Jun 13 2013

The Problem of Addiction

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174 Responses to “The Problem of Addiction”

  1. Insomniacon 13 Jun 2013 at 9:00 am

    Steven,

    What about marijuana ? My understanding was that it did not cause any direct physical dependance, although its use does stimulate reward circuits.

    And you said :
    “those drugs by their very nature take away liberty and freedom”

    I don’t know if there is the hidden assumption here that we possess any form of free will. I’d like to know where you stand in the free will debate, because although I looked into compatibilist arguments, it seems to me that there is no strong case possible for free will in a naturalistic worldview.

  2. praktikon 13 Jun 2013 at 9:52 am

    Steven,

    Studies have shown that people who try hard drugs end up dependent (following cohorts over the years after their first experience) at roughly the 5-12% level.

    If many individuals are then able to sample – even hard drugs – without developing dependency, then I think there is still some element of freedom and liberty that is a valid argument for the legalization of drugs.

    A useful example is alcohol, where dependent alcoholics ruin lives and families – yet many people enjoy the freedom of being able to indulge in this drug in social venues where it performs the function of “social glue”.

    Now this may be a cultural bridge too far from the world you inhabit Steven, but in the circles I’ve travelled many illegal drugs (most prominently marijuana – but including hallucinogens, ecstasy and even cocaine) perform these same functions. As with alcohol I have seen people develop problems. But also with alcohol, I’ve personally used all the substances I’ve listed in the same social way that others do with alcohol (they are ingrained in the night-life subculture I inhabit).

    You may be overgeneralizing from a rather mechanical view of the way drug use works on the brain – leaving out the statistics showing that dependency is still something that happens to a minority and the socio-cultural milieus in which these drugs are taken.

    Furthermore, when it comes to worry about the harm from drug use and our legal rubric – I think there is a strong case to be made that prohibition exacerbates and multiplies these harms. Too much to list here, but I find this site to be a very worthwhile compendium of research and studies across a variety of aspects of drugs and prohibition: http://www.countthecosts.org

  3. ccbowerson 13 Jun 2013 at 9:53 am

    “More to the point – neuroscientific research into addiction seems like a powerful argument again legalizing recreational drugs…
    I know there are potentially practical arguments to be made for legalization, but that is a debate I am not addressing here. I simply don’t buy arguments for drug legalization premised on liberty and freedom.”

    I think the first sentence is way too strong a statement, because there is far too much to unpack here. Your next paragraph is a bit better, but I don’t see how this neuroscience research is ” a powerful argument again (sic) legalizing recreational drugs.” It adds to our understanding of addiction, but it does not tell us what to do about our laws. There are too many specifics that matter much more than this general understanding. We would need to evaluate the effects of various controlled substance laws to know what is best. This is basic research, and you are extrapolating that research beyond what it tells us when you say it is a powerful argument against legalization.

    Also, I am not sure what precisely you mean by “practical arguments.” What becomes law must also be practical, or you have lost me. I know you must mean you are excluding arguments based upon practicality, but then what arguments are you talking about? Just freedom arguments?

    The practical arguments are critical to know what to do with our laws: What impact do our laws regarding controlled substances have on the use of those substances and the citizens more generally? In which ways do they help, and in which ways do they hurt. How are they different between substances? Are the laws on specific substance proportionate to their harm? Do the punishments help or hurt? etc

    I agree that arguments solely based upon liberties and freedoms are not good ones, which you get to in this post, but those are only a small part of the arguments. Also, I think in order to have disussions about addiction and recreational drugs, we actually need to speak about specifics, since by lumping them into one category very few conclusions can be drawn. Not all recreational substance have them same addictive properties, and some substances cause addiction in a minority of the population (e.g. marijuana, alcohol) while others cause addiction in close to 100% (heroin, cigarettes).

    To be clear, I am not necessarily a legalization advocate, I just disagree with your argument.

  4. cannotsay2013on 13 Jun 2013 at 10:32 am

    Steven,

    “At least, it seems to refute the argument that people should be free to choose for themselves if they want to use recreational drugs, because by the very nature of those drugs and brain function, they take away that freedom.”

    Only for those who have already dogmatically concluded that,

    - A experiment about behavior in rats extrapolates to humans completely

    - Humans do not have “free will”

    Even you admit that the second point is a contentious point. I side with “humans’ free will” over “rat experiments that provide insight about human behavior” any time, but again, my thinking is not corrupted with so called “skeptic dogma” :D .

  5. Steven Novellaon 13 Jun 2013 at 10:46 am

    cc – I specifically did not get into the question of whether or not specific recreational drugs should be legal. That’s what I meant when I wrote, “that is not a debate I am addressing here.”

    Regarding the research, I said it “seems” like an argument against legalization, then immediately clarified that by stating that it removes the argument based upon liberty and free choice because the very nature of addiction removes free choice.

    I could have explicitly added that this is also a matter of degree and different substances have different addictive potentials. Different people also have different susceptibility to addiction to different substances.

  6. Steven Novellaon 13 Jun 2013 at 10:49 am

    There is a great deal of clinical addiction research on humans. Rat studies are helpful to sort out the neuroanatomical correlates because we can do things like slice up their brains. But there is plenty of human clinical research.

    There is no such thing as “skeptic dogma” – only cranks who don’t understand scientific skepticism.

  7. cannotsay2013on 13 Jun 2013 at 10:55 am

    Steven Novella,

    Actually the two threads in which psychiatry has been duly deconstructed (it was about time) show very convincingly that there is plenty of dogmatism in your movement. You have written in the past several posts that after May 2013′s crisis in psychiatry look ridiculous (they were ridiculous back then, only now authoritative figures in psychiatry have refuted many of your points). The post called “Responding to a Szaszian” is the poster example of the type of canards the so called “skeptic movement” dogmatically beliefs such as,

    “ADHD is demonstrably a brain disorder and fits well into our current models of brain function, specifically the role of executive function in guiding our attention and behavior”

    Well, no, as Insel said ADHD (like other DSM labels) is just a label created by “consensus” of DSM committee members about a pattern of behavior that has a low reliability measure (0.6) and for which some time in the future some think there will be a “biological biomarker” but nobody has demonstrated in a way that passes any reasonable test that it is a “brain disorder” :D .

  8. Steven Novellaon 13 Jun 2013 at 11:21 am

    I am not the skeptical movement. There is actually quite a diversity of opinion among skeptics on this topic, and I am the only skeptic of note that I know of who writes regularly on this topic.

    Second – a science-based and rational argument for a position does not equal “dogma.” It if very telling that you cannot tell the difference, or that you don’t care about the difference.

    Regarding ADHD, your simplistic quoting out of context of one individual is also very revealing. Meanwhile, and actual scientific discussion on the nuances of validity and reliability are happening within psychiatry.

    Here is one review that takes a frank and honest look at the current state of the evidence. They acknowledge the limitations of the diagnosis, but also note: http://psych.colorado.edu/~willcutt/pdfs/Willcutt_Carlson_2005.pdf

    “This paper summarizes the results of a comprehensive review of the internal and external validity of ADHD as defined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Results indicate that for most individuals DSM-IV ADHD is a valid disorder in the sense that it is associated with significant impairment in social, academic, and occupational functioning and increased risk of accidental injury across the life span.”

    About the notion of validity of mental disorders more broadly, they write:

    “As described in more detail elsewhere in this special issue, the criteria, which must be met for a mental
    disorder to be considered valid, have been the focus of considerable discussion. These authors have
    considered an extensive range of important issues, including the role of theory in the development of diagnostic criteria, the utility of a dimensional versus categorical conceptualization of mental disorders, the extent to which the definition of a mental disorder is influenced by social values, and the potential usefulness of evolutionary theory to identify mental processes that have gone awry.”

    Here’s also a more recent 2012 review: http://www.ncbi.nlm.nih.gov/pubmed/22612200

    “Results indicated that DSM-IV criteria identify individuals with significant and persistent impairment in social, academic, occupational, and adaptive functioning when intelligence, demographic factors, and concurrent psychopathology are controlled. Available data overwhelmingly support the concurrent, predictive, and discriminant validity of the distinction between inattention and hyperactivity-impulsivity symptoms, and indicate that nearly all differences among the nominal subtypes are consistent with the relative levels of inattention and hyperactivity-impulsivity symptoms that define the subtypes.”

    But they go on to conclude that the DSM IV subtypes are not sufficiently supported by evidence, and perhaps we should rethink (more dimensional, less categorical) how subtypes of ADHD are defined.

    Contrast this to your simplistic cartoon. Where’s the dogma?

  9. LittleBoyBrewon 13 Jun 2013 at 11:29 am

    Your statement

    “I simply don’t buy arguments for drug legalization premised on liberty and freedom, when those drugs by their very nature take away liberty and freedom.”

    seems to be an backhanded slap at the libertarian viewpoint. Whether you did that with intent I do not know. I once heard Penn Jillette (a big libertarian, for those who do not know) say that when considering potential solutions to a problem, one should consider whether increasing liberty and freedom is a better solution than decreasing it. In the case of addiction you seem to be limiting the discussion of freedom and liberty to the person consuming the drug. What about the liberty and freedom of a person who lives in a neighborhood that is unsafe due to crime, crime that is related to the sale and distribution of illegal drugs? If you are afraid to leave your house because you might be robbed or shot, I would say your freedom has been taken away to a degree.

    I understand your premise, the irony that the freedom to take a drug results in a certain loss of freedom. And that irony should be considered as a part of any smart drug policy. But there is a much larger picture to consider.

  10. ConspicuousCarlon 13 Jun 2013 at 11:34 am

    Steve Novella said
    I simply don’t buy
    arguments for drug legalization premised on
    liberty and freedom,

    Someone else already mentioned that the loss of freedom from addiction is far from universal, so I will deal with the first half of the sentence.

    I get the impression that you think drugs ought to all be illegal unless someone argues for “legalization”. But these drugs weren’t found in the woods wrapped up in prohibition laws. Prohibition was implimented without much more than political hatred, and I can dismiss the blanket “lock you up for your own good” brutality just as easily as you dismiss freedom.

    The difference is that you are, by phrasing it as “legalization”, supporting a system which actively affirms the paternalistic basis for criminal prosecution as a default. I don’t ask for “legalization”, which implies that I am asking for a thing to be done, I ask that the government stop actively imprisoning people who haven’t harmed anyone.

    I’m sure you want to respond with a claim to want to avoid making political assertions, but you have already made one.

  11. ccbowerson 13 Jun 2013 at 11:35 am

    “Regarding the research, I said it ‘seems’ like an argument against legalization, then immediately clarified that by stating that it removes the argument based upon liberty and free choice because the very nature of addiction removes free choice.
    I could have explicitly added that this is also a matter of degree and different substances have different addictive potentials. Different people also have different susceptibility to addiction to different substances.”

    I agree with all of your follow up, but your post implies something different. I assume that this post is a continuation of previous conversations that you have had with others with a libertarian/legalization perspective, but without this context it is misleading. I agree that the freedom of choice argument alone is not a good one, but there is much more to this conversation.

    “Contrast this to your simplistic cartoon. Where’s the dogma?”

    Apparently he thinks that if he repeats the word dogma in different forms, it becomes more true. He has used it dozens of times, and keeps using it despite the fact that I have demonstrated that he doesn’t know what the word means or is at least misusing the term.
    Dogma is really argument from authority, and the skeptical movement is not heirarchically structured- there is no built in authority. It’s one of his weasel words of choice.

  12. Bruce Woodwardon 13 Jun 2013 at 12:00 pm

    If illegalization of drugs was to be done on addiction alone, surely nicotine should be added to the list?

    Personally, I think (note think, this is not based on facts) that making recreational drugs legal would solve more problems than it causes and would open the door for taxation and regulation.

  13. dawso007on 13 Jun 2013 at 12:03 pm

    You are correct about the low probability of encountering a foodstuff that will contain an addictive compound that will hijack your brain. There are currently 322 addictive drugs and precursors on the DEA list of controlled substances compared with a total of 34 million compounds in Chem Abstracts. George Koob has defined addiction as a disorder that moves from an impulse control disorder involving positive reinforcement to compulsive disorder involving negative reinforcement. In clinical work with addicts this is commonly observed as “chasing the high”. With chronic use it is rare to talk with anyone who is getting high anymore and the bulk of their behavior is focused on avoiding withdrawal symptoms. I also agree with your observations that legalization of drugs doesn’t make any sense from the standpoint of neurobiology. Historically we have already done these experiments and they have failed. That does not mean that addicts need to be criminalized and treatment is an option. Musto does a good job of documenting what he describes as oscillations between periods of tolerance of drug use to periods of disapproval and demarcating three temperance movements so far in the US.

    Reality is not as harsh as being stuck on the compulsive negative reinforcing side of an addiction. The reward system operates well in response to the less intense biological reinforcers like social affiliation, more intimate relationships, and hedonic activities that activate the reward system in more predictable ways. Those same activities can be a pathway to sobriety for anyone who is experiencing an addiction.

  14. cannotsay2013on 13 Jun 2013 at 12:42 pm

    Steven Novella,

    First, I must note that this is your first non condescending answer to me that goes to address the meat of the matter.

    Let’s see where now it seems there is agreement: the issue of whether DSM “labels” are genuine brain disorders is controversial. If this is the case, then what you said that “ADHD is demonstrably a brain disorder” cannot be true at the same time.

    So admitting that there is controversy on this matter is a perfectly valid position. Calling “denialist” somebody who has your opposite point of view on the controversy, controversy that exists because the issue has not been given a scientifically valid answer, not only is not scientific but is counterproductive.

    In other areas of science, there are controversies and arguments being made about which position is true. For instance, on the https://en.wikipedia.org/wiki/P_versus_NP_problem , most top notch computer scientists and mathematicians are in agreement that it is very likely that P is not NP. There is anecdotal evidence that it is the case. However, nobody, to my knowledge, has called “denialist” to those who take the opposite position because the history of science is full of instances of controversies where the “mainstream thinking” was proven wrong.

    But here is the thing, when it comes to psychiatry- June 2013 which is after both those studies you have mentioned-, the mainstream thinking is that “there are no biomakers for DSM mental disorders” and as a result the validity of “DSM labels” has not been established with the same criteria that HIV has been shown to be the VALID cause of AIDS. This takes me to the next point, from one of the studies you refer,

    “Results indicate that for most individuals DSM-IV ADHD is a valid disorder in the sense that it is associated with significant impairment in social, academic, and occupational functioning and increased risk of accidental injury across the life span.”

    This was something that another commenter already addressed (I think it was BO but I could be wrong). With that notion of validity, homosexuality is a genuine and valid “mental illness” in homophobic societies. So a country like Iran is its perfect right to “quarantine” homosexuals that pose a danger to the “public health”. Since I can only assume that you find this proposition preposterous, then you’ll have to agree that this notion of validity is BS and it’s the type of fallacious thinking that psychiatry needs to engage in to justify itself.

    Instead, the scientifically honest position to take is to say that to this day none of the DSM labels has been shown to have a valid biological cause in the sense HIV has been shown to be the cause of AIDS. It might be a “simple statement” but it also happens to be scientifically true.

    That statement, as sonic also pointed out, is perfectly consistent with admitting that a) I could be wrong and that this time’s promise that “biomarkers are around the corner” will not be empty, and b) I could still be true that Insel’s program will fail miserably.

    Whether a) or b) is true is a matter of controversy. What is not controversial in June 2013 is the statement: “DSM disorders lack scientific validity with the criteria of validity that HIV causes AIDS”. So to put somebody like me in the company of AIDS denialists is offensive.

    Now, to support b) what I have said (since it is impossible to prove the negative) is that most of the evidence provided by those who “believe” in a) is “correlates of brain physiology with behavior” of the kind that support that dead fishes respond to human emotion or that Internet Explorer usage is the cause of crime in the US. Really, none of your arguments is stronger than the arguments that could be made to support either statement.

    If you “believe” that biomarkers will eventually found, as Tom Insel does, fine, but state it as such, don’t give the false idea to your readers that those biomarkers have been found because that is categorically false as of June 2013.

    Now, the reason this matters is because you have a following and you could be a great influence to fix the current system that results, more often than not, in blunt human right abuses, like those 10000 British citizens who had their civil liberties restricted gratuitously, or that guy who was until last year forcibly ECT-ed in New York, or that woman who is now facing criminal charges because the state wanted to force anti psychotics on her daughter against the woman’s judgement. This type of human rights abuses are specific to psychiatry, which is ironically the only branch of “medicine” that has not had any of its invented labels scientifically validated. These are the lives of individual people, like mine, that have been ruined by a quackery.

  15. steve12on 13 Jun 2013 at 12:44 pm

    “I know there are potentially practical arguments to be made for legalization, but that is a debate I am not addressing here. I simply don’t buy arguments for drug legalization premised on liberty and freedom, when those drugs by their very nature take away liberty and freedom.”

    I would tend to agree that this liberty argument is naive considering the data (though marijuana is an exception to this), but I think the practical argument that you’re not addressing trumps this argument re: legalization.

    The current model doesn’t stop drug use in any way. Anyone can get any drug whenever they want – and driving up the cost doesn’t lead to ess use as much as it leads to crime. So now, we have all of the drug use + the cost of a drug war, which is substantial.

    I think we need a treatment regime – in some cases forced treatment, especially when a crime is committed. If someone were to apply the libertarian argument at this point I woud indeed reject it for the reasons that you site.

  16. chrisjon 13 Jun 2013 at 12:45 pm

    “Once addicted, however, withdrawal from the substance creates a powerful dysphoria, and users seek out drug use in order to reduce this extremely negative experience. This leads to not just addiction but dependence.”

    Steve, this is not the same thing as there being no choice whether to seek out the drug. As you said the human brain is much more sophisticated than other animals. While I do not dispute the idea that humans work on a reward/aversion model, we should not think about this in overly simple terms. A lot of cognition occurs between the feeling dysphoria and seeking out drugs as a means of stopping the dysphoria. In other words, the reward/aversion system is not the only system in operation here. If it is possible for a one of those cognitive processes to override drug seeking behavior, then the person does have a choice in the relevant sense for this question. I think it is clearly the case that this is possible for some people at the very least. If it weren’t, its hard to see how people who overcame their addiction did so.

  17. Steven Novellaon 13 Jun 2013 at 12:59 pm

    Chris – the vast majority of people cannot simply override their addiction by making a choice. It’s not a matter of will power. Those that can beat their addiction mostly have help, whether counseling or otherwise. I agree with the consensus of opinion among addiction experts that framing addiction as a matter of choice or will power does not fit the evidence and is counterproductive.

  18. starikon 13 Jun 2013 at 1:14 pm

    “The deeper conflict here is between living in harsh reality, and making the best of it, vs bypassing the adaptive nature of the reward/aversion circuits in our brain in order to escape to a pharmacologically/electrically/virtually induced fantasy euphoria.”

    Once we’re able to do this without harm, plus immortality, it would be hard to convince anyone to opt out. Maybe this is why haven’t seen any evidence of advanced alien civilizations.

  19. Steven Novellaon 13 Jun 2013 at 1:17 pm

    cannotsay – I characterize your style of argument as that of denial. You continue to display this pattern, and have been called on it my numerous other commenters without acknowledging or countering their arguments, or changing your behavior.

    There is no significant controversy among actual neuroscientists about whether or not ADHD is a brain disorder. You keep quoting one person’s statement out of context, while I provide systematic reviews. This body of evidence did not change when Insel made his comment.

    You keep falsely stating that there are not biomarkers for any mental illness when this is demonstrably not true – and copious evidence has been provided to you. You keep confusing the existence of biomarkers useful in diagnosis with those useful in characterizing underlying neurophysiology.

    You ignore the point that mental illnesses lack classical pathology (like infection) but are based in brain function determined by the pattern of neuronal connections and regulations of these circuits.

    Further to the extent that brain function can be imaged for this, researchers are finding physiological correlates of the main mental illnesses. To keep with ADHD – there are several genetic correlates (http://www.ncbi.nlm.nih.gov/pubmed/21409419)

    The neuroanatomical correlates of ADHD are even more well established -http://www.ncbi.nlm.nih.gov/pubmed/20546170. In short, ADHD is primarily a disorder of executive function, with reduced activity in those parts of the frontal lobes that are responsible for executive function.

    Finally, you keep doing the denialist shuffle – attempting to refute one valid point with another unrelated point. Your homosexuality point is an example of this. You claim that mental disorders do not have validity. I provide evidence that ADHD diagnosis has validity. You do not acknowledge this, you simply argue that validity is pointless because of the example of homosexuality. But this does not dispute validity, merely the implications of specific diagnoses in a social/cultural context. Some diagnoses are more culturally subjective than others, and you keep choosing a historical diagnosis (homosexuality) that is among the most sensitive to cultural context – and one that has already been dealt with within psychiatry (making its relevance even more dubious).

    It is for all these reasons that I argue your style of argument fits cleanly into what has been identified as a denialist strategy. This is not dismissive or unfair – it is an accurate portrayal of your illogic. Continuing to demonstrate that poor logic is making my case, not yours.

  20. cannotsay2013on 13 Jun 2013 at 1:48 pm

    Steven Novella,

    Again, insulting and “strawmanning” will not take you very far. You’ve made only one valid admission and now you are back to your insults.

    “I characterize your style of argument as that of denial. You continue to display this pattern, and have been called on it my numerous other commenters without acknowledging or countering their arguments, or changing your behavior. ”

    WOW, now it’s not that I have not addressed arguments (to the opinion of several commenters I have perfectly addressed the arguments put forward by people like you), it’s that I “exhibit a denialist behavior” or something. Glad you didn’t have a say in any DSM discussions :D .

    More seriously,

    “There is no significant controversy among actual neuroscientists about whether or not ADHD is a brain disorder. You keep quoting one person’s statement out of context, while I provide systematic reviews. This body of evidence did not change when Insel made his comment. ”

    I remind you that the two studies you have provided are very clear that their “notion” of validity is,

    “in the sense that it is associated with significant impairment in social, academic, and occupational functioning and increased risk of accidental injury across the life span”

    That is not what Insel or anybody who takes medicine seriously thinks that “validity is”. Your counter argument is just a Clintonian answer, known in your circles as a “semantics fallacy”.
    So, don’t pile sh%@#$%#$ on you because you were doing just fine with the previous post admitting that there is a controversy.

    “You keep falsely stating that there are not biomarkers for any mental illness when this is demonstrably not true – and copious evidence has been provided to you. You keep confusing the existence of biomarkers useful in diagnosis with those useful in characterizing underlying neurophysiology.”

    “Further to the extent that brain function can be imaged for this, researchers are finding physiological correlates of the main mental illnesses. To keep with ADHD – there are several genetic correlates (http://www.ncbi.nlm.nih.gov/pubmed/21409419)”

    As for the study which you fail to put the tile on, I’ll put it:

    “Neuroanatomical correlates of attention-deficit-hyperactivity disorder accounting for comorbid oppositional defiant disorder and conduct disorder.”

    Again, none of the so called “evidence” provided is stronger than the evidence that can be provided to show that dead fishes respond to human emotion: it has a name: confusing correlation with causation in a situation where there are with many hypothesis at play, scenarios in which anything can be shown to be correlated with almost anything.

    I do not dispute that somebody with your point of view takes this so called “evidence” as something that puts your position on the “brink of being finally established” but for those of us for whom science matters and who cannot afford to make unscientific statements in our lines of work, we’ll take it as some studies that you use to confirm your own bias and beliefs but that actually accomplish nothing with respect to the matter at hand.

    Regarding you straman tendency, here is a perfect example,

    “Your homosexuality point is an example of this. You claim that mental disorders do not have validity. I provide evidence that ADHD diagnosis has validity. You do not acknowledge this, you simply argue that validity is pointless because of the example of homosexuality. But this does not dispute validity, merely the implications of specific diagnoses in a social/cultural context.”

    YOU ARE THE ONE who have as notion of validity adaptation with society. No real biological disorder has that notion of validity. In order to accept ADHD as valid, you need to accept that canard, to which I add, if you accept that, homosexuality is also a valid disorder in homophobic societies. After all, in Iran, being homosexual results in “impairment in social, academic, and occupational functioning”. So indeed, it seems to me that this is a cheap attempt on your side at double backing by introducing a strawman (your specialty, like that nonsense that I was denying the existence of extremes in a continuum). You cannot have it both ways. If “impairment in social, academic, and occupational functioning” is VALID as a criteria to establish scientific validity, then homosexuality is also a valid “mental illness” in most non Western societies. Similarly, graduating from Yale might not be a desired outcome in societies where he/she (normally he) who owns most land is the most powerful, so something as what is labelled as “ADHD” might prevent that somebody from going to Yale, but it will give that somebody the skills required to become very successful in that other society. So no pal, you cannot have it both ways no matter how many strawmen you introduce in your reasoning.

    “It is for all these reasons that I argue your style of argument fits cleanly into what has been identified as a denialist strategy. This is not dismissive or unfair – it is an accurate portrayal of your illogic. Continuing to demonstrate that poor logic is making my case, not yours.”

    Just as for all the reasons I have described I claim that you lack critical thinking skills and that you argue from the point of view of “skeptic dogmatism” -you are even on record now admitting that this is a matter of controversy in scientific circles, but you still insist on showing as “proof” something that shows “correlation” at best. Again, “not dismissive or unfair-it is an accurate portrayal of your illogic. Continuing to demonstrate that poor logic is making my case, not yours.” :D .

  21. ConspicuousCarlon 13 Jun 2013 at 1:50 pm

    Little boy Brewers,
    ” What about the liberty and freedom of a
    person who lives in a neighborhood that is
    unsafe due to crime, crime that is related
    to the sale and distribution of illegal drugs?”

    “Related to” is a pretty loose legal standard. It sounds like you want the person you sympathize with to be treated as an individual with rights, but anyone who uses drugs is part of some inhuman conglomerate.

    And I feel for my fellow non-drug users. I hate stoned dipshits who can’t hold jobs and alcoholics who lie to get money for vodka. But not everyone who has snorted coke, smoked weed, or drinks alcohol is like that. A lot of the pot prohibitionists drink alcohol, which kills 10k people on the road every year, and yet they don’t expect to be locked up simply for consuming beer at home.

  22. DOYLEon 13 Jun 2013 at 1:56 pm

    Here is something I have wondered about.With the exponential progress of human endeavor(tech,science,medicine)are we getting over on evolution.Are we antagonizing our biology that evolution has selected for.

  23. ccbowerson 13 Jun 2013 at 2:01 pm

    Cannotsay- I guess this post is an example of skeptical dogma in action, right? Of course, Steve is well known person in skepticism, but that does not stop others from from being critical of his posts, even when there is mostly agreement. Skepticism requires a rigorous process for evaluating claims so often that results in similar conclusions, but note that this is not a top-down process.

    PTSD is another diagnosis that had been ignored during this discussion. The increase in recognition of this disorder has increased access to treatment. In the past, problems after tramatic experiences like war or assault were more likely to be framed as character or morality issues, which caused many people to go untreated/ unhelped. . You fail to acknowledge these obvious benefits that have come from attempts to categorize mental illness by focusing on the difficulties. This is another denialist strategy, to add to the ones others have mentioned.

  24. cannotsay2013on 13 Jun 2013 at 2:12 pm

    ccbowers,

    With respect to Steven Novella, he is making no favors to the “skeptic movement”, when he claims that “impairment in social, academic, and occupational functioning” is a valid criteria to establish scientific validity of a “mental illness” (something that BTW will gain him a lot of enemies even among those who believe that psychiatry has scientific validity) and then reject that standard applied to homosexuality or other invented DSM disorders. He cannot have it both ways. What he is doing is digging deeper into the hole just when he was about to start climbing out of the hole he has dug over the years. I expect that at least some of the readers are smart to see that he has written two entries in this blog entry that are utterly contradictory, first admitting to a controversy, then going back to his nonsense to claim that there is no controversy.

    I am not very familiar with PTSD, but here is the historical fact that cannot be denied. Even in the context of American history alone, many more million people went to war and died in war than those who have gone to war or died in the wars of Afghanistan and Iraq. Many veterans came back, had some issues adjusting back to civil society but they eventually did, to the point that many WWII, Korea and Vietnam veterans are among our most successful members of society. I don’t think that the veterans of those wars had an experience any less traumatizing than the average experience of today’s veteran. What the historical context of those wars didn’t have was an unholy alliance between Big Pharma and academic psychiatry to label a normal reaction to trauma as a “mental illness” to be treated with drugs. If my memory serves me well, PTSD was “invented” as a disease by DSM-III.

  25. evhantheinfidelon 13 Jun 2013 at 2:15 pm

    The whole recreational drug issue is one that is difficult for me to work out. By many of the criteria people often list, it seems to me that alcohol should absolutely be illegal. The problem is that we tried that out, and it failed utterly. Maybe for other drugs, there could be legal levels like blood alcohol content. The problem is that it may be difficult to test, like the commonly heard poppy seed and positive opium test story. Of course, I’m not saying that specific case is a problem.

  26. praktikon 13 Jun 2013 at 2:28 pm

    The main problem is seeing prohibition as a vector to reduce the harm of drug use. This assumption undergirds the thinking in Novella’s posts.

    Skeptics should be conditioned to question this as a matter of course….

  27. praktikon 13 Jun 2013 at 2:37 pm

    Actually I can safely say that Drug War politics, and the skeptical study of prohibitionist claims, was a major signpost on my journey to skepticism!

    It was one of those things as I grew up in my teens where things I believed turned out to be entirely untrue…

  28. steve12on 13 Jun 2013 at 2:56 pm

    “The main problem is seeing prohibition as a vector to reduce the harm of drug use. This assumption undergirds the thinking in Novella’s posts.”

    Exactly. The free will argument is almost irrelevant to the public policy prescription re: prohibition because it does nothing to stop drug use.

  29. Hannahon 13 Jun 2013 at 3:12 pm

    I haven’t read most of the comments, so this point has probably already been made, but I don’t see the neurological research as an argument against legalizing drug use as much as an arugment in favor of decriminalizing drug use. Currently our justice system treats drug addiction as a crime, rather than a medical issue in need of treatment, although that has started to change somewhat in recent years.

    It’s a tricky question because, on the one hand, we don’t want to encourage drug use, but on the other hand, we don’t want to lock people up simply for being addicted, which I don’t see as a crime. As others have said, making drugs illegal seems to have done very little to prevent their widespread use, and the war on drugs has been a total failure. Our society needs to find a better way of dealing with drugs and people who use them rather than simply arresting and incarcerating drug addicts over and over for something they can’t help.

  30. chrisjon 13 Jun 2013 at 3:14 pm

    Steve,

    I didn’t mean to suggest that addiction can be simply over come with will power and I agree that addicts generally cannot overcome addictions without help. However, counseling is not a direct pharmacological intervention on the reward/aversion system. As I understand it, the consensus is that cognitive behavioral therapy is the best form of counseling. This consists in helping patients think about their situation in a new way and in suggesting ways to build new behavioral patterns. The patient presumably has to CHOOSE to accept this advice and implement it. So there is an element of choice in overcoming addiction. My complaint is that you are oversimplifying the problem by ignoring the cognitive element.

  31. praktikon 13 Jun 2013 at 3:15 pm

    Good point Hannah, thats probably the right direction to take if we take the mechanistic approach to understanding drug approach at face value…