Stats for nerds
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3mentions
2people
2014–2016years
33% recommend67% neutral
Mentions per year
What Hacker News says
- A lot of the more successful drug treatment programs today treat addiction as a symptom, not as the disease in and of itself. I'm glad that this model is gaining popularity, because I think it is the correct one.
I was lucky to have the chance to study with Dr. Carl Hart in college. His Drugs and Behavior class was one of the best I've ever taken - an actually scientific, medical look at drug use instead of haphazard generalizations that we have come accustomed to reading even in otherwise reputable news sources and even some academic settings.
A lot of Dr. Hart's research (at least at the time) involved methamphetamine - he is one of only a handful of people across the country authorized to administer methamphetamine in research settings (ie, for the purposes of a study).
I commonly see methamphetamine ("meth") used as a scapegoat these days, with references to it being a demon-drug, and how there is "no such thing as a casual meth user"[0].
Unfortunately, this caricature of methamphetamine is inaccurate, managing both to overstate and understate its risks. Methamphetamine is certainly habit-forming for a number of reasons, but one interesting fact to note is that, according to the most recent NSDUH report[1], half of all people who used methamphetamine in the last year don't meet DSM criteria for substance abuse (which is an even lower threshold than substance dependence)[2]. (Ironically, I've seen these reports cited to show how "prevalent" meth addiction is, pointing at the higher usage rates, but conveniently ignoring the questions which evaluate actual substance abuse and dependence - why let facts get in the way of a good scary narrative?)
Even if your goal is to reduce methamphetamine use across society, treating all users as "addicts" when, medically speaking, they are not is like sending all underage college students to Alcoholics Anonymous if they are caught with alcohol in dry dorms - it's clearly not going to be successful.
Trying to treat drug use as a problem in and of itself isn't a model that is backed by medical data or even our best understanding of psychology. We don't use this model for alcohol (we distinguish between the drug use and the atypical behaviour which defines pathological use[3]) or caffeine (in which we completely ignore pathological use, even when it is clearly present).
[0] This is, incidentally, almost the exact same rhetoric during the crack cocaine scare in the 80s, which is commonly accepted today as having been exaggerated for political reasons at the time.
[1] The NSDUH is one of the three standard ways that drug usage rates and turned are measured in the US. The raw numbers are usually less meaningful than the relative numbers, for obvious reasons.
[2] The DSM is flawed in many ways, so I am not holding it up as a gold standard by any means. Rather, it's an example of how a relatively strict (but still scientific) definition of substance abuse fails to model actual behavior appropriately.
[3] ie, the definition of "alcoholic" is generally understood to mean more than "someone who drinks alcohol"
- When describing the process of getting someone involuntarily committed to be evaluated for court-ordered treatment, the engineer at my graphite manufacturer said “Really, you can do that? … I’m going today.” One of his old friends has been self-destructive/’crazy’ for a while. They suspected he was using methamphetamine.
On the one hand, people who are ‘crazy’ won’t seek and can’t consent to medical care. This is certainly how we ended up with “mental health courts” and “court-ordered treatment”. But most of the treatments that the courts order people to submit to are palliative rather than curative. The courts have to order people to take the worst of the drugs, the sedatives (”anti-psychotics” [1]), because they wouldn’t take them otherwise [2].
[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4118918/ [2] "Drugs and Behavior: An Introduction to Behavioral Pharmacology", by William McKim
If society is going to force treatment on people, we ought to help them while we’re at it. But the system I’ve observed over these past few months is little more than a haphazard collection of poor practices. Robert Whitaker [3], author of Mad in America, does a good job of heckling the status quo, but they haven’t reached a threshold where they can demonstrate dramatically better strategies for helping people through their mental problems.
- My girlfriend became acutely psychotic when quitting methadone and alcohol cold-turkey. She was taken to the hospital. After a week she was mostly out of it, but it was too late - the hospital had started the process for an evaluation for involuntary psychiatric treatment. When I realized what they were doing I tried to protect her by obtaining a court order, but was unsuccessful.
My girlfriend's treatment by the system has been worse than I could have possibly imagined. These psychiatrists certainly have good intentions, but don't realize the collateral damage inflicted by their treatments.
Today I found a copy of "Drugs and Behavior: An Introduction to Behavioral Pharmacology", by William McKim. Hopefully this text will help me figure out how to talk reason into a psychiatrist.
