[Basic] Disadvantage of the week: Addiction and Alcoholism

[Flyndaran]

Originally Posted by sir_pudding

In the real world there's a lot more and cheaper support for quitting smoking than for quiting heroin, so maybe this actually makes sense.

I would assume the opposite for legality. It's a lot easier to avoid places and people that sell illegal drugs than cigarettes or alcohol.
You're not bombarded daily by signs and ads for heroin, for example. Nice coworkers don't ask if you want to hang out after work for meth. You don't have to walk past a bus stop full of clouds of cocaine.

[Icelander]

Originally Posted by Flyndaran

I would assume the opposite for legality. It's a lot easier to avoid places and people that sell illegal drugs than cigarettes or alcohol.
You're not bombarded daily by signs and ads for heroin, for example. Nice coworkers don't ask if you want to hang out after work for meth. You don't have to walk past a bus stop full of clouds of cocaine.

While I haven't actually read the studies, I am assured by those of my players who are doctors and have done rotations in emergency psych wards (where a lot of addicts are treated and where they often have to figure out available longer term options) that the success rate of treating opioid addiction is far higher than nicotine.

Anecdotally, several clients who have gone through clean-up clinics report that quitting various heroine substitutes, methamphetamines, methylphediate, cocaine and several other popular drugs is easier than auitting smoking.

[Flyndaran]

I agree, though anecdotes can get odd. My grandmother smoked for decades, then decided it wasn't good to continue. She quite and says she never felt the desire ever again.

[Bruno]

"Quitting" addictions is a very complicated thing.

Opiate addictions that started as pain control tend to be pretty "easy" to quit if the source of pain is managed appropriately - there's no significant psychological factor to fight against once the pain is dealt with.

Drug addictions (including alcohol, etc) of any kind that start as an attempt to self-medicate (whether for physical, mental, or social problems) are often extreeemely challenging to shake until the patient has their underlying problem dealt with. This includes problems like "my entire peer group uses X" - if you go back to that peer group, relapse is nearly unavoidable.

Nicotine is a very odd duck in that it isn't (usually) used to cope with anything. Some people can quit nicotine fighting and clawing all the way, but some people just can't. But. There's a weird phenomenon with nicotine where the patient will suddenly be able to quit, even after decades of struggling. It's not that the patient's motivation changes, or life circumstances change, or they suddenly understand the dangers (very very few smokers in developed countries are ignorant of at least the major risks). They just *poof* can quit suddenly.

It's a thing that's been tricky hard to study as there's no obvious triggers.

[Daigoro]

Originally Posted by Bruno

There's a weird phenomenon with nicotine where the patient will suddenly be able to quit, even after decades of struggling. It's not that the patient's motivation changes, or life circumstances change, or they suddenly understand the dangers (very very few smokers in developed countries are ignorant of at least the major risks). They just *poof* can quit suddenly.

It's a thing that's been tricky hard to study as there's no obvious triggers.

A quick and lazy google (like, i only read the preview paragraphs without opening any links) suggest it's common in the early stages of lung cancer.

[Flyndaran]

Turning this into gaming scenarios... knowing the reasons for a character's addiction could help or hinder their resistance rolls.

I know someone that's courted alcoholism due to her severe anxiety.
Finding an effective medication would pretty much remove the temptation for addiction.
But evilly, one could cause coincidental looking social encounters that would push her toward drinking more.

[Bruno]

Originally Posted by Daigoro

A quick and lazy google (like, i only read the preview paragraphs without opening any links) suggest it's common in the early stages of lung cancer.

That's really interesting, I hadn't heard that before.

[johndallman]

Originally Posted by Bruno

There's a weird phenomenon with nicotine where the patient will suddenly be able to quit, even after decades of struggling. It's not that the patient's motivation changes, or life circumstances change, or they suddenly understand the dangers (very very few smokers in developed countries are ignorant of at least the major risks). They just *poof* can quit suddenly.

My father had that. He'd had a severe chest infection which lasted several weeks. The first time he felt well enough to light up, he realised that he didn't need to any more. Obviously part of that case was that he'd had some time to get used to the lack of nicotine.

[vicky_molokh]

Originally Posted by Bruno

That's really interesting, I hadn't heard that before.

A lot of people reportedly can't get away from coffee the way others can't get away from smoking. But my personal experience with coffee is that I underwent several sudden and long-term (from several months to a couple years) shifts from drinking three cups a day to drinking none, with no ill effect. Somehow I think that coffee does not correlate with lung cancer, but the differences between people who can just decide to stop and those who can't still seems to exist.

[Icelander]

Originally Posted by Bruno

"Quitting" addictions is a very complicated thing.

Agreed.

Originally Posted by Bruno

Opiate addictions that started as pain control tend to be pretty "easy" to quit if the source of pain is managed appropriately - there's no significant psychological factor to fight against once the pain is dealt with.

I've been on opiates for several months on two separate occasions, both times after suffering accidents that broke a lot of bones and ruined other things pretty seriously and required reconstruction. I've never experienced any sign of opiate addiction once my pain grew dull enough to make sleeping possible and may simply be physiologically or psychologically unlikely to suffer from it.

Morphine and strong opiates feel very nice and I can totally see how someone would abuse them, but while I would probably pop the occasional Vicodin if obtaining them was easy and cheap, I doubt it would become a significant part of my life.

Mind you, my doctor friends tell me that the success rate in treating intravenous morphine (usually as Contalgin here) and heroine (rare in Iceland) abuse is still far ahead of nicotine abuse. Physiologically, nicotine is amazingly addictive and psychologically and socially, of course, it often forms a part of personal identity, daily routine and all social ties.

If you're injecting heroine into your eyeballs, there may still be people in your life you don't do that around. Currently, however, it's still socially acceptable to smoke around almost anyone and in any professional setting, as long as you step outside to do so. Combine with the strong habit that forms in many smokers, who do not know how to manage daily stress, boredom and fatigue without smoke breaks, and it's extremely hard to quit.

Or so I've heard. I actually used to smoke the occasional cigar and pipe, but have somehow lost the habit lately. When I was at school, I used to hang out with the smoking kids the night before each exam and smoke maybe a pack of cigarillos in a few days. I also smoked a hookah/habibi (water pipe) nearly daily. Now, though, I think I've smoked a total of one pipe and one cigar in the past two years. Never really noticed any signs of addiction, but, as I said, I may be bad at addictions.

Originally Posted by Bruno

Drug addictions (including alcohol, etc) of any kind that start as an attempt to self-medicate (whether for physical, mental, or social problems) are often extreeemely challenging to shake until the patient has their underlying problem dealt with. This includes problems like "my entire peer group uses X" - if you go back to that peer group, relapse is nearly unavoidable.

My experience of addicts who have problems functioning in society* is that not a single one of them started using drugs and only as a result of drug use became poorly functioning socially. They all had major psychological issues or trauma in their lives before they began heavy use of drugs and the theory that their drug use was primarily an attempt to self-medicate these seems compelling to me.

Mind you, I've also met a lot of people who use drugs, but who do not seek treatment, appear addicted or have problems relating to friends and family. Some of these are also clients, yes, but others are just people I know from school, friends of friends, etc.

What seems to distinguish them from the extremely damaged addicts is that they do not have underlying psychological issues. I'm fairly skeptical any time those chemical substances currently illegal are posited as some sort of magical addict creation potions.

I mean, yes, there is a legitimate, documented risk of physical addiction, the treatment of which is allegedly extremely uncomfortable, with opiates and some other chemicals, like nicotine. But that physical addiction does not automatically translate into pathological psychological dependency that seriously interferes with a person's ability to function, at least not absent other psychological factors.

People aren't somehow addicted to amphetamines, cannabis, cocaine or most other recreational drugs simply because they tried them once. Not even if they use them occasionally, no more than with any other chemical. I've seen no evidence that the rate of addiction is any higher than those who try alcohol, for example. And most people are aware that the number of people who sometimes drink alcohol, socially or otherwise, but function normally enough in life, is massively higher than that of those who find themselves unable to control their drinking.

*Which as a defence attorney, I encounter a lot.