are many on the pro-legalisation side who take that position precisely because of an understanding of the risks, not in spite of it. Drugs are too dangerous to leave to the black market, and I do not believe that the criminal justice system is the most appropriate or effective means of treating addiction and drug dependence.

  • Lab Lemming says:

    Something else you have to remember when evaluating anecdotal accounts is that cannabis addicts generally have much lower self-awareness of their problems than nicotine addicts. With ciggies, knowing that you're addicted isn't really part of the problem- in fact, the awareness that the smokes are controlling your life is why trying to quit can be so painful and dispiriting. In contrast, cannabis addicts will often claim they're fine, even if they're so brain damaged that they can't form complete sentences any more.

  • Curt Fischer says:

    I have a question for DrugMonkey if he is still reading.
    In general, how much does the addictive potential/negative health impacts/bad stuff depend on the dosing regimen for a given drug, say THC (or MDMA is DM knows that one better)?
    What effects would legalization of that drug have on recreational dosing regimens? I realize the latter question is more sociological than physiological, but I think it is a key question.
    If THC were legal, would people be more likely to smoke a quick one while they were walking to the train station after work, and be done with THC for the day?
    Or would baking some Duncan Hines brownies, heading over to the basement of a friend whose parents are out of town, and taking bong hits from 9:30pm to 1:30am while listening to Jimi Hendrix remain "the norm"?
    My examples are worse than anecdotes because I made them up, but hopefully they illustrate my point. Is there (i) any evidence that legalization would actually make it more likely for people to take more moderate doses, albeit perhaps more frequently, and (ii) if it did or could do this, would that be a healthy thing or would it not matter much? I suspect that for some drugs (e.g. cocaine/coca leaves) the answers are likely "yes" on both counts, but I don't have any evidence to back me up.

  • DuWayne says:

    Curt -
    In general, how much does the addictive potential/negative health impacts/bad stuff depend on the dosing regimen for a given drug, say THC?
    As far as addiction potential goes, the dose regimen for it is hard to quantify, because everyone's relationship with their drugs is different - addicts and non-addicts alike. For some people it just takes that first hit and they are on their way to becoming an addict. It may not manifest as addiction right away, but the feeling they got is something they simply cannot let go of. It's there in the back of their mind and often in the front.
    For others, it may be that they just do it often enough for social reasons, that it becomes a firmly entrenched habit and from that becomes an addiction. For still others, it may well be that they are using to self-medicate - indeed a book I just got (I love my readers!!!) by Drs. Khantzian and Albanase, Understanding Addiction as Self Medication uses that base assertion as the foundation for a treatment methodology and stake it as a fundamental of addiction. I am not really sure if I agree with the notion of it being fundamental, but they do make compelling arguments and as a basis for treatment modality it very well may be an effective label for most, if not all addicts.
    The problem with making assumptions about addiction thresholds is that there are a lot of people who smoke or otherwise use cannabis at the very same rates as addicts, who never experience addiction. They go through their party phase and then, often when school is over with and they have to go to work, they either quit altogether, or their use gets relegated to special occasions. While overt dependence thresholds for drugs like heroin or meth are somewhat easier to quantify, the actual addiction threshold for even those drugs has the same problems. Because once you detox someone from the acute dependence, some of them are never going to touch it again, while others are going to have issues with it for the rest of their lives.
    What effects would legalization of that drug have on recreational dosing regimens? I realize the latter question is more sociological than physiological, but I think it is a key question.
    Very little. Having spent a few years in Portland, OR, where it's legal for medical purposes, it's status doesn't have much effect. About the only difference would be that some people are more inclined to ingest it, something that requires rather more cannabis than smoking and is therefore not as popular where growing or possessing large quantities is likely to get one in trouble.
    As far as people being more likely to smoke one on the way to catch the morning train - no more likely than they are now, to smoke one in their home before they head out the door.

  • David says:

    fascinating topic.
    I know of 2 studies in humans directly comparing the intensity of cannabis withdrawal against tobacco withdrawal (there are other publications which are cross-study comparisons, meta-analysis, or literature reviews, without primary data). So these are the primary literature...
    1) Budney et al. 2008 Comparison of cannabis and tobacco withdrawal: severity and contribution to relapse. J Subst Abuse Treat. v35(4)p362
    2) Vandrey et al. 2008 A within-subject comparison of withdrawal symptoms during abstinence from cannabis, tobacco, and both substances. Drug Alcohol Depend. v92(1-3)p48
    Both suggest that in heavy users, the cannabis withdrawal syndrome is comparable in intensity to the withdrawal syndrome associated with tobacco use.
    But there may be a difference. The above studies reference heavy cannabis use. I don't know of any studies demonstrating withdrawal symptoms in light users, or intermittent users. One the other hand, such are easy to find in the case of tobacco, for example:
    Rubinstein et al. 2009 Withdrawal in adolescent light smokers following 24-hour abstinence. Nicotine Tob Res. v11(2)p185

  • DrugMonkey says:

    Very little. Having spent a few years in Portland, OR, where it's legal for medical purposes, it's status doesn't have much effect.
    Not quite the same thing, DuWayne. And I'm going to speculate that perhaps your view on the effects of legalization may be shaped by a disproportional consideration of those for whom legal status isn't that important.
    Looking at the trends for more casual use (tried in the past 12 mo, ever tried) and comparing that with, say use in the past 30 days (as with the MtF data, see sidebar for website link) in the general population is informative. Also helps to look at some of the subjective "availability" data. It is very hard to support the contention that everyone who might try a drug if readily available and legal is already doing so in the illicit environment.
    beyond that we delve down to the usual personal anecdotes and have to ask if legal status has any effect on one's choices. In my case that is clearly a 'yes' for some substances, 'maybe' for others and 'no' for additional ones.

  • DuWayne says:

    Sorry if I was giving the impression that I don't think more people would be likely to use cannabis if it were legal, I suspect that it is likely more would. But as far as the legal status changing the amount that people use, I just don't see it making a significant difference. About the only significant change, would be that a lot of people actually smoke it less, preferring to ingest it instead.
    But for those who's main interest is getting stoned, there is unlikely to be a whole lot of change.
    That said, there isn't a question that my view on the effects of legalization being shaped by consideration of those for whom legal status isn't an issue. I just don't see it as being disproportionate. I will readily admit that there are a lot of people in Portland (and I imagine many other places) who wouldn't even consider cannabis, were it not legal for them to use it. I just don't see that as being much of a problem.
    And I think that the benefits of legalization for addicts and those who help them, outweigh the issue of having more addicts around. But that is also influenced by my tendency to think that the increase in actual addicts, compared to the increase in users will be smaller than the current ratio of addicts to users. I would contend that addicts are probably more likely to try cannabis in the first place, given it's current legal status - but that is most definitely just my assumption and compared to the folks who would be more likely to try, say, heroin and people who are likely to be addicts, the figures make it a lot more likely that someone trying heroin already has addiction issues.

  • becca says:

    DuWayne- I think the self-medication angle is really important. It's a bit like the autism thing- you can rant until you're blue in the face about vaccines, but until we can present people with a good alternative explaination, we'll be fighting an uphill battle. Until there are good and accessible treatments for depression, anxiety, bipolar, ADHD, ASD, ect., ect. there will be people turning to illegal drugs.
    I've gotta say, legal status per se has never kept me from using drugs. However, knowing exactly how many mg of something I'm getting, and what peace-of-mind one gets from FDA regulation is a big incentive to use legal pharmaceuticals as opposed to illegal ones. Bathtub of rat poison from a creepy guy at a club? No thanks. Top-notch organic chemists following GMP providing known amounts of MDMA? Well, that I might have tried...

  • Most teenagers want deperately to get high. I wonder if legalizing pot would decrease the number of kids who die of overdoses of prescription drugs they steal from their parents or who kill themselves with shit like poppy seed tea.

  • becca says:

    "Most teenagers want deperately to get high. "
    WTF mate?
    Ok, I know you think it's "cool" to write about motherfucking Jameson, and how shitfaced you were during college and all that jazz (because somehow, if you killed all those brain cells and screwed up early on, it makes you all the more impressive now?). But I simply don't buy that you are the norm- frankly you are deviant enough I'm beginning to wonder how you function. And I'm at Big Ten Football/Drinking University (and was for my undergrad as well)- it's not like I don't see plenty of excessive intoxication.

  • leigh says:

    oh hell, becca, are we really getting into "killing brain cells" now?
    adolescence is generally when a lot of experimentation with drugs goes on. i don't know if i'd go so far as to say teens want "desperately" to get high, but they're definitely more open to novel experiences and risk-taking than adults.

  • becca says:

    leigh-
    It was the hyperbole I objected to as much as anything (It's CPP- I know. It was a moment of weakness. But still. I can't shake the feeling that if I'm the mature one around here, we're all in trouble)
    Your point about adolescent drug use relative to adults is probably correct, although I think the easy acquisition of alcohol for adults makes it hard to compare as a metric of "how much they want to alter their consciousness". And the truth is, (on average) there are more novel experiences available as a teenager. But the risk-taking thing is pretty well supported by neuroscience, from what I understand. I just think the way CPP phrased it sounds like he's trying too hard to make whackaloon behavior seem normal.
    Maybe I just knew really lame teenagers?

  • Nick says:

    As someone who has struggled with marijuana dependence, let me make two points:
    (1) It is real. The withdrawal is real. I was nervous, anxious, and restless for days. I used to smoke cigarettes, too. Marijuana withdrawal was only easier for me because it's harder to get: I can't run down to the corner store and pick up a bag of weed (at least not in my neighborhood).
    (2) The persistence of attitudes like SouthernFriedSkeptic's among the enlightened serves to more deeply stigmatize those of us who do develop a dependence on marijuana. My friends act like I'm being ridiculous for treating my marijuana dependence like an actual addiction. It is inconceivable to them that I can't just smoke less, so I don't talk about it and suffer in silence. I have enough shame as a result of my complex of mental illnesses, I don't need to deal with this one too.
    All that said, mine is also an anecdotal argument. Mine at least squares with the science.

  • leigh says:

    risk-taking and novelty-seeking behaviors are both increased in adolescence. i would recommend a read through LP Spear's definitive review published in 2000 if you're interested in adolescent behavior and drugs. she covers humans and compares to animal models- a real landmark in the field.
    acquisition of alcohol is not hard for underagers, and illicit drugs aren't too hard to get either.

  • yolio says:

    I would add weight gain/loss to your list of things that this attitude applies to. Many people believe that their experiences with food, exercise and fat should be relevant to everyone.
    As for the pot-heads, it seems pretty clear that they are responding to all of the overblown anti-pot stuff that has been shoved down our throats all of our lives. I recall a high school assembly where a guy explained how smoking pot led him to spend two years in a turkish prison with dirt floors. Somehow, I think we were being lied to. The debate is polarized by hysterical anti-drug sentiment that starts young and teaches youth that "responsible adults" can't be trusted on this issue.

  • DuWayne says:

    Honestly Becca, I tend to think that while CPP was a bit hyperbolic, he has a very good point. According to studies (I will try to find links and post them later) and not just one or two, between sixty and seventy percent of adolescents will try alcohol and/or illicit drugs (including prescription drugs, not their own). Same studies generally indicate that roughly ten percent less will use more than a couple of times. Keep in mind that these studies are based on self-reporting in confidential questionnaires, usually administered in school.
    Nick -
    I can assure you that there are those out there who would love to talk with you and more importantly listen to you talk about your experience. You are far from alone in your experience and have absolutely nothing to be ashamed of, either because of your addictions or because of mental illness. (I have very severe ADHD and am depressive with type two bipolar - I am also an addict)
    If you would like, I can provide you with links to forums for people with addiction issues, people suffering neurological issues - people dealing with both, which is a lot of us. And of course, I would be happy to talk to you as well. I am also considering setting up a closed forum, invite only, password protected and would love to know if that would be of interest. I have run across a number of folks who would really like to have a safe place to discuss these issues, that is not accessible to the casual observer
    To contact me, just click on my name and my email is on the top right. If you are uncomfortable with emailing, you can also pick a really old post and drop a comment, which I will get in my email and respond to in that same thread.

  • Hyperbole is ruining the entire Internet.

  • SouthernFriedSkeptic says:

    Let me start by saying that I would not say I am a science denialist. I have not even looked at the science very much. As someone who no longer participates in either vice, it hasn't been an issue on my radar. I perhaps should not have said I disagree with your comparison without more detailed research into the issue, but it was just a first impression comment in response to your post, not a formal post of my own, nor intended to suggest that I would ultimately take a position in opposition to yours. In my mind it was more of an invitation to provide me with more information.
    I spend a lot of time attempting to convince evolution doubters that it really is good science on message boards. But I try to take the approach that someone skeptical of evolution probably has not had exposure to the facts before I assume they have a personal ideology that opposes it. I wish you had approached my post with a similar mindset rather than declaring me a "science denialist cannabis fan".
    I had not read the paper you referenced. I was simply sharing my initial reaction to that single sentence in the post about nicotine and marijuana having similar withdrawal effects. And without denying that the withdrawal symptoms may be similar for those addicted, I was under the impression that the rate of addiction was much higher for nicotine than marijuana and felt the comparison was somewhat misleading in the sense that the likelihood of becoming addicted to marijuana was much less than becoming addicted to nicotine, and it follows that the risk of experiencing withdrawal symptoms was less. But that was just an opinion, and I readily admit I am no expert and would welcome any specific information on the addiction rates.
    I also concluded with the statement that it is hard to imagine that they are similar. That was based on my personal experience. It is also hard to imagine 3 billion years of evolution. It is hard to imagine relative time at very high speeds. It doesn't mean I deny the reality or the scientific evidence supporting these ideas. I'm sure most people find the singularity that forms a black hole hard to imagine. I don't think that means they deny its validity.
    When I acknowledged my post was anecdotal, I did not mean to imply that even though it was anecdotal it is still valid because it's my anecdote. I was merely acknowledging that this was my personal reaction, not intended to be an evidence based argument. The reaction you had to my post was exactly what that preface was supposed to prevent. I do have to say that I don't think your response was very evidence-based in its assumptions of my position or intention. But having said that, I'm sorry I did not present it more clearly so it would not generate such a reaction.

  • DrugMonkey says:

    According to studies (I will try to find links and post them later) and not just one or two, between sixty and seventy percent of adolescents will try alcohol and/or illicit drugs (including prescription drugs, not their own). Same studies generally indicate that roughly ten percent less will use more than a couple of times. Keep in mind that these studies are based on self-reporting in confidential questionnaires, usually administered in school.
    One such readily available source of survey data is the Monitoring the Future survey, see sidebar.
    This page has a collection of some of the figures and tables that are most relevant to DuWayne's points.

  • DuWayne says:

    I'm not sure what amazes me more, that I remember the actual figures, or that I forgot you have, if anything, more links to this stuff in your sidebar than I have in mine. I don't suppose you happen to have a link to NIDA's page that compares several studies (I seem to have lost track of the link)? It may well be that I actually have the right link and it's just disappeared, as it was a little oldish...

  • becca says:

    "According to studies (I will try to find links and post them later) and not just one or two, between sixty and seventy percent of adolescents will try alcohol and/or illicit drugs (including prescription drugs, not their own)."
    Trying alcohol or cannabis or even something utterly dumb like nitrous oxide does not = "desperate to get high". Most of the teenagers I knew had tried a few intoxicants. Many were frequent users. In fact, some were flat out total pot heads. They weren't "desperate to get high". They were teenagers with too much time on their hands who were in a band. They were actually fairly rational (at least as much as a lot of adults I know if one considers alcohol) about risk:benefit and they had reasonably good knowledge of physiological consequences. If they started coughing too much, and it interfered with their other activities, they cut way back. Heck, even most of the teens that called into Loveline (anybody remember that as a radio show?) weren't "desperate to get high". Although, given the show, I wouldn't argue with "desperate to get laid".
    I'm not arguing "teenagers don't get high". I guess I'm arguing "it's not that different from how adults do it" (and I don't think the majority of usage constitutes "desperate" let alone "dangerous").

  • DuWayne says:

    I guess my next question becca, would be where the hell were these particular kids? because while I would agree and mentioned that CPP was hyperbolic, I don't know a hell of a lot of kids that are all that aware. And a great many of them, while not desperate per say, are definitely pretty fucking motivated to get high and too often willing to do really stupid things to do so.
    The big thing these days, seems to be these fucking prescriptions, which when used the way a lot of the kids I'm talking to have used them or seen them used, are not just a little bit dangerous. We're talking about mixing all sorts of scripts, many of which are dangerous enough in the quantities and mixes they make of them - and often alcohol is thrown into the mix. And this is coming from the kids - many of whom are fresh out of high school, some of them dual enrolled, who hang out in the smoke shack at school. And these observations mesh well with the stats from mapping the future.
    And it is important to keep in mind that the mapping the future surveys, along with most of the stats we're talking about, are the ones that kids are willing to admit to on a confidential survey given at school. I took these surveys in school and doubt that I'm the only one who lied on them out of paranoia. I do know that drug and alcohol use and abuse was pretty rampant at my high school and kids were pretty enthusiastic, if short of desperate to get high or drunk.
    There is a lot more responsibility than some folks would assume, but lets not pretend that kids tend to be as responsible as many adults are about it. In aggregate, a great many teens are simply to ignorant to make reasonable choices. While it's pretty rare for adults to accidentally take too many pills, the wrong combination - throw alcohol into it, it happens with alarming regularity to kids. And while it's reasonable to assume that some of those cases are suicide, the majority are just ignorant mistakes. In contrast, when this happens to adults it is generally assumed to be suicide, because that is usually what it turns out to be.

  • becca says:

    South Suburbs/southside of Chicago, circa 1997-2001 (before that, I wasn't a teenager. After that, I was at Uni). Though in fairness, a huge bulk of the kids I knew weren't in high school (homeschooled). And most of the other folks I hung out with were post-high school anyway. So they wouldn't have been surveyed at all. Like I said, maybe I just knew really lame kids.
    Also, few kids I knew were totally uninformed for long simply because I knew them and enjoyed discussing it, at length (I, of course, knew about drugs only vicariously through my father-the-ex-hippie's stories and the internets [bless erowid and pubmed]).
    Also, I'm not at all convinced teens are too dumb to figure out how many pills to take. I speak from the painful perspective of someone who's had a suicidal friend calling them up after having taking a number of pills (that they knew exactly, but wouldn't tell me... because they looked it up and calculated the correct amount to minimize risk of ending up with a stomach pumped and maximize success). Teens are fucking smart. Just fucked up. At least, my friends were.
    Alternatively, maybe most were a lot more desperate to get high than they ever let on to me.
    Alternatively, I might just know whackaloon irresponsible "adults".

  • Leni says:

    I wonder what the comparative studies on withdrawal say about coffee?
    I am addicted to coffee. Right now I am sucking down my third enormous cup of chocolate-mint Bocha Jova. Earlier this morning, in my meth lab kitchen, I added a potentially lethal quantity of sugarfree Hazelnut Interational creamer to this already potent concoction. (Oh yeah, I set my brewer to "Strong". I am quite badass indeed.)
    I don't care if they say it will ruin my life and give me eyeball tumors, it's so damn tasty!
    ...
    Sorry, since hyperbole already ruined teh internets I figured a little more wouldn't hurt.
    ...
    More seriously, obviously addiction is not good. But it is not a sufficient reason for criminalization, especially because so many of the consequences of criminalization are so much worse and so much more immediate.
    Nick wrote:

    It is inconceivable to them that I can't just smoke less, so I don't talk about it and suffer in silence. I have enough shame as a result of my complex of mental illnesses, I don't need to deal with this one too.

    That's a good point and I'm probably guilty of this kind of thinking as well. I consider pot mostly pretty harmless and have a tendency to roll my eyes at the alarmist "but it's addictive!!" thing. However, I have some friends who are heavy pot users (I don't like the stuff, so before anyone "accuses" me of being a pot addict...) and I have no desire to alienate or belittle them and hadn't considered this. So thanks for pointing it out and I will keep your comments in mind.
    On the other hand, the kind of denigrating comments you see coming from the other direction aren't much better. In fact, they generally sound a lot worse. I wouldn't want anyone to treat me like a brain-damaged criminal for my love of and probable addiction to coffee. And I don't think this about the people I know and love with "real" drug problems, even when they are damaged and/or criminal.
    It's sad and painful to watch an intelligent, decent person go down in flames over drugs or alcohol and I absolutely hate it when otherwise intelligent people refer to users as brain-damaged or stupid. It's something I don't think should even come up in a rational discussion about drug use, except in terms of clinical significance. And when it does, I would hope it would be with concern for users, not disdain.

  • Arren says:

    I absolutely hate it when otherwise intelligent people refer to users as brain-damaged or stupid. It's something I don't think should even come up in a rational discussion about drug use, except in terms of clinical significance. And when it does, I would hope it would be with concern for users, not disdain.

    Thank you for that, Leni.

  • Hakal says:

    "The big thing these days, seems to be these fucking prescriptions"
    A friend of mine was prescribed hydrocodone is high school for an athletic injury once, and the label said to take 1/2 tablets. He thought it meant one or two. He took two, and upon his mom's inquiry if he was okay you can imagine his response..... I imagine he would have done the same thing with 1/4.

  • Travis says:

    The question of addition is a very tricky proposition. On one end of the curve we have those substances that have been, in most all studies on humans, proven to be physically addictive (e.g., heroine). Then we have those substances (objects, beliefs, etc.) where the data is inconsistent. For example, is it possible (I think probable) that Emelda Marcos experienced withdrawal symptoms when her thousands of shoes were taken away from her (she was diagnosed as having a shoe fetish). Is it possible that the superstitious person experiences withdrawal symptoms when their rabbit's foot is lost.
    Moreover, should combat soldiers be asked to refrain from their ritualistic behaviors prior to departing on combat missions (don't attempt this, they have loaded weapons). I personally had one heck of a problem (withdrawal symptons included) eliminating my ritualistic behaviors upon returning to the "world". I did have physiological symptoms of withdrawal! Was I then suffering from an "addicttion"?
    The list of DSM IV categories, other than chemical dependence, that can have withdrawal symptoms is quite extensive. Should all of the substances (objects, ideas, behavioral patterns)that produce withdrawal in symptoms in some persons be made illegal? Are the same physiological process at work in each variation? Do the same theraputic methods result in effective treatment.

  • DrugMonkey says:

    I did have physiological symptoms of withdrawal! Was I then suffering from an "addicttion"?
    You may have been, sure. It is not inconceivable that the arousal state that a soldier maintains in a combat situation results in an unusually elevated neurochemical state, say involving even dopaminergic and noradrenergic mechanisms. If so, it would be completely consistent if long term sustained exposure to combat circumstances led to a down-regulation response in the relevant neurochemical systems. Upon returning home, this might very well be expressed as a syndrome similar, if not identical, to drug withdrawal. That's certainly possible to be described as a dependence syndrome. Addiction? well, there the semantics interfere, in my view. As per your comment, you think that you are making a ridiculous comparison that somehow invalidates a certain other category that is more universally accepted to be "addiction". This is where the emotive concepts fail us.
    Personally I think we would be best to talk simply about "plasticity" which is a fairly generic concept about ongoing brain changes that occur in response to experience, including ingested substances. Maybe about tolerance and sensitization as well. And for that matter, it can interfere with things to talk about "withdrawal" from substances/experiences because that is such a laden term as well, better to talk about "discontinuation symptoms".
    But since we live in the real world, I choose to work on the other end of things, hopefully showing how dependence and withdrawal are as readily applied to subtle affective symptoms as they are to the most cartoonishly obvious symptoms of heroin discontinuation.
    Should all of the substances (objects, ideas, behavioral patterns)that produce withdrawal in symptoms in some persons be made illegal?
    Of course not. And this is obviously not the case in most societies. dependence liability or any other health risk is only one part of the political policy decision. what is your point?
    Are the same physiological process at work in each variation?
    There is a good chance, yes. There is a great deal of evidence that recreational drugs have some common neurochemical effects on brain mechanisms which people describe as parts of the "reward" circuits or pathways. Meaning that no matter what the primary neurochemical effect of the different drugs, they may all have the same immediate effect on, for argument's sake, increasing dopamine signaling in the nucleus accumbens. There are additional bodies of work which focus on the substance dependence state and again, there is a lot of evidence for a similar brain change which does not depend on the substance in question.
    At least in the case of the immediate pleasurable or rewarding effects, these common pathways are also involved in the rewarding effects of the so called natural reinforcers, food, sex, etc.
    Do the same theraputic methods result in effective treatment.
    well, so far we have crappy methods so it is hard to claim that we have "effective treatment" for any addictive disorder. One big category at present is called agonist therapy- oral methadone for heroin injecting and nicotine patch/gum for smoking being the best known. It can be summarized as giving a weenie version of the drug in question- either via a slightly different molecule (methadone) or changing the rate/dose at which it hits the relevant receptors (nicotine patch). Obviously, these are not going to generalize across addictions.
    There are some pharmacotherapies which act on systems other than the one related to the primary drug effect- in some cases at the level of the hypothesized final-common-pathways. These would be predicted to help with the "other" addictions.

  • DuWayne says:

    proven to be physically addictive (e.g., heroine).
    Two things - first, it's all physical. Whether it is whats going on in your brain that pushes you to use or fall into the behavior of addiction, the actual mechanism behind it is physiological. Second, you are talking about over, acute dependency, which is not really addiction. Addiction is what keeps you wanting it, even after you have it out of your system and your body adjusts.
    For example, is it possible (I think probable) that Emelda Marcos experienced withdrawal symptoms when her thousands of shoes were taken away from her (she was diagnosed as having a shoe fetish).
    It is most certainly possible, but we are not talking about the same thing a heroin junkie experiences within an hour or so of their last hit really wearing off. In this case we are talking about something that is entirely neurological in nature, with the brain manifesting the symptoms of acute withdrawal.
    Moreover, should combat soldiers be asked to refrain from their ritualistic behaviors prior to departing on combat missions (don't attempt this, they have loaded weapons).
    As you say, they have guns - so no, I don't think this would be a good idea...Seriously though - no they shouldn't. There are a lot of things going on in most human brains prior to something as stress inducing as a combat mission. When there is the possibility of killing or being killed, fear and anger and a lot of other feelings I won't even begin to insult people who have actually experienced this are running rampant. The person so affected absolutely must keep their composure and one of the best ways to do that is to go with their rituals - whether it's praying, clowning around, oozing machismo or simply quietly contemplating - it's what keeps their head together.
    Was I then suffering from an "addicttion"?
    Assuming you are talking about returning from combat, yes and no is the best answer I can give. Yes, you are suffering from something very much like addiction, but in the case of military - especially after combat, prison or anywhere else you are so utterly divorced from the mainstream of human experience (some foreign travel would qualify) it usually produces a disconnect. It's like being out of phase with reality, because your perception of reality has been dramatically altered - your experience of reality has been so dramatically altered, that it can actually become painful just to sit down in a situation where you should be relaxed, because it isn't a part of who you are anymore.
    You have become a different person. If your drill sergeant did his or her job right, you were broken down and rebuilt into a fucking soldier! And a goddamned good thing, because if you went into combat you had to be a fucking badass soldier to stay alive. Then you went through whatever you went through actually being a soldier.
    When it's all over, it would be quite remarkable if you didn't experience something very much like withdrawal and honestly, I am not inclined to argue that it isn't. My cousin, who was (is?) in combat an awful lot hates being stateside as a drill sergeant - too much time not being on combat missions. The few times I've seen him since he spent time in Afghanistan and wherever else he's been, he has done reasonably well at hiding it, but it's painfully obvious that he is not comfortable around civilians or non-combat personnel. And his symptoms are very much like those of an addict who is doing reasonably well hiding their need for the substance of their abuse.
    Should all of the substances (objects, ideas, behavioral patterns)that produce withdrawal in symptoms in some persons be made illegal?
    Personally, I don't think any of them should be illegal - it makes it harder to fucking treat addiction.
    Are the same physiological process at work in each variation?
    No, though there are some fairly common threads.
    Do the same theraputic methods result in effective treatment.
    There is no "one size fits all" approach to treating addiction. There aren't now and probably never will be any one therapy that is effective for everyone suffering any addiction. There aren't even any therapies that are effective for everyone addicted to the same substance or behavior.
    Everyone's relationship with the substance or behavior of addiction is different. Some people engage in those very same behaviors or use those same substances without experiencing addiction at all. For some folks, their addiction may stem from simple exposure - they do it because their fathers or mothers did it all the time and thats what they know. For others, it may and usually is (in some form or another) self-medicating or avoidance. But what is being medicated or avoided can be any of thousands, if not millions of things.
    There are just way too many variables to make any legitimate generalizations.

  • Alexandra Lynch says:

    I admit that my own interest in pot legalization stems only from a personal feeling that once it's legalized and is legal for several years will be when I trust studies that say it actually does help neuropathic pain, and by that point someone will probably have a delivery route that does not involve smoking the stuff or eating hash brownies, and I will be able to consider whether or not to try it. Of course, in ten years, I may be able to afford Lyrica when it goes generic, so we'll see. The question may be moot. Now? Hell, no. As much as I would enjoy not hurting all the time or being distanced and flat on (rationally used prescription)opiates for it, I enjoy my freedom a lot more.
    But I confess, I am like quite a few people; the anecdote is my way of finding common ground with the discussed experience. But that's a psychology point, not one on addiction.

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